PharmD to PA

[hajenkin]

I'll be graduating soon with a PharmD from a top school (I know this doesn't mean much in the pharmacy field anymore, but the curriculum is pretty rigorous). I also have a BA in psychology and a BS in pharmaceutical studies. I've worked as a technician/intern for over 6 years now, and the school I'm interested in said they'd accept those hours as PCE (~4000-5000 at this point). My overall undergraduate GPA is 3.8, sGPA around 3.5. I have leadership experience in both undergraduate school and pharmacy school, as well as worked nearly full time while going to pharmacy school. Because of this (and some personal chronic health issues and terminal family illness), my pharmacy school GPA isn't stellar (will graduate with about a 3.2ish).

I'm thinking about pursuing PA school after graduating. I've followed some PAs and worked with some at the hospital while on clinical rotations for school and I find their practice more appealing (problem solving, patient interaction... essentially the clinical aspect that much of pharmacy lacks).

The average class admission profile (median 60%) for the school I'm interested in are as follows:

cGPA (undergrad): 3.35-3.77
sGPA (undergrad): 3.39-3.82
Pre-req GPA: 3.72-4.0
patient care hours: 5000-17000

1. With strong LORs and personal statement, how competitive of a candidate do you think I would be?
2. Will my pharmacy school GPA be considered, or just undergraduate?
3. What can I do to improve my overall profile?

Thank you!

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[Splenda88]

If you are <= 30 yrs old, I think MD/DO makes more sense.

You should definitely be ok for PA with your credentials.

 

[pamac]

I agree. You probably have the chops for medical school. You have the study skills, and it would be more of an investment in time than it would be a gargantuan struggle. The payoff to all your effort would be so much more. You could see the day when PA's are in the same boat as what you are seeing in pharmacy. In some respects, things are panning out to be very similar.

 

[Ganon]

I'm an MD student, but have lots of friends in both of those fields, as well as a few PharmD->other field friends. Please take what I say with a grain of salt, but since nobody answered I figured I'd take a crack

1. With strong LORs and personal statement, how competitive of a candidate do you think I would be?
Very.

2. Will my pharmacy school GPA be considered, or just undergraduate?
Just UG as far as your "scoring" goes, but I'm sure they'll peek at your GPA from grad school. I can only speak to how the local PA school does admissions, idk about the rest of the world though.

3. What can I do to improve my overall profile?
PA shadowing etc!

As the other's have said, consider MD/DO if you are youngish, but you've got a great shot at PA.

 

[hajenkin]

I'm an MD student, but have lots of friends in both of those fields, as well as a few PharmD->other field friends. Please take what I say with a grain of salt, but since nobody answered I figured I'd take a crack

1. With strong LORs and personal statement, how competitive of a candidate do you think I would be?
Very.

2. Will my pharmacy school GPA be considered, or just undergraduate?
Just UG as far as your "scoring" goes, but I'm sure they'll peek at your GPA from grad school. I can only speak to how the local PA school does admissions, idk about the rest of the world though.

3. What can I do to improve my overall profile?
PA shadowing etc!

As the other's have said, consider MD/DO if you are youngish, but you've got a great shot at PA.

I’d love MD, but I’m already 28 and want to start my life hah. I’m on clinical rotations in ICU now, a majority of it is spent rounding with an attending and his residents, and I’m kicking myself for not going to med school instead.

Also, I don’t think I’d be competitive enough to get into medical school.

 

[pamac]

PA isn’t what it used to be as far as wages, benefits, and work environment. You are a dependent provider, and employers are taking notice of that when they sit down with you and hash out terms. It used to be that terms worked out well because PAs were seen as rare assets. More PA programs and more competition from NPs are complicating things quite a bit. The pile of job applications is pretty high at each job location.

 

[hajenkin]

PA isn’t what it used to be as far as wages, benefits, and work environment. You are a dependent provider, and employers are taking notice of that when they sit down with you and hash out terms. It used to be that terms worked out well because PAs were seen as rare assets. More PA programs and more competition from NPs are complicating things quite a bit. The pile of job applications is pretty high at each job location.

That’s what im afraid of. Spending 2 more years in school and $100k+ in student loan debt just fo graduate into a saturated market and end up with the same problem that I have now.

 

[pamac]

That’s what im afraid of. Spending 2 more years in school and $100k+ in student loan debt just fo graduate into a saturated market and end up with the same problem that I have now.

I dont think it’s as bad as what I hear pharmacy is. What seems to be happening in pharmacy is an absolute oversupply right now. What I see for PAs might be an earlier stage of what happened to pharmacy. There are places that have significant need for providers, and PAs are well suited to fill those roles, but they have speed bumps, like their ability to practice being limited to either their employers, or else having a physician supervisor. In a few states, PAs have been allowed to have a facility essentially oversee them, but in no states can they practice independently. That means that they have to approach their jobs with their hat in hand, particularly in a tight market. So I feel like that’s why wages seem to be trending down. You also have a bunch of new desperate providers taking jobs for very weak wages “just to get the experience”, and hoping to move on. I’m not seeing that they are able to do that once that experience comes into pla

15 years ago, $120k was a wage you could do a lot with, and the going wage one expected as a PA before they entered the market. Now, you never hear those kinds of wages for new PA. RN wages are close to what I’m seeing PAs make these days. As an RN, I’d work 3 shifts per week, and be making close to the wages of the PAs working in the hospital with me. When I picked up an overtime shift, I was killing it by comparison, and still working fewer hours per week than a lot of PAs that were documenting after their shift ended for free. I know nurses that easily make $115k, just as nurses with no leadership responsibilities, without relying on significant overtime to produce a large portion of their wages. No call, no after hours charting, no stress that I couldn’t shed the moment I clocked out. Many folks have to work night shift to get to that point, and 12 hour shifts can be brutal, but with that comes 4 day weekends, and usually one can get time off to be sick, go on vacation, etc. You can get someone to take your shift if you need to do you can show up for something important.

