why not choose PA/ NP instead of MD since I start late

[NRAI2001]

You get paid alot more especially if you specialize....Where I am starting for internal med is 150 and cardio 300.....both of those figures jump by 2x at least where I am.


You are comparing a PA to a CNA?!?!? I do not see your rationale is this at all.

I love how everyone says its so easy to make 100K in sales.....ask all the people in sales who are out of jobs right now. It is not as easy as you think it is. Most people don't make it big in the business world.

I think USArmyDoc is right...if you re not 100% of going to med school to start off with AND you re a non-trad student with family its smarter to go to PA school. Most PA programs are 1.5 to 2 years in length. By the time she is done taking pre-reqs and ready to start mcat studying she could be graduating from PA school with very little debt.

PAs start with salaries around 80K but I think most PAs make low 100s after a few years...and you could always specialize in the PA fields also (surgical PAs, oncology, nephrology...etc).

---

Members don't see this ad.

 

[njbmd]

I think that the key to me in the PA/MD-DO debate is the limitation. Once a person goes to PA school she will never be a medical doctor. There is no reasonable path from PA to MD. Someone will come up with a contrary example, but, if so, that would be the far-out exception. Almost no medical school will accept a PA as a student for obvious reasons.
I don't like being limited in what I can achieve. Alright, at my age its unlikely that I will ever be president, win the Nobel Peace Prize, or argue a case in front of the Supreme Court. People who do these things usually start younger in life. But, should the need and the occasion arise I CAN do any of these things while practicing as a doctor. But a PA will never rise higher than a PA. She will never be head of the emergency department or supervise other doctors. She will never earn as much as the doctors in her department. She'll never be the attending physician for anyone. I don't like "you can't" positions. They go against my grain.

This is not true. The path to medical school after PA is the same as the path into medical school without a PA. The head of emergency medicine at GW is a former PA who attended medical school. There were 3 PAs in my medical school class who are now practicing physicians. There is no medical school in this country that will not accept a former PA into their class as long as that person otherwise meets the criteria for admission.

What's reasonable or not reasonable is in the eye of the beholder(opinion). Since a fair number of folks who were former PAs are now physicians, I certainly would not characterize them as taking an unreasonable path into medicine. There is nothing exceptional or "far out here" but people who decided to pursue medicine much as an IT professional would pursue medicine or a college professor would pursue medicine.

PAs can do anything with their degree (including attend medical school)that anyone without a PA can do. There are also plenty of PA who own and manage practice groups and in the management aspects do supervise physicians. There are PAs who run emergency rooms in many areas in this country (physician is miles away and certainly not head of the emergency room).

In terms of the practice of medicine, PAs and physicians have different roles but neither is necessarily "limited". They are complementary and one is not subservient to the other. It was a PA who taught me, the MD, how to close a chest on a thoracic case. His teaching was exactly the same as my faculty adviser's teaching on the subject. Many PAs teach physicians and medical students as part of their roles as faculty in various departments.

Entering the PA profession with the idea that it's a stepping stone into medical school is somewhat flawed unless you are otherwise qualified to enter medical school but plenty of PAs do enter medical school as do lawyers nurses and as do pharmacists (or any other profession).

The implication that being a PA is somehow "limiting" in terms of practice is not sound thinking. You clearly do not know or understand the scope of practice of either of these professions. Fortunately, I employ 3 PAs and do know their salaries and their scope of practice in my state. All three are very happy to be working in my practice.


Here's a link from a March Health Digest article: Health Digest Article on PA Profession

 

[Simplify]

those pa #s are actually low. last yrs survey of all working pa's found an avg of 86k. this #goes up about 2k/yr every yr.
2007 #s
http://physician-assistant.advanceweb.com/editorial/content/editorial.aspx?CC=108754
2008#s
http://physician-assistant.advanceweb.com/Article/PA-Salaries-by-Specialty-2008-2009-2.aspx

You're missing the point. If you don't also address changes in physician salaries since that time, a higher salary for PAs is meaningless. You have to compare salaries in the same zip code for the same time period in order to be meaningful.

I just used salary.monster.com, which is fairly accurate, and arbitrarily chose somewhere near San Diego, CA.

50th percentile PA (non surgical): $88,404
50th percentile family practice MD: $171,110

Seattle, WA:

50th percentile PA (non surgical): $93,040
50th percentile family practice MD: $180,082

I could go through every zip code in the US and produce similar wage differences between the two, but that isn't really necessary. All I'm pointing out is MDs aren't making $80k/year as a previous poster suggested unless a PA in the same area is also making an even lower salary. You won't find the cost curve of PA and physician inverted, at least not at this point in time.

As for whether to be a PA or MD that is all a matter of personal preference. If I get in this year I'll be starting med school at 31. That doesn't deter me at all. If I were 40, I might give it a second thought. To the OP, though, you have to do what is going to make you happy. Go with your gut and follow through.

