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Does the PA Profession Have a 2030 Expiration Date?

Physician assistants (PA) are number #1 in healthcare, so getting a job for an experienced PA should be super simple. Right? Maybe not always. I personally awakened to the looming problems in the physician assistant profession in 2018. I had always enjoyed an easy time finding a position, and with an upcoming out-of-state move, I expected nothing less. I applied, however, to over 50 PA/NP jobs with few responses.

Many of the jobs required a state license to apply, so I had difficulty making it past computer algorithms and human resource screeners. This was because antiquated legislative laws dictated that I have a supervising physician in order to acquire a state license. In essence, it was an endless cycle wherein I could not apply for a job without a state license, but I couldn’t acquire a state license without a job. As I began to wonder what I was going to do for a job, I realized that physicians and NPs did not have this same mandate. It awakened me to the grave realization that the PA profession was not competitive in my new environment. 

Exit… Stage Left

I eventually decided that if I couldn’t readily get a job as a PA, I would need to maneuver into another profession. Nurse practitioners (NP) and physicians have professions that are flexible enough that they can readily pivot into other professional roles, such as education, research, pharmaceuticals, medical malpractice expert, and medical writer. Although PAs can be found in all of these roles as well, there are relatively few PAs, in both number and percentage, that leave clinical practice in comparison to nurses and physicians.

I personally decided to fall back on teaching at the collegiate level-something I had been doing on the side for the past decade. Even in academia and with my experience, I had difficulty finding an academic placement due to the relative lack of PA schools in my metropolitan area. As I was forced to compete for general biology undergraduate positions, my stiff competition was likely from masters-level high school biology teachers.

Generalizing the Generalist

In general, PAs are excellently trained to provide competent, exceptional care to the most vulnerable and fragile in our society. Healthcare employers, however, have difficulty fully understanding a PA’s capabilities, so it is little surprise that the larger populace has no working construct for the PA. As a result of all this, I came face to face with the challenges of being able to pivot into other roles. I had difficulty transitioning into academics, recruiters for clinical research told me that PAs were too risky for their market clientele, and administration wouldn’t consider my underwhelming administrative working experience and education. My training in clinical medicine was excellent, but it did not equip me for job mobility. Unfortunately, I fear PAs will increasingly try to row this same proverbial boat when clinical PA positions become increasingly scarce.

Roughly half of PAs have been in practice for seven years, meaning that a majority of the profession has substantial student loans and a long career ahead. There is dire news for PAs that fall into this category. Our profession may not last long enough to pay-off those substantial loans, much less last the entirety of their professional career. There are a few reasons why our profession may be headed for rough days.

APP Jobs will be dominated by NPs

Consistent with nurse practitioners’ objectives of “meeting the existing and future primary care needs of our nation”, all sectors of healthcare will be dominated, if not completely run, by nurses and nurse practitioners within ten years. As a little background; nurse practitioner numbers were projected to increase a staggering 130% between 2008 and 2024, with a projected NP workforce of 198,000 by 2024. There is projected to be a surplus of primary care nurse practitioners by 2025, with 13 states boasting an oversupply of primary care NPs by 2025. A 2015 Monthly Labor Review article goes on to state that registered nurses and nurse practitioners “are projected to add the newest jobs and grow the fastest” from 2014 to 2024.

The projected nurse practitioner numbers were wrong, as there are already more than 290,000 nurse practitioners in 2020. In comparison, the PA profession is expected to increase by 72% by 2025. The increase in primary care PA supply is also projected to exceed demand by 2025 but to a lesser extent. With full practice authority for NPs, the squeeze for jobs will be much harder felt for PAs than NPs. This is because it is cheaper and easier to hire an unrestricted NP than it is to hire a PA plus a supervising physician. There is then the added administrative work of finding a physician to supervise a PA hire. 

Legislative Restrictions will Limit PAs

In addition to the NP surplus problem for the PA workforce will be the administrative disparities between NPs and PAs. NPs have full practice authority in 24 states and are legislatively close to achieving it in an additional 16 states.  Much has been said about training and educational comparisons between the three types of providers, but in the end, this is just a distraction from the numerous studies showing the most important issue of outcomes, for which the professions are similar. The truth is that healthcare employers hire nurse practitioners and PAs because of their financial appeal.

