"Don't become a PA"

[charmstarz]

I"m not trying to start controversy on this forum but looking for genuine advice on what to do.

 

Last year I was taking my pre-reqs for a PA program. During that time, I was attempting to rack up as many patient contact hours as possible, shadowing and interviewing PA's, MD's and NP's just to get a feel for each discipline. Sadly, several (not just a few) of these people said "DO NOT become a PA (and it wasn't isolated to this discipline but to their own as well MD and NP)". I often inquired as to the different reasons that I should not and it basically came down to a few things:

 

1) the "direction" healthcare is headed (more quantity vs. quality of care)

 

2) salaries to decrease in the future

 

3) debt that will not easily be paid off

 

4) criteria for entering these programs will be lowered because of the higher need for these disciplines (thus education that is not up to par)

 

5) one PA and MD said "people coming into healthcare think they are diagnosing patients when in reality they are being TOLD what to do and have to follow those orders vs. their own instinct"

 

6) another MD said his daughter wanted to go to school for PA or MD and he told her "absolutely not, you're better off going into some other field"

 

7) one PA said that their office was not making enough money and that the doctor would probably be leaving because after paying all of the expenses, liability, school loan debt and living expenses, they were only making about $50,000 a year. I was in TOTAL SHOCK with that one.

 

and I could go on and on but because of this, I took a full time job this year and have kept a PRN position at the hospital. I would like to add that these are not the only disciplines to state their fear of the healthcare plan's full implementation. I work in the Rehab dept. with Physical, Occupational and Speech Therapists and 90% of them say the same thing. RN's have echoed this sentiments as well.

 

I only need a couple more classes to qualify for a few programs I'm interested in, however, I took a full time job this year (in a non-healthcare field) to save money and also to sit back and see if the climate of healthcare changes. When I hear professionals telling me (i.e. scaring me) with these "warnings", I fear the investment of a 2 year, $60,000-$80,000 program (depending on area and living expenses). I love anything that has to do with medicine. Heck at my current job, I sit during lunch and read this forum, MD forums, NP forums, medical journals, articles, watch YouTube surgeries. I LOVE it, but I'm scared because I just can't afford to take on all of this debt if I will end up screwed in the end (not making enough money, competing with many PA's for lower salary positions if it comes to that point, or not getting hired at all like a lot of new grad RN's are struggling with). I have a house, huge debt from undergrad and I just don't know what to do.

 

I think to myself that I could be dealing with a "sample population" that is a small percentage that feels this way about healthcare. This forum is a platform for many voices across the country and I would love your thoughts about what these professionals have said, and your own thoughts on the matter (especially in regards to the healthcare climate and where you think it is heading).

 

I appreciate any advice and thank you for taking the time to respond.

[LT_Oneal_PAC]

Oh my, only 50k after everything is paid to do whatever you want with?! How does he survive?

 

First, it should go without saying that you should find the cheapest school possible that has a good reputation and go there. USA I believe has a MS PA program that costs 30k, and I promise living in Mobile, AL is cheap if you want it to be.

 

Secondly, as an RN, I can tell you that anyone who cannot find a job in health care is just putting to many restrictions on where they will work. Sure you may have to move or be in a specialty you don't like (unlikely you would have to sacrifice both), but there are plenty of jobs. Training RN students, I saw so many say they couldn't find a job. "Um...we have 3 openings here." "Oh I mean I can't find a job at [insert place where everyone wants to live]."

 

Is it al sunshine and rainbows? No. It's definitely not the same atmosphere it used to be and there is more regulation, but I still wouldn't do anything else. Except maybe astronaut, but that's not in my cards.

[ventana]

private practice doc's are dying....

 

I am learning why.....

 

 

BUT when they go work for the hospital they make $160K as a minimum for IM, much higher for specialists....

 

The gravy train days of small practice is over, so is the days when the doctor was supreme and got to write what even new drug they wanted (because that drug rep had just taken them skiing to Aspen - true story)

 

It is now just big business.....

 

 

having said that I feel now where else would be any better and I am excited beyond belief to be a PA. It is a great occupation that you can take with you and try many different things, learn, practice medicine, help others, and have a great time.

 

The least I have ever made was right out of school at ~ 60k in 2002 - with in 8 years I was at 120k - and had tried about 4 different fields, then decided I am a primary care guy and took a pay cut to to return to primary care (from the ER - 35k ouch) But I love what I do......

 

 

Their will always be those people down on the profession, and there is with out a doubt some growing pains that we as a profession are going through, but this is because we have reached a critical mass and now need to spread our wings and fly..... and with this comes some discontent....

