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How is it being a PA in your city/sate?

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Lately, I have been thinking a lot about moving out NYC and go live somewhere else.

main reasons are so that I could buy a house, have a greater work/life balance, save more, have a decent safety net and retirement money, and get AWAY from cold snowy winters.

Most of you know that it's expensive living here in the city and I know it too. 

My main problem is that I DO NOT know which state/city to go. I know how it is here for PAs in NY, but elsewhere I have no clue.

 

main concerns:

- Income? (I'm between 110-120K) not sure if income would be lower

- How are PAs utilized?

- Any limitations in the way I would practice, compared to NY?

- How diverse are the facilities? 

- Cost of living?

- Beach or Lake near by?

 

How is it being a PA in your city/state?

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I live in midwest, in a metropolitan area of about half-million people.  

In the city, PA/NPs in the ED have decent autonomy (but often have to run cases by attending), and pay ranges from $65-$75/hr with okay benefits (average 1 week PTO, 6% match, $2K CME).  Schedules are 8-12 hour shifts, with rare overnight shifts.  In my opinion, people frequently forget to factor in the lack of overnight shifts of most ED APPs (because bigger EDs are staffed with Docs who cover nights).

I drive 2 hours away from the city and make $90/hr (+ shift diff) with great benefits (2 weeks PTO, 1 week CME), and I do 24 hours shifts.  High levels of autonomy.  This also means I have large amounts of quality time off, and that's very important to me as I work on other endeavours.

According to Payscale.com, the city I live in is only 60% as expensive as New York, NY.  So to live like you do in NY with $120K/year, I would only have to make $72K/year.

Reversing this calculation from Payscale.com, the $180K/year I make here would equate to making $300K/year in New York City.

Currently live in a paid for $100K house that is a decent house but in a not-so-good neighborhood.  Building our dream house an hour outside of city. I expect to have it paid off in 6 years, and then I retire (which I define as work simply to afford travel and extras) at 54.

While I don't live near a beach or mountains, there are some small lakes that we spend a great deal of time on (and we have 2 ponds of our own).  Better yet, we are able to take 2 good vacations (to the Islands, to the mountains, or to big cities) a year.

Caveat:  Our lifestyle isn't just from my income as a PA.  My wife also makes more than average income for our area, my military retirement is just below average income for our area, and we have some real estate income as well.  We also (generally) follow the Dave Ramsey financial plan and have virtually no debt to tie up our income.

How do I like being a PA in my city/state?  I freaking LOVE IT!

Did I answer all your questions?

One favor to ask though.  If you move to my neighborhood, PLEASE leave any semblance of New York politics there in New York.  We have it so good here for a reason. 

Edited by Boatswain2PA
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13 hours ago, Boatswain2PA said:

retire (which I define as work simply to afford travel and extras) at 54.
 

YAAASSS 🙌.  I say this all the time and people think I'm crazy.  "Retire" in the next 20 years looks like working part time in a place I plan to fully retire to take advantage of health insurance benefits and have twice as much free time.

OP - that is such a broad question that has so so many variables.  Even if you compare 10 PAs in the same city, you'll get a variety of answers.  

Your best bet is to start with cost of living and find what suits you then look for employers that will pay what you think you deserve and have culture that you want.  

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1 hour ago, ArmyVetDude said:

I see why boatswain is very satisfied with the current situation as a PA and dont want name change and OTP. Not everyone has that level of autonomy at their jobs, Mr. Forever satisfied ASSISTANT

Hang in there, most of the Pro-Assistant PA's will be retiring soon.  As I tell my kids about the world in general, my hope is in you.  My generation of PA's failed the next generation when it comes to a proper name change.  They were short sighted, full of fear and in the end impotent.  Don't be like us.  Don't apologize to anyone for changing this irrelevant and outdated name and pushing for more independence. 

Our hope remains in you. 

