PAs and Doctors are very different: Doctors give orders; PAs carry them out.

[MikePlayingDoc]

Someome on a previous thread I started about money and being a doc posted this sentence to me: "PAs and Doctors are very different: Doctors give orders; PAs carry them out. "

This is simply not true. PAs do the EXACT same job as primary care docs in many settings. They have NO direct supervison and in some cases know more about medicine than docs. I know this because I volunteered on a service that had no residents. They used PAs to cover the extra work. The PAs who worked there for years were often consulted by the younger docs because you dont learn **** is school. You learn more about being a doc in the first two years AFTER residency than you ever will during school or residency.

Believe me school is nothing but reading a bunch of ****. You wont use most of it ever again after you take boards.

So if you want to be a primary care doc just go to PA school.

[primadonna22274]

Well, Mike, you got some of it right, and thanks for correcting that hideous statement...I certainly haven't "carried out" an order from my supervising physician in, like, ever.
There are still excellent reasons to be a doc--to be at the helm of the ship comes to mind. If you don't mind playing second fiddle to the doc, be a PA. If you don't mind always having to explain yourself year after year after year to patients and friends and new dates what you do and how you function and no, thanks, I'm NOT the person who takes your blood pressure (although I do that often enough), be a PA.
What I and most other PAs want you all to realize is that while we function quite autonomously in most settings, we don't practice independently. Our scope of practice is determined by what our supervising physician is willing to give and what the BME will approve. We are NOT trying to take over the world but there are certainly places you will find PAs where there are no docs, because no docs want to go there.
I posted some PA literature citations on another thread... something about "I'm going 200k in debt for this??" Funny, the whiner who posted the thread hasn't responded to me. Maybe I calmed him down.
Lisa PA-C

Originally Posted by MikePlayingDoc

Someome on a previous thread I started about money and being a doc posted this sentence to me: "PAs and Doctors are very different: Doctors give orders; PAs carry them out. "

This is simply not true. PAs do the EXACT same job as primary care docs in many settings. They have NO direct supervison and in some cases know more about medicine than docs. I know this because I volunteered on a service that had no residents. They used PAs to cover the extra work. The PAs who worked there for years were often consulted by the younger docs because you dont learn **** is school. You learn more about being a doc in the first two years AFTER residency than you ever will during school or residency.

Believe me school is nothing but reading a bunch of ****. You wont use most of it ever again after you take boards.

So if you want to be a primary care doc just go to PA school.

[emedpa]

MIKE-although I understand your frustration(been there myself) I find your post a little over the top, especially this"So if you want to be a primary care doc just go to PA school." I am well aware that pa's can/do/have worked as pcp's for over 30 yrs and are very capable in this role, however it's hard to match the breadth of an md/do level education. I agree that most of medicine is learned on the job( and I precept fp residents myself) but it is comments like these that get the future md's of the world hating us from day 1 before they even meet a pa.at the same time comments like those that started your post( "md's write orders, pa's carry them out" ) are also misguided and uninformed. as a new grad I presented lots of patients to the docs I worked with to get second opinions(not orders), now more often than not I am the second opinion for the new docs.....anyway, I guess the bottom line here is don't kick the sleeping tiger in the butt. as pa's we need to learn to peacefully coexist with other clinicians(md/do/np) who perform similar roles.

[ChungMooDoc]

Forgive my ignorance, but what is a PA? what does PA stand for?

[primadonna22274]

WHOA. Anyone else wanna field this one? I'm taking a day off.
L.

Originally Posted by ChungMooDoc

Forgive my ignorance, but what is a PA? what does PA stand for?

[gujuDoc]

Originally Posted by ChungMooDoc

Forgive my ignorance, but what is a PA? what does PA stand for?

Yes you are correct, it means physician assistant.

Primadonna

I agree with your post full heartedly. That said, I would still rather go the full way and be the doc rather then a pa. Of course, I also don't want to go into family practice either.

[AcousticDoc]

Don't you need to be in an EMS service for like 1500hours before you can appl to PA school?

[gujuDoc]

Originally Posted by AcousticDoc

Don't you need to be in an EMS service for like 1500hours before you can appl to PA school?

The requirement is different at different schools. They just require one year exposure in the medical field and this can come from a lot of different ways other then EMS. I actually know someone that was able to get in just by volunteering/shadowing for a year, rather then having to work at any actual medical job.

[DrBuro]

Originally Posted by AcousticDoc

Don't you need to be in an EMS service for like 1500hours before you can appl to PA school?

Most of the PA schools around NY/NJ do not require anything really except the GRE.

[Flopotomist]

I had to pipe in here. The PAs that I work with are AMAZING. In fact, once a week when the providers have conference, the PAs run the entire ED (quite well I might add.)

In the ED I work in, the PAs see the same acuity patients as the residents, and are arguably often better than many residents (20 years of experience in the department gives them a huge advantage).

I was pretty upset when Kaiser recently made me change from having a NP (same scope as a PA) as my primary provider to an MD. I felt that the NP was able to spend more time with me, and had a better ability to HEAR what I was saying. Medical school doesn't teach the listening skills or personality skills that are so important to me.

[primadonna22274]

Thank you Flopotomist. It's nice to get positive feedback about what we do.
I think it really does come down to experience. My own PA (and the person largely responsible for exposing me to the PA career as a viable option to medical school) told me that her first five years in practice were virtually her residency. Now that I've been "in the field" for five years, I can absolutely attest to this. I know there are nitty-gritty details of medicine I don't know because I haven't yet learned them, but I'm pretty darn comfortable with most of general medicine. There's plenty of stuff I haven't done yet--inpatient medicine comes to mind, something I'm vaguely interested in-- but I believe most physicians, nurses, patients, etc., recognize we're good at what we do.
FYI: I have plenty of patients who are required by their insurance plan to name an MD as PCP, but they're free to see me for anything and everything. It works out fine. Couldn't you still choose to see the NP you like at Kaiser? i.e. just schedule with him/her instead of the MD? Any NP or PA worth his/her salt will freely tell you if s/he thinks you're over his/her head.
On another note: a lot of research has been done to figure out WHY PAs & NPs are perceived as having better "people skills" than MD/DOs. Most of the studies have suggested it has more to do with how we're selected for training (more clinical hours required up front, at least for most programs--don't even get me started on the ones that don't require experience--more life experience, e.g. PAs & NPs are generally older than MD/DOs because it's usually a second or third career; etc.) Certainly not ALL will listen well because we don't all have the same skill set. There are plenty of docs who listen well, especially if they can afford to take the time. My internist literally spent twenty minutes TALKING to me about a sinus infection...but I think part of that is just his personality and the fact that I work with him and maybe he wanted me to feel valued??? Dunno. I think he probably spends a lot of time with ALL of his patients, the vast majority of whom are chronically ill whereas I'm chronically healthy. He joked my chart was too thin to be one of his patients
OK, now I'm rambling. Time to get back to the garden. Thank goodness for a sunny day off!!
L.