 

I have no great wise words for you - I knew beyond a shadow of a doubt I wanted to be in primary care I would do NP instead of PA as they have a much more activ effective lobby, but you are somewhat pigeon holed with NP.

 

 

Don't listen to everything you hear and take into consideration the source- asking a doc who is failing at private practice and the answer will likely be negative no matter what the question.....

 

 

If you want it do it!

[EMEDPA]

the question you should be asking yourself is PA vs MD.....keep in mind docs who are unhappy would also be unhappy as PAs.

there are good reasons to consider both but only you can decide which reasons are the most important.

everyone working in healthcare will be employable for the foreseeable future. as oneal said you can't always work at the place and specialty you want BUT YOU CAN ALWAYS FIND A JOB.

"you can't always get what you want, but if you try sometimes, you'll find, you get what you need"

[Guest JMPA]

I"m not trying to start controversy on this forum but looking for genuine advice on what to do.

 

Last year I was taking my pre-reqs for a PA program. During that time, I was attempting to rack up as many patient contact hours as possible, shadowing and interviewing PA's, MD's and NP's just to get a feel for each discipline. Sadly, several (not just a few) of these people said "DO NOT become a PA (and it wasn't isolated to this discipline but to their own as well MD and NP)". I often inquired as to the different reasons that I should not and it basically came down to a few things:

 

1) the "direction" healthcare is headed (more quantity vs. quality of care)

 

2) salaries to decrease in the future

 

3) debt that will not easily be paid off

 

4) criteria for entering these programs will be lowered because of the higher need for these disciplines (thus education that is not up to par)

 

5) one PA and MD said "people coming into healthcare think they are diagnosing patients when in reality they are being TOLD what to do and have to follow those orders vs. their own instinct"

 

6) another MD said his daughter wanted to go to school for PA or MD and he told her "absolutely not, you're better off going into some other field"

 

7) one PA said that their office was not making enough money and that the doctor would probably be leaving because after paying all of the expenses, liability, school loan debt and living expenses, they were only making about $50,000 a year. I was in TOTAL SHOCK with that one.

 

and I could go on and on but because of this, I took a full time job this year and have kept a PRN position at the hospital. I would like to add that these are not the only disciplines to state their fear of the healthcare plan's full implementation. I work in the Rehab dept. with Physical, Occupational and Speech Therapists and 90% of them say the same thing. RN's have echoed this sentiments as well.

 

I only need a couple more classes to qualify for a few programs I'm interested in, however, I took a full time job this year (in a non-healthcare field) to save money and also to sit back and see if the climate of healthcare changes. When I hear professionals telling me (i.e. scaring me) with these "warnings", I fear the investment of a 2 year, $60,000-$80,000 program (depending on area and living expenses). I love anything that has to do with medicine. Heck at my current job, I sit during lunch and read this forum, MD forums, NP forums, medical journals, articles, watch YouTube surgeries. I LOVE it, but I'm scared because I just can't afford to take on all of this debt if I will end up screwed in the end (not making enough money, competing with many PA's for lower salary positions if it comes to that point, or not getting hired at all like a lot of new grad RN's are struggling with). I have a house, huge debt from undergrad and I just don't know what to do.

 

I think to myself that I could be dealing with a "sample population" that is a small percentage that feels this way about healthcare. This forum is a platform for many voices across the country and I would love your thoughts about what these professionals have said, and your own thoughts on the matter (especially in regards to the healthcare climate and where you think it is heading).

 

I appreciate any advice and thank you for taking the time to respond.

 

I can not contradict anything said. Just look around and see how many smiling PAs or MDs you find. It's a twisted type of self fulfillment that is not for everyone, and yes even with debt eventually paid off and an increase in salary, there is always the demanding continuation of education that absorbs ones life and ever increasing fees for nonsense certifications and registrations. Not to mention ever changing healthcare rules and regulations. I believe in speaking the truth so here it is.

[Just Steve]

I can not contradict anything said. Just look around and see how many smiling PAs or MDs you find. It's a twisted type of self fulfillment that is not for everyone, and yes even with debt eventually paid off and an increase in salary, there is always the demanding continuation of education that absorbs ones life and ever increasing fees for nonsense certifications and registrations. Not to mention ever changing healthcare rules and regulations. I believe in speaking the truth so here it is.

 

What sort of jobs are there that pays six figures does not require hoop jumping?