 

[Nasrudin]

In terms of the practice of medicine, PAs and physicians have different roles but neither is necessarily "limited". They are complementary and one is not subservient to the other. It was a PA who taught me, the MD, how to close a chest on a thoracic case. His teaching was exactly the same as my faculty adviser's teaching on the subject. Many PAs teach physicians and medical students as part of their roles as faculty in various departments.

See. I gather you are one of those exceptional leaders who knows instinctively how to get the best work out of a health care team. I know this. Because you consistently honor the work of other team members. An indelible mark of insight par excellence.

But. As is typical with your type of physician. Is that you underestimate the effect of the dark magi in your midst. Those of you who are abusive. Subtly or not so. Maybe you have to be on the other end of the orders to get it.

This factors is heavily into where you can fit in into the schema. Which is always a pyramid of power. Always one subservient to the other. Always and forever.

Every midlevel knows it. They aren't in "The Club." Though they might share the same field of battle.

 

[BennieBlanco]

To each his own.

If you want to do more and have more responsibility / learn more, then be an MD. I personally like learning how this biological machine works and I like understanding what is happening why things go awry. More education serves this curiousity.

Knowing ONLY that drug X needs to be delivered at time Y in amount Z wouldn't be as fun for me. Although I would likely still enjoy it.

It is clear that after 8 years of training you will have more expertise than after 2. I think this is what makes jobs fun, being excellent at them and being difficult to replace.

But again, if I were only looking at financial expense #1 and income #2, I could easily chose a PA. The difference between 100-200k+ isn't that big of a difference. Both people go on vacations, just one may go on a "nicer" vacation. Both have homes, one just may have a "nicer" home. Both can feed a family, one may just have "better" food. Both have cars, one just might have a "nicer" car.

All of this stuff is insignifcant anyhow. When you are 95 years old on your death bed you aren't thinking about the fact that you had to drive to your vacation site rather than fly to an exotic beach, you are thinking about who you went on a vaca' with. You aren't thinking about your car, but what you were driving to do and with whom. Etc.

 

[QofQuimica]

Interesting. However. To me. Your flexibility in finding contentment is a good doctor trait. Intrinsically you are in sinc with your choice. My experience squiring for docs is that a good number of them are ill suited to working in health care at all. Aside from their abilities. Disposition wise.

I think there is an intrinsic match between a profession and individual if only generally so. The culture of medicine does not do the best job of matchmaking for itself.

A cat can waltz into med school without ever seeing someone ****ting all over themselves in agony. Hands clean. What sense does that make. For a profession that serves the sick.

That some people can't or won't find any contentment with where they currently are is the whole point. I would wager that many of the people you know who are miserable in medicine would be miserable in just about any job. There is a good reason why they call what you do at your job "work," and anyone who doubts that being a physician involves a significant amount of unpleasant work and administrative hassle will be in for a nasty shock.

Everything in life is a trade-off. You may not want to stay in your current career, but there are aspects of it that are better than what you will experience in medicine. We talk a lot on this forum about how it's important to be running to medicine rather than running away from your previous career. People who do the latter are quickly going to find that medicine ain't no utopia, either. There are many rewarding aspects of medicine, and there are also many frustrations. You really can't have one without the other; it's a package deal.

 

[USArmyDoc]

See. I gather you are one of those exceptional leaders who knows instinctively how to get the best work out of a health care team. I know this. Because you consistently honor the work of other team members. An indelible mark of insight par excellence.

But. As is typical with your type of physician. Is that you underestimate the effect of the dark magi in your midst. Those of you who are abusive. Subtly or not so. Maybe you have to be on the other end of the orders to get it.

This factors is heavily into where you can fit in into the schema. Which is always a pyramid of power. Always one subservient to the other. Always and forever.

Every midlevel knows it. They aren't in "The Club." Though they might share the same field of battle.

As I said before, njbmd is awesome. If you need advice, ask her.

 

[BrainBox]

I think that the key to me in the PA/MD-DO debate is the limitation. Once a person goes to PA school she will never be a medical doctor. There is no reasonable path from PA to MD. Someone will come up with a contrary example, but, if so, that would be the far-out exception. Almost no medical school will accept a PA as a student for obvious reasons.

I don't like being limited in what I can achieve. Alright, at my age its unlikely that I will ever be president, win the Nobel Peace Prize, or argue a case in front of the Supreme Court. People who do these things usually start younger in life. But, should the need and the occasion arise I CAN do any of these things while practicing as a doctor. But a PA will never rise higher than a PA. She will never be head of the emergency department or supervise other doctors. She will never earn as much as the doctors in her department. She'll never be the attending physician for anyone. I don't like "you can't" positions. They go against my grain.

