Jump to content

The future of the profession - concerns of a recently accepted student


Recommended Posts

...and having enough income to pay back what will be LARGE student loans. :=Z:

 

Large, yes... But not unmanageable. If you qualify for income based repayment, it's not too difficult at all. But the end of the story is this: it shouldn't be THAT expensive to get through PA school. I can understand 200k, but how much are you talking? 250? 300k? If that's the case, then you should have gone to medical school... Isn't that the point of using PAs? We're cheaper to train?

 

Andrew

Link to comment
Share on other sites

  • Replies 59
  • Created
  • Last Reply
Large, yes... But not unmanageable. If you qualify for income based repayment, it's not too difficult at all. But the end of the story is this: it shouldn't be THAT expensive to get through PA school. I can understand 200k, but how much are you talking? 250? 300k? If that's the case, then you should have gone to medical school... Isn't that the point of using PAs? We're cheaper to train?

 

Andrew

 

I have to get into a lot of debt in either case. If I go for the dual MPH/MMSc-PA at Emory, assuming I can live on 20k a year in Atlanta (which I have to do more research on to confirm), it works out to be $170k in debt A big factor in that is to get two Master's degrees, it takes 3.5 years, so that's 3.5 years of living expenses. If I go for the MSN at Vanderbilt, and I know I could live on 20k in Nashville (because I live here now), it comes out to $144k in debt. Vanderbilt is way more expensive per year than Emory, but it's only 2 years of living expenses.

 

I've pretty much resigned myself to working in an ICU setting for at least 2 years, working 6 of those 12 hour shifts to pay it off. Of course I won't be able to apply for the NHCS scholarship or know if I get it until after I would complete my MPH at Emory. From what I understand, Emory PAs have an excellent record of getting those scholarships though.

 

The markets around here are crazy though! Because of Vanderbilt's NP school and Trevecca Nazarene's PA Program, the area/market is saturated with NPs and PAs. But I was doing some more research on surrounding areas here in Tennessee, and I found that if I was willing to commute to Murfreesboro, Shelbyville, or Smyrna, I could make 100k starting out as a primary care PA, whereas in the saturated market in Nashville, if I worked at Vanderbilt, even in like a cardiovascular ICU, I would be starting out at 85k and the salary range for PAs and NPs tops out at 100k. Crazy...

Link to comment
Share on other sites

Look into all of the loan repayment options. The new Pay As You Earn plan caps your monthly payment at 10% of your discretionary income, which is adjusted gross income minus 150% of the federal poverty line amount. Under that plan, if you work for a non-profit, the balance is forgiven after 10 years of on-time payments. If you work for a for-profit, it is forgiven after 20 years, however you will be taxed on the amount forgiven. Of course with some of these extended payment plans you will pay a lot more in interest, but if your concern is the monthly payment being too high to live you an ample amount to live on, there are these programs to help with that. Unfortunately there's no way to avoid this massive debt, unless your family is wealthy and can pay for your school. I wouldn't let that be the deciding factor, though. Money is not that important when it's all said & done.

Link to comment
Share on other sites

I have to get into a lot of debt in either case. If I go for the dual MPH/MMSc-PA at Emory, assuming I can live on 20k a year in Atlanta (which I have to do more research on to confirm), it works out to be $170k in debt A big factor in that is to get two Master's degrees, it takes 3.5 years, so that's 3.5 years of living expenses. If I go for the MSN at Vanderbilt, and I know I could live on 20k in Nashville (because I live here now), it comes out to $144k in debt. Vanderbilt is way more expensive per year than Emory, but it's only 2 years of living expenses.

 

I've pretty much resigned myself to working in an ICU setting for at least 2 years, working 6 of those 12 hour shifts to pay it off. Of course I won't be able to apply for the NHCS scholarship or know if I get it until after I would complete my MPH at Emory. From what I understand, Emory PAs have an excellent record of getting those scholarships though.

 

The markets around here are crazy though! Because of Vanderbilt's NP school and Trevecca Nazarene's PA Program, the area/market is saturated with NPs and PAs. But I was doing some more research on surrounding areas here in Tennessee, and I found that if I was willing to commute to Murfreesboro, Shelbyville, or Smyrna, I could make 100k starting out as a primary care PA, whereas in the saturated market in Nashville, if I worked at Vanderbilt, even in like a cardiovascular ICU, I would be starting out at 85k and the salary range for PAs and NPs tops out at 100k. Crazy...

