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My last day was Halloween ‘19 at age 60.  I wanted to tell my last patient that day that they were the end of the road for me but like so many others, they wanted to argue about what they knew that they needed so I just stayed quiet.

As far as retirement funding is concerned, I have been using a 457b plan through my last employer, retirement funds from my brief time with the VA, and a traditional IRA that I wanted to burn through since there was no other income from myself and thus it would lower the tax rate (worked out great this past year with taxes).  I also used this to cover our daughter’s wedding and a celebratory trip to Maui last March before widespread COVID with my in-laws since my B-i-L retired the same day from a municipal fire department.  I still have a Roth IRA to go through as well.  Once I hit 65 in ‘24, I’ll start drawing SSI (my full retirement age for SSI is 66/10), as well as two separate state pensions.  We’ve decided that my wife will retire at the end of the ‘21-‘22 college year at which point we’ll start drawing down her state sponsored Roth IRA, followed by her personal Roth IRA.  Since she is two years younger than I she’ll start taking SSI and utilize her pension (WEP impacted) at age 63.  We’re leaving a buffer of $200K between summer of ‘22 and ‘24.  Annual income at that point will be $120K, and we’ll be taxed on our SSI due to our pensions.  We have owned our home for about a decade or more and have no debt aside from monthly recurring utilities, etc.  I’ve got the taxes covered in my retirement budget even though they’ll actually be a withholding from the monthly SSI/pension disbursements, such as I do each month by prorating our annual property taxes on our home.  I check our numbers quarterly (just did so last week) to make sure that we’re still on budget, which we were.  We both may decide to go back and pick up a piddly job just to get out of the house.

Edited by GetMeOuttaThisMess
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@Boatswain2PA I couldn't imagine being constantly and consistently called a racist, bigot, behind the times etc everytime I voiced my opinion. That's got to, in the words of a millennial, suck.

How many times are you going to say "woke" Boats?  We get it, you are a Tucker Carlson and Shawn Hannity guy.  Everyone knows what you mean by it.  You inject politics into virtually all of your posts

I think we might be a little off the track a bit. If you look at the statistics, there usually at least 10 times as many guests here than members. We probably all started out as guests and decided to

On 4/3/2021 at 1:54 PM, Cideous said:

Can you elaborate?  I'm interested in what you mean.

Read this entire thread...that's a start.

 

Also the constant doom and gloom. I don't look through rose tint glasses and I understand the issues we have, but seriously, some folks need to bang a different drum.

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10 minutes ago, Will352ns said:

Also the constant doom and gloom. I don't look through rose tint glasses and I understand the issues we have, but seriously, some folks need to bang a different drum.

When PAs start becoming cheaper than NPs, economic forces will turn in our favor. While the Betamax/VHS analogy can be illustrative, the professional lifetime of a medical professional is a lot longer than that of consumer electronics, so different forces apply.

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1 hour ago, rev ronin said:

When PAs start becoming cheaper than NPs, economic forces will turn in our favor. While the Betamax/VHS analogy can be illustrative, the professional lifetime of a medical professional is a lot longer than that of consumer electronics, so different forces apply.

How much cheaper do you want PA's to be? I do not think your statement is necessarily true. In an NP independent state the hospital system hires NP over PA, unless in certain specialties, such as surgery.  The primary care independent NP's make as much and often more than specialty/surgery PA's.  Admin says it is because they are so much easier to hire and deal with than PA.  NP's are still cheaper than physicians, but they will not consider PA, even at a cheaper rate due to the hustle. Thankfully, for future of PA's, many are seeing and working toward the need of OTP, independence, whatever and a title change. Then you may see the turn around toward PA's. 

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On 4/3/2021 at 11:25 AM, Will352ns said:

The forum tends to be a depressing read. Worse over the few years.

I'd have to agree with you on that. However, this group was instrumental for me and many others when it came to getting into school. 

I for one do grow weary of the doom and gloom on here regarding the profession. Especially as an up and coming PA. The last thing you want to read is monotonous threads regarding how the profession is coming to an end as a new grad.

I know it may not look like it on here but I can attest to the fact that there are lots of young PA's out there who realize what is going on and want to effect change regarding the NP/PA situation. 