I don’t know where pharmacy is compared to that, but I do know that the final bill for PA school will be more than $100k. $100k is just for school itself. It doesn’t account for living expenses. Some folks have suggested that one can work during Pa school, but you can’t expect PA schools do do anything to facilitate that. You should actually expect the opposite. You have to calculate whether the money you’d make from working a handful of shifts per month is worth more than prepping for exams, or simply providing recovery time from a hectic schedule.

 

[deleted6669]

There are a few part time PA programs out there that allow you to work year 1 and 2 and then year 3 is full time. Worth considering. I attended one and was able to work 24-30 hrs/week year 1 and 2 and a bit year 3 as a paramedic.

 

[pamac]

Rutgers part time PA program is like $1200 per credit for 122 credits. So $144k over 3 years. The other ones I looked up were at least $97k. So when you consider part time PA programs, add in an extra year of living expenses at the very least, and subtract an extra year of PA wages. If new PAs make $108k on average per year in a good market, and it costs $40k to live decently per year, that’s $148k you will be missing overall. Will you make $148k working while going to school? And you have to judge how well an employer will work to accommodate you, or how well a program will handle you having to work on an important date.

There are PRN positions out there as a pharmacist, and there actually might be a niche for folks that can pick up shifts at a moments notice. What you have to ask yourself is how much it would be worth your time to juggle that. If you could throw more time into studying and have school be easier and faster due to that time you could put in, then the hassle of working during school might not be worth it compared to that extra year of investment. Again, that extra year of school cuts out a huge chunk of earnings. If you work your guts out and make $50k per year for 2 years, then great…. You are 2/3 of the way to covering the cost of what you lost by having an extra year. Congratulations for the misery you invested in. Now you still have to pay back the $100k in tuition. You aren’t really covering much of your tuition balance at all, you are just paying to live an extra year at school, and paying yourself back for the year you lost when you could have been making money.

Part time PA school is a suckers bet. Even if you live on a poverty budget of $25k. That lost year of wages still kills the deal.

Any way you stack the deck, it sounds like taking on a PA to your education is a net negative. This goes for so many people out there. I’ve seen it financially change the lives of people who were making almost nothing as CNAs and paramedics, folks that were undergrads who cruised through, and folks going into the military. Career changers, not so much. Same for struggling students who take a long time to get in. School is $100k. Expenses to live on top of that are $40k per year at least for the student with obligations to attend to. That’s $180k. Then you start working making $90k-ish, and have taxes to pay, and loans to pay back. How many years before those funds aren’t spoken for so that you can actually buy a house, and replace a car, and begin to see the payoff? Let’s do a math exercise with very basic numbers. You make $100k. $20k goes to taxes under generous circumstances. Then $10k per year goes to your student loans. WITHOUT accounting for interest, it will take 18 years to pay that off, and you’ll have about $70k per year to live on. For a pharmacy student with extra debt to pay off….

I don’t think you need a $180k adventure tacked on as a solution to the problems that you fear about the pharmacy industry. Hell, go into pharmaceutical sales and you’d do better as a rep than being a PA. Come into my office every now and then and tell me about why I should work your company’s drug into my pipeline. The folks coming to see me don’t have PharmD’s. Walk in and say “Dr hajenken would like to bring in lunch for PAMAC and talk to him about x, what day can you fit him in? Oh, and here are your samples.” Yeah, every rep around will be shaking in their shoes knowing you are out there doing your thing, and their bosses are wondering why they don’t have a PharmD rep in their lineup.

So go and get some pharmacy experience just to have it on the resume, then test the waters in the pharmaceutical sales game. That advice will give you something to add spice to your occupational outlook. We all work in the industry of trying to convince people to do things. We sell people on doing things they need to do to be healthy. Pharm sales is a noble profession. You go and talk to people. You aren’t stuck in an office. It sounds pretty appealing to me, really. I know several reps that do quite well. Life is about living, it’s not about the details of your job.

 

[hajenkin]

Rutgers part time PA program is like $1200 per credit for 122 credits. So $144k over 3 years. The other ones I looked up were at least $97k. So when you consider part time PA programs, add in an extra year of living expenses at the very least, and subtract an extra year of PA wages. If new PAs make $108k on average per year in a good market, and it costs $40k to live decently per year, that’s $148k you will be missing overall. Will you make $148k working while going to school? And you have to judge how well an employer will work to accommodate you, or how well a program will handle you having to work on an important date.