As someone who works in Atlanta I will make two comments on the NP route. If I look at someone who graduated two years ago and hasn't worked in the field for two years then I would be very reluctant to hire them due to skill atrophy. In most medical professions, being outside the workforce for two years mandates retraining before re-entry. On the other hand most of the hospitals around here won't hire direct entry NPs because of the lack of experience. There are plenty of non DE NPs churned out for HR to even bother looking at DE NPs. Vanderbilt does have a habit of hiring their own and is more NP centric if you want to work there. Finally if I was hiring for nursing positions I would probably pick a non NP over an NP since the NP is probably going to find an NP job as soon as they can (although we get plenty of nurses that stay here for 1-2 years to go to CRNA school).

Link to comment
Share on other sites

Look into all of the loan repayment options. The new Pay As You Earn plan caps your monthly payment at 10% of your discretionary income, which is adjusted gross income minus 150% of the federal poverty line amount. Under that plan, if you work for a non-profit, the balance is forgiven after 10 years of on-time payments. If you work for a for-profit, it is forgiven after 20 years, however you will be taxed on the amount forgiven. Of course with some of these extended payment plans you will pay a lot more in interest, but if your concern is the monthly payment being too high to live you an ample amount to live on, there are these programs to help with that. Unfortunately there's no way to avoid this massive debt, unless your family is wealthy and can pay for your school. I wouldn't let that be the deciding factor, though. Money is not that important when it's all said & done.

 

I was not aware there were so many repayment options! Thank you for the information. I really do want to work with underserved populations, and it would be great to know that would be an option.

Link to comment
Share on other sites

You're welcome! If you are interested in underserved areas, you also have the NHSC loan repayment if you don't get the scholarship (I've also read on this forum this may be the better option, as those on the scholarship seem to have less of a choice of their site). For two years of service in an underserved area, they will repay up to $60,000 of your loans. Priority goes to the highest HPSA score, so it is based on the available funds, and just how underserved the location is. I have browsed job openings, and some have said the loan repayment is guaranteed due to their high HPSA score.

 

Here is a link to all of the federal loan repayment options: http://studentaid.ed.gov/repay-loans/understand/plans

Link to comment
Share on other sites

I was faced with the same predicament as the OP. Accepted to both esteemed PA and direct entry NP programs. I opted for PA based primarily on the education model... And secondarily, I felt they were better poised for practicing EM. Finally, the NP school was significantly more expensive. But the education was the main piece, for me.

Link to comment
Share on other sites

I was faced with the same predicament as the OP. Accepted to both esteemed PA and direct entry NP programs. I opted for PA based primarily on the education model... And secondarily, I felt they were better poised for practicing EM. Finally, the NP school was significantly more expensive. But the education was the main piece, for me.

 

It is good to meet someone else in my shoes! For me, because I would be getting a dual degree (PA/MPH), the NP bridge program is substantially cheaper, but I am more interested in having the right career. I wish we had a crystal ball to see how legislative changes will play out. If I had to wager a bet, I would imagine NPs will ultimately become "autonomous practitioners" in most states (especially as they are transitioning to the DNP, and especially in fields like family medicine), and PAs will have the limitations on their practice and supervision requirements loosened to the point of "supervision" being effectively meaningless.

 

From a physician's standpoint, having fewer supervisory requirements makes better business sense. If a physician can "supervise" many PAs acting functionally autonomously without the headaches of strict chart co-signs or on-site requirements, it would bring in a lot more money for the practice and ultimately benefit them. Heck, a physician could sit at home all day and watch TV and let the PAs bring in the money. If PAs ever tried to become autonomous in the way NPs are becoming, the AMA would flip out.

 

For me it raises philosophical and values questions. To what degree is being a "dependent" versus "independent" practitioner matter? If supervisory requirements become functionally impotent, does it even matter? To what degree does having my own medical license matter to me? Did those things come into play for you?

 

What schools were you accepted to, and where did you end up going, if you don't mind me asking?

 

I am a very knowledge-driven person, I've always wanted to have a cadaver lab, and because Emory's PA Program is located within the school of medicine, they share all the same facilities and resources as the medical center. So, for me, those are very strong selling points. Oh, and I just found out I was awarded a 25% scholarship to Emory's MPH program. It would be very nice to get an MPH and be so close to the CDC.

Link to comment
Share on other sites

If a physician can "supervise" many PAs acting functionally autonomously without the headaches of strict chart co-signs or on-site requirements, it would bring in a lot more money for the practice and ultimately benefit them.

 

Depending on the state, PA's already have a great deal of autonomy. In TN for example, where I'm going to school, the SP only needs to review 20% of the PA's charts (except for certain circumstances) every 30 days. In Indiana, where I'm from, the SP has to review 100% of the charts within 72 hours for a new PA for his or her first 3 years, and 50% after that, still within 72 hours.