Originally Posted by Flopotomist

I had to pipe in here. The PAs that I work with are AMAZING. In fact, once a week when the providers have conference, the PAs run the entire ED (quite well I might add.)

In the ED I work in, the PAs see the same acuity patients as the residents, and are arguably often better than many residents (20 years of experience in the department gives them a huge advantage).

I was pretty upset when Kaiser recently made me change from having a NP (same scope as a PA) as my primary provider to an MD. I felt that the NP was able to spend more time with me, and had a better ability to HEAR what I was saying. Medical school doesn't teach the listening skills or personality skills that are so important to me.

[emedpa]

Originally Posted by DrBuro

Most of the PA schools around NY/NJ do not require anything really except the GRE.

that's why they suck.....

[DrBuro]

Originally Posted by emedpa

that's why they suck.....

They might suck, but many of them work great hours for higher pay than beginning primary docs.

[gujuDoc]

Originally Posted by emedpa

that's why they suck.....

How can you say which one's suck and don't suck when you don't live in that area???? I understand that you are a PA instuctor and all, but come on give some credit.

I have a few friends who started to do the EMT training but were told they wouldn't need to do it, so didn't end up finishing it prior to getting their admission to PA school. Yet, I think when they do start learning the clinical training, they'll get the hands on experience in and get the hang of it.

[Ambs]

Hi everyone,

I've worked in the medical field the past few years, and most recently, I worked in a cardiology practice where I worked with a PA. He is actually a cardiology specialist. I know that all PAs are board certified in primary care, but if they so choose, they can land a job in a specialty and get on-the-job training. In fact, I had been seeing my dermatologist for years until I switched over to a PA specializing in derm, as she was able to spend more time with me and really hear me out as opposed to the very, very busy doctor.

From my experience with working with a PA, I have a new found respect for the profession. Some patients actually prefer them because they don't have to wait in the lobby for hours to see the PA, and the PA is able to spend more time with them when they've been roomed. I have observed that PAs do act independently, but they recognize their limitations in certain situations and do consult the physicians. Furthermore, many of their interpretations have to be "overread" by a physician. I feel that sometimes PAs are more careful, decisive, and comprehensive with the care they provide and testing they order because they are being "supervised" or "overread" by the doctors they work for.

It is unfortunate that initially many patients think that PAs are glorified MAs with a few months of training. But after seeing the PA (at least the one I worked with), they are reassured that they are in good hands. Having to constantly explain what you do and what your title means must get frustrating.

[63768]

PAs learn what the doctor learns, except on a topical level. the doctor knows 10x as much as a PA. true medical school is crap because all you learn is how to talk to patients, but when you go into residency, you learn way more than PA ever will. PAs will forever work under a doctor. they don't work "independently" or anything; you're being fooled. they have to consult with the doctor on many things.

honestly, i see PA as those people who couldn't make it into medical school. when i met my first PA, i thought he was a nurse. and that's pretty much what you are. if you enjoy being a nurse, then go for it.

and along the same lines of "PAs make more and work less than primary docs," a doctor has more prestige in our society than a PA. if you want money, go for it. i'll laugh at you as people ask you what a PA is and what he does, and watch you explain yourself. i'm not angry at PAs or anything. i acknowledge that some people have a different calling and that some are happy with interacting with patients without the pressure of being a doctor. i just don't like how this thread glorifies a profession that is equivalent to a med school reject/half-assed doctor.

and to address the comment from the OP about how those who want to be primary care docs should just be PAs, patients don't trust someone without an MD. i've seen patients ask who the PA is and where the doctor is. they want a doctor because a doctor is more qualified.

[gujuDoc]

Dermatology hmmmmmmm...........

Yes, the funny thing is that every dermatologist that I've either met or heard of always seemed like they used their patients to see the patients more then they themselves did. At least, thus far.......this has been my impression.

[bbas]

Originally Posted by yourmom25

PAs learn what the doctor learns, except on a topical level. the doctor knows 10x as much as a PA. true medical school is crap because all you learn is how to talk to patients, but when you go into residency, you learn way more than PA ever will. PAs will forever work under a doctor. they don't work "independently" or anything; you're being fooled. they have to consult with the doctor on many things.

honestly, i see PA as those people who couldn't make it into medical school. when i met my first PA, i thought he was a nurse. and that's pretty much what you are. if you enjoy being a nurse, then go for it.

and along the same lines of "PAs make more and work less than primary docs," a doctor has more prestige in our society than a PA. if you want money, go for it. i'll laugh at you as people ask you what a PA is and what he does, and watch you explain yourself. i'm not angry at PAs or anything. i acknowledge that some people have a different calling and that some are happy with interacting with patients without the pressure of being a doctor. i just don't like how this thread glorifies a profession that is equivalent to a med school reject/half-assed doctor.

and to address the comment from the OP about how those who want to be primary care docs should just be PAs, patients don't trust someone without an MD. i've seen patients ask who the PA is and where the doctor is. they want a doctor because a doctor is more qualified.

PA's are not people "who couldn't make it into medical school," and they are not equivalent to being a nurse. Many people choose to be a PA because they don't want to go through the years of training that being a physician requires, nor do they want the responsibility of a doctor. Sure, there may be some PA's who settled for going to PA school after being rejected from med school, but I'd bet that these people are in the minority. Many of the PA's that I have talked to had the credentials for med school, but CHOSE to go to PA school.

[gujuDoc]

Originally Posted by bbas

PA's are not people "who couldn't make it into medical school," and they are not equivalent to being a nurse. Many people choose to be a PA because they don't want to go through the years of training that being a physician requires, nor do they want the responsibility of a doctor. Sure, there may be some PA's who settled for going to PA school after being rejected from med school, but I'd bet that these people are in the minority. Many of the PA's that I have talked to had the credentials for med school, but CHOSE to go to PA school.