There are PRN positions out there as a pharmacist, and there actually might be a niche for folks that can pick up shifts at a moments notice. What you have to ask yourself is how much it would be worth your time to juggle that. If you could throw more time into studying and have school be easier and faster due to that time you could put in, then the hassle of working during school might not be worth it compared to that extra year of investment. Again, that extra year of school cuts out a huge chunk of earnings. If you work your guts out and make $50k per year for 2 years, then great…. You are 2/3 of the way to covering the cost of what you lost by having an extra year. Congratulations for the misery you invested in. Now you still have to pay back the $100k in tuition. You aren’t really covering much of your tuition balance at all, you are just paying to live an extra year at school, and paying yourself back for the year you lost when you could have been making money.

Part time PA school is a suckers bet. Even if you live on a poverty budget of $25k. That lost year of wages still kills the deal.

Any way you stack the deck, it sounds like taking on a PA to your education is a net negative. This goes for so many people out there. I’ve seen it financially change the lives of people who were making almost nothing as CNAs and paramedics, folks that were undergrads who cruised through, and folks going into the military. Career changers, not so much. Same for struggling students who take a long time to get in. School is $100k. Expenses to live on top of that are $40k per year at least for the student with obligations to attend to. That’s $180k. Then you start working making $90k-ish, and have taxes to pay, and loans to pay back. How many years before those funds aren’t spoken for so that you can actually buy a house, and replace a car, and begin to see the payoff? Let’s do a math exercise with very basic numbers. You make $100k. $20k goes to taxes under generous circumstances. Then $10k per year goes to your student loans. WITHOUT accounting for interest, it will take 18 years to pay that off, and you’ll have about $70k per year to live on. For a pharmacy student with extra debt to pay off….

I don’t think you need a $180k adventure tacked on as a solution to the problems that you fear about the pharmacy industry. Hell, go into pharmaceutical sales and you’d do better as a rep than being a PA. Come into my office every now and then and tell me about why I should work your company’s drug into my pipeline. The folks coming to see me don’t have PharmD’s. Walk in and say “Dr hajenken would like to bring in lunch for PAMAC and talk to him about x, what day can you fit him in? Oh, and here are your samples.” Yeah, every rep around will be shaking in their shoes knowing you are out there doing your thing, and their bosses are wondering why they don’t have a PharmD rep in their lineup.

So go and get some pharmacy experience just to have it on the resume, then test the waters in the pharmaceutical sales game. That advice will give you something to add spice to your occupational outlook. We all work in the industry of trying to convince people to do things. We sell people on doing things they need to do to be healthy. Pharm sales is a noble profession. You go and talk to people. You aren’t stuck in an office. It sounds pretty appealing to me, really. I know several reps that do quite well. Life is about living, it’s not about the details of your job.

That's great advice, thank you. The main concern, like you said, is money. I'm already a couple hundred in debt from pharmacy school and getting my bachelors - I'd hate to take on more debt (plus accounting for wages lost for 2-3 years) and come out making the same amount of money as I would as a pharmacist. I'm just going to have to find an area in pharmacy that I enjoy.

 

[pamac]

In your position, you certainly should look at simply using the effort to enhance where you've invested already. I've noticed that "the cream rises to the top", and in your case that means that folks that are go-getters manage to succeed. Its the same in my industry as a psyche NP. I'll be fine, because I'll "beat the market" through quality. I understand the temptation to look at the trends to get a feel for where you'll stand, but success tends to vary among all industries. That's how you have disparities in income within professions. It involves some hustle to be among the top percentiles for wages, but sometimes it's less than you think. You can always change your mind later and hit PA school if things really don't look like they are panning out. There's no rush.

 

[jwk]

That's great advice, thank you. The main concern, like you said, is money. I'm already a couple hundred in debt from pharmacy school and getting my bachelors - I'd hate to take on more debt (plus accounting for wages lost for 2-3 years) and come out making the same amount of money as I would as a pharmacist. I'm just going to have to find an area in pharmacy that I enjoy.

Not sure where you're located, but doing a CAA program (certified anesthesiologist assistant) is not a bad option either. Programs run 24-28 months, tuition around $100-110k for the entire program. Generally considered one of the highest paying non-physician healthcare jobs. Most new grads from this years graduating classes are starting in the $160k+ base salary range and many are now over $200k with OT potential in lots of practices. Geographic limitations may be an issue for you, but other than that it's been a great career for me. There's a new school about to open in Denver in addition to the other existing programs, and more on the horizon. Job placement is essentially 100% over the last decade.

I looked at med school ages ago after I was already an AA. Way too much financial downside, and that was when my salary was much less. You need to look at lost income potential for a minimum of 8 yrs of med school and residency, plus all the tuition and costs of living for those 8+ years. For me it was an easy financial no-brainer.

 

[hajenkin]

Not sure where you're located, but doing a CAA program (certified anesthesiologist assistant) is not a bad option either. Programs run 24-28 months, tuition around $100-110k for the entire program. Generally considered one of the highest paying non-physician healthcare jobs. Most new grads from this years graduating classes are starting in the $160k+ base salary range and many are now over $200k with OT potential in lots of practices. Geographic limitations may be an issue for you, but other than that it's been a great career for me. There's a new school about to open in Denver in addition to the other existing programs, and more on the horizon. Job placement is essentially 100% over the last decade.

