PAs Don't Have It That Bad.

[MediMike]

So I am around 6 years out of school.  I make close to $150k/yr working 120 (12) hour shifts per year giving me an hourly income >$100/hr.  I am published, active in research, maintain a fantastic work-life balance and practice full scope medicine. 

Through my 6 years I have taken multiple students and been involved in teaching at my local program. 

Every. Single. One. Of. Them. has obtained a successful job with goodworking conditions.

I am sure there are regions of the country where many of these things aren't true, but there are plenty of areas where it is.  The regions of the country where the pay sucks? Well it sucks for everybody.  It sucks for NPs, it sucks for MDs, it sucks for PAs.

We have a lot of growth to go as a field and I completely agree that some of the old guard are likely holding us back.  As they retire or die off the field WILL move forward.  The profession is advancing by leaps and bounds in a variety of states but yes, we've got a ways to go on the national level.

Best way to keep our profession down is to come on here and open up thread after thread after thread with this Chicken Little B.S. about the world burning down around us constantly.  That way we will disenfranchise anyone from joining the PA career field and all we will have is the geriatrics and ineffectuals. 

And I guar-an-fricking-tee that not a single one of you will go to NURSING school and making it through a fluff nursing theory class, let alone nursing clinicals.  If you do, I'll buy you a beer at the next conference we all meet up at.

Mods can we maybe have like a weekly quota of "everything is terrible" posts allotted to each member?

[WantToHopeForPAfuture]

You're right. Established PAs have it okay.  But NPs are in better position than us. We suck right now admit it... some NPs got to open their own businesses opened covid clinics made millions.  Now you will have to work over 10 years to make up that difference. You ,  I and other PAs do not have the privilege to that. We have work for someone under their rules and take a tiny fraction of their profits.. Moreover NPs took over telemedicine from us. We are seen as second class in this field.  In addition, many newbie PAs are struggling. Some are frustrated right now looking for full time employment but no luck for  over 6 months post graduation. 

Edited May 8, 2021 by WantToHopeForPAfuture

[Cideous]

4 hours ago, MediMike said:

So I am around 6 years out of school.  I make close to $150k/yr working 120 (12) hour shifts per year giving me an hourly income >$100/hr.  I am published, active in research, maintain a fantastic work-life balance and practice full scope medicine. 

Through my 6 years I have taken multiple students and been involved in teaching at my local program. 

Every. Single. One. Of. Them. has obtained a successful job with goodworking conditions.

I am sure there are regions of the country where many of these things aren't true, but there are plenty of areas where it is.  The regions of the country where the pay sucks? Well it sucks for everybody.  It sucks for NPs, it sucks for MDs, it sucks for PAs.

We have a lot of growth to go as a field and I completely agree that some of the old guard are likely holding us back.  As they retire or die off the field WILL move forward.  The profession is advancing by leaps and bounds in a variety of states but yes, we've got a ways to go on the national level.

Best way to keep our profession down is to come on here and open up thread after thread after thread with this Chicken Little B.S. about the world burning down around us constantly.  That way we will disenfranchise anyone from joining the PA career field and all we will have is the geriatrics and ineffectuals. 

And I guar-an-fricking-tee that not a single one of you will go to NURSING school and making it through a fluff nursing theory class, let alone nursing clinicals.  If you do, I'll buy you a beer at the next conference we all meet up at.

Mods can we maybe have like a weekly quota of "everything is terrible" posts allotted to each member?

Ok, we will pin this thread and check it in 5 years after NP's take a 3rd victory lap around us (by taking full independence in Texas) and specifically new PA's, but hey....everything is great.  I'm sure younger PA's struggling to find a job, any job, would agree with you. Or not.

[MediMike]

1 hour ago, Cideous said:

Ok, we will pin this thread and check it in 5 years after NP's take a 3rd victory lap around us (by taking full independence in Texas) and specifically new PA's, but hey....everything is great.  I'm sure younger PA's struggling to find a job, any job, would agree with you. Or not.

And I'm sure the younger PAs who aren't struggling would. See what anecdotes get us? 

Quit being so hyperbolic. I didn't say everything was amazing but it sure isn't the pit of despair that you make it out to be. Even the Bitcoin guy is making >$150k/yr. We see good offers put up on this site for review on a regular basis.

I'm sorry you're struggling, I truly am. I guess that's all I can say besides hoping you find some joy in your field, change your field or get out of the profession with your mental state intact.

[ohiovolffemtp]

I think things are highly variable: by region, by specialty, and even more by new grad vs experienced.  PA has always been a 2 tier job market: new grad/few years vs 5+ in a specialty.