 

See here: http://www.aapa.org/the_pa_profession/federal_and_state_affairs/resources/item.aspx?id=755

Link to comment
Share on other sites

  • Moderator

I practice in oregon and washington.

oregon requires 10% review within one month and washington does not require chart review at all, just that the SPONSORING(love the title) physician have an "ongoing awareness of pa practice patterns"..

the issue is that hospitals may require different standards. every hospital I now work at requires 100% chart review so that becomes the default despite what state law says. on the bright side, although both or and wa are np "independent states" the hospitals also require 100% chart review of np notes as well.

Link to comment
Share on other sites

  • Moderator
Sponsoring Physician... yes, that sounds great! I've seen other states that don't require chart reviews as well. Though, when I'm first out of school I will probably ask my sponsoring physician to review all of my charts for a while.

initially you should probably present a lot of cases as well, just for their input. especially sick folks....

Link to comment
Share on other sites

I practice in oregon and washington.

oregon requires 10% review within one month and washington does not require chart review at all, just that the SPONSORING(love the title) physician have an "ongoing awareness of pa practice patterns"..

the issue is that hospitals may require different standards. every hospital I now work at requires 100% chart review so that becomes the default despite what state law says. on the bright side, although both or and wa are np "independent states" the hospitals also require 100% chart review of np notes as well.

 

love washington. can't wait to get back up there

Link to comment
Share on other sites

As someone who works in Atlanta I will make two comments on the NP route. If I look at someone who graduated two years ago and hasn't worked in the field for two years then I would be very reluctant to hire them due to skill atrophy. In most medical professions, being outside the workforce for two years mandates retraining before re-entry. On the other hand most of the hospitals around here won't hire direct entry NPs because of the lack of experience. There are plenty of non DE NPs churned out for HR to even bother looking at DE NPs. Vanderbilt does have a habit of hiring their own and is more NP centric if you want to work there. Finally if I was hiring for nursing positions I would probably pick a non NP over an NP since the NP is probably going to find an NP job as soon as they can (although we get plenty of nurses that stay here for 1-2 years to go to CRNA school).

 

coloradopa or anyone else:

If a student had the following options, which would be more competitive and likely to be hired.

Emory Acute Care NP with 2 years ICU exp

Emory PA with 1 year previous HCE in any area

Now here's the kicker: Both have completed "Emory's Critical Care NP/PA residency program"

 

I'm in the same situation and I am really interested in Emory's Critical Care NP/PA residency program but with the two options being equal (# of years education , I'm not sure which route would be more beneficial to me.

Link to comment
Share on other sites

the residency would make the two equal in my opinion. there are several other critical care pa residencies out there so you don't have to pin your future just on emory, apply to several. see them all at www.appap.org

 

EMEDPA, you appear to have a substantial amount of experience in this profession. I see in your signature that you are a "Doctor of Health Science & Global Health Student". What is that degree? Does it allow any more clinical freedom, or is it primarily a research degree? What are your career goals? Based on your experience, what would your predictions of the future (from a legislative perspective) for PAs and NPs be?

 

I recently applied to switch my MPH concentration from Epidemiology to Health Policy and Management, so maybe I will have more leadership opportunity as a PA.

Link to comment
Share on other sites

  • Moderator

A little on the DHSc from our friends at wikipedia:

http://en.wikipedia.org/wiki/Doctor_of_Health_Science

no extra clinical freedom( should note here that the dnp does not give more freedom over an ms np either).

I am doing the DHSc due to an interest in global health and a desire to likely teach more in the future.

career goals? in a perfect world I would work 3 days/week in a small rural er with full scope practice and teach 1 day/week.

actually in the most perfect of worlds I would work 8 24's/mo solo coverage at a rural er and tech 1 day/week giving me 18-19 days off/mo and a full time+ salary.

Predictions? I think NP's will become independent in all 50 states within 10 years.

eventually PAs will earn the right to be called physician associates. in the future PAs will have to do a 1 yr residency followed by a cert exam (CAQ) to work in specialties.

more pa to physician bridge programs will be created.

PAFT will become a driving force in pa politics and legislation.

see http://pasfortomorrow.us/ and sign up. these are the folks pushing the frontiers for PAs today.

Link to comment
Share on other sites

coloradopa or anyone else:

If a student had the following options, which would be more competitive and likely to be hired.

Emory Acute Care NP with 2 years ICU exp

Emory PA with 1 year previous HCE in any area

Now here's the kicker: Both have completed "Emory's Critical Care NP/PA residency program"

 

I'm in the same situation and I am really interested in Emory's Critical Care NP/PA residency program but with the two options being equal (# of years education , I'm not sure which route would be more beneficial to me.

 

I agree that both would be competitive. The kicker would be for the NP to get ICU experience. Its very hard to get into an ICU as a new grad (or even a job). Two years ago the only Emory BSN students that had jobs after six months were the scholarship students. If you want to do a post grad course I would also agree with EMEDPA that PA is the way to go. There are five or six NP post grad programs out there. There are more critical care post grad programs than that for PAs.