Hi

I have been practicing PA since 2002. I know 5 or 6 MDs that were PAs first. The route that a PA would take to become a physician is the same as anyone else. Being a PA is not the same as being a physician. Our license allows us to do a lot. What you do depends on number of things, one being your field.

I don't see a reason for medical schools not accepting PAs into their class. The only thing that will make it harder for a PA to enter medical school would be the fact that he or she is nontraditional, therefor the number of seats per class is much less. Other then this, I doubt that they would discriminate against PAs or NPs.

I find that too many people our days talk about money first. Unfortunately, I noticed that large portion of people entering medical field as a RN, PA, NP or MD because its a "safe job." This is very sad and concerning. I hope that the admission committees for all the schools would nor accept such applicants.

I would have to agree with njbmd. Before making your decision in either direction, you would help to talk or shadow NP, PA or MD. Get their views and stories. To be happy in any profession requires it to be the right fit for you. Good luck.

 

[BrainBox]

See. I gather you are one of those exceptional leaders who knows instinctively how to get the best work out of a health care team. I know this. Because you consistently honor the work of other team members. An indelible mark of insight par excellence.

But. As is typical with your type of physician. Is that you underestimate the effect of the dark magi in your midst. Those of you who are abusive. Subtly or not so. Maybe you have to be on the other end of the orders to get it.

This factors is heavily into where you can fit in into the schema. Which is always a pyramid of power. Always one subservient to the other. Always and forever.

Every midlevel knows it. They aren't in "The Club." Though they might share the same field of battle.

Well put!

 

[deleted6669]

She will never be head of the emergency department or supervise other doctors. She'll never be the attending physician for anyone. .

There are pa only emergency depts out there with distant supervision from an md who never works there and only does chart review. in these depts the chief of the er can be a pa.
I have worked as associate chief of an emergency dept before. part of my admin. duties included hiring/firing/disciplining md/pa/np staff.
lots of pa's work as primary care providers and these patients have no other "attending physician".
don't be so quick to say what roles others can or can't fill.
I frequently teach medstudents and residents and have for over 10 yrs.
p.s. lots of pa's get into medical school. in fact 5% of all pa's end up becoming physicians later in their careers. I know many, both in person and on this board.

 

[Tangi303]

I'll be submitting my application for NP school in a couple of months. It's a career change for me and I'm excited about it. I have a PhD in the biomedical sciences and have done research for a number of years and now have an educational position. I'm applying for an NP specialty in an area of great interest to me, and aligned with my current professional interests. I look forward to working with patients and eventually being able to practice autonomously (NPs do not need to work under a physician in my state). I am old enough that medical school is not a good fit in many ways (and they probably wouldn't accept someone of my age anyway). In addition to being very interested and excited about becoming an NP, I am looking forward to having a profession where I am not on a 100% soft money salary and where I could find a job in most cities. Becoming an NP in the specialty I'm targetting will provide an adequate salary--more than I make now--and I won't have to do the infinitely demoralizing "always writing grants" thing. Grants are just harder and harder to come by and I am tired of the instability. I probably know more in biochemistry, genetics, and pharmacology than most MDs do, and I can continue to read the literature in the fields most germane to the areas I choose to specialize in as an NP. Just because one doesn't become an MD doesn't mean that there is no intellectual challenge. As an NP with my science background, I can be as expert as I want in the underlying mechanisms. And I think that every patient (in my specialty) will be a bit like a mini-experiment, as I try to read the clues and signs, make a diagnosis, and come up with the best treatment approach. I think my scientific reasoning skills will come in handy. I also like that NPs can spend more time with their patients. MDs are under such pressure to only spend a few minutes with each one. I think being an NP will allow me greater satisfaction in working with patients. With a PhD, I also have the option of becoming Nursing faculty, so it is nice to have this as a potential direction too. I'm not a "have to be top dog" kind of person, so I anticipate no dissatisfaction because I didn't become an MD. With my interests and background, I'm thinking I might combine NP practice with some university teaching and possibly do some research too.

I just hope I can get into the NP program. I do worry that my age will make them cast my application in the trash.... But nothing I can do about that. I'm trying to make my application strong in all the other ways I can.

Good luck to everyone here. I think that if you feel becoming an MD is the only thing that will make you happy in life, and you are not too old with too many financial obligations (lots of debt already, unable to save enough for retirement with the long MD training period), then go for it.

 

[BrainBox]

Hi Tangi303

written from the heart.

I wish u all the best and many happy years. I hope u get into NP school of ur choice.

 

[deleted6669]

which np field are you going to pursue?