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Having practiced in many states and locations, it is my feeling that our profession is accepted and respected in general by physicians and the public. Is there a perfect place to practice as a PA? I think not as perfection is a dream not reality. That said, I've held some very rewarding positions with good working conditions, that paid well, had supportive supervisors but nothing in life is static. We all know that people come and go, practices close or are taken over, major elements in one's life changes. One must make decisions based on their own needs and life goals, weighing decisions based on what will best help you achieve your desired outcomes. I have found Alaska to be perfect for my needs but I have no doubt that many others would find life in the villages as hell on earth! My answer is, you will have to look around and try other areas to practice until what you seek is found.

Edited by CAdamsPAC
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4 hours ago, ArmyVetDude said:

We need  to at least even the playing field with  NP's. If they have independent practice rights so should we.  As I had mentioned  earlier, in some states due to a large number of new grads, hospitals positions are becoming scarce.  Many PA's end up working outpatient. Some are owned by NP's. I met some PA's working for NP bosses. All this because they have the ability to hang their own shingle while we do not. Things like this is making public perception that we are the inferior provider of the two. I don't care what you claim, how we have superior education and training is all that. What matters is public perception and what other professionals think,  not our  own ddamn opinions

 hope this guy boatswain end up working for an NP run clinic or ER someday so he can shut the f*** up. IF NP's have independent practice rights so should we, unless we want to end up working for them someday. If our beleife is that we are better than NP's in providing medical care, we should have at least the same amoutn of rights and privilege as them - I believe we shoudl have more in fact

Settling for anything less makes us vulnerable to being kept pushing for settle for less. Look what happened in Vriginia and Texas. Those states delegates wanted to appease docs and medical organizations there and wanted to modify the otp statement and include the clause  that "PA shoudl collaborate with Physicians  at all times" bullshit. And they caved in. Physicians saw that and wanted to pursue more and take away some of there independent thinking and practices, We can;t let this happen

By the way, go read SDN boatswain. Most ER docs think PA's like you as dispensable ignorant meat movers. And you still want to be LEGALLY attach to them supervising you? u must like feeling lowered by someone

 

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That sums it up very nicely. Nothing is going to happen one way or the other until the consulting firm completes its study next year. So why bother to get all worked up over it now.

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If you're in NY, I'd suggest Maine or Vermont. Lots of autonomy to be had, decent wages, much lower cost of living. Lake Champlain is very nice, and in Maine you could be near the ocean (although you'd need a wetsuit!). I suppose that doesn't help with the snowy winters, though. I'm not very familiar with PA practices laws in NY to make a decent comparison, and most of what I can offer about nearby states is from word of mouth. In the end, as I am sure you are aware, so much is practice/hospital specific. 

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Have you thought about doing locums work ?  Seems like that would allow you options to check out  locations / sites etc that are of interest to you without making a significant upheaval / commitment right off the bat.  Plus, I think that a lot of locums jobs can turn into permanent if the chemistry works.  ?? just a thought ! 

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Wow... ArmyVetDude... I think “somebody has a case of the Mondays.” No need to be a jerk to BoatSwain. It seems you advocate for PA independence so that the nurse practitioners don’t overshadow us and take our jobs. But is it right to advocate for independence just because the NPs are doing it? No - not a good enough reason. How can a PA or an NP a year or even five years out of school practice without supervision? It’s ludacrous and dangerous. Personally I think the fact that we are supervised only adds to our credibility over NPs. Anyway, I am not independent and if I wanted to be I would have gone to medical school... 

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full disclosure.  

 

I deleted all the off topic banter.  Let’s keep it on track and not attacking each other.  

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If you’re still looking for reasonable proximity to NYC, look at Connecticut. We aren’t Midwest cheap, but once you get past Fairfield county the cost of living is much more affordable. My town calculates out to being 72% cheaper than Queens (never mind Manhattan). I live on the shoreline, 5 minutes from the beach in one direction and a state park in the other, but I can still hop in the train and head into NYC for a Yankee game or a broadway show (going with my wife to see Harry Potter next month...).

Our state practice act hits all six elements of the AAPA, and in general PAs are treated relatively well. If you aren’t quite ready for the cosmic jump to Alaska or Nebraska, we are a nice alternative to NYC (I left an ED job in Queens 16 years ago and would never go back).