I looked at med school ages ago after I was already an AA. Way too much financial downside, and that was when my salary was much less. You need to look at lost income potential for a minimum of 8 yrs of med school and residency, plus all the tuition and costs of living for those 8+ years. For me it was an easy financial no-brainer.

I looked into this and was seriously considering it, however it appears the program I was looking at that was close to my location stopped the program. Hopefully another will pop up here soon, because I'd seriously consider that route.

 

[deleted6669]

I did the part time program at Drexel and would do it again. Financially it made sense for me. Also taking 3 courses at a time instead of six allowed me to absorb the material better. The top six students in my class ( I was #2) were all part time option students(and there were only 12 of us in a class of 80).
PAMAC means well, but he tries to talk every single poster on this board out of going to PA school. It isn't the answer for everyone, but nothing is. Look at a variety of opinions before you write off the career. I work less than 1/2 the month and make as much as many primary care physicians doing a job I love with oversight equivalent to what an ED physician has to deal with(administrative). My state requires no chart review or MD on site. My credentialing and privileges are the same as the physicians in the group. This is both a function of my years of experience and the state and settings(rural) in which I choose to work. There are certainly some fields in which it makes sense to be an NP, like psych and nicu. PAs also dominate in a few fields , like EM and surgery.
Being a clinical pharmacist at a rural hospital isn't a bad gig either. AA is also a great career if you are interested in practicing in a state in which they are currently licensed.. Best of luck whatever you decide.

 

[pamac]

-Sorry Emed, but PAs do not “dominate” ER by any means. I think they comprise about 2/3 of the ER nonphysician provider realm, but NPs do fine. NPs aren’t turned away in favor of PAs, but your N=1 experience will probably show up to insist that your group doesn’t touch them. Well, I know people in your neck of the woods in Washington state, and NPs work all over the place in ERs there. Also, most PAs have to work incredibly hard to crack $200k, and that’s definitely an outlier. Convincing someone to take on $150k in debt (at least) requires more than an outlier. All the OP has to do is go to the PA forums website and hear about the reality of experienced PAs talking about how life really is. You work far off the beaten path for a facility that uses your many years of experience and pays you more that most PAs because it’s cheaper for them to do that than to pay a board certified ED physician. You are 20 years into your career, and at the top of your skill set. No new PA would have that opportunity. I also have a wage that puts me ahead of some physicians (and that indeed was as a new grad). However, any physician that I make more than would definitely be an extreme outlier on the poor side. That’s such an outlier that I don’t personally know any docs that make less than me. The poorest doc I know makes at least $196k, and does not care about money at all. I think that maybe some docs at the VA make less than I do, bit that’s not really apples to apples

-AA is geographically constructed… severely. Think on that. You can work in a handful of states.

Also, think on why I would suggest that someone who is a pharm D shouldn’t commit hundreds of thousands of dollars to becoming a PA, and ask yourself who is the one selling a crap sandwich? Am I really trying to talk every single person out of becoming a PA, or am I the only one taking folks best interests to heart here? PA and AA aren’t choices, they are investments. Who in their right mind would suggest to someone in to go into even more debt to make PA money? I could see how medical school would be a good idea, but PA? You’ll notice I’m not even trying to sell NP here.

The last friend I had that became a PA before the pandemic made less money at their first job than I made as an RN of <10 years. I wasn’t one of those overtime chasers either. That PA is a few years in, and nothing has changed much. They changed production bonuses so that they are still screwed. Other opportunities haven’t even tempted this PA away, so that tells you what the market is. My acquaintance isn’t making “primary care doc money”, or even “half primary care doc money.” They can’t even buy a house. House payment sized checks go to pay down a six figure loan. This person works more hours than I did as a nurse. A second job would be nice, but there are enough folks around working as NPPs that PRN work isn’t as lucrative as it needs to be to make it worthwhile.

Anyway, I’ve said my piece.

 

[deleted6669]

I would call 66% to 33% dominating. The surgical numbers are probably more like 90 to 10. Yes, NPs can get good ER jobs. If you look at single coverage, rural, critical access hospital Emergency departments(where a non-physician has the broadest scope of practice) , these jobs are held predominately by PAs, likely in an 85%+ factor. Yes, there are NPs doing this kind of work, just like there are NICU and psych PAs, but it is an uphill pull. I have my finger on the pulse of these types of jobs nationally and rarely see one posted looking for an NP. Most want an FP doc or an EMPA. There are good jobs out there for every PA and NP if they are willing to relocate. Health care providers who can't find jobs often are constrained by geography.
Every discussion can't be about money. Maybe the pharmacist is bored and wants to do something else. If I wanted to be a professional concert clarinet player it wouldn't be a great financial decision ,but if it made me happy to work for 45k as a clarinet player and it cost me 200k to go to Julliard music school to get there it would be money well spent.
I did mention AA is a great career if you can deal with the geographic limitations. This is where AAs can practice today:

https://aaaa.memberclicks.net/assets/aaaa%20work%20states%20.pdf%20map%20april%202014%20hi%20rez.pdf

So if you live in one of those states, want to practice anesthesia, and are not an RN, great. If not, CRNA is the more sensible option. The training is equivalent and Medicare considers AAs and CRNAs to be interchangeable.