Who is “best” for the job is -and has always been- financially driven. The most cost-effective, least burdensome provider will win. When physicians largely ran medicine, burdens of supervision, malpractice risk, and administrative issues were par for the course, as NPs and PAs provided competent care, increased revenue profits, and had a similar scope of practice. Now that physicians are no longer making a majority of the financial decisions for healthcare, they likely don’t want to be saddled with these burdens. Administrators arguably don’t want the burden either. In essence, PAs maintain financial appeal but are increasingly less desirable than our legislatively unrestricted NPs. The following NP perspective is acutely accurate.  

“PAs are not allowed to practice independently of the physician, but an NP may have authority to diagnose, treat, and prescribe without physician supervision. Thus, when NP [scope of practice] SOP is broader, NP capabilities are closer to those of a physician and PA capabilities are more limited when compared to an NP’s.”

When given a choice, the unrestricted provider will always be a more desirable hire. 

NPs will shift into Surgery and Specialties

PAs’ footprint in primary care is already shrinking and this shrinkage will likely seep into all specialties over the next ten years. Likely, this is due to two main issues. First, the primary care surplus NP issue likely pushes restricted PAs and expensive physicians out of the primary care marketplace. Second, PAs have legislatively mandated tethers to physicians. Simply stated, even if NP oversupply wasn’t an issue, lack of supervising physicians in primary care inadvertently forces tethered PAs into the specialties where physicians are located.

Once oversupply in primary care becomes problematic for NPs, they will likely work to increase job opportunities for their profession via certifications, legislation, and advocacy. A realistic projection is that once NPs have dominated the primary care sector by 2025 and oversupply becomes a problem, unrestricted NPs will spread into surgical and specialty positions via an RNFA certificate, further reducing the PA footprint. A 2018 study showing that employment of specialty NPs grew at a 13% faster rate than the employment of PAs from 2008 to 2016 leads credence to this. By this, NPs will bleed into specialties and continue to push out PAs from their already marginalized areas of practice, and they will do it with an unrestricted license. This will further decrease the PA footprint in medicine. 

New Frontiers for Physicians

Telemedicine is another nail in the PA professional coffin.  Physicians have an Interstate Medical Licensure Compact system, which makes it significantly easier to obtain licenses in multiple states. Adding this to their unrestricted licenses, physicians are currently seeing a boom in telemedicine jobs. NPs and PAs do not have this compact. However, NPs do have a Nurse Licensure Compact and are working to expand this for their NP counterparts. Without such compacts, the wait time and difficulty in acquiring multiple licenses are costly and time-consuming. For PAs, the requirement for physician licenses and physician supervision costs must be added to this administrative licensure headache. The logical outcome is that PAs are not desirable candidates for telemedicine. Considering the explosion of telemedicine with the pandemic and its projected exponential growth over the next ten years, the financial incentive to hire an NP, their independence in about half of the states, and the developing NP multistate licensure compact, PAs will have increasing difficulty finding work in telemedicine. 

Perhaps the final blow for the PA profession will be from unmatched international medical school graduates (IMG). Every year, thousands of medical school graduates (mostly foreign) are unable to place in US residencies. These graduates have created a niche license known as the assistant physician (AP). Just as the name is similar to physician assistants, these assistant physicians work in much the same way. APs must have a collaborative agreement with a licensed physician and have varying degrees of physician delegation based on the state and terms with the collaborating physician. Missouri passed legislation allowing for these IMGs to practice back in 2014. Since then, Arkansas, Kansas, and Utah have allowed some form of license for these graduates despite troubling USMLE scores from this group of poor residency candidates. They are considered physician assistants for reimbursement purposes but don’t need to have passed the Physician Assistant National Certifying Exam (PANCE), need a named collaborating physician, or need to list their practice type. With an average compensation of $48,381 in July of 2019, there are considerable concerns about salary competition with NPs and PAs. 

What Can We Do?