Link to comment
Share on other sites

A little on the DHSc from our friends at wikipedia:

http://en.wikipedia.org/wiki/Doctor_of_Health_Science

no extra clinical freedom( should note here that the dnp does not give more freedom over an ms np either).

I am doing the DHSc due to an interest in global health and a desire to likely teach more in the future.

career goals? in a perfect world I would work 3 days/week in a small rural er with full scope practice and teach 1 day/week.

Predictions? I think NP's will become independent in all 50 states within 10 years.

eventually PAs will earn the right to be called physician associates. in the future PAs will have to do a 1 yr residency followed by a cert exam (CAQ) to work in specialties.

more pa to physician bridge programs will be created.

PAFT will become a driving force in pa politics and legislation.

see http://pasfortomorrow.us/ and sign up. these are the folks pushing the frontiers for PAs today.

 

What does "full scope of practice" mean in your context? Does it mean the ability to do all procedures, order and interpret diagnostic tests, and write all prescriptions necessary for practice of medicine in a rural ER? What current limitations do you face? How do you see the future of physician supervision requirements changing? I am aware of the AAPA document of the "six key elements of a modern PA practice" and the goals that it describes (http://www.aapa.org/the_pa_profession/federal_and_state_affairs/resources/item.aspx?id=760). Do you see all states moving towards that, and do you think that once those goals are met in the majority of states, that will constitute the final goals of advancement of the profession? What is your conceptualization and opinion of physician assistant to physician bridge programs? I know there is one PA to DO program, but it only cuts off one year of medical school, and there are some medical schools that are moving towards being a 3 year program anyways.

Link to comment
Share on other sites

  • Moderator

full scope practice means no arbitrary restrictions that only apply to PAs. " PAs can't do u/s, PA's can't manage level 1 pts", etc

at my regular job I am restricted from many procedures and pt populations(busy trauma ctr). we also run a satelite facility where I work solo most of the time now. at that facility I am limited only by minimal ancillary staff and lack of certain labs and diagnostic capacity so end up transferring a lot of folks.

at my rural job I can do pretty much anything I want. I would love to work there full time and over the past yr have increased my hrs there from 16 to 36/mo....maybe when the kids go to college(schools suck there).

I think in time with the provider shortage and increased requirements for PAs to practice that supervision will be lessened but never go away completely(except maybe in outpt primary care). the aapa goals are good and noble but don't cover a lot of important ground. oregon, for example per the aapa looks great, but in reality is not very pa friendly. stuff regarding your practice is sent to your sp with a cc to you as an afterthought. we are managed in a sub-board of the bom that also covers acupuncture. they take forever to make simple changes to practice descriptions. adding a new skill is like pulling teeth.

I am in favor of pa to doc bridges but think they should work towards 2 years( 1 classroom, 1 clinical) and not require the mcat as a prereq.

in my perfect world of pa to doc bridges they would require at least a bs to apply, 6 yrs as a pa and passage at least once of the panre. I would have no problem if they did what lecom does now: 50% of seats for primary care, 50% for specialties.

Link to comment
Share on other sites

initially you should probably present a lot of cases as well, just for their input. especially sick folks....

 

AMEN to this....too many new grads think that they can instantly manage most patients on their own. Problem is, I've seen some not so great outcomes from this...After doing this for a long time, and being in a supervisory capacity hiring and watching new grads....I would say it takes at least 1.5-2 years to get comfortable managing most common illnesses comfortably on your own, and closer to 4-5 years to where you are comfortable managing complicated patients independently.

Link to comment
Share on other sites

in a perfect world I would work 3 days/week in a small rural er with full scope practice and teach 1 day/week.

 

HAHA...and in my perfect world...I would be in my office working on research 90% of the time, seeing patients 1 day every week or 2......Sigh.....C'mon grant fairies....step it up!!!!

Link to comment
Share on other sites

HAHA...and in my perfect world...I would be in my office working on research 90% of the time, seeing patients 1 day every week or 2......Sigh.....C'mon grant fairies....step it up!!!!

 

physasst - I see your title is "Health Services Researcher/Collaborative Scientist focused on PRO (patient reported outcomes), analyses of response shift/recollection bias in PRO models, clinical decision rule implementation/evaluation, shared decision making models, and audit and feedback research in providers. Methodologist. PA practicing in non operative spine management."

 

Could you tell me a little bit about what that means and what you are doing? It is interesting to see you are a PA with non-clinical responsibilities as well.

Link to comment
Share on other sites

Archived

This topic is now archived and is closed to further replies.


×
×
  • Create New...

Important Information

Welcome to the Physician Assistant Forum! This website uses cookies to ensure you get the best experience on our website. Learn More