cardsgirl Posted July 19, 2012 Share Posted July 19, 2012 Hey everyone? What is your prediction on the affordable care acts impact on PA and MD jobs and salaries? I have heard doc's where I work talking about early retirement ect. due to the possible problems ahead. Do you think new MD grads will have a hard time paying back their 300k student loans with decreased salaries? what about PAs? Just curious.... Thanks! Elliy Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted July 19, 2012 Moderator Share Posted July 19, 2012 changed title from "obamacare" to affordable care act. let's try to keep this on topic and not politically bent either way. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted July 19, 2012 Moderator Share Posted July 19, 2012 sorry to nit pick but a similar thread recently got out of control and resulted in the banning of a frequent poster with a political agenda. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted July 19, 2012 Moderator Share Posted July 19, 2012 in answer to the original question, I think this will be very good for pa's in general, especially those working in primary care as we are an affordable option for practices.. many high end specialists such as spine surgeons will take salary cuts to redistribute more govt. money to preventative primary care services. Link to comment Share on other sites More sharing options...
discogenic Posted July 19, 2012 Share Posted July 19, 2012 I think there will be financial incentives to encourage providers to go into primary care, and cuts in some specialties. But I can see those cuts or incentives affecting all providers, instead of PAs being singled out to get pay increases. In other words, a family practice PA will likely see a pay increase, just like a family practice MD, while a (pick a specialty) PA will see a pay cut just like an MD in that specialty can expect. Link to comment Share on other sites More sharing options...
Guest hubbardtim48 Posted July 19, 2012 Share Posted July 19, 2012 Yay!!! That sounds awesome to me since I want to practice rural medicine. :) Link to comment Share on other sites More sharing options...
andersenpa Posted July 20, 2012 Share Posted July 20, 2012 Specialists will go from being horrendously overpaid to only obscenely overpaid. Link to comment Share on other sites More sharing options...
primadonna22274 Posted July 20, 2012 Share Posted July 20, 2012 Cute ;) Any hope for primary care? I envision physician-led primary care teams and a pleasant career in academic FM training MD/DO/PA students/interns/residents side-by-side.... Specialists will go from being horrendously overpaid to only obscenely overpaid. Link to comment Share on other sites More sharing options...
cardsgirl Posted July 20, 2012 Author Share Posted July 20, 2012 I want to work for IHS for a while so I really hope primary care gets a boost! :) Thanks for the input guys! Link to comment Share on other sites More sharing options...
cardsgirl Posted July 20, 2012 Author Share Posted July 20, 2012 Sorry EMEDPA! Thanks for fixing my post :) Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted July 20, 2012 Moderator Share Posted July 20, 2012 Cute ;)Any hope for primary care? I envision physician-led primary care teams and a pleasant career in academic FM training MD/DO/PA students/interns/residents side-by-side.... sounds like a nice plan. back when I was looking at medschool I had a similar but slightly different career plan in mind. dual fm/em residency(5 yrs) then teaching fm/em for a smaller community hospital residency program, likely a DO residency site. Link to comment Share on other sites More sharing options...
andersenpa Posted July 20, 2012 Share Posted July 20, 2012 Cute ;)Any hope for primary care? I envision physician-led primary care teams and a pleasant career in academic FM training MD/DO/PA students/interns/residents side-by-side.... I envision competent primary care Physician Associates providing highly autonomous care, as they currently demonstrate nationwide. I would think physician-led teams are more necessary in specialty care. PCPs (PAs, NPs, MDs and DOs) should hopefully have greater reimbursement for their cognitive services and fewer insurance hassles, but that may be a pipe dream. Link to comment Share on other sites More sharing options...
discogenic Posted July 20, 2012 Share Posted July 20, 2012 I envision competent primary care Physician Associates providing highly autonomous care, as they currently demonstrate nationwide. I would think physician-led teams are more necessary in specialty care. PCPs (PAs, NPs, MDs and DOs) should hopefully have greater reimbursement for their cognitive services and fewer insurance hassles, but that may be a pipe dream. I think it's conceivable that the shortage of PCPs created by tens of millions of people entering the healthcare system through Obamacare will force reimbursement changes to attract more PCPs. Link to comment Share on other sites More sharing options...
andersenpa Posted July 20, 2012 Share Posted July 20, 2012 I think it's conceivable that the shortage of PCPs created by tens of millions of people entering the healthcare system through Obamacare will force reimbursement changes to attract more PCPs. I agree ....with anticipation. Link to comment Share on other sites More sharing options...
dkwee Posted July 20, 2012 Share Posted July 20, 2012 I think it's conceivable that the shortage of PCPs created by tens of millions of people entering the healthcare system through Obamacare will force reimbursement changes to attract more PCPs. Absolutely agree. As physicians go into specialty areas, PAs should fill in the primary care generalist holes. Link to comment Share on other sites More sharing options...