Mindset Shift

Fear is a powerful force. My four-year-old daughter has struggled recently with confidence in swimming. She completed infant-swim-rescue (ISR) training last year and is a capable, albeit inexperienced swimmer. On a recent swimming trip, she would have drowned in a pool for nothing more than her paralyzing fear that she couldn’t do it. PAs are experiencing their own version of drowning. PAs are a proven, capable profession, but many are admittedly afraid physicians will start negative campaigns if PAs ask for legislation that reflects clinical practice. Others are simply afraid of failure.

Most don’t understand that fear is not an inherent problem. However, how individual PAs handle this fear repeatedly will determine our professional fate. Failure to act is still a failure. Failure will occur and is a necessary ingredient for success. The only way to overcome this fear is to develop the winner mindset, with the understanding that failure will occur, can be overcome, is necessary, and is rooted squarely on the path to eventual success. For my daughter, overcoming fear meant returning her to an ISR refresher course. For the PA profession, it likely means submitting legislation that may have negative physician reception or pushing for legislation that may initially fail. Are we ready, as a profession, to embrace our upcoming failures on the road to success? Or, more importantly, have PAs yet decided whether they want the PA profession more than their fear of failure?

The biggest issue with professional advancement, in this author’s opinion, is the mindset of pre-PAs, PA students, and early career PAs. As a pre-PA, I was delighted to know that someone else would be ultimately in charge of my care decisions, due to personal fears of failure with someone’s life. These ideas were uneducated. For every patient a PA encounters without a supervising physician physically present, that PA is providing autonomous care.

PAs are held to the same standard.

Any experienced PA could explain that PAs are required to be as competent and capable as their physician counterparts and are held to the same legal standards of care as physicians. This is born out of the legal mandate requiring equal standards of care for physicians, PAs, and NPs. Because we are legally required to be equal in our care standards and research studies show equal care outcomes, we need to as a profession embrace and promote our achievements and abilities. Own this responsibility. Push for legislation to reflect it. Demand our organizations promote it. The profession started out as someone’s assistant, yes, but it quickly evolved from that role. Recent studies reveal that 76% of PAs currently clinically practice autonomously. It is time to start pushing legislation similar to North Dakota, Minnesota, and Maine. Asking for PA legislation to mirror PA clinical practice is nothing more than asking for the legal authority to do what we are already doing.

Should PAs be restricted with mandated physician oversight? In short, no. If for no other reason than to allow patients better access to competent, capable providers, PAs should not be restricted. All providers should be allowed to work at their fullest capability to provide care for our patients. NPs understand it. Physicians fear it. The US government acknowledges it. It is time for PAs to stop our professional infighting and push for legislation to keep a better pace with our training and professional skills.

From this, it becomes evident that we must modernize our professional views relative to physicians. PAs must continue to clinically collaborate with all healthcare entities. PAs must stop desiring physician agreement with the PA profession. PAs need to acknowledge that they already provide quality care in the absence of a physical physician presence in the patient’s room. PAs need to take leadership positions and push for legislative advancements that reflect current clinical practice. 

Name Change

This leads to the inevitable issue of the PA title. Many PAs, likely due to our historical origin, are just fine with our current title and feel that we simply need to market it better.  This author contends that it is difficult, if not impossible, to market a lie. PAs do not assist physicians in their job duties. PAs perform the same job duties as physicians. The name is an oxymoron that creates confusion due to the fact that in no other profession does a subordinate do the actual job of the senior. Much research has concluded that PAs substitute for the physician in 85% of primary care tasks and produce the same productivity outputs as physicians in outpatient settings. The 15% difference likely has much to do with legislatively mandated restrictions on experienced primary care PAs.

PAs make medical treatment decisions for millions of patients per year. PAs perform in all levels of healthcare management, including medical director, chief medical officer, clinic owner, and CEO. PAs need to acknowledge our professional abilities, acknowledge that the name hurts advancements, acknowledge our excellent training, and advocate for a name change. PAs need to grasp the seriousness of how the PA title has hindered forward progression in states such as Ohio, Florida, and many others.