[EMEDPA]

What sort of jobs are there that pays six figures does not require hoop jumping?

rock star, nfl quarterback, movie star.....:)

[GREEN]

rock star, nfl quarterback, movie star.....:)

 

Awesome, where can I apply?

[True Anomaly]

I can not contradict anything said. Just look around and see how many smiling PAs or MDs you find. It's a twisted type of self fulfillment that is not for everyone, and yes even with debt eventually paid off and an increase in salary, there is always the demanding continuation of education that absorbs ones life and ever increasing fees for nonsense certifications and registrations. Not to mention ever changing healthcare rules and regulations. I believe in speaking the truth so here it is.

 

I won't disagree about certification fees....but you're complaining about having to keep learning in a field that's actually interesting? It's not like you're having to learn new burger- flipping regulations at Micky D's

[physasst]

 

1) the "direction" healthcare is headed (more quantity vs. quality of care)

 

Actually, it's headed in the opposite direction to a degree. New payment models, both CMS and private in the ACO model and using bundled payment methods (Prometheus), will be based on quality metrics and outcome measures, both clinical and non-clinical. At the same time, there will be more insured patients. Demand will increase, but payments will fall slightly. There's actually a HUGE focus on quality initiatives now, and a lot of the grants coming out, specifically through PCORI are looking at this. So, it might be true thinking about a higher quantity of patients seeking services, but quality will likely rise as providers and organizations seek to maximize revenue. This will create some backlogging of patients, but that likely doesn't matter as much as we think.

 

2) salaries to decrease in the future

 

More concerning for physicians. They are looking at almost certain salary reductions, especially in certain procedurally oriented specialties, while PC may see a slight increase. PA's, at least from my perspective and analysis won't likely see a pay decrease per se, but we will almost certainly see wage stagnation, meaning little growth over the next 5-10 years.

 

3) debt that will not easily be paid off

 

VERY legitimate concern these days. I'm actually writing a paper...one of several, that examines the effect of PA educational debt in the current climate of reduced reimbursements and wage stagnation, and how this will affect future demand for PA education.

4) criteria for entering these programs will be lowered because of the higher need for these disciplines (thus education that is not up to par)

 

Again, legitimate concern, but as long as the accrediting bodies are doing their job, might not be that bad.

 

5) one PA and MD said "people coming into healthcare think they are diagnosing patients when in reality they are being TOLD what to do and have to follow those orders vs. their own instinct"

 

Bullocks. We still diagnose. In fact, there was a great paper in BMJ in February that examined patients and their diagnoses, they found that the more patients saw their providers...the more diagnoses that they accrued in the chart, and more tests and spending that they piled up, but, there was no difference in morbidity and mortality when compared with a similar cohort who saw their providers on a much more limited basis. In other words, we made them sicker on paper, and we charged them more...but the end result was the same. We still diagnose. What they are referring to I think, is not diagnosing, but managing patients. This is true. There will be changes....We need to reduce practice variance and get providers to follow established guidelines (when available). This will be tied to reimbursement going forward. Evidence based practice is coming...one way or the other.

 

6) another MD said his daughter wanted to go to school for PA or MD and he told her "absolutely not, you're better off going into some other field"

 

I've heard a similar comment from many......unhappy is unhappy.

 

7) one PA said that their office was not making enough money and that the doctor would probably be leaving because after paying all of the expenses, liability, school loan debt and living expenses, they were only making about $50,000 a year. I was in TOTAL SHOCK with that one.

 

Sounds like they weren't managing that office well if the doc was that unhappy, but if the doc was making 50,000 a year after paying for all living expenses, that's pretty dam good.

 

Answered questions above....

[rookiejay]

I could not find work for over a year. Due to a legal issue I had with some renters of my home, I couldn't leave. I had to stay in my hometown. No work there, but if I could have relocated or taken a locum, I would have had a job in hours.

[Guest]

Am I the only one who doesn't have those concerns because I can't imagine myself working in any other field but medicine because it is just so interesting to me?

[lang]

Am I the only one who doesn't have those concerns because I can't imagine myself working in any other field but medicine because it is just so interesting to me?

No! I feel this way. I definitely heard these things too before applying to PA school but I just thought to myself, this is the only field I've ever been happy in so, like ALL things in life, I will have to take the bad with the good. But I'm also one of those ppl that say, wow! you're gonna pay me THAT much to do my dream job!

[GREEN]

You could voice those concerns about any career but none of it matters because it comes down to each individual. If I can do something that I enjoy for a living and make the amount of money that I want, that's all that matters.