 

[BennieBlanco]

I'll be submitting my application for NP school in a couple of months. My return key doesn't work on my keyboard. It's a career change for me and I'm excited about it. I have a PhD in the biomedical sciences and have done research for a number of years and now have an educational position. I'm applying for an NP specialty in an area of great interest to me, and aligned with my current professional interests. I look forward to working with patients and eventually being able to practice autonomously (NPs do not need to work under a physician in my state). I am old enough that medical school is not a good fit in many ways (and they probably wouldn't accept someone of my age anyway). In addition to being very interested and excited about becoming an NP, I am looking forward to having a profession where I am not on a 100% soft money salary and where I could find a job in most cities. Becoming an NP in the specialty I'm targetting will provide an adequate salary--more than I make now--and I won't have to do the infinitely demoralizing "always writing grants" thing. Grants are just harder and harder to come by and I am tired of the instability. I probably know more in biochemistry, genetics, and pharmacology than most MDs do, and I can continue to read the literature in the fields most germane to the areas I choose to specialize in as an NP. Just because one doesn't become an MD doesn't mean that there is no intellectual challenge. As an NP with my science background, I can be as expert as I want in the underlying mechanisms. And I think that every patient (in my specialty) will be a bit like a mini-experiment, as I try to read the clues and signs, make a diagnosis, and come up with the best treatment approach. I think my scientific reasoning skills will come in handy. I also like that NPs can spend more time with their patients. MDs are under such pressure to only spend a few minutes with each one. I think being an NP will allow me greater satisfaction in working with patients. With a PhD, I also have the option of becoming Nursing faculty, so it is nice to have this as a potential direction too. I'm not a "have to be top dog" kind of person, so I anticipate no dissatisfaction because I didn't become an MD. With my interests and background, I'm thinking I might combine NP practice with some university teaching and possibly do some research too. I just hope I can get into the NP program. I do worry that my age will make them cast my application in the trash.... But nothing I can do about that. I'm trying to make my application strong in all the other ways I can. Good luck to everyone here. I think that if you feel becoming an MD is the only thing that will make you happy in life, and you are not too old with too many financial obligations (lots of debt already, unable to save enough for retirement with the long MD training period), then go for it.

reread this post carefully at the beginning

 

[spudbunny]

It is good to see you posting again Nasrudin - are you applying for med school for this year's cycle?

 

[Nasrudin]

It is good to see you posting again Nasrudin - are you applying for med school for this year's cycle?

Thanks spudbunny. I'm all bright eyed and bushy tailed. Applying now.

Take it easy.

 

[Tangi303]

Thanks for the well wishes, BrainBox.

which np field are you going to pursue?

Psych

BennieB, I haven't done much psych training yet but hope to learn more later about personality disorders.

 

[BennieBlanco]

Thanks for the well wishes, BrainBox.

Psych

BennieB, I haven't done much psych training yet but hope to learn more later about personality disorders.

Hopefully they teach you about the unity and coherence of ideas among sentences, a writing tool called the paragraph.

 

[deleted6669]

psych

you might want to consider this 1 yr post grad psych residency for np's/pa's as well:
http://www.appap.org/mn.shtml

 

[BennieBlanco]

you might want to consider this 1 yr post grad psych residency for np's/pa's as well:
http://www.appap.org/mn.shtml

This also may be of interest:

http://www.writingclasses.com/

nix that, start simple:

http://www.writingclasses.com/CourseDescriptionPages/GenrePages.php/ClassGenreCode/CB

 

[QofQuimica]

Folks, please cool it with all the not-so-subtle digs. If another user's writing style or posting in general annoys you, go to your user CP and put him/her on ignore.

 

[BennieBlanco]

Folks, please cool it with all the not-so-subtle digs. If another user's writing style or posting in general annoys you, go to your user CP and put him/her on ignore.

it's all in fun Q! This is human bonding at the best. (jab strike jab)

I've never been annoyed once on this website.

And honestly, I suck at writing. I am a math/science dude. This may be validated when I get the letter behind my MCAT score.

faces are cool, i never use them

I thought the children's book writing class was a nice touch though. Oh well.

 

[BigBoi]

For me it's all or nothing! I'm 34. Love the sciences and the academic challenge that medicine embodies. I haven't really had a "real" career...was in the military for a while, got out...tried the 'CNA/GNA' can't see myself doing that till 75! lol...So knowing that I've got what it takes..., it's on from here on...I'm completing a dual major (Biology and Social Science) and studying for MCAT along the way...I MUST GIVE THE MCAT AND MED SCHOOL ATLEAST ONE BIIIIGGGGGGG SHOT...

So I say GO FOR IT DEAR!!!!! Go straight (do not stop or collect $200-Monopoly Lol...) Just Go!!!! And in a few years you'd look back and say "wow! I did it"

 

[USArmyDoc]

There are pa only emergency depts out there with distant supervision from an md who never works there and only does chart review. in these depts the chief of the er can be a pa.
I have worked as associate chief of an emergency dept before. part of my admin. duties included hiring/firing/disciplining md/pa/np staff.
lots of pa's work as primary care providers and these patients have no other "attending physician".
don't be so quick to say what roles others can or can't fill.
I frequently teach medstudents and residents and have for over 10 yrs.
p.s. lots of pa's get into medical school. in fact 5% of all pa's end up becoming physicians later in their careers. I know many, both in person and on this board.