Moving Forward

What then is to become of the PA profession? Only time will tell, but the likely outcome is that the PA profession will steadily become less favored in the healthcare marketplace. This may very well lead to the extinction of the PA profession. Will this happen in ten years? Given the above market forces, this is a conceivable outcome. What an interesting path it would be to go from number one to not at all. Changing healthcare preferences for one provider type over another can affect which occupations are employed in an industry. The good news is that PAs have not been pushed out of all job markets yet and several states are making headway with legislation.

There is a real foreseeable danger of being forced out of the profession when employment challenges and professional competition becomes fierce. My job search prior to the pandemic showcases this. The solution of moving to a PA friendly state or changing medical specialties may not be an option for everyone, as was the case for me. If any of this speaks to you, I suggest joining the effort for reform

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Author: Nicole Mason, DMSc, PA-C, Psychiatry CAQ

Dr. Mason graduated from the University of Illinois at Urbana-Champaign with a Chemistry degree and the highest distinction in the curriculum. She then went on to graduate from Midwestern University’s Physician Assistant program where she completed a Master’s project on the concept of international PAs, leading her to receive that year’s Master’s Project Award. Upon completion, she transitioned into primary care medicine and has remained in the primary care field for the last fourteen years. Dr. Mason holds a Doctorate in Medical Science from the University of Lynchburg. She is a member of AAPA and the Oklahoma Academy of Physician Assistants. Dr. Mason is also the co-founder and current president of the Academy of Doctoral PAs. To find out more about this important organization, please check out their website www.PADoc.org.

 

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https://thepadoctor.com/does-pa-profession-have-expiration-date/?fbclid=IwAR0YdMOYxC1RJuUyxRhGpBNwIO_IzZht4iO4OsEbzGNakIYuGKz8eUj4X44 Does the PA Profession Have a 2030 Expiration Date?

Sorry Rev, but nope.  As long as we are tethered to docs and carry the "assistant/associate" name we won't be attractive to admins.  It takes a lot to pay a doc for us to be assistants to.... Np'

Let's get real, 1. NP will get FPA in all 50 states eventually. Just matter of when.  2. Associate/Assistant Physician are coming to your state and they are here to stay. https://assistantph

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I have literally been screaming these exact points for 15 years.  Like a cry in the wilderness they have gone unheeded and unheard.  I called California the tipping point years ago, and now it has happened.  I must admit, I didn't see FL coming, but that one hurt...big time.  Next to fall?  Texas.

 

You see, this profession will not die overnight.  I have and continue to call it a dead man walking the green mile.  One day very soon, the dominance of NP's will become so great that even seasoned PA's will be out of work.  Phased out or flat out replaced by an APP that does not need a supervising physician to meet state law requirements.  It will trickle back through professional contacts and people will stop applying to PA school.  PA schools will start going under and the profession will massively contract, further degrading its ability to lobby.  Eating 100k in school loan debt with little to no chance of work is not going to be enticing to most college students.

 

Let's face it, we had a good run.  Before NP's steam rolled us legislatively we were doing well.  But, with a lack of aggressive PA leadership on the name change, legislative laws and this "battered child syndrome" like fear of pissing off docs....it's basically too late.  

Grim?  Fatalistic?  Yep, but it doesn't make it any less true.  In regards to the article, I have applied now to over 20 positions with one call back and a thank you we will get back to you...crickets.  I also now have a gap on my CV (DURING A PANDEMIC) which for some stupid reason people treat like I was in a jail or something.  

Frustrating after giving my entire professional life to this profession, to see it end this way.  

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16 minutes ago, Cideous said:

Frustrating after giving my entire professional life to this profession, to see it end this way.  

Only a year in but I’ve made it a point of planning my 10 year exit strategy. So I, no pun intended, don’t look back on my career like this. Which I fear is inevitable if I don’t.