Anesthesiologist Assistants

www.asahq.org

 

[pamac]

Single coverage rural access hospitals are such a small part of the market, and no new grad, or newer grad, or even non cowboy PA would get into that role. A facility that allows that is one that is willing to handle the liability of having a PA where a physician would be more appropriate. They have looked at the books and have figured out where they are exposed, and what they save by having a cheaper PA onboard, and those roles tend to be fairly lucrative for a PA or NP, but it’s because it’s a place where the locals don’t care what they get as long as it’s somebody that can send them on to an acute care facility. And PAs are dependent providers, so they actually are tethered to a physician, so it’s no surprise to me that a facility that takes on the liability of PA solo coverage would want that dependent relationship nailed down. NPs often don’t agree to having a physician to report to as well.

As you know, to get to one of those rural access solo coverage jobs often requires a long commute, camping out in town for the shifts you work, or relocating to places where most folks don’t want to live. You personally are one of the old guard, not the typical 24 year old PA with no HCE under your belt. HCE these days isn’t heavy on bachelors degree paramedics, but instead consist of scribes, EMTs, and CNAs.

Excessive money isn’t everything, but abject poverty needs to be a consideration, particularly because money is a tool to obtain free time and quality of life. Additionally, not being compensated to ones potential while falling on ones sword to make someone else rich is demoralizing as well.

 

[Splenda88]

Single coverage rural access hospitals are such a small part of the market, and no new grad, or newer grad, or even non cowboy PA would get into that role. A facility that allows that is one that is willing to handle the liability of having a PA where a physician would be more appropriate. They have looked at the books and have figured out where they are exposed, and what they save by having a cheaper PA onboard, and those roles tend to be fairly lucrative for a PA or NP, but it’s because it’s a place where the locals don’t care what they get as long as it’s somebody that can send them on to an acute care facility. And PAs are dependent providers, so they actually are tethered to a physician, so it’s no surprise to me that a facility that takes on the liability of PA solo coverage would want that dependent relationship nailed down. NPs often don’t agree to having a physician to report to as well.

As you know, to get to one of those rural access solo coverage jobs often requires a long commute, camping out in town for the shifts you work, or relocating to places where most folks don’t want to live. You personally are one of the old guard, not the typical 24 year old PA with no HCE under your belt. HCE these days isn’t heavy on bachelors degree paramedics, but instead consist of scribes, EMTs, and CNAs.

Excessive money isn’t everything, but abject poverty needs to be a consideration, particularly because money is a tool to obtain free time and quality of life. Additionally, not being compensated to ones potential while falling on ones sword to make someone else rich is demoralizing as well.

The Dunning-Kruger effect is real in medicine. But it seems like it's more of an NP phenomenon than PA. I can see why as a former RN.

 

[deleted6669]

And PAs are dependent providers, so they actually are tethered to a physician, so it’s no surprise to me that a facility that takes on the liability of PA solo coverage would want that dependent relationship nailed down.

There is a lot less to this in many places than people would make you believe. My state does not require chart review or a physician on site, so my sponsoring physician is just a name in a file somewhere. He gets $5/hr above his base pay for being the doc of record for 3 PAs . The state requires that he have "an ongoing knowledge of PA practice patterns". In practice that means we sign out patients to each other and discuss cool cases and xrays, not because we have to, but because that is what ED providers do. Ten years from now the concept of PA supervision will be talked about even less than it is now as PAs go to a collaborative model, which specifically does not hold physicians liable for PAs actions or require specific oversight beyond what is required at the practice level. Many states have passed this type of legislation in the last two years and like NPs, this will eventually pass in almost every state. Legislatively, PAs are where NPs were 10-15 years ago. We are behind the curve but catching up quickly.

 

[pamac]

There is a lot less to this in many places than people would make you believe. My state does not require chart review or a physician on site, so my sponsoring physician is just a name in a file somewhere. He gets $5/hr above his base pay for being the doc of record for 3 PAs . The state requires that he have "an ongoing knowledge of PA practice patterns". In practice that means we sign out patients to each other and discuss cool cases and xrays, not because we have to, but because that is what ED providers do. Ten years from now the concept of PA supervision will be talked about even less than it is now as PAs go to a collaborative model, which specifically does not hold physicians liable for PAs actions or require specific oversight beyond what is required at the practice level. Many states have passed this type of legislation in the last two years and like NPs, this will eventually pass in almost every state. Legislatively, PAs are where NPs were 10-15 years ago. We are behind the curve but catching up quickly.

But you have a supervising physician that has to be the “doc of record”, and PAs cannot practice without supervision of some kind. Even with the best OTP legislation ever, it merely substitutes “physician supervision” for “facility supervision” and the facility/entity shoulders liability vs a supervising physician who may not even meet up with a PA on a regular basis. You would definitely notice if your physician of record decided to not supervise you, because your ability to function would immediately cease until other arrangements are made. If requirements for supervision are dictated “at the practice level” that still puts control over you in the hands of someone else, not in your own.