Agreed. Most of the pre PA students I've met chose to go into PA school rather then med school, because they didn't want the hell of 4 years of med school and another 4-9 years of residency and fellowships.

They didn't really care about the 100k+ salaries. They wanted a job that would allow them to live comfortably without the worries of having to deal with all the issues with HMOs and what not or constantly being on call. They wanted to be in healthcare without having to have the greater extent of responsibility that doctors have to deal with. They chose the job they are in out of their own preference. So don't assume that people become PAs because they couldn't get into med school. Last but not least, getting into PA school is not easy as it is. It is actually easier to get into pharmacy school, in my opinion, then it is to get into PA school.

[primadonna22274]

I'm so grateful that you guys fielded this one. That's one of the nasty facts of being a PA--people assuming we "couldn't hack it" in medical school. Most of us made conscious decisions to be PAs INSTEAD of physicians. Some of us are still unsettled about it, but the majority have made peace with their choice. And for the record, I've NEVER had trouble getting patients to see me...sure, a few are initially apprehensive..."what's a PA? are you sure she knows what she's doing?"...but by the time they leave my office they're satisfied they've received competent care from a conscientious professional. I'm not shy about saying "gee, I'm not sure what the problem is, but let's talk to one of the other doctors and see what they think". I go get the other doc (this is very infrequent anymore...maybe once a week or less), we discuss it, they go in and visit the patient with me, and more often than not they're stumped too. Patients are generally accepting if they know you can admit your limits. Sure, once in a while I meet a total a** but it doesn't happen often, and chances are they would've been an a** to the doc too.
If patients were so hell-bent on seeing a "doctor" my schedule wouldn't be jam-packed 22-26 patients a day (including 4-5 physicals, usually repeat visitors) and I wouldn't be making my clinic $30k++ a month.
Lisa PA-C

Originally Posted by gujuDoc

Agreed. Most of the pre PA students I've met chose to go into PA school rather then med school, because they didn't want the hell of 4 years of med school and another 4-9 years of residency and fellowships.

They didn't really care about the 100k+ salaries. They wanted a job that would allow them to live comfortably without the worries of having to deal with all the issues with HMOs and what not or constantly being on call. They wanted to be in healthcare without having to have the greater extent of responsibility that doctors have to deal with. They chose the job they are in out of their own preference. So don't assume that people become PAs because they couldn't get into med school. Last but not least, getting into PA school is not easy as it is. It is actually easier to get into pharmacy school, in my opinion, then it is to get into PA school.

[gujuDoc]

Originally Posted by Peterock

I hope you realize that many MD's choose to maintain that lifestyle. When a field is full of overdriven, prestige-hungry, type A personalities, I don't see this group happy to work 25 hours / week and ONLY make 75k/yr. Just remember this is a masochistic group, hard working group and that it isn't just that the profession demands this behavior, many expect nothing less from themselves.

I DO REALIZE THAT. I'm just pointing out that as MD's choose the busier life, PAs choose the not so busy life. It really depends on the lifestyle preference.

But my point wasn't to say that MDs don't choose that type a sort of lifestyle, but to point out that PAs are not people who couldn't hack med school.

[63768]

^^^ i wholeheartedly agree with you. i have four PA friends and 2 others dropping med school for PA school. they all tell me that they can't cut it in med school/couldnt muster a good score on the MCAT/don't have the drive.

PAs and doctors are different people and i'm sorry if i offended anyone. being a future doc, i just cant hold PAs in the same esteem as a doctor. in fact, doing so would insult every doctor out there.

[J1515]

I've got 3 PAs in the family and another who is a childhood friend. ALL of them didn't want to go into a quarter million $ of debt, spend an additional 7-10 years going to school after college, and didn't want to bother with the MCAT. That doesn't mean some PA's aren't med school dropouts, but think before you make a blanket statement. For every PA you know that is dropping out of med school, there is one I know who had a 3.8 GPA and chose PA school. You cocky and arrogant idiots who think your blanket statements of "anyone who isn't an MD (should I add "or DO?") is inferior to me in all aspects of life" are going to be in for a rude awakening when you have NPs, PAs, FMGs and DOs working right along side of you, doing the same procedures you're doing, and in some cases making just as much if not more money than you are. But hey, you want to be a doctor because **you like to help people** Ah, gotta love the typical pre-med kiddies.

[bbas]

Originally Posted by J1515

I've got 3 PAs in the family and another who is a childhood friend. ALL of them didn't want to go into a quarter million $ of debt, spend an additional 7-10 years going to school after college, and didn't want to bother with the MCAT. That doesn't mean some PA's aren't med school dropouts, but think before you make a blanket statement. For every PA you know that is dropping out of med school, there is one I know who had a 3.8 GPA and chose PA school. You cocky and arrogant idiots who think your blanket statements of "anyone who isn't an MD (should I add "or DO?") is inferior to me in all aspects of life" are going to be in for a rude awakening when you have NPs, PAs, FMGs and DOs working right along side of you, doing the same procedures you're doing, and in some cases making just as much if not more money than you are. But hey, you want to be a doctor because **you like to help people** Ah, gotta love the typical pre-med kiddies.

Here we go again. It's attitudes like that which spark the entire doctor vs. PA argument. PA's do not do the same procedures as doctors, and they certainly do not earn more than doctors. The purpose of a PA is not to do the same things as a physician, it is to ASSIST them. In ER's, for instance, the physician assistants will often staff the non-emergent section of the ER. Why? So that the physicians can focus their attention on the complex medical problems. You said that some people go to PA school so that they don't have to go to school for an additional 7-10 years, so why do you think that PA's should do the same things/earn the same as people who do choose to receive this extra training?