I do not know how to say this without coming off obnoxious so I won't even try. I would not tolerate a PA disciplining me unless it was ordered by a physician higher up on the food chain......simple

Seniority rules....sorry

With that being said, I am very much into working together without throwing rank. When I am rotating and being taught by a PA, I take what they have to say at the same level of a physician. At times, I feel like they are better teachers than doctors. Nurses are even better! lol

 

[Tigerct]

USArmyDoc,

I don't think EMEDPA is trying to discipline anyone. He is just stating facts based on his experience !

 

[USArmyDoc]

USArmyDoc,

I don't think EMEDPA is trying to discipline anyone. He is just stating facts based on his experience !

He stated that part of his duties were to discipline MD/DO's and all I said was I would not put up with that as a doctor unless a physician above me ordered it.

Was there a point to putting a link in there?

 

[montessori2md]

I'm confused, I thought it was not at all unusual for non-MDs to outrank MDs in the military.

To the OP:

This is why I decided to go MD instead of PA:
"As you go through your training, you will only skim the top of a subject. You will learn what and how but not a lot of detail on why."
I don't have a science background, and I wanted the why. I've just skimmed the big 3-0, though. If I were further on in years, I might of decided the why wasn't worth it.

With all the gentleness possible on a forum, I suggest you work on your feelings about LPNs and perhaps your techniques on communication with them. Don't let a negative experience ruin an entire corps, use it as a learning opportunity if you wish to be successful, and for pity's sake, don't EVER say anything like that anywhere near an admission's interview (or a nurse of any sort, for that matter).

 

[USArmyDoc]

I'm confused, I thought it was not at all unusual for non-MDs to outrank MDs in the military.

To the OP:

This is why I decided to go MD instead of PA:
"As you go through your training, you will only skim the top of a subject. You will learn what and how but not a lot of detail on why."
I don't have a science background, and I wanted the why. I've just skimmed the big 3-0, though. If I were further on in years, I might of decided the why wasn't worth it.

With all the gentleness possible on a forum, I suggest you work on your feelings about LPNs and perhaps your techniques on communication with them. Don't let a negative experience ruin an entire corps, use it as a learning opportunity if you wish to be successful, and for pity's sake, don't EVER say anything like that anywhere near an admission's interview (or a nurse of any sort, for that matter).

Sorry if I confused you....What I am saying is if I was a physician (not in military) I would not stand for being disciplined by a PA UNLESS it was some administrative mistake that I was not aware of. That I could understand, but I would not allow a PA, NP, nurse manager etc discipline me for my medical decisions. If I am doing something wrong, I would expect a fellow physician to bring it up to me.

 

[deleted6669]

Sorry if I confused you....What I am saying is if I was a physician (not in military) I would not stand for being disciplined by a PA UNLESS it was some administrative mistake that I was not aware of. That I could understand, but I would not allow a PA, NP, nurse manager etc discipline me for my medical decisions. If I am doing something wrong, I would expect a fellow physician to bring it up to me.

most of my admin stuff with md's was being part of interview teams for new hires and on disciplinary boards for outright negligence(not intubating a pt who couldn't protect their airway or allowing others to do so despite the recommendations of multiple md and pa colleagues watching the disaster unfold that resulted in a pts death... or patient complaints regarding non-medical issues( calling a pt a "fat sow" or my favorite " you are one big family of a-holes" for example....).
the negligent physician resigned(so we wouldn't fire them). the one who was found of calling pts names had to do some "sensitivity training" to keep their job.
I didn't really enjoy the admin work and dropped the position after 2 yrs. I was doing it in addition to full time clinical practice so often was off work at 2 am and at an admin mtg at 7 am....I was recently offered the opportunity to apply for an "associate medical director" position at my current job and turned it down. another pa took it who really loves the admin side of things and she is doing a fine job.

 

[USArmyDoc]

most of my admin stuff with md's was being part of interview teams for new hires and on disciplinary boards for outright negligence(not intubating a pt who couldn't protect their airway or allowing others to do so despite the recommendations of multiple md and pa colleagues watching the disaster unfold that resulted in a pts death... or patient complaints regarding non-medical issues( calling a pt a "fat sow" or my favorite " you are one big family of a-holes" for example....).
the negligent physician resigned(so we wouldn't fire them). the one who was found of calling pts names had to do some "sensitivity training" to keep their job.
I didn't really enjoy the admin work and dropped the position after 2 yrs. I was doing it in addition to full time clinical practice so often was off work at 2 am and at an admin mtg at 7 am....I was recently offered the opportunity to apply for an "associate medical director" position at my current job and turned it down. another pa took it who really loves the admin side of things and she is doing a fine job.