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2 hours ago, Hope2PA said:

How much cheaper do you want PA's to be? I do not think your statement is necessarily true. In an NP independent state the hospital system hires NP over PA, unless in certain specialties, such as surgery.  The primary care independent NP's make as much and often more than specialty/surgery PA's.  Admin says it is because they are so much easier to hire and deal with than PA.  NP's are still cheaper than physicians, but they will not consider PA, even at a cheaper rate due to the hustle. Thankfully, for future of PA's, many are seeing and working toward the need of OTP, independence, whatever and a title change. Then you may see the turn around toward PA's. 

1) You misunderstand.  I don't WANT PAs to be cheaper.  Right now, we're not cheaper, so the jobs are going to NPs.  That's reality, not my preference.

2) Your admin is lying.  PAs cost more, but they're not going to come right out and say that; they will say "we don't want to deal with the administrative overhead".  It's true, but not sufficient.  If PAs were willing to work for $20k/year less than NPs, that specious "supervision" thing would go right out the window.

3 words that will never steer you wrong: Follow. The. Money.

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39 minutes ago, Rose66 said:

I thought DNP and NP's make more than PA's.

It's certainly possible, and I haven't looked up the stats lately, but NPs are completely saturating the market worse than PAs are.  If you keep location, specialty, and experience constant, I'm not sure who would be paid more, but I'm sure in many places NPs make more than PAs.  CRNAs and Psych NPs draw good money, AFAIK, but I don't know that an adult/geri NP is going to make significantly different than any PA in the same role.

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4 hours ago, rev ronin said:

1) You misunderstand.  I don't WANT PAs to be cheaper.  Right now, we're not cheaper, so the jobs are going to NPs.  That's reality, not my preference.

2) Your admin is lying.  PAs cost more, but they're not going to come right out and say that; they will say "we don't want to deal with the administrative overhead".  It's true, but not sufficient.  If PAs were willing to work for $20k/year less than NPs, that specious "supervision" thing would go right out the window.

3 words that will never steer you wrong: Follow. The. Money.

You are saying that if PA's start accepting salaries at least $20,000 below NP's then job outlook or economic fortune will turn in their favor!  Is that the answer to lack of PA jobs? Accept extremely low salaries so the cost and headache of supervision would be worth it to admin? Is that what PA's who are against OTP/staged independence and title change are hoping for, to have salaries decrease by $20,000+ just to have a job?  Thankfully, it appears more and more PA's appear to be on board with progression over the past few years and are looking toward a more positive outcome. 

How about these 4 words; Independent Medical Care Practitioner=admin hiring most qualified not cheapest. (not including physicians in this mix as they are more qualified than NP or PA in most instances)

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1 hour ago, Hope2PA said:

You are saying that if PA's start accepting salaries at least $20,000 below NP's then job outlook or economic fortune will turn in their favor!  Is that the answer to lack of PA jobs? Accept extremely low salaries so the cost and headache of supervision would be worth it to admin? Is that what PA's who are against OTP/staged independence and title change are hoping for, to have salaries decrease by $20,000+ just to have a job?  Thankfully, it appears more and more PA's appear to be on board with progression over the past few years and are looking toward a more positive outcome. 

How about these 4 words; Independent Medical Care Practitioner=admin hiring most qualified not cheapest. (not including physicians in this mix as they are more qualified than NP or PA in most instances)

You're taking things too literally; all of my numbers are examples, not particular predictions.  It doesn't need to be that big of a gap for a large organization to hire cheaper labor.

I also don't think you're getting my contention that name and independence don't matter much compared to cold, hard cash.  That is, I don't think independence will matter much, even if it is a positive thing. I don't think a name change will matter much, again, even if it is a positive thing.  The real world, for better or worse, runs on money rather than prestige or paperwork.

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7 hours ago, Hope2PA said:

You are saying that if PA's start accepting salaries at least $20,000 below NP's then job outlook or economic fortune will turn in their favor!  Is that the answer to lack of PA jobs? Accept extremely low salaries so the cost and headache of supervision would be worth it to admin? Is that what PA's who are against OTP/staged independence and title change are hoping for, to have salaries decrease by $20,000+ just to have a job?

Its more complex and nuanced than that. The reasons have been discussed so many times but I'll run them down as best I can in a few sentences.

In states where NPs are independent they are simply easier to hire and cheaper to keep employed. Imagine, as the employer, you compare the administrative burden and man hours to bring on board a PA vs an NP. The time and paperwork to arrange and maintain supervision, the money paid to the SP for the supervision and then the ongoing maintenance. Multiply that x the number of PAs and NPs in a large system and it can easily be millions a year. This more than anything else drives the market.