In fact, PAs under OTP are not where NPs were 15 years ago in any respect. 15 years ago, NPs were all practicing independently, except in states where they weren’t. But now, NPs are independent in even more states than they were 15 years ago. If OTP is what is meant by catching up quickly, then it means that if I went from independent practice to OTP, I’d be going backwards. 10 years ago I was aware of what was going on in the field of nonphysician providers, and threw my hat in the ring with NPs instead of PAs because of NPs being independent, and am still glad for that. I can say with certainty that the PAs of today aren’t where NPs were 10-15 years ago legislatively. Today there are no states with full PA independence. The NP world is not interested in OTP, we shoot for straight independence.

I could walk out of my workplace tomorrow and start my own practice just by myself, along with anyone I want to hire or partner with (well, not a PA because I would need to have my PA get permission from a supervising physician, and then jump through those hoops).

HOWEVER, with OTP, I actually might be able to hire and supervise a PA in my independently owned practice, so I would stand corrected on the point that I could hire whomever I wanted. That might be something I’d be willing to do, because I could probably hire and supervise a PA for a lot cheaper than one of my NP colleagues, so that’s something I might do in the future if I start my own practice. And thanks to OTP I could supervise PAs through the clinic policy. So in essence, thanks to OTP that PAs are operating under, you’ll see NPs in charge of PAs at the practice level. So keep getting those OTP laws passed so I can put some PAs to work under me someday. I love it. PAs jumped out of the frying pan, and into the fire.

 

[deleted6669]

Now that PA practice is controlled at the practice level, if my sponsoring physician died right now while I am on shift I could make one phone call, scribble on a piece of paper "Dr Jones is no longer the sponsoring physician for Emedpa. Dr Green will assume that role immediately". Time and date it and I am good to go. The medical board no longer keeps a record of SPs after initial accreditation.
PAs working for NPs is a fantasy. We have oversight through the board of MEDICINE, not nursing. No medical board would ever allow that. Some states have gone to a group supervision model, wherein any doc in the group can be an alternate supervisor without being named or filing individually.

Did a PA piss in your cheerios or steal your favorite teddy bear when you were a child? I can not understand your consistent rants against PAs. The vast majority of your posts on SDN read like this: Don't ever be a PA. They suck. All of them. Even the best PA can't change diapers safely. Nurses, NPs, and docs are all better. If you become a PA you will end up working at walmart and your mother will stop loving you and you will die unloved and in poverty.
I get that you are happy being an NP. Good for you. It's a great career, but so are PA and AA. Everyone needs to do their own research and make their own choices. You conveniently glaze over the differences in PA and NP education in the vast majority of your posts. This might be a significant detractor for many looking at the NP field. You also conveniently never talk about the fact that a not insignificant number of NPs go back to practicing as RNs because they can not find work that pays more than their RN salaries (and I mean pre-covid, not the crazy RN traveler rates of 100+ /hr that exist this week).
US News named PA both the best career and the best health care career this year. We must be doing something right:

100 Best Jobs of 2020

These are the 100 best jobs in America.

money.usnews.com

 

[pamac]

-I’ve never once said that PAs aren’t practicing safety, or questioned their training, so you are off base with that hyperbole. My concerns are with the limitations of the profession and the impotence of the trade groups that are supposed to advocate for you guys, as well as the reality that they create for you guys.

-Tell us what you think the “not insignificant number” of RNs leaving bedside due to wages is, because if you don’t have numbers, then that’s just N=1, and your statement is just conjecture that is meant to poison the well. However, since PA wages closely mirror NPs, then if NPs are leaving NP to go back to bedside, then PAs are in worse shape, because PAs would be alongside NPs, except worse. While RN wages are great, PAs who were CNAs or scribes prior to PA school would just be able to go back to that I guess. What you are really suggesting is that NPs can find jobs while PAs are able to, which is pure bunk. But in a tight market, NPs have the option of working a great paying job as a nurses until they find the right fit, whereas new PAs with six figure debt, and no good paying job to fall back on, find themselves taking crap jobs at poor wages. I know one PA in particular who wished they could go back to something like bedside nursing while they waited through covid for a position to open up. I also know PAs who were furloughed during covid, and couldn’t go bedside in the meantime. I know NPs who were furloughed that went and started a cash pay operation to ride things out, and an Np who went bedside as a traveler and made more money than as an NP before their job opened back up. And you act like RN travel jobs are fly by night, and not sustainable. Dude, travelers have been paid very well for decades, and many of my RN traveler friends stay and travel local without having to go to far flung locales.

-US news and world report indeed lists PAs as the number one career. NP is number 3, with 110,000 projected job openings vs 39,000 projected jobs for PAs. Physician is number 5 on that list. Would you suggest PA is a “better career” than physician?

-PAs working under the authority of NPs is going to happen. Here’s how: me, an NP, opens a clinic in an OTP state. OTP means a PA doesn’t derive supervision from a physician, but from policy developed at the clinic level. Since I own the clinic, I am the clinic. Are you aware of any requirements that physicians have to be involved in the OTP process? If they are, then is OTP really a form of independence, because if not, then it’s not truly making PAs independent. If the BOM would restrict that, then PAs aren’t truly independent either. So there’s a trap for you to find your way out of. OTP is fine by many physicians who aren’t interested in shouldering liability for PAs, but still want them under their thumb. As far as I can see, it did that perfectly.