Ok, I understand it better now. Some of the things you mention above deserve harsh discipline.

Thanks for clearing it up

 

[Jasil]

The largest element I would evaluate is your family and how they are affected, their dreams, aspirations, and wants. I know my wife wanted to go for med school, but after much discussion over the course of two months we decided she would go be a NP instead. We have 4 children, taekwondo, gymnastics, cheer, a 17yr old about to go to college, just so much going on to commit to the hectic crazy life of med school let alone residency.

She runs a Occ. Health Clinic now as a RN and is great friends with the MD's that come in, but with Obama care being up in the air, insurance reimbursement drama, the MD's telling her horror stories that she doesn't really want to hear, she wonders if she really would want to be a doctor in this day in age anyway. She misses the old time way of house calls and personal service......idealist!! She loves people, helping people, and making people feel better, reassurance, uplifting, consoling, etc. The money part is not even a consideration in her eyes.

I'm not sure how your family is, but for us the risk was too great for missing out on the small stuff. In reality my wife will be just as happy being a NP getting to go to a 3rd world country 1 or 2 times a year to vaccinate the poor than being a MD.

We can still raise our family and watch them grow up. Good luck!!!

 

[deleted6669]

The largest element I would evaluate is your family and how they are affected, their dreams, aspirations, and wants....
I'm not sure how your family is, but for us the risk was too great for missing out on the small stuff. ...
We can still raise our family and watch them grow up. Good luck!!!

very true...when I was about 5 yrs out of pa school I started taking my missing prereqs to apply for md( and did very well in them) but when it came down to it I didn't want to miss the kids growing up, etc
as a specialty pa there is a lot less financial incentive to get the md because I currently make more than many primary care physicians so it was always more about the job than the money.. in the long run it just worked out better to get a few interesting per diem jobs and join state. federal, and international disaster medical teams to keep myself from getting bored yet still be around for the family.

 

[markdk86]

Speaking of financial incentive, how to you all feel the PA/NP profession will be affected if/when we move to public health care? I've seen opposing arguments, saying that there will be more money available and increased mid-level providing opportunities, or the exact opposite with even less reimbursement that is seen now.I wonder if this could result in lower salaries for mid-levels?

 

[deleted6669]

Speaking of financial incentive, how to you all feel the PA/NP profession will be affected if/when we move to public health care? I've seen opposing arguments, saying that there will be more money available and increased mid-level providing opportunities, or the exact opposite with even less reimbursement that is seen now.I wonder if this could result in lower salaries for mid-levels?

I think everyone who works in medicine will take a pay cut and medical jobs of all types will remain plentiful. people will always get sick.
the high end specialists who bill for procedures will lose the most money but I think all healthcare salaries will take a dip.

 

[immanuel11421]

If we really have the healthcare reform, I know doctor will get a big pay cut. But for the mid-level healthcare worker like NP/PA, will their pay be cut to the same percentage?
Pardon me if I am missing something and not totally up to date since I have been working fulltime and studying as well and was travelling for work. Correct me for any inaccurate quote.
I heard that in socialized Europe, malpractice law enforcement is so minimal that malpractice fees is almost negligible and student pay almost next to nothing to go to medical school. People will not need insurance since everyone is under government run health plan and physician will rarely have option of private practice where they only see patients who pay out of their own pocket instead of leaving it up to government for reimbursement. Though they make less than 100k, they don't have big malpractice fees and student loan to pay back. (It still sucks to put in so much time and hardly make more than an average joe but at least they are not seriously in debt and at the same worry about being sued)

How closely are the reform be like that? Is the doctor going to make as low as those in Europe but still have the big loan and malpractice fees to pay? If so, wouldn't doctor be even poorer than the average joe?

And again, I am not totally up to date, correct me if I am wrong.

And if doctor make less than 100k, will NP/PA eventually make less than 70k?

Beside the 'everybody got insured by goverment 'and cutting wages of physician', what are some of the other deals like malpractice fees?

 

[EdLongshanks]

If we really have the healthcare reform, I know doctor will get a big pay cut. But for the mid-level healthcare worker like NP/PA, will their pay be cut to the same percentage?
?

The devil is in the details. Being that it's Washington, there are probably several hundred devils in these details. I wouldn't even be surprised if they were devils of the "Exorcism of Emily Rose" variety.