If you look at administration in larger organizations you will find lots of nurses and very few, if any, PAs. We tend to stay in direct care and nurses often seek out admin roles. Nurses take care of nurses.

On the legislative front we all know the beating we have taken in the last 20 years. I can't count the number of times we have been excluded from legislation or simply told "no" because we are assistants. Assistants assist...right?

More recently the shake-and-bake NP schools have been cranking out mountains of graduates and in some markets there simply aren't enough jobs. So salary offers go down and new grads jump at positions that pay poorly. That drives the market further down.

Are we doomed? Only if we fail to act. Great things have been happening and OTP has made more progress in the last year or 2 than I could have imagined after it became a national policy and effort. However, we have already been lapped several times by the NPs and we have a lot of catching up to do. We can't seem to get out of our own way and the primary drag on our efforts are old PAs who just don't see the need for change or have a "it worked fine for me" attitude as if this is still 1990 when there were 7 jobs for every PA and NPs were pretty obscure.

I spend a bit of time visiting with students and young (in the profession) PAs and mostly they get it. One of the problems is they put there head down when some old "expert" gives an opinion. (Expert= Ex/is a has been and a spurt is a drip under pressure). 

Yes we doom and gloom a lot. The reason is just what I said.... we can't seem to get out of our own way and if we forget the possible cost we will lose momentum.

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3 hours ago, sas5814 said:

Its more complex and nuanced than that. The reasons have been discussed so many times but I'll run them down as best I can in a few sentences.

In states where NPs are independent they are simply easier to hire and cheaper to keep employed. Imagine, as the employer, you compare the administrative burden and man hours to bring on board a PA vs an NP. The time and paperwork to arrange and maintain supervision, the money paid to the SP for the supervision and then the ongoing maintenance. Multiply that x the number of PAs and NPs in a large system and it can easily be millions a year. This more than anything else drives the market.

If you look at administration in larger organizations you will find lots of nurses and very few, if any, PAs. We tend to stay in direct care and nurses often seek out admin roles. Nurses take care of nurses.

On the legislative front we all know the beating we have taken in the last 20 years. I can't count the number of times we have been excluded from legislation or simply told "no" because we are assistants. Assistants assist...right?

More recently the shake-and-bake NP schools have been cranking out mountains of graduates and in some markets there simply aren't enough jobs. So salary offers go down and new grads jump at positions that pay poorly. That drives the market further down.

Are we doomed? Only if we fail to act. Great things have been happening and OTP has made more progress in the last year or 2 than I could have imagined after it became a national policy and effort. However, we have already been lapped several times by the NPs and we have a lot of catching up to do. We can't seem to get out of our own way and the primary drag on our efforts are old PAs who just don't see the need for change or have a "it worked fine for me" attitude as if this is still 1990 when there were 7 jobs for every PA and NPs were pretty obscure.

I spend a bit of time visiting with students and young (in the profession) PAs and mostly they get it. One of the problems is they put there head down when some old "expert" gives an opinion. (Expert= Ex/is a has been and a spurt is a drip under pressure). 

Yes we doom and gloom a lot. The reason is just what I said.... we can't seem to get out of our own way and if we forget the possible cost we will lose momentum.

I love your posts Scott.  You say exactly what this profession needs to hear.

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BTW, I got this last night.  *sigh*

 

 

MedEvals Management
6:18 PM
Hello,
PAs have done very well in this position but unfortunately PA's require a physician supervisor. Which we can not provide. If you have a physician supervisor willing to serve please let us know. Steve N
 
 
 
This was a job I applied for last week.  This was their response.  Btw, the job listed NP's AND PA's to apply.
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So, an interesting aside with some relevance to the sky is falling, we are losing to NPs, etc.

One of my per diem jobs is at a rural, critical access hospital that was just taken over by a larger organization affiliated with a well-known academic medical center. Yesterday, I went to the mother ship to get my formal ID. There was an NP there as well for the same purpose. We both got badges that say :

Name (no title)

Advanced Practice Provider

Apparently docs both MD and DO get one that says Physician.

My point is, they are treating PAs and NPs the same, despite this being an NP independent state. I know for a fact that the one NP in the group (we have 2 PAs and one NP) has to meet the same oversight requirements as myself and the other PA.

The take home point is that a large medical organization is blurring the lines between PA and NP and treating us exactly the same, despite differences in the laws governing us. At the end of the day, what happens at the practice level is just as important, if not moreso, than what the state laws say we can do.

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