[primadonna22274]

You're a little naive to assume that we don't do the same "procedures" as doctors. In fact, there are only a handful of procedures which the docs do but I don't do--vasectomy, neonatal circumcision, office flexible sigmoidoscopy, and colposcopy--and except for colpo I've been trained in and performed all of them with supervision but don't choose to do them so I don't have privileges for them.
I do 4 or 5 physicals a day--easily twice as many as any of the doctors. I do routine office visits, med checks, chronic illness management. This is physician "assisting" in that it enables the physicians to see other patients, many of whom are patients just like mine. Sure, I occasionally get the inappropriately scheduled definitely-needs-an-MD patient, and I do what I can for that person and get them in to see one of the MDs ASAP. But far more of what I do amounts to physician substitution than physician assisting.
I'm a very typical primary care PA, by the way. My job is not at all unique. Roughly 45% of the practicing PAs in the US have jobs just like mine (AAPA census data supports this).
I agree that ERs typically utilize PAs in the fast-track section, and that's absolutely appropriate. I do an awful lot of urgent care in my job too, which keeps my job interesting.
And while I don't expect the same pay as my physician colleagues, it is frustrating to do the math and realize I'm working as hard as most of them, bringing in more revenue than some of them, and being paid half of what the lowest-paid physician is. But I suppose that's the bargain: half as much school, half as much pay, half as much respect...???
If we can believe salary surveys, you will occasionally see the PA who makes $600k/year. I have no idea who that PA is or what that person is doing but that's definitely more than most MDs out there. All things are possible.
L.

Originally Posted by bbas

Here we go again. It's attitudes like that which spark the entire doctor vs. PA argument. PA's do not do the same procedures as doctors, and they certainly do not earn more than doctors. The purpose of a PA is not to do the same things as a physician, it is to ASSIST them. In ER's, for instance, the physician assistants will often staff the non-emergent section of the ER. Why? So that the physicians can focus their attention on the complex medical problems. You said that some people go to PA school so that they don't have to go to school for an additional 7-10 years, so why do you think that PA's should do the same things/earn the same as people who do choose to receive this extra training?

[Ambs]

I agree with this based on my observations. The PAs I have met and worked with specifically chose to go to PA school as opposed to medical school. They didn't want to go through the extensive training of an MD program and residency. Plus, they didn't want the financial strain of med school. I've also met some "PA-doctors," who are still insecure about their choice of becoming a PA and become forgetful of their limitations and scope of practice. But that's besides the point. I found that indeed some patients initially are not comfortable with seeing a PA. But once the PA is given the chance to talk to the patient, I swear, it's magic. The patients are immediately at peace and reassured that they will be treated very well. And when the PA is unsure, they do (and should) get the opinion of the doctor. The PA presents the case to the doctor, and then the two go in and see the patient together. The majority of the time the doctor agrees with the PA's plan based on my observations, and then when the diagnostic testing has been performed, the doctor overreads/verifies the PA's interpretations.

The whole point, though, is that we as future (and current) health care professionals need to finally realize that medicine is increasingly becoming an interdisciplinary field. We are colleagues, and I believe that through efficient collaboration and communication, an interdisciplinary mode to patient care is not only more comprehensive and beneficial to the patient but also lucrative. PAs can be a tremendously valuable resource to physicians and their medical practice, and I'll leave it at that.

Originally Posted by primadonna22274

I'm so grateful that you guys fielded this one. That's one of the nasty facts of being a PA--people assuming we "couldn't hack it" in medical school. Most of us made conscious decisions to be PAs INSTEAD of physicians. Some of us are still unsettled about it, but the majority have made peace with their choice. And for the record, I've NEVER had trouble getting patients to see me...sure, a few are initially apprehensive..."what's a PA? are you sure she knows what she's doing?"...but by the time they leave my office they're satisfied they've received competent care from a conscientious professional. I'm not shy about saying "gee, I'm not sure what the problem is, but let's talk to one of the other doctors and see what they think". I go get the other doc (this is very infrequent anymore...maybe once a week or less), we discuss it, they go in and visit the patient with me, and more often than not they're stumped too. Patients are generally accepting if they know you can admit your limits. Sure, once in a while I meet a total a** but it doesn't happen often, and chances are they would've been an a** to the doc too.
If patients were so hell-bent on seeing a "doctor" my schedule wouldn't be jam-packed 22-26 patients a day (including 4-5 physicals, usually repeat visitors) and I wouldn't be making my clinic $30k++ a month.
Lisa PA-C

[primadonna22274]

Thank you Ambs.
You're a good egg
L.

[Ambs]

Originally Posted by primadonna22274

Thank you Ambs.
You're a good egg
L.

You're welcome!

[riceman04]

Originally Posted by primadonna22274

Well, Mike, you got some of it right, and thanks for correcting that hideous statement...I certainly haven't "carried out" an order from my supervising physician in, like, ever.
There are still excellent reasons to be a doc--to be at the helm of the ship comes to mind. If you don't mind playing second fiddle to the doc, be a PA. If you don't mind always having to explain yourself year after year after year to patients and friends and new dates what you do and how you function and no, thanks, I'm NOT the person who takes your blood pressure (although I do that often enough), be a PA.
What I and most other PAs want you all to realize is that while we function quite autonomously in most settings, we don't practice independently. Our scope of practice is determined by what our supervising physician is willing to give and what the BME will approve. We are NOT trying to take over the world but there are certainly places you will find PAs where there are no docs, because no docs want to go there.
I posted some PA literature citations on another thread... something about "I'm going 200k in debt for this??" Funny, the whiner who posted the thread hasn't responded to me. Maybe I calmed him down.
Lisa PA-C

Yeah, Kaiser Permanente is full of PA's.
When I had a slither of my nail removed the first time, a PA from Baylor CoM did the procedure. Although he was lifeless (zombie like), he did a good job. A doc did the same procedure on my other big toe and screwed the ish up. Now I have to go back in and get it fixed. Damn it hurts!

My lesson learned: Use a nail clipper to clip your nails. PA's are just as knowledgeable (i think is mispelled but oh well) about certain procedures as docs are.

[emedpa]

Originally Posted by DrBuro

They might suck, but many of them work great hours for higher pay than beginning primary docs.

I meant those particular programs, not pa's in general. if you will notice my screen name, I am an em pa. I just have no respect for programs that will accept folks without prior experience (which is a critical component of a good pa education.) and yes, I make more than many primary care docs, and not just" beginning docs"

[J1515]

Originally Posted by bbas

Here we go again. It's attitudes like that which spark the entire doctor vs. PA argument.

Wrong. It's arguments like yourmom25's who show a blatant disrespect for PA's that spark the entire argument.

[/QUOTE=bbas]PA's do not do the same procedures as doctors, and they certainly do not earn more than doctors. [/QUOTE]

Are you saying a PA in the ER can't suture a lac? Are you also saying there aren't family medicine physicians who earn less than a PA in say cardiothoracic? It's blanket statements that start heated debates - not me sticking up for a profession I'm not even going into.