On of the reasons that I think that this reform effort will ultimately fail to pass anything significant is because the devils have been allowed to have their way. In other words, the lobbyists are running wild. There are lobbyists in Washington right now who are trying to get Anesthesiologists the best deal while stabbing the Radiologist Lobby in the back. Meanwhile the Unions don't want to lose their recruiting advantage while the large corporations would love to get someone, anyone, to take their medical insurance nightmare off of their hands. The Insurance companies want to pay Medicare Rates while the rural Hospitals want Medicare to bus every Granny and Grandpa to the city.... etc etc.

The current system has lots of inequities. A young child with Juvenile Rheumatoid Arthritis cannot get Enbrel if his parents don't have good insurance while some people can get yearly Rooster Boosters.

Those of us who work in medical insurance know how complex the whole crazy system is. But, on the other hand, this very complexity is what keeps us on top of the pile. No other company really understands it.

No one seems to be able to come up with a SIMPLE system that could replace it. There is no positive rallying cry. Every reason to reform the system is negative. The insurance companies are bad; the drug companies make too much; the rural doctors don't get paid enough. But until someone can describe the system that will replace this monstrosity the American people are left with ---- "The Devil you know"

Is that enough Satanic imagery in one post? We are talking about politicians, after all.

 

[shouldvestudied]

No one seems to be able to come up with a SIMPLE system that could replace it.

Sorry, brother. There is a very simple solution. It's single payer. Or if you insist on keeping insurance companies around, a Germany style program works just as well. Either way, there have been very plausible fixes suggested that are scoffed off the table by the MSM and politicians who's political lives depend on contributions from Big Pharma and Insurance Companies.

 

[EdLongshanks]

Sorry, brother. There is a very simple solution. It's single payer. Or if you insist on keeping insurance companies around, a Germany style program works just as well. Either way, there have been very plausible fixes suggested that are scoffed off the table by the MSM and politicians who's political lives depend on contributions from Big Pharma and Insurance Companies.

Yes, the single-payer system is simple enough. Unfortunately, there's a few simple objections to it that most americans can understand. For example, do I really want to replace an insurance bureaucrat with a government bureaucrat?

I doubt that anyone disagrees that the current system is a mess. An example that I know personally shows this. A family made a mistake and became uninsured for a year. The son got appendicitis and they ignored the early symptoms because they didn't want a huge doctor bill. As a result, they ended up with a huge surgery bill from a burst appendix. The state medicaid ended up paying for the surgery. Earlier intervention would have saved everyone money.

That's a mess. It's the result of the system that grew out of the World War II wage and price controls (another government mistake). Some conservatives are pushing the Medical Savings Account solution. I can foresee some problems here also.

Here's one idea that I haven't heard anyone propose. What about two-tiered system for everyone. Free government clinics for minor and minor urgent issues - colds, simple fracture repairs, cuts, abrasions, regular checkups, prescription refills, etc. Then have a required MSA (non-government) major med coverage for everyone with tax rebates for the working poor. The non-working poor can use the free-clinics as an entree to the hospital, just like they do now.

Doctors, PA's, and nurses could be required to put in so many hours each year in the free clinics as part of their license requirements. It probably wouldn't be that onerous of a burden.

 

[shouldvestudied]

Yes, I would rather have a government bureaucrat deciding whether or not I get my shoulder surgery compared to a health insurance employee whose yearly bonus relies on denying a certain number of claims.

 

[EdLongshanks]

Yes, I would rather have a government bureaucrat deciding whether or not I get my shoulder surgery compared to a health insurance employee whose yearly bonus relies on denying a certain number of claims.

I'm not aware of that system of bonus payment. I'm one of the maintainers on the premium software in the world that is used by insurance payors and I can state with confidence that it doesn't do that calculation. My company hosts one of the largest insurance companies in the world and that report is never run on our systems. The only bonus system that I know about is based upon number of claims adjudicated - not denied.


People can differ on who they want deciding their care. The best system would be one where everyone decided their own. Somehow the system has to balance everyone's need against the scarcity of equipment and personnel. I, personally, am not a great fan of the U.S. government's tight-wire walking ability. But democracy will decide. Right now I doubt that most voters will prefer the government option - but I could be wrong.

 

[shouldvestudied]

Right now I doubt that most voters will prefer the government option - but I could be wrong.

3/4 Americans supports the creation of a Public Insurance Option.

http://www.huffingtonpost.com/2009/08/20/new-poll-77-percent-suppo_n_264375.html

A majority of Americans even support single-payer.

http://www.wpasinglepayer.org/PollResults.html

I'm not aware of that system of bonus payment.

http://www.cga.ct.gov/2008/rpt/2008-R-0071.htm

A California denial case where it was discovered that Health Net was giving bonuses for denying coverage.

 

[EdLongshanks]

3/4 Americans supports the creation of a Public Insurance Option.

http://www.huffingtonpost.com/2009/08/20/new-poll-77-percent-suppo_n_264375.html

A majority of Americans even support single-payer.

http://www.wpasinglepayer.org/PollResults.html



http://www.cga.ct.gov/2008/rpt/2008-R-0071.htm

A California denial case where it was discovered that Health Net was giving bonuses for denying coverage.