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I have about 10 years left before I can hopefully retire.  I am hoping to ride this train into the grave.   I saw this coming a long time ago also and posted numerous times on this site and others only to be told "move to where the jobs are", 
"we are better educated",  "it is useless trying to partner with the NP profession" etc, etc, etc.    I wish I had gone ahead and done the NP route  part time when I was seeing what was happening so long ago.     I would rather work as long as I can - but it seems that my job will be phased out eventually.   Maybe if the AAPA and other states can pull out a hail mary for OTP- we might survive.     But, I think if that does not happen in the next few years, we are completely done.    I feel bad for the PA students that are taking out large loans that they might never be able to pay back in the profession they chose.    

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1 hour ago, ANESMCR said:

Only a year in but I’ve made it a point of planning my 10 year exit strategy. So I, no pun intended, don’t look back on my career like this. Which I fear is inevitable if I don’t.

Do you mind sharing your "exit strategy"?

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Bascially we are on the tracks, heading toward an almost certain death....

 

what is going to prevent it???

 

$$ and lobying.... yup get active, join your state and AAPA, throw them a few hundred dollars (you can afford it)  Call you state and federal officals, do some grunt work and THIS WILL CHANGE

 

I am as confident in the aspect of change as I am in the death of the profession (both highly confident especially when they are pumping out new grad NP's who are more then happy to work for 80k)  

But now that NP have so much independence they can be what we springboard off to gain independence, and a name change getting rid of the dreaded "A" - 

then look out - we define our own future - Just like DO's did years ago....

 

IF (I mean WHEN) we do this - the primary care fields will pretty quickly become ours....  

Then the speciality fields where a company can hire an NP (*but then have to spend a lot more effort training them then a PA) will start to follow... 

 

We will be okay IF EVERYONE HELPS OUT!!!

IF not????  Well I retire in 10-15 years and I will be done, and out....

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I am already active within my state board (KAPA) and AAPA.  I have served on the KAPA board since 2014 and continue to be active with legislation issues in KY.     Trying to get practicing PA's in my state to take on an active role is frustrating and exhausting.    Our state membership is less than 10% of practicing PA's.  We are our own worst enemy - apathetic until it affects our jobs.   COVID furloughs/layoffs/job loss has finally brought our issues front and center for many PA's  but unfortunately, it is too little/too late.   

 

Like you - I am 10-15 years out from retirement.    In some ways, I am fortunate to work in a more rural area - BUT our practice has moved to being corporate owned - like everyone else these days.    So when COVID hit,  the docs had no input when they furloughed me - and no influence to if/when I was  brought back.  One of the docs emailed the CEO every few days to bring me back.  The answer was a flat "no".    My patients even called corporate and wrote emails - to no avail.     At one time, I thought I was an important part of the community - and to my patients, I think I still am.   But to the CEO  - I am just a name on paper to cross a line through when trying to save money.    And to that matter - I have no doubt that if they thought they could save more money somehow - they would let me go to bring in an NP that would do the work for less and have less administration burden.      

Edited by bobuddy
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Ventana...

Typically I think your advice would be great about joining our state and National organizations, and allowing our lobbyists to make a difference.

 

The reality is (and without giving away too many specific details) I reached out to our state lobbyists well over a month ago regarding blatant discrimination and restriction of PACs practice. 
 

I haven’t gotten any acknowledgement back. Not an auto generate response, not an email, not a phone call, nothing...

 

It is very discouraging to me, and makes me wonder just what is being done with our membership dues. Are the PACs on “the board” actually interested in helping, or is it just a resume builder...

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55 minutes ago, ShakaHoo said:

Ventana...

Typically I think your advice would be great about joining our state and National organizations, and allowing our lobbyists to make a difference.

 

The reality is (and without giving away too many specific details) I reached out to our state lobbyists well over a month ago regarding blatant discrimination and restriction of PACs practice. 
 

I haven’t gotten any acknowledgement back. Not an auto generate response, not an email, not a phone call, nothing...

 

It is very discouraging to me, and makes me wonder just what is being done with our membership dues. Are the PACs on “the board” actually interested in helping, or is it just a resume builder...

then do what I did, join your state board so you can see what direction they are going in.  Help guide them towards the future, and insist on them advocating for you.