My personal perspective, based on doing EM in Ohio, KY, and IN: a year ago the job market in these states was terrible in EM, now it's just tight - for experienced EM PA's.  Many experienced EM folks were laid off or had significant cuts in hours.  Now most have finally found something.  I've had contact with multiple new grads in Ohio.  Several wanted EM, some just wanted anything.  Most (80%+) of the 2020 graduates went months without finding anything.  Now, they're just beginning to get jobs.

I on the other hand was fortunate: I saw the hand writing on the wall and left the hospital and large staffing co I'd been working for before the cuts hit after finding an ideal job at a rural critical access hospital.  I'm the only provider in the hospital at night, so I've been immune to cuts.  I do 14 12's/month - but would still be full time and get benefits at 10 shifts/month.  But, I'm socking it away for retirement, maxing out 401K, ROTH, and HSA contributions.  Not $100/hour, but probably equivalent given likely lower local cost of living.

My overall take: the sky isn't falling, but it's a much tougher job market than what I experienced as a new grad, or even as an experienced EM PA.  I don't see the future getting brighter, given the struggles doc's are having finding employment and the large growth in the numbers of PA graduates (doubling of the numbers in my 3 state area) and the massive growth in the numbers of NP graduates.

[sas5814]

I'm doing just fine and always have yet I'm part of the doom crowd. If we don't get some things handled our profession (employed not graduates) will shrink by half in the next 5 years and half again in 5 more.

I always ask the same question. Which is the greater risk? That I am wrong or that you are?

[ventana]

On 5/7/2021 at 8:06 PM, MediMike said:

So I am around 6 years out of school.  I make close to $150k/yr working 120 (12) hour shifts per year giving me an hourly income >$100/hr.  I am published, active in research, maintain a fantastic work-life balance and practice full scope medicine. 

Through my 6 years I have taken multiple students and been involved in teaching at my local program. 

Every. Single. One. Of. Them. has obtained a successful job with goodworking conditions.

I am sure there are regions of the country where many of these things aren't true, but there are plenty of areas where it is.  The regions of the country where the pay sucks? Well it sucks for everybody.  It sucks for NPs, it sucks for MDs, it sucks for PAs.

We have a lot of growth to go as a field and I completely agree that some of the old guard are likely holding us back.  As they retire or die off the field WILL move forward.  The profession is advancing by leaps and bounds in a variety of states but yes, we've got a ways to go on the national level.

Best way to keep our profession down is to come on here and open up thread after thread after thread with this Chicken Little B.S. about the world burning down around us constantly.  That way we will disenfranchise anyone from joining the PA career field and all we will have is the geriatrics and ineffectuals. 

And I guar-an-fricking-tee that not a single one of you will go to NURSING school and making it through a fluff nursing theory class, let alone nursing clinicals.  If you do, I'll buy you a beer at the next conference we all meet up at.

Mods can we maybe have like a weekly quota of "everything is terrible" posts allotted to each member?

said the canary in the coal mine right before succumbing to poison gas.......

[MediMike]

I think the issue you doom 'n gloom folks are missing are that you can be worried about the profession and our future without losing your bloody minds.

@sas5814 you post (mostly) thoughtful and provoking issues with suggestions for improvement. 

@ventana you repeatedly encourage folks, suggest job openings, attempt to recruit new grads, showing that there are jobs open out there.

If things are this bad are both of you leaving the field? Are you going back to nursing school? I imagine if you honestly believe that this career is done for that you're moving on ASAP.

It's the people running around like their hair is on fire screaming about the end of the world that gets to me and does nothing but demoralize folks.

There are PLENTY of people on this board who are doing well, PLENTY of regions of this country who are doing well. The graduates in my realm of the country are doing great. As has been pointed out repeatedly we have such a tiny portion of the profession represented on here and in all honesty we only have around 20 people who post regularly.

Accepting the fact that not everybody is doing poorly doesn't exclude the fact that some places aren't.  These things aren't mutually exclusive.  Just because Texas is a cesspool of hate for the PA profession (reportedly) doesn't mean the rest of the world is.

[sas5814]

Actually I'm retiring in 4 years or so. I don't have a reason to jump ship. Its on the calendar God willing. My thoughts are with the younger PAs.

Yes lots of people are doing just fine.  That is indisputable. Texas is a cesspool that is indisputable. But I spend a lot of time speaking to people all over the country (speaking in the internet connected virtual sense of the word). Today I have had fairly long discussions with 6 different folks in 6 different parts of the country (5 of which are doing OK)  and I see disturbing trends and forces in play that could have a very bad impact on the profession.