-If my collaborating physician dies, then all I have to do is….. well, I don’t have a collaborating physician. Or a supervising physician. Or a sponsoring physician. Or a clinic policy stating a succession plan. I don’t have to have a physician in the picture, or even have my independence derived from an association with a practice run by physicians or other NPs. I don’t have to write anything on paper, or time and date it. I don’t have to have a backup supervising physician or NP to supervise me.

PA needs to be the choice for a narrowing group of individuals due to the high cost of obtaining the degree and it’s prerequisites. I will agree that “independence” is most likely less of a factor for most providers, but it can be for many. However, cost issues and wages bring a lot to the table. I don’t always recommend NP for a lot of folks either. My thoughts on PA are that it’s no longer an avenue for those with chequered academic history who are banking of PA programs overlooking problem grades. I feel like it’s appeal should be more narrowly tailored. It’s worth considering, but so are the drawbacks. The same for AA. That list of states that shows where they could work in 2014 that you posted is THE SAME as the map they posted this year….no more states have been added to their scope IN 7 YEARS. When it costs $100k+ for tuition, plus living expenses and lost wages while you go to school, one might want more latitude than what is provided by that career. If me highlighting the downsides of that kind of thing constitutes peeing in Cheerios, then I’m comfortable with that completely.

 

[deleted6669]

Mostly reasonable post. Anecdotally I know a handful of NPs who continue to work as RNs as they could not find jobs that paid as well as their RN jobs. I know PAs who still do side gigs as medics, resp therapists, occupational therapists, and physical therapists. Most PA folks who leave clinical medicine go into teaching or do medicine adjacent jobs like drug or device rep. Apparently the NP to RN thing isnt that uncommon. There are internet groups on the subject and articles such as this:Bouncing Back To The Bedside - Elite Learning Some of these reasons sound like great options while others sound like a glut of FNPs. That being said, FNPs are the only NP speacialty that I have seen go back to RN practice. Sorry my last post was a bit confrontational. You caught me during a rough patch of a 24 shift. My apologies.

 

[pamac]

I think my written words come across more confrontational than what I’m thinking in my head at times.

I ultimately feel the days of PA being a refuge for academically faltering individuals is over. I also think that it needs to be a primary destination for someone with along career ahead of them. It just costs too much to be something that people flirt with or retool for if they aren’t the hard core adventure hungry type. I know too many poor PAs that didn’t expect to be poor because they “know a PA that makes $180k”.

I remember when PA went from the best kept secret, and morphed into the place everyone thought they would try their hand at, and it was about the time the US News folks made it sound like just another graduate program. Then folks with good HCE were squeezed out, which bugs me a lot. And then a lot of folks flocked to nursing with similar things in their mind, like hearing their nurse neighbor works 3 shifts a week, gets good healthcare benefits, and has job security and mobility. That gold rush occurred with the 2008 economic downturn. Then all those same folks went to FNP school when they again, heard about NPs making bank and having good working conditions. And now we have both Pa and NP career fields in a place that we aren’t excited about, facing a bit of a glut, and a race to the bottom in terms of benefits, conditions, wages, and employer expectations. All those dissatisfied FNPs are now turning to psyche, and asking me to train them so they can go and take a job cheaper than me, but higher than the sweatshop conditions they work in at the minute clinic. (Consequently I don’t allow FNPs to train with me… for one, I can’t keep up with the requests, and for two, they made their choice, and now clearly are in it now for the money and lifestyle they think they will get). If I’m wrong about the motivation, then that’s ok. Many think nothing of prescribing psyche meds without my training as is and many are willing to do it poorly in the 15 minutes they get to hash that out.

So I definitely have concerns about my own “tribe” that seem more pressing than anything the PA field presents me with. But nobody asks questions on here about that.

 

[Splenda88]

I think my written words come across more confrontational than what I’m thinking in my head at times.

I ultimately feel the days of PA being a refuge for academically faltering individuals is over. I also think that it needs to be a primary destination for someone with along career ahead of them. It just costs too much to be something that people flirt with or retool for if they aren’t the hard core adventure hungry type. I know too many poor PAs that didn’t expect to be poor because they “know a PA that makes $180k”.

I remember when PA went from the best kept secret, and morphed into the place everyone thought they would try their hand at, and it was about the time the US News folks made it sound like just another graduate program. Then folks with good HCE were squeezed out, which bugs me a lot. And then a lot of folks flocked to nursing with similar things in their mind, like hearing their nurse neighbor works 3 shifts a week, gets good healthcare benefits, and has job security and mobility. That gold rush occurred with the 2008 economic downturn. Then all those same folks went to FNP school when they again, heard about NPs making bank and having good working conditions. And now we have both Pa and NP career fields in a place that we aren’t excited about, facing a bit of a glut, and a race to the bottom in terms of benefits, conditions, wages, and employer expectations. All those dissatisfied FNPs are now turning to psyche, and asking me to train them so they can go and take a job cheaper than me, but higher than the sweatshop conditions they work in at the minute clinic. (Consequently I don’t allow FNPs to train with me… for one, I can’t keep up with the requests, and for two, they made their choice, and now clearly are in it now for the money and lifestyle they think they will get). If I’m wrong about the motivation, then that’s ok. Many think nothing of prescribing psyche meds without my training as is and many are willing to do it poorly in the 15 minutes they get to hash that out.