 

FYI - depending on who you emailed it might not get a response - if you emailed the hired PR firm for the state agency they might only answer to the State Board (they should at min forward your email)

 

Also, a HUGE thing to ask - is the hired PR firm representing anyone else?  It is the kiss of death if they represent The Medical Society, or other MD/DO organizations - I would think the same for the NUrsing Lobby.  I am suspicious that his happened for years in many states and created a tiered advocacy system where the Doc's paid more then the PA so the PA's got crappy second level representation.  While wrongly thinking they were doing good as they had the same company.   In short you want the company representing the State PAC to be solely committed to the PA's.

 

 

Look what has happened with AAPA - they were a bunch of out of touch, essentially useless administrators who did not listen to the PAs in the trenches.  They all got voted out and now we have  board fighting for us.    Change happens, but it does take effort.   

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12 hours ago, bobuddy said:

I am already active within my state board (KAPA) and AAPA.  I have served on the KAPA board since 2014 and continue to be active with legislation issues in KY.     Trying to get practicing PA's in my state to take on an active role is frustrating and exhausting.    Our state membership is less than 10% of practicing PA's.  We are our own worst enemy - apathetic until it affects our jobs.   COVID furloughs/layoffs/job loss has finally brought our issues front and center for many PA's  but unfortunately, it is too little/too late.   

 

Like you - I am 10-15 years out from retirement.    In some ways, I am fortunate to work in a more rural area - BUT our practice has moved to being corporate owned - like everyone else these days.    So when COVID hit,  the docs had no input when they furloughed me - and no influence to if/when I was  brought back.  One of the docs emailed the CEO every few days to bring me back.  The answer was a flat "no".    My patients even called corporate and wrote emails - to no avail.     At one time, I thought I was an important part of the community - and to my patients, I think I still am.   But to the CEO  - I am just a name on paper to cross a line through when trying to save money.    And to that matter - I have no doubt that if they thought they could save more money somehow - they would let me go to bring in an NP that would do the work for less and have less administration burden.      

Honestly this is the answer (and I truly believe this after seeing one of the best IM doc's I have worked with unceremoniously simply get walked off his job by the CEO due to not following the company line of NOT quarantining patients whom had travelled to high risk COVID states)

 

PCP and out patient medicine is going to swing back to private practice.  With OTP, direct bill, no supervision, far better education then the NP and folks like you who are in the and part of the communities we will own our own practices and the CEO bean counters and corporate folks will no longer have any control over us.  I see it coming like a freight train as  long as we disconnect from the docs.  Direct bill is coming, and we can order VNA, DM shoes are soon to changes if the bill gets passed this year (fingers crossed).  So if States pass OTP - I predict a slow but very sig shift in the medical practice ownership (by people like you and me) to owning our own practices (IM/PCP) and the corp folks can piss off.  I also think there will be a fair sig group of doc's (like my friend) who want to work but will never again work for corporate medicine due to the undue influence that non-medical folks exert over medical decisions.

 

I hope anyways.....

 

In my case - I will likely own my own practice again some day as I want to control my own destiny and don't need to make 200k per year, but want to do it the right way.   Small practice, control overhead, simple, you can make $100-150k per year with out too much killing yourself

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As a newer PA, I cannot agree more. I had to dig in and claw my way into urgent care (I've about given up on my dreams of getting into EM as all the major hospital systems nearby only accept PAs in surgery) only to be training fresh NPs who have never so much as seen a suture put in or an I&D. 

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1 hour ago, EastCoastPA said:

As a newer PA, I cannot agree more. I had to dig in and claw my way into urgent care (I've about given up on my dreams of getting into EM as all the major hospital systems nearby only accept PAs in surgery) only to be training fresh NPs who have never so much as seen a suture put in or an I&D. 

Story after story after story.....

 

 

I am really starting to wonder if PA jobs are going to come back post pandemic, or will employers take this opportunity to rid themselves of providers that require a supervising doc.  The article surmised that our profession could be for all intent and purposes, dead by 2030.  I think the next 15 months will  really speed that up if admin's re-hire NP's instead of PA's post pandemic.  I am already seeing MANY more jobs that are NP specific, PA's need not apply, on Indeed.  If this trend during the pandemic bleeds over post pandemic, we could be finished by 2026.