 

 

Sent from my iPhone using Tapatalk

 

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56 minutes ago, medic25 said:

If you’re still looking for reasonable proximity to NYC, look at Connecticut. We aren’t Midwest cheap, but once you get past Fairfield county the cost of living is much more affordable. My town calculates out to being 72% cheaper than Queens (never mind Manhattan). I live on the shoreline, 5 minutes from the beach in one direction and a state park in the other, but I can still hop in the train and head into NYC for a Yankee game or a broadway show (going with my wife to see Harry Potter next month...).

Our state practice act hits all six elements of the AAPA, and in general PAs are treated relatively well. If you aren’t quite ready for the cosmic jump to Alaska or Nebraska, we are a nice alternative to NYC (I left an ED job in Queens 16 years ago and would never go back).

 

 

Sent from my iPhone using Tapatalk

 

This is a reasonable starting point.......

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well you mentioned weather and getting away from cold snowy winters, so I would start by finding a few area you would be willing to live and narrow it down and ask for opinions on those areas.  As for cost of living, pretty much anywhere is better than the city...except perhaps the bay area and Seattle...but even Seattle you can live affordably with a 30-45 minute commute, but not necessary because from what I've seen PAs make just as much outside of Seattle as in the city.  For salary you said you make 110-120k...what specialty and how much experience ? Many jobs in my area (Austin Tx) seem to be around 90-110k, however living outside of Austin proper my cost of living is MUCH lower.  And in Texas (and other states with no income tax), I automatically get a 5-10% raise over NY or Cali. From what I've seen in Texas, the more rural you go not only do the salaries increase but the cost of living drops which is a double bonus...I saw a job a few weeks ago paying 140-150k that wanted 2 years experience but would consider new grads....unfortunately it was in BFE.  Weatherwise however we are the opposite of NY and our summers are brutal...95 degrees plus for 3 months, often 30 days straight of 100 degree weather.  Our practice laws are not great but neither are NPs' so salaries are decent and there are plenty of jobs unless you want to live in a popular area like downtown Austin or San Antonio.  Its also a very red state and they like hard workers so I rarely if ever see good PTO packages. I am actually considering moving to a place with better weather...dare I say, possibly California, and may be asking the same question myself in the next 6 months or so. I always see folks from Cali posting great salaries with good PTO benefits and not just in the bay area. 

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On 3/18/2019 at 7:20 PM, medic25 said:

If you’re still looking for reasonable proximity to NYC, look at Connecticut. We aren’t Midwest cheap, but once you get past Fairfield county the cost of living is much more affordable. My town calculates out to being 72% cheaper than Queens (never mind Manhattan). I live on the shoreline, 5 minutes from the beach in one direction and a state park in the other, but I can still hop in the train and head into NYC for a Yankee game or a broadway show (going with my wife to see Harry Potter next month...).

Our state practice act hits all six elements of the AAPA, and in general PAs are treated relatively well. If you aren’t quite ready for the cosmic jump to Alaska or Nebraska, we are a nice alternative to NYC (I left an ED job in Queens 16 years ago and would never go back).

 

 

Sent from my iPhone using Tapatalk

 

I'm about to graduate from a PA program in CT, and in all of my rotations the PAs have been treated with respect and collegiality from docs, nurses, residents, etc. Tomorrow is my last day of a cardiology elective, and the group I'm rotating with has two PAs and a doc (rotating) that provide inpatient coverage. CT for the most part really does respect PAs and treat them well.