Those polls are from biased sources and pretty flawed. The California case is the exception not the rule.

 

[jl lin]

I have done volunteer work. Maybe not the right one. I volunteered in hospital in Brooklyn and I told them I want direct patient contact to maximize the 'experience'. I ended up getting abused by LPNs doing their dirty work while they chit chat.
Stupid nurses who got the nerve to blame me when she couldn't find her menu after I picked up lunch take out for her.
I learn nothing but really resent the LPNs and the nurses.
What's the right place to volunteer n maybe I should ask for different department?

Sorry you had some bad experiences. Not all nurses are like that. Do you think you might like kids? I've worked at children's hospitals in critical care. Usually they have child life departments. Try to volunteer through them--and then go help out in the various areas--including critical care. You will find more professional models for nursing. Even if the nurse-to-nurse cattiness (which today is often more behind the scenes but is no less a pain) is still there.

Don't take resentment toward nursing with you. First, they all aren't like that. Second, you have to learn to work with them as a team. There are plenty of other good reasons too.

If I read one more absurd thing about residents getting stupid pages and calls, I just may scream. Why? Honestly, most nurses, including myself, do not call the on-call person unless we have to do so. I certainly get no joy in waking someone up--especially some poor surgical resident that has to get up at 4 or 5 anyway, round by 6 and be in the OR around 7--and who has killed herself or himself working 70-80 hours already. But if I have to call you, it is b/c there is a need the patient has, and I either need you to come down, up, or over and help me hone in on what is going on with the crashing patient and give appropriate orders, or my (and your) pt is in pain and even the break thru meds aren't cutting it for him or her. . .or the poor patient is so stressed and tired and needs at least one night of sleep and someONE FORGOT to write for sleeping med orders--even after "last call rounds" (and then I got busy and didn't see that you didn't write for them).

Our patients have needs and they need to be addressed--LEGALLY. So, no, I can't forge an order for you or just pull a narc out and give it without appropriate orders.

And for the patient that is really dumping into his/her chest tubes in getting closer and closer to compromise, well, no. Guess what? The blood bank won't send me some packed cells and FFP just b/c I say my patient really needs such things--even if they know me and fully trust my knowledge and experience as a critical care nurse. BTW, if that is the case, your behind (covering resident or fellow) should be there to assess as well. Uh. . . Makes sense, No? And no, we won't take orders from a medical student--only from the appropriate signed-on resident, fellow, attending, NP or PA--and the latter two depends on the area and the policy in place.

So no, most of us good nurses aren't calling you just to be stupid or b/c of some sick sense of humor or b/c we are pizzed at you. If there is a pt need, as physicians or future physicians, you must learn to listen to caring, on-the-ball nurses that are there with your patients nonstop and see even the most subtle of changes many times, way before you may.

I haven't met a whole heck of a lot of stupid critical care nurses--usually if a RN in this area isn't swift enough, he or she is weeded out--or sometimes it can be a matter of weeding if some nurses don't like another nurse. Yea, it's stupid, but it happens. Mostly, however, critical care nurses in time learn a lot and have to be reasonably bright and vigilant to work in the area of intensive care/critical care nursing or emergency nursing. Many physicians realize this.

And really it just isn't wise to carry that negative attitude with you. You really don't want to get nurses against you in general. Trust me on this; it is very unwise.

 

[QofQuimica]

I haven't met a whole heck of a lot of stupid critical care nurses--usually if a RN in this area isn't swift enough, he or she is weeded out--or sometimes it can be a matter of weeding if some nurses don't like another nurse. Yea, it's stupid, but it happens. Mostly, however, critical care nurses in time learn a lot and have to be reasonably bright and vigilant to work in the area of intensive care/critical care nursing or emergency nursing. Many physicians realize this.

And really it just isn't wise to carry that negative attitude with you. You really don't want to get nurses against you in general. Trust me on this; it is very unwise.

We are going totally off topic here, but I have to agree that critical care nurses tend to be among the best and brightest. They are also friendly on the whole, and the ones I worked with went out of their way to help me on my ICU rotation. My experience in general has been that most nurses are just there to do their job. Plus, the ones who have been around for a long time know a lot more about many things than med students or even junior residents do. The oldtimers can really teach you a lot if you're not too proud to ask them.

Probably the simplest thing you can do to improve relations with the nurses as a med student or resident is to take two seconds at the start of your rotation to introduce yourself and get their names, too. It's a lot harder for people to take out their frustrations on you when you're Bob or Mary compared to when you're just some anonymous, standoffish med student or resident. You can't go wrong saying please and thank you when you ask for their help, either.