Future of PA field

[djquick83]

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I have heard many things recently, especially that the PA field is growing rapidly from now til 2010 and that many ppl will decide to choose this career. I have always wanted to do medicine as an MD, but most Doctors I speak to say its not worth it. All those long years and in the end, PA's do many things that doctors themselves would do and make quite a good living. I have seen that first hand from shadowing a PA. Part of me says that if I make it into medicine, I shouldnt go to med school because I might regret it. The PA field might be getting hot within the next few years, and I will be much happier because I made the right career choice at the right time. This is most important for me cause I live in NYC, where If u dont make 100,000 plus, dont expect to change ure lifestyle by much. In any other state with low mortgage rates, I could make 50,000 and be happy. Its not about money, but it still is a factor when u live in this miserable city where everything is becoming costly. What would u guys say about it ? Is medicine still worth it like it was back in the 80's and early 90s when HMO's actually paid out?

 

[deleted6669]

Facts At A Glance

October 2004,

* GRADUATES ? AAPA estimates there were 50,121 people in clinical practice as PAs at the beginning of 2004.this number is expected to be 80,000 by 2010.

* MEMBERS ? 38,066 (as of October 12, 2004). The number varies throughout the year as a result of renewals, reinstatements, and as new members join.

* ACCREDITED PA PROGRAMS ? 135. Programs are accredited by the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA). (John McCarty, 770/476-1224) The ARC-PA is recognized by the Council for Higher Education Accreditation (CHEA)

The typical PA program is 24-25 months long and requires at least two years of college and some health care experience prior to admission. The majority of students have a BA/BS degree and 45 months of health care experience before admission to a PA program. While all programs recognize the completion of the professional component of PA education with a certificate of completion, more than half of the programs award a master?s degree. [87 award master?s degrees or a master?s degree option, 50 award bachelor?s degrees or a bachelor?s degree option, 6 award associate degrees, and 50 award certificates. Some programs offer more than one option.] The Physician Assistant Programs Directory is now available on line through www.apap.org at $35 for one year?s unlimited access.

* STUDENTS ? About 10,000 students are enrolled in PA programs. The number of new graduates in 2003 was approximately 4,415.

* PRESCRIBING ? Forty-eight states, the District of Columbia, and Guam have enacted laws that authorize PA prescribing. (Indiana, and Ohio do not yet authorize prescribing by PAs.)

* INCOME ? Results of the 2003 AAPA Physician Assistant Census Survey indicate that the mean total income from primary employer for PAs who are not self-employed and who work at least 32 hours per week for their primary employer is $76,039 (standard deviation $19,596); the median is $72,457. The comparable mean for PAs who have been in clinical practice for less than one year is $64,565 (standard deviation $12,562); the median is $63,437.

* OUTLOOK ON PROFESSION ? According to the findings published in AAPA?s Information Update: Projected Number of People in Clinical Practice as PAs as of January 1, 2004, 90 percent of 2003 PA program graduates were estimated to be in clinical practice as PAs in 2004. The United States Bureau of Labor Statistics (BLS) projects that the number of PA jobs will increase by 49 percent between 2002 and 2012. The BLS predicts the total number of jobs in the country will grow by 15 percent over this 10-year period.

* STATE LAWS ? All states plus the District of Columbia and Guam have laws or regulations authorizing PA practice.

* CERTIFICATION AND CME ? PAs receive their national certification from the National Commission on Certification of Physician Assistants (NCCPA). Only graduates of an accredited PA program are eligible to take the Physician Assistant National Certifying Examination (PANCE). Once a PA is certified, he/she must complete a continuous six-year cycle to keep her/his certificate current. Every two years, a PA must earn and log 100 CME hours and reregister her/his certificate with the NCCPA (second and fourth years), and by the end of the sixth year, recertify by successfully completing either the Physician Assistant National Recertifying Examination (PANRE) or Pathway II. All states require passage of the PANCE for state licensure. Forty-six states have provisions for new graduates to practice prior to passage of PANCE.

 

[djquick83]

I am aware of all the info. My question was what the ppl here on this board feel about it ? PA's and non PAs. I need some advice as my future depends on it.

 

[FoughtFyr]

I am aware of all the info. My question was what the ppl here on this board feel about it ? PA's and non PAs. I need some advice as my future depends on it.

First of all, HMOs never paid out (from your OP). What you are thinking of is back even further when 80/20 insurance dominated. And yes, medicine has changed significantly since then.

The opinions you will find on PAs will vary wildly, much as they will for MD vs. DO, or CRNA vs. MD. One thing is certain, PAs are here to stay. While there remains some ignorance by many people, both inside healthcare and out, the role they (and nurse practitioners) play is vital to the modern practice of medicine in many settings. What you need to decide is the scope of practice you wish to have. Most basic healthcare is now provided by PAs (and NPs) in many areas. They provide basic hospitalist care in the inpatient setting, provide "urgent" care in emergency departments, act to extend the abilities of FPs and pediatricians to provide primary care, and they even perform basic surgeries and scrub in as "second" surgeons on complicated cases. However, the more specialized the care required, the less of a role PAs (and NPs) play. This is your decision, the folks on this forum, or others like it, are unlikely to guide you to the right choice. Ultimately you need to decide what it is you want to do with your life... If you want to be a research endocrinologist, establishing new protocols and medication schedules, then being a PA is not likely a good fit. If you want to provide primary care, establishing a practice and seeing to the healthcare needs of your patients, then take a look at becoming a PA.