I have no more advice to give.  I've said it all save this one thing.  If you have a job, keep it.  The grass is not greener, in fact there is no grass at all on the other side of the job fence.

 

 

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30 minutes ago, EastCoastPA said:

So...

Plan A- Everything works out and we get Full Practice in a few years
Plan B- We give up and make an NP bridge?
Plan C- Scorched Earth? Team up with MDs and fight to re-restrict NP practice?

Plan D- If you can afford it, go back to school for MBA/MHA to go into administration or another profession all together

Best possible outcome is Plan A...but I doubt it will come true as MD/DO will fight for their lives to prevent this from happening....I hope I’m wrong
 

 

Edited by kang1208
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34 minutes ago, EastCoastPA said:

So...

Plan A- Everything works out and we get Full Practice in a few years
Plan B- We give up and make an NP bridge?
Plan C- Scorched Earth? Team up with MDs and fight to re-restrict NP practice?

Plan A will not happen.  We are not even trying for full practice.  You can't achieve something you are not trying to achieve.

Plan C will not happen.  Docs have little to no power over NP's, which is why NP's have full practice authority in well over 30 states.  Docs are for the most part just employees now.  They have very little say anymore and the nursing unions/organizations are utterly RELENTLESS legislatively.

Plan B is really my only hope for the profession moving forward.  We pissed around for too long legislatively while NP's ran circles around us.  Our movement now should be to convince them that by joining forces we can do more together.  Will they go for it?  Probably not, but we are out of time.

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We aren't trying? I thought that was the whole point of the MCP push. I agree that if we don't bury the idea of "OTP" with the "assistant" title then we are dead in the water, but I'm still hopeful for the FPA push if for no other reason than I have to be.

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One of the things y'all are discounting is that when APP salaries are in the toilet for everyone--because both NPs and PAs are churning out graduates at a ridiculous rate--we will have 1) more absolute political clout, just based on the number of people, and 2) when our salaries have fallen to what NPs are, we become financially attractive again.

Now, that's NOT a positive, hopeful outcome, but it does take into account that economic forces WILL work to balance the doom and gloom.  Perhaps the biggest thing that's hurting us isn't the NPs, but the AAPA salary survey...

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3 hours ago, rev ronin said:

One of the things y'all are discounting is that when APP salaries are in the toilet for everyone--because both NPs and PAs are churning out graduates at a ridiculous rate--we will have 1) more absolute political clout, just based on the number of people, and 2) when our salaries have fallen to what NPs are, we become financially attractive again.

Now, that's NOT a positive, hopeful outcome, but it does take into account that economic forces WILL work to balance the doom and gloom.  Perhaps the biggest thing that's hurting us isn't the NPs, but the AAPA salary survey...

Sorry Rev, but nope.  As long as we are tethered to docs and carry the "assistant/associate" name we won't be attractive to admins.  It takes a lot to pay a doc for us to be assistants to....

Np's in what, 34 states now don't have that burden?

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7 hours ago, Cideous said:

As long as we are tethered to docs and carry the "assistant/associate" name we won't be attractive to admins. 

You underestimate the power of human greed. 🙂 Preference doesn't win; profit does. You attribute far too much, in my opinion, to the lack of supervision, when in fact, NPs are the WalMart of medical professionals: cheap, readily available, and generally of adequate enough quality.

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30 minutes ago, rev ronin said:

You underestimate the power of human greed. 🙂 Preference doesn't win; profit does. You attribute far too much, in my opinion, to the lack of supervision, when in fact, NPs are the WalMart of medical professionals: cheap, readily available, and generally of adequate enough quality.