It is many many things but, at its most basic, NPs are graduating huge numbers and the numbers are going up. We are graduating more PAs annually than ever in our history. NPs are out graduating us by about 2 to 1.

NPs have independence in about 27 states(?) though that number might be a few low. They will have it in 50 states. It is as inevitable as the next sunrise.

Simple economics, in those states, make it cheaper and easier to hire them and keep them employed (no cost to maintain supervision). Arguments about our superior training will not carry the days. Hiring is done by nurse managers, MBAs, and administrators. They need the most bang for the fewest bucks.

Nurses fill leadership positions in most hospital systems. Nurses look after nurses. PAs rarely have administrative leadership positions by comparison.

We are making progress on OTP which improves our position in the marketplace but doesn't make it equal, economically. with an independent NP.

We still have a fairly large cadre of "everything is just fine" PAs in influential places throughout the profession so we spend a lot of time and energy arguing among ourselves. Nursing leadership charges ahead and if you don't want to come along... tough.

That is my best summary of the current state of things. Based on that NPs are killing us with numbers, are running laps around us legislatively, and they don't care what physicians think about anything. Combined with their political clout from their numbers and money they just continue to move much faster than we do in the regulatory and legislative arena.

It is only the end times if we do nothing or do something but too little too late. 

I fear we are in the latter phase of our collective professional lives. Too little too late. When it is too late.... well it will just be too late. By the time most people feel the pain it will be too late. In my darker moments I fear it already is.

There is a vicious cycle argument to consider. Our numbers drop because of all the above. PA programs dry up and blow away so there are fewer PAs. Fewer PAs apply for jobs so more slots get filled by NPs. Lather , rinse, repeat.

20 years ago I predicted the physicians were not our friends and we needed to create and promote ourselves as distinct and different from the NPs. I was shouted down as a radical and a wild man who would make enemies of both groups. 

Here we are.

I'll be happy to be wrong. I just had a nice back and forth with Jim Kilgore over in the Huddle who told me I am a wild man and I'm not convincing anyone (paraphrasing just a bit). I told him I hope so and hoped, in 10 years, assuming nobody has killed me yet (that includes my wife) we should get together and see who was right.

[ventana]

2 hours ago, MediMike said:

I think the issue you doom 'n gloom folks are missing are that you can be worried about the profession and our future without losing your bloody minds.

@sas5814 you post (mostly) thoughtful and provoking issues with suggestions for improvement. 

@ventana you repeatedly encourage folks, suggest job openings, attempt to recruit new grads, showing that there are jobs open out there.

If things are this bad are both of you leaving the field? Are you going back to nursing school? I imagine if you honestly believe that this career is done for that you're moving on ASAP.

It's the people running around like their hair is on fire screaming about the end of the world that gets to me and does nothing but demoralize folks.

There are PLENTY of people on this board who are doing well, PLENTY of regions of this country who are doing well. The graduates in my realm of the country are doing great. As has been pointed out repeatedly we have such a tiny portion of the profession represented on here and in all honesty we only have around 20 people who post regularly.

Accepting the fact that not everybody is doing poorly doesn't exclude the fact that some places aren't.  These things aren't mutually exclusive.  Just because Texas is a cesspool of hate for the PA profession (reportedly) doesn't mean the rest of the world is.

I am out in 5-10 years

I try to hire PA (I get 10:1 NP:PA applicants)  

I am likely going to hire an NP

I see the writing on the wall and something has to give.  Just give us OTP and ANY name with out assistant in it and it will be okay.  

 

I can not overstate now is the time to act - or we risk being left behind.....

[MediMike]

4 hours ago, sas5814 said:

Actually I'm retiring in 4 years or so. I don't have a reason to jump ship. Its on the calendar God willing. My thoughts are with the younger PAs.

Yes lots of people are doing just fine.  That is indisputable. Texas is a cesspool that is indisputable. But I spend a lot of time speaking to people all over the country (speaking in the internet connected virtual sense of the word). Today I have had fairly long discussions with 6 different folks in 6 different parts of the country (5 of which are doing OK)  and I see disturbing trends and forces in play that could have a very bad impact on the profession.

It is many many things but, at its most basic, NPs are graduating huge numbers and the numbers are going up. We are graduating more PAs annually than ever in our history. NPs are out graduating us by about 2 to 1.

NPs have independence in about 27 states(?) though that number might be a few low. They will have it in 50 states. It is as inevitable as the next sunrise.

Simple economics, in those states, make it cheaper and easier to hire them and keep them employed (no cost to maintain supervision). Arguments about our superior training will not carry the days. Hiring is done by nurse managers, MBAs, and administrators. They need the most bang for the fewest bucks.