[/QUOTE=bbas]The purpose of a PA is not to do the same things as a physician, it is to ASSIST them. In ER's, for instance, the physician assistants will often staff the non-emergent section of the ER. [/QUOTE]

It depends what your definition of "assisting" is. The first thing that comes to mind when you use that word is they hand the doctor a scalpel or take blood pressures. The PAs I've *seen* first-hand through my clinical experiences worked right along side the ER docs. Something as simple as a lac or possible broken bones, they handled themselves, no questions asked. And you're right in saying that this is what the majority of their work consisted of. But then again, that's what the majority of a physician's work consists of in an ER without PAs, in which case they are actually doing the same thing. Now if the ambulance brings in a 70 y/o man who is coding, obviously the physician will be chosen over the PA.


[/QUOTE=bbas]You said that some people go to PA school so that they don't have to go to school for an additional 7-10 years, so why do you think that PA's should do the same things/earn the same as people who do choose to receive this extra training?[/QUOTE]

In the end, they DO have a doctor "watching" over them and double checking for something that might be overlooked when necessary. I'm sure some PAs are better than others and are trusted differently by their overlooking physicians. Listen, I think nearly everyone would admit that the majority of what you learn and retain as a doctor will come from rotations and residency. I believe this example has been given already, but who do you think would know more in a clinical setting, a PA who has been on the job for 20 years, or someone just entering their residency, or even someone just fresh out of a residency? Again, I didn't make the blanket statement that said PA's should earn more than doctors and most don't. But what would "yourmom25" say during his ER rotation when a PA of 20 years tries to give him advice? "I'm not listening to you, you're not a real doctor, in fact you're not a doctor period."? The blatant disrespect some people have for other professionals and even other human beings is incredible.

[emedpa]

"How can you say which one's suck and don't suck when you don't live in that area???? I understand that you are a PA instuctor and all, but come on give some credit."

I went to a quality east coast program(ranked #2 at the time). lived there for 3 years before moving back to the west coast. trust me, programs that will accept a 22 yr old bio major with no medical experience aren't worth attending.yes, you will graduate and pass your boards but you will not be of the same caliber as someone who was a nurse, r.t., or paramedic for 10 yrs before pa school. I interview applicants for positions and know by a quick resume review who to call. prior experience, good school=interview. no prior experience, poor school=no interview.

to another poster who said:
"PA's do not do the same procedures as doctors, and they certainly do not earn more than doctors. The purpose of a PA is not to do the same things as a physician, it is to ASSIST them. In ER's, for instance, the physician assistants will often staff the non-emergent section of the ER. Why? So that the physicians can focus their attention on the complex medical problems. You said that some people go to PA school so that they don't have to go to school for an additional 7-10 years, so why do you think that PA's should do the same things/earn the same as people who do choose to receive this extra training?"

I will keep this in mind the next time I am intubating someone or putting in a central line working solo in a relatively busy small e.r.(saw 35 pts in 12 hrs last night including several traumas stabilized and sent to the regional trauma ctr and several acute medical and surgical pts with dka, appys, etc).also when I cash my paycheck (which last yr was 60k greater than the local fp docs) I will remember that I made a poor career move.

[svalentePA-C]

Originally Posted by yourmom25

PAs learn what the doctor learns, except on a topical level. the doctor knows 10x as much as a PA. true medical school is crap because all you learn is how to talk to patients, but when you go into residency, you learn way more than PA ever will. PAs will forever work under a doctor. they don't work "independently" or anything; you're being fooled. they have to consult with the doctor on many things.

honestly, i see PA as those people who couldn't make it into medical school. when i met my first PA, i thought he was a nurse. and that's pretty much what you are. if you enjoy being a nurse, then go for it.

and along the same lines of "PAs make more and work less than primary docs," a doctor has more prestige in our society than a PA. if you want money, go for it. i'll laugh at you as people ask you what a PA is and what he does, and watch you explain yourself. i'm not angry at PAs or anything. i acknowledge that some people have a different calling and that some are happy with interacting with patients without the pressure of being a doctor. i just don't like how this thread glorifies a profession that is equivalent to a med school reject/half-assed doctor.

and to address the comment from the OP about how those who want to be primary care docs should just be PAs, patients don't trust someone without an MD. i've seen patients ask who the PA is and where the doctor is. they want a doctor because a doctor is more qualified.

what are you an 18 year old retard???? I am in my 30's and chose PA school not because i couldnt get into med school, but because i wanted to be a PA. I live in NC, I RUN MY OWN clinic without a doc on site. I am smart enough to know when i dont know something but to be honest i rarely have to make that phone call. All of my patients know that i am a PA and want to come see me. Trust and confidence does not come with initials after a name, its the relationship you form with your patients.

Why shouldnt we be glorified....I hope you are never injured but if you are taken to a trauma center most likely you will have a PA working on you. If you goto surgery guess what, most likely a PA will be there and oh my god, he will probably do most of the proceedure while the doc goes and gets another pt ready.

get over your inferiority complex..

[CJMPre-Med]

Originally Posted by gujuDoc

I DO REALIZE THAT. I'm just pointing out that as MD's choose the busier life, PAs choose the not so busy life. It really depends on the lifestyle preference.

But my point wasn't to say that MDs don't choose that type a sort of lifestyle, but to point out that PAs are not people who couldn't hack med school.

Except that most doctors DON'T "choose" that lifestyle nowadays-- many, especially in primary care, need to work 50-60 hours/week just to keep their practices solvent. Figure in the call and the continuing education requirements (reading journals, conferences etc.), and you're talking about a lot of time. An internist who earns $150K and works 55 hours/week does not "bring that onto himself"; the fact is that if we lived in a normal society, a physician's service would be more valued, and they would be paid appropriately. I'm sure many/most physicians wouldn't mind working 40 hours/week and getting paid the same money, thereby keeping their heads above water. But the fact is that they aren't paid enough, in many cases, to justify cutting back on their hours.


Yes, you do have the gunners who live for the job, but more and more, the factors I mention above come into play.

