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By rural you mean working in a clinic style setting or a hospital in a small city as opposed to something like Kaiser in LA? Do you find it easy to switch locations and departments as a PA (FP to ER or whatever)?

From what I've gathered, MDs are specialized more or less in a specific department, and they must re-specialize to switch departments. It is similar for PAs?

 

Tim

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By rural you mean working in a clinic style setting or a hospital in a small city as opposed to something like Kaiser in LA? Do you find it easy to switch locations and departments as a PA (FP to ER or whatever)?

From what I've gathered, MDs are specialized more or less in a specific department, and they must re-specialize to switch departments. It is similar for PAs?

Tim

by rural I mean a health provider shortage area without a lot of md specialists. generally at least 2-3 hrs from a major metro area.

I always work in em or urgent care although I think I could do fp, trauma, or hospitalist without too much difficulty.

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I should have gone to medschool. I am making the most of it now by seeking out high autonomy positions(solo coverage, etc) but the restrictions associated with being a pa for me are not ideal given the job I would like to be doing...it's not about money. it's about respect, autonomy, and scope of practice.

 

So, from your experience, do you think that the scope for PAs will at all expand in the future with the field growing at a relatively rapid rate? Also, what is restricting about being an ED PA? Maybe a better way to phrase it is what can't you do that a physician can do in the ER?

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So, from your experience, do you think that the scope for PAs will at all expand in the future with the field growing at a relatively rapid rate? Also, what is restricting about being an ED PA? Maybe a better way to phrase it is what can't you do that a physician can do in the ER?

many places have arbitrary restrictions that PAs can not do specific procedures or see specific types of patients. here is an annoying thing...we just went to a new emr that does not allow pas to put an impression in for an xray because we are not physicians and "PAs don't interpret tests"....major pain to get me added as an authorized reader of xrays and ekgs. The work around is I have to sign in as a doc.

over time I have sought out the very few positions within 200 miles of my home which do not have these restrictions. it requires hours of driving to do so. would be nice to have a good scope of practice at the hospital down the street from my home...

I think this will get better but it will first require mandatory residencies and board certifications. maybe 20 yrs from now we should be in better shape....

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Rev and EMEDPA,

Very interesting. I seem to have been misled somewhat. So are you two happy with your choice to become PAs? Keep in mind that pay has little to do with it for me. As long as my income is enough to support a family, I'll be happy.

 

I definitely am. Practicing medicine is cool and humbling, and right now, I'm ahead in terms of money, practice, and prestige vs. where I would be going to med school... but that won't last forever. I could be finishing my third year med student, instead of my first as a PA. In five years, I will still be a PA, and my hypothetical self who went to med school again would be a board certified family medicine physician. Given my age, I would probably never make the additional tuition and lost money back, even at tens of thousands of dollars difference in salary.

 

But I didn't even run those scenarios. I have a wife and kids, and was not willing to put them through five extra years of training. I value them more than any career choice. If I didn't have them, then yeah, I would have gone to med school.

 

What was a disconnect from when I first started researching the PA profession is that I thought "assistant" meant "Assistant". I love assisting in surgery, and I have a great deal of experience presenting options for management decisions. But that's not what I do. I do my own procedures with an MA assisting me, and never really get to assist. I occasionally get to consult with other providers, but I am expected to handle a full patient load all on my own. I consult specialists on my own, without going through physicians. It really is an *associate* position, where I'm expected to do everything every other provider does... for under half the pay.

 

It's still enough to feed my family, pay my (small) student loans, and live well. It's probably as fair as anything else is, financially, but I don't get to miraculously practice medicine without the dedication and responsibility expected of the other providers. Not that I'm a slacker or anything, just that it's way more autonomy, way earlier than I expected... and that's in a practice with dozens of docs in my same building. I worked 7:30-6:45 today, with about 25 minutes in that entire time for breaks and lunch. You want a cushy job in medicine? I haven't found one yet.

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It is an interesting question: do you like your job or do you wish that you had done something else with your life? There are some forum members who wish they had become physicians and feel like they work as much or more than and MD and make less money for it. And I respect that. There are thousands of PAs and they work in thousands of places with thousands of docs. It is not surprising that they have had different experiences.

 

I work for one doc in a solo practice in one city in one state with its own particular (and sometimes peculiar) PA practice rules. My SP works 7 days a week. Monday through Friday, he works from 7 AM until about midnight, except for the hour or so he goes home to have dinner with his family. On the weekend, he still rounds at hospitals. He seems to love his job, though he wishes he had more time off.

 

After 7 years in practice, I now work four 12 hour days and have weekends off. Most days, I am wherever my SP is not. I see patients in the hospital and in clinic. I like what I do. I didn’t know my job all that well when I started and it has been a growth experience. I feel that most practitioners treat me with respect and I do the same for them. I try not to be pretentious and invite everyone to call me by my first name (which is also easier to pronounce). I have made wonderful friends who are physicians, patients, nurses, MA’s, administrative types, PCAs, and janitors. Being in the hospital is like working on an aircraft carrier.

 

I started this career after decades of other jobs so becoming a physician just wasn’t a practical option. The PA route has been fine with me. Are there things I’d change? Sure! Would I have become a physician if I had started in medicine when I was younger? I don’t know. Remembering the joys of my family’s life over the years and seeing the strain being a physician places on their family lives, probably not. I would have done something else, which is pretty much what I did.

 

To those who are considering this profession, I would encourage you to shadow and not just one PA. You will get a chance to see some different settings, supervisors, and PA personalities. You need to do that not just to check a box for an application committee, but to see if this is how you want to be spending a substantial part of your life.

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