Nurses fill leadership positions in most hospital systems. Nurses look after nurses. PAs rarely have administrative leadership positions by comparison.

We are making progress on OTP which improves our position in the marketplace but doesn't make it equal, economically. with an independent NP.

We still have a fairly large cadre of "everything is just fine" PAs in influential places throughout the profession so we spend a lot of time and energy arguing among ourselves. Nursing leadership charges ahead and if you don't want to come along... tough.

That is my best summary of the current state of things. Based on that NPs are killing us with numbers, are running laps around us legislatively, and they don't care what physicians think about anything. Combined with their political clout from their numbers and money they just continue to move much faster than we do in the regulatory and legislative arena.

It is only the end times if we do nothing or do something but too little too late. 

I fear we are in the latter phase of our collective professional lives. Too little too late. When it is too late.... well it will just be too late. By the time most people feel the pain it will be too late. In my darker moments I fear it already is.

There is a vicious cycle argument to consider. Our numbers drop because of all the above. PA programs dry up and blow away so there are fewer PAs. Fewer PAs apply for jobs so more slots get filled by NPs. Lather , rinse, repeat.

20 years ago I predicted the physicians were not our friends and we needed to create and promote ourselves as distinct and different from the NPs. I was shouted down as a radical and a wild man who would make enemies of both groups. 

Here we are.

I'll be happy to be wrong. I just had a nice back and forth with Jim Kilgore over in the Huddle who told me I am a wild man and I'm not convincing anyone (paraphrasing just a bit). I told him I hope so and hoped, in 10 years, assuming nobody has killed me yet (that includes my wife) we should get together and see who was right.

I appreciate the reasonable reply wild man. Agree that the future is looking rough in many areas of the country and that we need to be doing something as a profession. I also appreciate the fact that your informal survey demonstrated that 5/6 folks were doing alright.

Will we keep doing alright without action? No. Definitely not. But implying that the field is dead will do nothing but accelerate that end result.

Defeat leads to apathy and vice versa. If you think the end is here you are less likely to fight. This holds true for experienced folk as well as new grads coming on here and reading our boards.

Don't take their hope away was the main point I was trying to achieve in my post. I think folks who may have a little "aged wisdom" have a tendency to forget what impact their words can have on the young and impressionable.

[Reality Check 2]

I will throw this oil on the fire..........

When I graduated in 1992, I had LESS THAN $30K in debt. ZERO from undergrad. I was paid off in 5 yrs.

My starting salary back in 1992 was $55K. My first house cost $77K - listed today at $240K. 

Now, new grads are in easily over $100K plus or minus undergrad. Degree creep as well - everything is Masters.

Skills aren't different Masters or whatever - we have regulated educational requirements. 

New grads want to (have to) make enough to pay their loans.

I, as a very very experienced PA, deserve to be paid for my years of experience and skills. I am Plug and Play as it were - don't need training wheels or mentoring and can handle a bigger load and more complex issues. 

However, salaries really don't reflect the difference between newbie and 29 yrs anymore.

Is that fair? - no. It is life. 

This also happens in other trades and degrees - My husband is a Journeyman Electrician of 25 yrs. 

Should a new grad apprenticeship make what he does? No, but prevailing wage lets it happen.

We make all these new grads with all this debt. We have fewer jobs than when I graduated. 

I had NINE to pick from 3 months BEFORE I graduated and six months before I had my NCCPA. 

My aged wisdom doesn't want to discourage new grads - but they need reality as well. 

Our profession needs the retired emeritus to quite literally back off (folks on the Huddle dissing OTP) - if they aren't making the wage - let the middle age group advocate. We are still living it. 

The new grads need to know there is a ceiling and a starting salary - deal with it. Live within means, pay off loans. Don't make it worse for the middle age group. Let us guide - please - we aren't dead and we certainly aren't stupid. Don't walk over the folks who paved the way. 

We have to have a common goal with realistic and achievable items - reasonable wage, real autonomy - if we can't work together - nothing good will happen. We can't have new grads wanting huge wages and old timers wanting autonomy based on experience without having a common goal and method to achieve it. Mutually exclusive.

I am here to advocate and be positive. OTP is a must. 

Name change - yeah, it sucks - we gotta do something.

But we have to stick together..................

 

 

[MediMike]

9 hours ago, sas5814 said:

I'll be happy to be wrong. I just had a nice back and forth with Jim Kilgore over in the Huddle who told me I am a wild man and I'm not convincing anyone (paraphrasing just a bit). I told him I hope so and hoped, in 10 years, assuming nobody has killed me yet (that includes my wife) we should get together and see who was right.

Huh.  I just entered that ring myself, will let you know how it goes.