[svalentePA-C]

Originally Posted by primadonna22274

You're a little naive to assume that we don't do the same "procedures" as doctors. In fact, there are only a handful of procedures which the docs do but I don't do--vasectomy, neonatal circumcision, office flexible sigmoidoscopy, and colposcopy--and except for colpo I've been trained in and performed all of them with supervision but don't choose to do them so I don't have privileges for them.
I do 4 or 5 physicals a day--easily twice as many as any of the doctors. I do routine office visits, med checks, chronic illness management. This is physician "assisting" in that it enables the physicians to see other patients, many of whom are patients just like mine. Sure, I occasionally get the inappropriately scheduled definitely-needs-an-MD patient, and I do what I can for that person and get them in to see one of the MDs ASAP. But far more of what I do amounts to physician substitution than physician assisting.
I'm a very typical primary care PA, by the way. My job is not at all unique. Roughly 45% of the practicing PAs in the US have jobs just like mine (AAPA census data supports this).
I agree that ERs typically utilize PAs in the fast-track section, and that's absolutely appropriate. I do an awful lot of urgent care in my job too, which keeps my job interesting.
And while I don't expect the same pay as my physician colleagues, it is frustrating to do the math and realize I'm working as hard as most of them, bringing in more revenue than some of them, and being paid half of what the lowest-paid physician is. But I suppose that's the bargain: half as much school, half as much pay, half as much respect...???
If we can believe salary surveys, you will occasionally see the PA who makes $600k/year. I have no idea who that PA is or what that person is doing but that's definitely more than most MDs out there. All things are possible.
L.

I agree with above. I used to workin in genreal surgery and was on the trauma team. I was first cal for traumas and would show up and run the trauma until I made the decision if the patient needed surgery or not. Once that desicion was made i called the doc and he came in. The ED Docs would step aside and let me run the trauma. I would put in chest tubes, perctrachs, venous cutdowns right along side of them. Most of the time i would just stand back with my hands in my pocket and let them go at it with their crew.

Hey what does a new grad FP doc make?
I ask this because I recently changed specialties, something an MD cannot do without redoing a residency, to FP/EM. I am a sole provider at an irgent care/ I work three twelves a week TUE, WED, Thur and am compensated pretty damn well, in the low six figures. No call, no weekends, no holidays. Aint bad for a MED school reject as you say huh?

[gujuDoc]

Originally Posted by CJMPre-Med

Except that most doctors DON'T "choose" that lifestyle nowadays-- many, especially in primary care, need to work 50-60 hours/week just to keep their practices solvent. Figure in the call and the continuing education requirements (reading journals, conferences etc.), and you're talking about a lot of time. An internist who earns $150K and works 55 hours/week does not "bring that onto himself"; the fact is that if we lived in a normal society, a physician's service would be more valued, and they would be paid appropriately. I'm sure many/most physicians wouldn't mind working 40 hours/week and getting paid the same money, thereby keeping their heads above water. But the fact is that they aren't paid enough, in many cases, to justify cutting back on their hours.


Yes, you do have the gunners who live for the job, but more and more, the factors I mention above come into play.

It was Peterrock that said the Physicians Choose their lifestyle!!!!!!

I was just pointing out that most PAs I've met are people that chose of their own integrity and decision to be a PA. Every Pre PA student I've ever met, chose to go into the field for lack of desire to do 4 years of med school, 4+ years of residency, and a ton of other reasons.

Since they were mostly females, they wanted a job that would allow them a decent salary but that would be a bit more stress free then a doctor's life. This way they would be done with school earlier so that they'd be able to start a family and what not, and they'd not have to deal with the severe issues with HMOs etc.

So people DO CHOOSE to go into something other then MD or DO school.

[primadonna22274]

Svalente: where do you practice? I'm curious because although I live and work in Oregon (a Portland suburb) with a relatively high cost of living, I'm sure I'm underpaid.
I've been in FP for 5 years--my entire career--and this is my second job. When I started right out of school, I was hired as a new grad making $37k a year for 3 days/week. I kid you not. At the time I needed a job and I was married so I took what I knew to be a wimpy salary. Several months later when my student loans came due, I negotiated to work F/T for $51k. Woohoo! When I switched jobs 2 1/2 years ago, I "negotiated" for $61.5--more than the other NPs in the clinic (one of whom, btw, ran the coumadin clinic--not a job in any way comparable to mine; and the other two ran the local college student health center and worked 9 months a year seeing typically 6-12 patients a day, 6 hours a day). I've slowly convinced them to come up to $75k which is a nice living but easily $15k less than many other PAs, even primary care PAs, out there. I also don't get a production bonus no matter how hard I work, regardless of the fact that I see nearly as many patients as all the docs do (more than some of them) and more than earn my keep.
I believe my clinic hires a new FP doc at $100k guaranteed starting base + production incentive in the first year. I know that's very low so I'm sure that's what's driving my relatively low salary. The difference is the new doc can easily DOUBLE her salary that first year by seeing about as many patients a day as I do, often of the same acuity, doing no hospital except for kids and seeing new babies in the hosp.
Why do I stay? I like where I live. I love my little house. I like the people I work with. But I'm ready for a change. The one blessing about being used to a relatively low salary is that I can actually "afford" to go into education (which I'm considering) because I'm not used to making six figures.
L.

[svalentePA-C]

I live and work in southeastern NC. The clinic i work at is strictly an urgent care, however we do have about 500 -1000 patients tht use us as a PCP. I am one of two full time providers. The other is a board cert. IM doc. we hire a pat time PA to cover the shifts we want off. We pay him well also about 50 an hour. I make 105000 with no production bonus, full benifits to include health dental and 401 k and quarterly profit sharing(production bonus) 6 weeks combined cme and vacation. I will make full partner (WELL NOT FULL BUT 65-35)with no buy in, at my 1 yr anniversary.I work as stated above tues wed and thurs, the doc (owner) works monday and friday.
I bill on average 4000 (35-40 patients in a 12 hour shift minus 1 hour lunch)a day that i work, now that is an adjusted billing, our system is set up to show daily billing for what is the usual and agreed upon ammt by the insurance companies. So with that said, i make my annual salary in about 3 months. then the rest is profit for the company.

I have to admit though that this is not a typical PA Job, the owner and doc of the clinic was the one that pushed me into PA school and mentored me all the way thru. I just wanted to try surgery for a while, and now i have settled in. I have been out of school for about 8 months.