[Just Steve]

Am I the only one who doesn't have those concerns because I can't imagine myself working in any other field but medicine because it is just so interesting to me?

 

a few years ago I toyed with the idea of leaving medicine...environmental engineering maybe (working on renewable resources, not being a janitor) or perhaps education...I flitted around with a dozen ideas... all of them left me feeling empty. Medicine is where it is at for me...

[TWR]

Interesting in reading the comments to Charmstarz post the perception is quite different from the students view and the seasoned practicing PAs. One point did strike a personal nerve in the listing of reasons and that was #5 where after practicing for 26 years I was expected to follow orders (he called it protocol) rather than instinct and evidence based medicine. We did part and not amicably.

[Iain1028]

With Obama (2600 nightmarish pages of rules, regulations, and taxes) Care about to into full effect next year, PA and NPs are going to be Golden.

 

Just saying.....

[EMEDPA]

With Obama (2600 nightmarish pages of rules, regulations, and taxes) Care about to into full effect next year, PA and NPs are going to be Golden.

 

Just saying.....

you must mean the affordable care act.....what passed and was approved by congress is NOTHING like he original proposal....

[rpackelly]

If you are good at what you do, you will be able to find a job. When I started out (late 1970s) PA jobs were few, far between, very variable as to scope of practice, and paid very little. There were absolutely no guarantees the profession would survive. I found a job and practiced, and loved almost all of it despite pretty subpar wages for awhile there (which I am noticing now that it is time to think about how to retire eventually). Eventually I wanted to do something different and left family medicine to do HIV medicine and then oncology. I then pretty much moved on to health professions (PA and other) education because, after being a dependent practitioner for a long time, I wanted a bit more control of my destiny and not to be totally at the whim of bosses I hadn’t necessarily chosen, in larger organizations. Because I did keep up my credentials and some clinical experience, I could always go back to practice if I wanted, although I would likely choose a pretty low key environment (after many years in higher acuity settings, “boring” is not necessarily bad or even really boring!)

 

The beauty of the career was that I could do all of this.....practice, teach, do clinical management, academic administration, research, etc. There will always be down markets and “downsides” in certain areas of medicine and pretty much in anything else. Look at what happens with lawyers, nurses, teachers and pilots.......feast or famine. The key is doing what you love or at least like alot. It’s good to have time at lunch to watch you-tube videos; in most PA jobs you are lucky to eat, but it is very instructive that you like to watch videos of surgery. Never choose an occupation solely for the money. If debt is a problem, consider rural and underserved area loan payback, the military, the Public Health Commissioned Corps, etc. Live simply and worry about the quality of your work time and life rather than the “financial package”.

[EMEDPA]

 

This is great advice. Live within your means. Don't go buy a bmw the day you graduate from PA school.

[rev ronin]

This is great advice. Live within your means. Don't go buy a bmw the day you graduate from PA school.

 

Live BELOW your means. That's how I went through PA school with a family of five, got out with under $20k of debt, and didn't get a dime of public assistance other than subsidized loans.

 

Always have a budget surplus. Always pay off your credit cards every month. Never pay an ATM fee. Always pay off every debt you can, and don't rack up any new ones. Always have a side job or two, but never figure that income into your budget.

[EMEDPA]

Live BELOW your means. That's how I went through PA school with a family of five, got out with under $20k of debt, and didn't get a dime of public assistance other than subsidized loans.

 

Always have a budget surplus. Always pay off your credit cards every month. Never pay an ATM fee. Always pay off every debt you can, and don't rack up any new ones. Always have a side job or two, but never figure that income into your budget.

amen brother. I get quarterly bonuses but never count on them. I always assume them to be zero and when they arrive I use them for a little vacation or a night on the town, never to cover core expenses.

[crank]

Hello Guys,

Not only for PA's for each and every job position, salaries are decreasing. In this competitive job market getting jobs is difficult. 90% of the people are thinking in a such a way, getting into job market is important, they are considering the issues about the decrease in salaries.

[bobsquit3]

Hello Guys,

Not only for PA's for each and every job position, salaries are decreasing. In this competitive job market getting jobs is difficult. 90% of the people are thinking in a such a way, getting into job market is important, they are considering the issues about the decrease in salaries.

 

 

Care to cite your source?

[jwells78]

Being a PA is a pretty good gig. It can be what you make of it; good lateral mobility, interesting cases, gratifying at times, yada yada. Yeah there are groans of discontent in every career field, but keep this in mind: I'll bet you could find a zoologist who checks elephant prostates all day who LOVES and ADORES his job. Find something you dig, be good at it, be happy.