[sas5814]

10 hours ago, MediMike said:

Huh.  I just entered that ring myself, will let you know how it goes.

Jim and I have been at each other for a while. He will be the first to tell you he is the smartest guy in the room, quote all his assorted and many accomplishments so you know if you disagree with him you are wrong and actually said to me (about himself) "I'm pretty impressive". He also told another old well experienced leader that he knows more about OTP than WPP the internationally renowned company we paid a million bucks to do research.

So good luck. I have strong opinions but I don't take myself that seriously. I told him, flat out, that I aggravate him just because I think he is a big gasbag. Right or wrong I can't help myself. Its a character flaw.

[GetMeOuttaThisMess]

Man, I really enjoy trying to make folks go wheels off that smell too much of themselves.

[Joelseff]

Scott, I appreciate your posts on the HUDDLE. Hang in there...

Now about the HUDDLE. Seems like the old guard "Associate" stalwarts have tried some shady tactics like posting a thread that states (Paraphrasing) "Since 'Physician Associate' is the chosen name let's all get behind it"  I see you posted on that thread and some other people have as well. I have found myself posting long answers on the HUDDLE on my phone but have had some glitches where it didn't post and then it didn't auto-save. 

The issue of transparency in voting is also a HUGE issue and I couldn't believe there was opposition to it by the leadership! 

I have been pretty optimistic lately with AAPA due to some tangible changes like OTP wins (UTAH!!!) and Title Change but man, the old heads in leadership have a very myopic view about the future of the profession. One poster on the HUDDLE posted that it seems the ones who oppose change on AAPA seem to be near retirement (Scott, not you, you are different lol) and the choices they make will likely not impact THEM much but it will affect US who still have 10+ years left in this. 

I urge people here to voice their opinions on the HUDDLE but also reach out to your delegates. I've tried some of my state delegates and have not heard back at all. I will attend the virtual meeting though and hope it is not some kangaroo court type thing...

Edited May 11, 2021 by Joelseff

[sas5814]

Let me tell you what my friend Jim said about vote transparency...on 2 different occasions. 

1) It's none of your business how people vote

2) They are afraid you (me personally) are going to come after them based on how they vote.

The first is, of course, what people who don't want you to know how they vote say.

The second is some dilute feces. If you are that afraid of the world get out of the chair in the HOD and go home.

I posted all of my contact information down to my cell number and home address for anyone who wanted to "come after" me. So far not even a stern text.

 

and just for fun I have been changing my sig line every few days to things like "Perfect Attendence Mrs. Jones' Second Grade Class 1967" he let me know "they" noticed and were not amused.

Edited May 11, 2021 by sas5814

[Joelseff]

15 minutes ago, sas5814 said:

Let me tell you what my friend Jim said about vote transparency...on 2 different occasions. 

1) It's none of your business how people vote

2) They are afraid you (me personally) are going to come after them based on how they vote.

The first is, of course, what people who don't want you to know how they vote say.

The second is some dilute feces. If you are that afraid of the world get out of the chair in the HOD and go home.

I posted all of my contact information down to my cell number and home address for anyone who wanted to "come after" me. So far not even a stern text.

 

and just for fun I have been changing my sig line every few days to things like "Perfect Attendence Mrs. Jones' Second Grade Class 1967" he let me know "they" noticed and were not amused.

HAHAHA I've noticed that! I saw your response to him and also the deleted posts  Seems like Jim et al are doubling down as the HOD meeting approaches. 

[rev ronin]

On 5/11/2021 at 7:57 AM, sas5814 said:

He will be the first to tell you he is the smartest guy in the room,

I think being "the smartest guy in the room" is like a sex life: those who feel compelled to tell you about their status probably are insecure, mistaken, or lying.

[TexasPA28]

You guys are freaking out too much over NP independence.

I've worked in NP indepedent states and there are still plenty of PA job postings.

You guys make it sound like NP indepedent states = all PAs are terminated and no new jobs created.

There are still plenty of MD and PA positions in these states.

[LAWPA]

23 hours ago, TexasPA28 said:

There are still plenty of MD and PA positions in these states.

There's a Blockbuster open in Bend, Oregon, so they're still in the running against Netflix right?

[MediMike]

59 minutes ago, LAWPA said:

There's a Blockbuster open in Bend, Oregon, so they're still in the running against Netflix right?

You know... you're able to make an argument that the PA profession needs to make changes without trying to say that we are doomed.

I also have loads of jobs open in a three state region that I check regularly.

Rather than trying to make a false comparison how about you be happy that there are jobs out there in multiple regions of the country?

There's no need to be completely polarized where everything is amazing or everything is terrible.