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17 hours ago, ArmyPA said:

well you mentioned weather and getting away from cold snowy winters, so I would start by finding a few area you would be willing to live and narrow it down and ask for opinions on those areas.  As for cost of living, pretty much anywhere is better than the city...except perhaps the bay area and Seattle...but even Seattle you can live affordably with a 30-45 minute commute, but not necessary because from what I've seen PAs make just as much outside of Seattle as in the city.  For salary you said you make 110-120k...what specialty and how much experience ? Many jobs in my area (Austin Tx) seem to be around 90-110k, however living outside of Austin proper my cost of living is MUCH lower.  And in Texas (and other states with no income tax), I automatically get a 5-10% raise over NY or Cali. From what I've seen in Texas, the more rural you go not only do the salaries increase but the cost of living drops which is a double bonus...I saw a job a few weeks ago paying 140-150k that wanted 2 years experience but would consider new grads....unfortunately it was in BFE.  Weatherwise however we are the opposite of NY and our summers are brutal...95 degrees plus for 3 months, often 30 days straight of 100 degree weather.  Our practice laws are not great but neither are NPs' so salaries are decent and there are plenty of jobs unless you want to live in a popular area like downtown Austin or San Antonio.  Its also a very red state and they like hard workers so I rarely if ever see good PTO packages. I am actually considering moving to a place with better weather...dare I say, possibly California, and may be asking the same question myself in the next 6 months or so. I always see folks from Cali posting great salaries with good PTO benefits and not just in the bay area. 

California PA salaries have really caught up and in most cases passed Texas.  At least in Urgent Care.  Then throw in the benefit package such as PTO and it's no contest income wise.  Cal has a state income tax but Texas property taxes are the 4th highest in the nation and brother let me tell you from experience...they are bad, and just keep skyrocketing.  Texas will be facing a "come to Jesus" moment soon on property taxes.  I believe in the next few years they will have their "Prop 13" moment.  If you don't know what Prop 13 in Cal was, google it. 

Home owners insurance here is double the price of the homes I looked at recently in Cal.  Hurricanes, Tornados, hail, flooding have been devastating the TX Ins market the last 10 years.

No safety net in Texas.  No Medicaid expansion for lower income adults here.  Texas in the #1 least insured state in the country.  Dead ass last.  It's a blight and shame on this state.

Weather wise...well that depends on where you live in Texas.  It's been raining for what seems like forever here in DFW but it goes in cycles so your mileage may vary.

Cal has a sheepton of people and that bothers me.  Last week they had a superbloom of flowers in Lake Elsinore (socal), and so many people tried to go look at it, the entire freeway system was shut down.  It was that special kind of awful that only comes with living in the best weather in the world....everyone else wants to live there as well.

 

Good luck!

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On 3/18/2019 at 3:08 AM, ERCat said:

Wow... ArmyVetDude... I think “somebody has a case of the Mondays.” No need to be a jerk to BoatSwain. It seems you advocate for PA independence so that the nurse practitioners don’t overshadow us and take our jobs. But is it right to advocate for independence just because the NPs are doing it? No - not a good enough reason. How can a PA or an NP a year or even five years out of school practice without supervision? It’s ludacrous and dangerous. Personally I think the fact that we are supervised only adds to our credibility over NPs. Anyway, I am not independent and if I wanted to be I would have gone to medical school... 

I agree that keeping personal attacks out of the conversation is a good idea, you lost me when you stated that we as PAs being supervised adds credibility over NPs. That is the exact opposite of everyone else's opinion that I have seen. We are viewed as "assistants" by the ignorant and administration alike. Whether an APP being unsupervised from the start is a wise idea is beginning to be irrelevant, as NPs are already starting to practice without any ties to physicians.

The longer we tether ourselves as PAs to the old model, the harder it will be to stay relevant and be a viable profession.

 

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Thank you for all your valuable responses. I have read them all and liked the insights received from them.

Thanks MODs for keeping this thread from derailing on a tangent. 

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I think you have to break it down into 2 discrete areas:

1) the job

2) the location

Being a PA in Michigan feels the same to me as being a PA in any of the other 3 states I've worked in. Michigan is a PA-friendly state in terms of legislation, but it all boils down to the job. Regional pay here is good, not the best not the worst. Competitive area due to NPs and saturation.

I cannot recommend living/working in Michigan. I'm in Ann Arbor which is a major university town, but i am REALLY having a hard time with the weather here. Outside of the city there is some beautiful countryside, but also a lot of economic depression and dilapidation. 