So I definitely have concerns about my own “tribe” that seem more pressing than anything the PA field presents me with. But nobody asks questions on here about that.

Why do think physicians have it better than NP/PA?

Physicians are not immuned from the corporatization of medicine.

 

[deleted6669]

Why do think physicians have it better than NP/PA?

Physicians are not immuned from the corporatization of medicine.

1/2 the hrs for 3× the salary doing similar work in many fields for starters .

 

[Splenda88]

1/2 the hrs for 3× the salary doing similar work in many fields for starters .

Most docs work 50 hrs/wk on average. Are PA/NP working 100 hrs/wk? 3-4x the salary is true for most specialties. In primary care, the pay is probably 2x.

PA/NP are doing similar work in some fields, not many.

 

[pamac]

I did read that article just now. At first I was like “I’d never go back to bedside”. And I wouldn’t go back to anything but psyche. But if I went back to psyche, I think I could handle it like a boss. But the money wouldn’t be there for me, and it’s not the kind of daily work that I want to do. Everything is fun when it’s a novelty, but going back as a career…. No way. The article did speak to me in that that once you are done with work for the day, you are done…. no charting, no open ends. But life as a nurse, with 12 hour shifts and half hour lunches, and minutiae, and repetition, it’s not for me. I live a charmed life at work now, but life is so much better as a provider. I’m not sure that an FNP doing 15 minute slots in a minute clinic would be as hesitant to go back to turning patients and keeping track of 50 tasks per patient. I never wanted to hang around nursing long enough to have every list be second nature to me, and I left medical bedside before I got to the point where I didn’t have to think at least a little bit about what I was doing.

 

[Ho0v-man]

Go to med school. Med school will be harder. But you’d coast through a good chunk of it with your background. You’d probably be bored in PA school.

 

[deleted6669]

Most (primary care) docs work 50 hrs/wk on average. Are PA/NP working 100 hrs/wk? 3-4x the salary is true for most specialties. In primary care, the pay is probably 2x.

PA/NP are doing similar work in some fields, not many.

Fixed that for you.
A lot of EM docs work 10-12 eight to 12 hr shifts/month . That is 144 hrs max with most working somewhere between 108-120. Yes, many PAs routinely work a lot more than this. My last group routinely scheduled the PAs to work 160-180 hours at a busy urban trauma center. I am working 224 hrs this month at a rural , critical access hospital. That is fairly typical for me. EM docs make $200 hr+. A senior EM PA might make $75-95/hr. ACEP says only 5% of ED visits are true emergencies. That means 95% of the work in the ED is primary care, urgent care, and folks who will not die in the next hour if they are not immediately diagnosed correctly and resuscitated immediately, so yes, a good EMPA does(not knows), 95%+ of what an EM physician does for 1/3 to 1/2 the pay. I am not saying I deserve more, I am saying physicians in general outside of the OR are overpaid in relation to what they actually produce. I am a little tired of hearing docs complain that they no longer make $300/hr. If you can't survive on $200/hr there is something wrong with your standard of living. I understand school debt. Guess what? PA school debt can run quite a bit as well if looking at undergrad + PA school loans. I appreciate what a good EM doc brings to the table and believe that they are the gold standard in emergency medicine and deserve a good wage and CAN make a difference with the sickest of patients(that 5%), but $300/hr is ridiculous. There. I said it.
( I am well aware that provider salaries are not the main driver for overpriced health care, but that is another discussion entirely).

 

[Splenda88]

Fixed that for you.
A lot of EM docs work 10-12 eight to 12 hr shifts/month . That is 144 hrs max with most working somewhere between 108-120. Yes, many PAs routinely work a lot more than this. My last group routinely scheduled the PAs to work 160-180 hours at a busy urban trauma center. I am working 224 hrs this month at a rural , critical access hospital. That is fairly typical for me. EM docs make $200 hr+. A senior EM PA might make $75-95/hr. ACEP says only 5% of ED visits are true emergencies. That means 95% of the work in the ED is primary care, urgent care, and folks who will not die in the next hour if they are not immediately diagnosed correctly and resuscitated immediately, so yes, a good EMPA does(not knows), 95%+ of what an EM physician does for 1/3 to 1/2 the pay. I am not saying I deserve more, I am saying physicians in general outside of the OR are overpaid in relation to what they actually produce. I am a little tired of hearing docs complain that they no longer make $300/hr. If you can't survive on $200/hr there is something wrong with your standard of living. I understand school debt. Guess what? PA school debt can run quite a bit as well if looking at undergrad + PA school loans. I appreciate what a good EM doc brings to the table and believe that they are the gold standard in emergency medicine and deserve a good wage and CAN make a difference with the sickest of patients(that 5%), but $300/hr is ridiculous. There. I said it.
( I am well aware that provider salaries are not the main driver for overpriced health care, but that is another discussion entirely).

Lol... More $$$ is alway good. I am making 5x of what I used to make as a PGY3 and I feel like I need to make more. I am sure you sometimes complain that you don't make enough. It's human nature.