I don't understand how NPs are cheap - in my specialty (Psych) PAs are the cheap labor since NPs do not require supervision, can bill for psychotherapy, have a better name recognition. Lots of groups that hire them (psychologists and therapists) do not have the money to pay a psychiatrist to supervise a PA but can pay a little extra for an NP. They are also not going to work for less than they made as RNs; compare that to PAs most of who do not have a fall back career and even if paid $25 an hour, would still make more than let's say they did as an MA. I have friends in Florida working for $25 an hour with no benefits while continuing to look for better employment. You wouldn't find an NP willing to work for that wage. Nursing job market is great, and there is a shortage of all sorts of nurses; compare that to the APP market

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1 hour ago, iconic said:

I don't understand how NPs are cheap - in my specialty (Psych) PAs are the cheap labor since NPs do not require supervision, can bill for psychotherapy, have a better name recognition. Lots of groups that hire them (psychologists and therapists) do not have the money to pay a psychiatrist to supervise a PA but can pay a little extra for an NP. They are also not going to work for less than they made as RNs; compare that to PAs most of who do not have a fall back career and even if paid $25 an hour, would still make more than let's say they did as an MA. I have friends in Florida working for $25 an hour with no benefits while continuing to look for better employment. You wouldn't find an NP willing to work for that wage. Nursing job market is great, and there is a shortage of all sorts of nurses; compare that to the APP market

Exactly my point.

As I have said, pay close attention to what happens in the next 12 months as we slowly start to come out of the pandemic job losses in medicine.  Pay VERY close attention.  If this trend continues of NP's being hired to replace former PA positions...we are screwed, because those jobs won't be coming back.

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In my area, NP's and PA's are typically hired at the same rate.  However, NP's are now the hire of choice.  I work in a hospital system with many satellite clinics.   PA's actually have it pretty good, being one of the more PA friendly states, at least that is what someone against independence would say. However, I have been in informal meetings about 1-2yrs ago with CEO, CNO and other paraprofessionals, and the general idea, thanks  to your title and the CNO describing how NP's have 3years post grad and PA's are only 2years education to assist physicians. Fast forward, last couple months, two of the clinics needed a PCP.  The office manager told me they will only hire NP's because of INDEPENDENCE. I have been watching and waiting for a specialty clinic to hire an APP.  The doc had a PA in mind with absolutely excellent experience, admin was initially in agreement. The position was put on hold due to COVID. Now that things are picking up, the PA may no longer be a candidate, they are looking at an inexperienced new grad NP(online program). Doc will be okay, because she can negotiate a supervising/training salary bonus. They are considering the NP, although right now still needs extra paperwork, because in a couple years, she will not need supervision. The money is not the issue, it is the extra work it takes to employ a PA.  From someone who see's some inner discussions, Cidious is correct, the next 12 months are vital.  You need to give up the PA, become MCP and shoot for independence ASAP! May I add, with specific requirements to ensure quality of care, not new grads. The only way your education and credentials will show you are the best choice for APP provider, is if you become independent, like NP, and give up the chain(physician) and ball(assistant) title. For those who say it is not in best interest for patients to become independent, maybe if NP's had to compete solely on qualifications, nursing will decide they need to increase requirements for NP, which in the end would be better for patients, right now they have no reason to improve quality. 

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Understand that CNMs, Psych NPs, and CRNAs are specialists within the big, broad, NP field.  Anything I've said about the professions in general should not be assumed to be equally applicable to them, because, well, it's not.

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19 hours ago, iconic said:

I don't understand how NPs are cheap - in my specialty (Psych) PAs are the cheap labor since NPs do not require supervision, can bill for psychotherapy, have a better name recognition. Lots of groups that hire them (psychologists and therapists) do not have the money to pay a psychiatrist to supervise a PA but can pay a little extra for an NP. They are also not going to work for less than they made as RNs; compare that to PAs most of who do not have a fall back career and even if paid $25 an hour, would still make more than let's say they did as an MA. I have friends in Florida working for $25 an hour with no benefits while continuing to look for better employment. You wouldn't find an NP willing to work for that wage. Nursing job market is great, and there is a shortage of all sorts of nurses; compare that to the APP market

hiring for a PA/NP position

 

almost 30 apps from new grad NP's

seems like all would take around 80k to start - none have real world working provider experience, all have online or hybrid degrees with 400-700 hour so observational experience

PA's - only had 4 apply, one was toxic, three others were great but would not consider less then 100k and full bennies.  Not hard to figure out where the balance is....

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