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On 3/20/2019 at 1:02 PM, Cideous said:

California PA salaries have really caught up and in most cases passed Texas.  At least in Urgent Care.  Then throw in the benefit package such as PTO and it's no contest income wise.  Cal has a state income tax but Texas property taxes are the 4th highest in the nation and brother let me tell you from experience...they are bad, and just keep skyrocketing.  Texas will be facing a "come to Jesus" moment soon on property taxes.  I believe in the next few years they will have their "Prop 13" moment.  If you don't know what Prop 13 in Cal was, google it. 

Home owners insurance here is double the price of the homes I looked at recently in Cal.  Hurricanes, Tornados, hail, flooding have been devastating the TX Ins market the last 10 years.

No safety net in Texas.  No Medicaid expansion for lower income adults here.  Texas in the #1 least insured state in the country.  Dead ass last.  It's a blight and shame on this state.

Weather wise...well that depends on where you live in Texas.  It's been raining for what seems like forever here in DFW but it goes in cycles so your mileage may vary.

Cal has a sheepton of people and that bothers me.  Last week they had a superbloom of flowers in Lake Elsinore (socal), and so many people tried to go look at it, the entire freeway system was shut down.  It was that special kind of awful that only comes with living in the best weather in the world....everyone else wants to live there as well.

 

Good luck!

Yeah I'm in the Austin area and our salaries aren't the best because everyone wants to live here so employers have their pick of the litter...and were getting alot of displaced Californians moving because Austin is cheaper than many places in California. I'm not a huge fan of the property taxes I pay every year but I doubt the property lower property tax in CA makes up for the income tax...I pay about $7.5k on my $325k home in property taxes....the home itself would be worth double that in most places in CA if not more, and income tax on $100,000 income in CA is $6100.  Not to mention the overall cost of living because they tax EVERYTHING...gas is $1-1.50 higher per gallon in CA compared to TX. Overall I doubt there are very many places that I will be making a better living, but as you mentioned, the PTO and higher salary (not to mention the weather) may make up for it so I'm doing my research and saving my pennies.  

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Or rural Texas. That would be a culture shock from NY. Salaries are pretty good depending on where you are. COL is very low. Property taxes are mitigated by declaring your home a homestead and if you have land you keep it in an Agriculture exemption. Property taxes on my 225k home is about $1700 and that includes city and school tax.

Its also warm...

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I live and work in rural VT.  The area in which I work is economically depressed, but that is just where I work.  I am in the middle of ski country, hiking, camping (pick the outdoor event), live on 30+ acres, have a river running though my property, can hunt if I want (the wildlife is ridiculous where I live), play drums at 3 in the morning, and do whatever I want at my job. I work for a small hospital as a solo ED provider, am treated very well and make more than enough to live what I think is my best version of life.  Most important, VT is home to some of the finest beer brews in the world, and they are all within an easy drive to get.  

I know you want to get away from the cold, but there is a huge difference between coastal cold weather and mountainous cold weather. Not sure it matters for you but its one of the reasons I haven't gone south...

Boston is 2 hours away, NYC is 4, Montreal is 3, and the ocean is 90 minutes.  Growing up a city kid and working EMS for 2 decades in the Boston area made me think I would never like rural living.  Now - I would never go back.  

G

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14 hours ago, kargiver said:

 Most important, VT is home to some of the finest beer brews in the world, and they are all within an easy drive to get.  

image.jpeg.321f09eaf621b30b041b9d6da63b554c.jpegimage.jpeg.b8336daf95012223d74337a4663fd902.jpegImage result for hermit thrush beerImage result for can confirm letterkenny

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On 4/5/2019 at 12:23 PM, medic25 said:

image.jpeg.321f09eaf621b30b041b9d6da63b554c.jpegimage.jpeg.b8336daf95012223d74337a4663fd902.jpegImage result for hermit thrush beerImage result for can confirm letterkenny

Took a trip to Montreal, came back down through Vermont. Went to Alchemist to try the infamous Heady Topper! Personally, not the biggest fan, but I do admit that there's a lot of good beer in New England! Was just in Portland, ME, and for a small place, there's lots of great breweries!

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