[primadonna22274]

That's awesome. I work too much and I AM underpaid.
I work an extra day/week (on my day off) in urgent care making $45/hr (no benefits) so between my two jobs working 50+ hr/wk I still barely graze $90k.
Hmmmm.....
Lisa

QUOTE=svalentePA-C]I live and work in southeastern NC. The clinic i work at is strictly an urgent care, however we do have about 500 -1000 patients tht use us as a PCP. I am one of two full time providers. The other is a board cert. IM doc. we hire a pat time PA to cover the shifts we want off. We pay him well also about 50 an hour. I make 105000 with no production bonus, full benifits to include health dental and 401 k and quarterly profit sharing(production bonus) 6 weeks combined cme and vacation. I will make full partner (WELL NOT FULL BUT 65-35)with no buy in, at my 1 yr anniversary.I work as stated above tues wed and thurs, the doc (owner) works monday and friday.
I bill on average 4000 (35-40 patients in a 12 hour shift minus 1 hour lunch)a day that i work, now that is an adjusted billing, our system is set up to show daily billing for what is the usual and agreed upon ammt by the insurance companies. So with that said, i make my annual salary in about 3 months. then the rest is profit for the company.

I have to admit though that this is not a typical PA Job, the owner and doc of the clinic was the one that pushed me into PA school and mentored me all the way thru. I just wanted to try surgery for a while, and now i have settled in. I have been out of school for about 8 months.[/QUOTE]

[63768]

Originally Posted by svalentePA-C

get over your inferiority complex..

i believe that's a superiority complex if i think MDs are better than PAs.

i said that in my experience, PAs have been the ones who could not get into medical school or were afraid. i was not saying you were. because of my experience, i have formed an opinion that may be unfounded and/or wrong. i'd be interested to see statistics on what background PAs are. that is subject to change as it is after reading this thread.

i just don't see PAs performing surgery, doing cutting-edge research, or running the office. sorry if i offended anyone.

[gujuDoc]

Originally Posted by yourmom25

i just don't see PAs performing surgery, doing cutting-edge research, or running the office. sorry if i offended anyone.

That's just the point.......

Most PA students don't see PA's doing this sort of stuff. They just want something that will allow them to be in healthcare without the other more severe responsibilities that are held responsibility of doctors, but with the ability to go deeper then the nurse practicioners.

They are people who choose to go into the field for a slightly more lax lifestyle in terms of not having to deal with HMOs, etc. At least this is what I've observed. I don't think the PA students I know care about being treated like they are a doctor's replacement, nor do I think they care that they may be working under doctors. They just want something that will allow them to be in clinical diagnosis but yet be more comfortable due to lesser on call hours, years of schooling etc.

That's what I was trying to say.

[jon stewart]

so how do you become a PA? How long is does it take after undergrad? Do you need the MCAT the high GPA and all the other stuff you need if you want to become a doctor? Is it very competitve?

Based on what iv read to the responses to this post, am i right to assume that PA's cant perform surgerys?

[waterlily]

I know a PA who are tutoring some med school students at a top 10 school and was asked by the school to. Also, other med students from there have asked her to teach and review patient cases with them and would pay her for it (although she didn't accept b/c she found it offending that they think they could just pay for her services). My point, don't overgeneralize that PAs just can't hack it as doc's or aren't 'smart' enough.

[emedpa]

Originally Posted by primadonna22274

That's awesome. I work too much and I AM underpaid.
I work an extra day/week (on my day off) in urgent care making $45/hr (no benefits) so between my two jobs working 50+ hr/wk I still barely graze $90k.
Hmmmm.....
Lisa

QUOTE=svalentePA-C]I live and work in southeastern NC. The clinic i work at is strictly an urgent care, however we do have about 500 -1000 patients tht use us as a PCP. I am one of two full time providers. The other is a board cert. IM doc. we hire a pat time PA to cover the shifts we want off. We pay him well also about 50 an hour. I make 105000 with no production bonus, full benifits to include health dental and 401 k and quarterly profit sharing(production bonus) 6 weeks combined cme and vacation. I will make full partner (WELL NOT FULL BUT 65-35)with no buy in, at my 1 yr anniversary.I work as stated above tues wed and thurs, the doc (owner) works monday and friday.
I bill on average 4000 (35-40 patients in a 12 hour shift minus 1 hour lunch)a day that i work, now that is an adjusted billing, our system is set up to show daily billing for what is the usual and agreed upon ammt by the insurance companies. So with that said, i make my annual salary in about 3 months. then the rest is profit for the company.

I have to admit though that this is not a typical PA Job, the owner and doc of the clinic was the one that pushed me into PA school and mentored me all the way thru. I just wanted to try surgery for a while, and now i have settled in. I have been out of school for about 8 months.

[/QUOTE]
prima- time for you to go into a specialty or find a new job. I work a lot less than you in the same geographical region of the country and make almost twice your salary.....

[primadonna22274]

I know. You're so right. I guess that's part of why I'm dissatisfied....
L.

prima- time for you to go into a specialty or find a new job. I work a lot less than you in the same geographical region of the country and make almost twice your salary.....[/QUOTE]

[Fantasy Sports]

Originally Posted by MikePlayingDoc

Someome on a previous thread I started about money and being a doc posted this sentence to me: "PAs and Doctors are very different: Doctors give orders; PAs carry them out. "

This is simply not true. PAs do the EXACT same job as primary care docs in many settings. They have NO direct supervison and in some cases know more about medicine than docs. I know this because I volunteered on a service that had no residents. They used PAs to cover the extra work. The PAs who worked there for years were often consulted by the younger docs because you dont learn **** is school. You learn more about being a doc in the first two years AFTER residency than you ever will during school or residency.

Believe me school is nothing but reading a bunch of ****. You wont use most of it ever again after you take boards.

So if you want to be a primary care doc just go to PA school.

This is the dumbest post I have read on pre-allo, which is like saying you're the dumbest member of the Bush family.

PAs dont do the work physicians do, they ASSIST physicians in doing it. You are insulting primary care doctors and showing your lack of knowledge of the field by attempting to equate PAs with family docs. If anything, NPs are closer to PAs than either are to real doctors.

I think its interesting that people are saying that PAs didnt want to deal with long hours, hard work, and long residency, yet are somehow the equal of family docs? Think about it. Its the long hours, hard work, and long residency that makes you into a good doctor. So to think that PAs with easier work, shorter training, and shorter hours can substitute for FP docs is plain idiotic. Your responsibilities and pay are proportional to your work.. that's how we do things in America, and that is why there is no way in hell a PA is even in the same skill arena as an FP.

[bbas]

Originally Posted by jon stewart

so how do you become a PA? How long is does it take after undergrad? Do you need the MCAT the high GPA and all the other stuff you need if you want to become a doctor? Is it very competitve?

Based on what iv read to the responses to this post, am i right to assume that PA's cant perform surgerys?