primadonna22274 Posted July 20, 2012 Share Posted July 20, 2012 I don't think we will stray too far from physician supervision, at least physician of record. I am all for progressive autonomy with time earned in PA practice and demonstrated competency, but I don't see independent practice for PAs anytime soon. If I am wrong then so be it :) I envision competent primary care Physician Associates providing highly autonomous care, as they currently demonstrate nationwide. I would think physician-led teams are more necessary in specialty care. PCPs (PAs, NPs, MDs and DOs) should hopefully have greater reimbursement for their cognitive services and fewer insurance hassles, but that may be a pipe dream. Link to comment Share on other sites More sharing options...
andersenpa Posted July 20, 2012 Share Posted July 20, 2012 I don't think we will stray too far from physician supervision, at least physician of record. I am all for progressive autonomy with time earned in PA practice and demonstrated competency, but I don't see independent practice for PAs anytime soon. If I am wrong then so be it :) It depends on how you see as the philosophy of supervision- as a necessity, or a burden that PCP PAs will bear due to the overbearing nature of physician relations on PAs. There is no question that PA training produces PAs who can competently function as PCPs without physician supervision. Perhaps you have seen this demonstrated in your experience as a PA. NPs are currently doing it in over a dozen states, with less clinical training. Do PAs need supervision in primary care? There is enough evidence to say no, but there probably needs to be some extra metric to ensure competency for new PAs. Will PAs be yoked with supervision? With the current structure in place, probably. But the requirement for "supervision", and actual practice of "supervision of PAs" is becoming an antiquated notion which needs revisiting as PA practice enters the modern age. I am all for progressive autonomy with time earned in PA practice and demonstrated competency, but I don't see independent practice for PAs anytime soon. Just like the heroes of past generations, independent PA practice (for primary care) will need a physician champion. This will be born out of necessity, just like the original PA profession was. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted July 20, 2012 Moderator Share Posted July 20, 2012 I think we will see "physician collaboration" as a requirement(like np's in non-independent states) much sooner than any motions for independence. I think the future of primary care is likely the "team hone" concept being pushed by the aafp and others in which a patient is assigned to a practice run by a physician but with many team players acting as pcp's. these pa's and np's will be loosely in contact with the physician but much less than currently occurs. perhaps 1 md would "collaborate" with as many as 5-6 advanced practice clinicians by being available for consults as the APC's require/request. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted July 20, 2012 Moderator Share Posted July 20, 2012 downside to the trend of consolidating practices under hospital management is that hospitals tend to pay less and give worse benefits than independent groups. pa's working for independent groups in my area make great money and have incredible retirement, benefits, etc. those who work for the hospital barely make the natl avg wages and have poor benefits and retirement by comparison. Link to comment Share on other sites More sharing options...
andersenpa Posted July 20, 2012 Share Posted July 20, 2012 I think we will see "physician collaboration" as a requirement(like np's in non-independent states) much sooner than any motions for independence. I think the future of primary care is likely the "team hone" concept being pushed by the aafp and others in which a patient is assigned to a practice run by a physician but with many team players acting as pcp's. these pa's and np's will be loosely in contact with the physician but much less than currently occurs. perhaps 1 md would "collaborate" with as many as 5-6 advanced practice clinicians by being available for consults as the APC's require/request. the crux of this is whether PAs will continue to require docs for state practice acts if that doesn't change for PCP PAs then the changes you mention have less impact really just changing to a broader supervisory ratio and hopefully ridding of things like cosignature, on site presence etc Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted July 20, 2012 Moderator Share Posted July 20, 2012 practice acts are written by docs. I don't see them releasing us from their ultimate control. loosening supervisory requirements, sure, but if they "let us off the leash" how are we any different than np's? we become "the competition" in their (docs) minds....I could be wrong. perhaps state govts will take it out of docs hands given the impending shortage of primary care providers of all types. Link to comment Share on other sites More sharing options...
discogenic Posted July 20, 2012 Share Posted July 20, 2012 But hasn't it been said that at least some docs prefer to hire NPs because there are less supervisory requirements compared to PAs? So shouldn't docs want PAs to someday come with less supervisory burden too? Link to comment Share on other sites More sharing options...
andersenpa Posted July 21, 2012 Share Posted July 21, 2012 practice acts are written by docs. I don't see them releasing us from their ultimate control. loosening supervisory requirements, sure, but if they "let us off the leash" how are we any different than np's? we become "the competition" in their (docs) minds....I could be wrong. perhaps state govts will take it out of docs hands given the impending shortage of primary care providers of all types. I said it earlier maybe on another thread- it will be out of necessity if it happens. Only if the docs won't go where there is a need, then there will be practice expansion. The trick is seeing it remain the same for PAs and NPs. And we can't fool ourselves that it will work out for us because we've been "loyal" to our SPs. If non physician NPs can establish a model for independent practice, there must be a circumstance where it can work for PAs. Link to comment Share on other sites More sharing options...
andersenpa Posted July 21, 2012 Share Posted July 21, 2012 But hasn't it been said that at least some docs prefer to hire NPs because there are less supervisory requirements compared to PAs? So shouldn't docs want PAs to someday come with less supervisory burden too? Depends on who you ask. NPs say yes. PAs say they prefer PAs for less "competition" and being trained in medical model. IME it has to do with inertia. Practices that start NP tend to continue NP (and often having nurses that drive it) while PA driven practices go the other way. Link to comment Share on other sites More sharing options...
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