Most PA programs are two years long. I think that most programs either accept the MCAT or GRE. As far as competitiveness, that varies by school. Some PA programs require a certain amount of clinical experience before you can even apply, while others accept people right out of undergrad without much experience. There are also programs which accept people right out of high school with no clinical experience at all. Most of the programs that I have seen which accept people out of high school generally are 5 year masters programs. Hope that helps.

[hello23]

There is a reason why one has to go thru at least 12 years of education (from college to residency) to become a MD/DO. To every government authority out there that has anything to do with regulating medicine for the public safety, PA or NP are not the same as MD or DO. None of them share the amount of authority and resposibility we have for the patients.

To those who think the nitty-gritty of medicine that one has to learn in medical school is not useful beyond the board exam, it is simply factually wrong. I just finished medical school, and doing my internship now. There are many occasions that I wish I could still remember some of physiology from my first year of medical school to make adjust my patient's ventilator setting. Resp tech carry out the order I write for them to adjust the setting.

One does not need a MD/DO degree to take care simple sore throat or something else in primary care, but it's the subtilty of medicine that can make a huge difference in the patient outcome. Ever see a nurse perform a chest tube placement or central line in ED? Why not? because for god's sake, if something goes wrong, only MD/DO will know what might have gone wrong based on the patient's clinical picture. How do we do that? By integrating our medical knowledge fund in 8 years and correlating that with the clinical experience.

On the other hand, just because a PA or NP is successful doing a chest tube or some procedure, that does not mean they really understand the depth of knowledge behind what they are doing. Of course, human is not monkey. When you train a monkey to do certain things thousand times, a monkey can do it too. But do you think the monkey understand the subtilty of it, or do you think the monkey know what to do if something that you have not trained goes wrong. I don't think so.

And that's why in most civilized society, being a doctor requires the most rigorous and most advanced training in all health professionals. Why? for the patient. And that's why there are so many regulation out there by goverment to protect the patient, and one of them is all MD/DO have to take three national board exams, plus at least one year of residency to practice medicine.
How many years of training and exams a PA has to take to "see" a patient?

Saying something about being a PA is good enough and that can subsitute a family doctor is simply....what are the words I am looking for... yes, dangerously stupid.

To all premed out there, you all have made an outstanding decision in your life for yourself, and for others. Continue on what you're doing to get to that goal. Don't listen to some fool who just try to discourage you in this forum, so they can have a advantage. Who knows, they might be studying MCAT right now, and tell you that being a PA is good enough.

[hello23]

Just read one of the post above about a PA fix a broken bon in ED. First of all, as a MD I am going into my emergency medicine residency next year, and have a lot of experiences in ED so far. Having a broken bone fixed is not a simple thing, guys! you have to make sure no vascular is being damaged by the type of the fracture, and pt's clinical progression. Not only that, we have to read the xray, and sometimes confirm that with the attending and/or ortho docs on consult. Many simple fractures can turn in pretty nasty and complicated ones if no precaution is taken. If everything is fine, then yes, we can have a ER tech or med student to cast or splint. There is already tons of decision and information being processed way before the tech take out the cast in the cast room.

Again, to all those PA out there, I am not trying to be rude here, but if you really think that in ED you are capable of fixing a broken bone, then soon or later you will definitely be on someone's sue list, along with your supervising doctor who overestimate you or have lack of sufficient supervision on you.

Very importantly, PA should always remember and accept what what their title stand for, and should always practice and THINK within their scope of practice and training. If you don't, and start to think that you can do certain thing like we do, something will go wrong. And it's the patient that have to pay.

Side note: There is nothing glorified about medicine or being a MD. Our respect and sometimes incomes, is just proportional to our length of training. And I am not saying I am better than a PA as a person.

[MikePlayingDoc]

Originally Posted by Fantasy Sports

This is the dumbest post I have read on pre-allo, which is like saying you're the dumbest member of the Bush family.

PAs dont do the work physicians do, they ASSIST physicians in doing it. You are insulting primary care doctors and showing your lack of knowledge of the field by attempting to equate PAs with family docs. If anything, NPs are closer to PAs than either are to real doctors.

I think its interesting that people are saying that PAs didnt want to deal with long hours, hard work, and long residency, yet are somehow the equal of family docs? Think about it. Its the long hours, hard work, and long residency that makes you into a good doctor. So to think that PAs with easier work, shorter training, and shorter hours can substitute for FP docs is plain idiotic. Your responsibilities and pay are proportional to your work.. that's how we do things in America, and that is why there is no way in hell a PA is even in the same skill arena as an FP.

You are an incredibly stupid person. I volunteered on a service that had many PAs. They NEVER EVER EVER had to consult a doctor for anything. They did the exact same work that the docs did every day. Some administration MD signed their charts in the back room once a month. There was no supervision. Docs could not and did not give them orders. They were not their employees.

I think you are missing something very important in your thinking. School has very very little to do with work. I was a software engineer for many years and I can tell you that what you learn in school barely applies to the real world. My neighbor is an internal medicine doc. He told me he remembers virtually nothing from med school. It isnt important because med school does not apply that much to working as a doc. Internal med docs dont need to know the name of every spot on every bone nor every enzyme in every reaction. That has nothing to do with practicing medicine.

As for the idiot talking about broken bones and how PAs cant do the work equally to a doc that is absurd. I have a very good friend who is an ortho surgeon. The PAs in his practice do take call and they do fix bones.

Do you really think you needed to go to school for four years past college to cast a broken arm ? If so you probably got the short bus exemption into med school.

Seriously, I watched a bunch of surgeries and much of the work was simple and mundane. Any idiot with a few years practice could do the work. One of the neurosurgeons made a comment to me during a spine surgery that it really wasnt much more complicated than being a carpenter. He wasnt kidding. Much of the work is simple as pie.

Do you really think you need 8 years of post high school education and three years of training to diagnose colds ? Or the flue ? Or treat ear aches ? or do well baby checkups ?

PS - My ortho friend's PA makes $140K a year and works 9-5. Hell of a lot better than your average $100K a year FP doc who has $200K in debt and is working 60 hours a week.

I know another PA (cardio PA) who works about 60 hours a week and he makes $150K a year. Another N-surgery PA I know makes $120. PAs in cardio, N-surgery and ortho surgery have waaaay more interesting jobs than FP docs and get paid more.

Enjoy your pride. It doesnt pay well but it might keep you warm at night.