- H

 

[hospPA]

This is a long discussion, and you will get many opinions. Many docs tell me the same, "If I could do it over again" stuff. I don't know how much of that I believe. Being a doctor is harder than it used to be, and some would say it's not worth it. Obviously, I decided just that.
The decision is yours. If you must be the boss, then don't become a PA. You will never be satisfied. If you just want to practice medicine, have a good degree of autonomy, but are ALWAYS overseen to some degree by a physician and don't mind that, then PA is a viable option. I have no desire to be an MD unless the PA profession suddenly becomes undesirable or they shorten the track to it for PA's or something.
I doubt that, as the US bureau of labor statistics sees it as the fastest growing "professional" medical profession until 2010 (MA's are the first in medical, but hardly earn excellent wages). There is also a predicited physician shortage by 2020, which is more good news for PA's. We can help fill some of that void.
Pat

 

[hospPA]

Hi DJ,
I forgot to ask, what happended to your career? All of those rap hits in the 90's and now nothing? So you decided to go into medicine, what a change. I liked your stuff back then!
😉 🙂 😉 🙂 😉
Pat

 

[Febrifuge]

Hey hospPA... I work as a tech in an ED, and we have excellent PA's right there alongside the staff. But since we're also a big academic ED, we have residents galore. One observation that's been made is that, in this setting, a PA sort of becomes like a perpetual 2nd-year resident. They don't run a chunk of the department like a 3rd-year would, but then again a PA isn't training to run a whole department next year, like a 3rd-year is.

Would you say that's a fairly accurate summary of how the PA thing comes down? Autonomous, respected, totally a vital part of the team... but never the big cheese; sounds like a resident to me... 😉

Then again, my point of view is limited, and I'm interested in how PA works in other areas. To "just practice medicine" and not worry about administrative froo-fraw would be pretty awesome, I would think.

 

[J Lucas]

Hi DJ,
I forgot to ask, what happended to your career? All of those rap hits in the 90's and now nothing? So you decided to go into medicine, what a change. I liked your stuff back then!
😉 🙂 😉 🙂 😉
Pat

Thats funny

 

[hospPA]

Hey hospPA... I work as a tech in an ED, and we have excellent PA's right there alongside the staff. But since we're also a big academic ED, we have residents galore. One observation that's been made is that, in this setting, a PA sort of becomes like a perpetual 2nd-year resident. They don't run a chunk of the department like a 3rd-year would, but then again a PA isn't training to run a whole department next year, like a 3rd-year is.

Would you say that's a fairly accurate summary of how the PA thing comes down? Autonomous, respected, totally a vital part of the team... but never the big cheese; sounds like a resident to me... 😉

Then again, my point of view is limited, and I'm interested in how PA works in other areas. To "just practice medicine" and not worry about administrative froo-fraw would be pretty awesome, I would think.

I hear that resident stuff all the time seeing as I work alongside resident IM ward teams in an academic referal hospital. They say things like "ask Pat, he's been a resident for X years". I don't mind.
I would say it's more like a third year in that I am left alone for the most part, and ask questions when I need to. Some of the attendings I work around call me a "pseudo-attending", whatever that means. I think it's a compliment.
I am rarely second guessed. I do like to run things by the docs more to let them know what I am doing rather than approval. Running things by the docs helps me sleep better at night. The residents love having us around because we lighten the load for them. We enjoy a significant amount of respect from nearly all the physicians. There are some, as anywhere, who think we have no place. This is rare, and is usually the real old docs who probably should have retired 10+ years ago.
Pat

 

[deleted6669]

agree with pat on this. perpetual 3rd year resident is about right. I have interns and r2's rotate with me as their preceptor so someone must think of the pa's in our group that way. we run parts of the dept but do not have the responsibility for oversight of the whole enchilada as a 3rd year about to graduate might at some point.

 

[djquick83]

Hi DJ,
I forgot to ask, what happended to your career? All of those rap hits in the 90's and now nothing? So you decided to go into medicine, what a change. I liked your stuff back then!
😉 🙂 😉 🙂 😉
Pat

No Im not a DJ. Im actually a big fan of Electronic Dance Music so i just came up with this name. But thanx for all the info. I hate when ppl say doctors tell PA's what to do. I worked in the ICU for three years along side a PA and he did everything himself, inlcuding bed side procedures like Sawns, triple lumens, and cardiac catheterizations. He was very knowledgable and did it himself. He would then tell the attending doctor what he did and he would say ok, no problem. Thanx. Maybe not all PA's are free and able to do what he wanted, but I still think that with the amount of tiem we spend workin after we get out of school, we will know just as much as the doctors. Clinical work is all about observation and hands on learning. IMO, anybody can do it, regardless of how much they learned in medical school or not. 80% of the material is useless anyways. I would rather observe medicine and rely more on that with respect to treating my patients. Becoming a doctor was once my goal, (actually I have an interview for DO school soon) but I am beginning to reconsider it. I guess I will keep the acceptance letter to shut up all the ppl who think I wasnt smart enough to make it. Im doin PA for myself, not for everyone else. With DO, I think it would be more of what everybody else would see me as.

 

[hospPA]

No Im not a DJ. Im actually a big fan of Electronic Dance Music so i just came up with this name. But thanx for all the info. I hate when ppl say doctors tell PA's what to do. I worked in the ICU for three years along side a PA and he did everything himself, inlcuding bed side procedures like Sawns, triple lumens, and cardiac catheterizations. He was very knowledgable and did it himself. He would then tell the attending doctor what he did and he would say ok, no problem. Thanx. Maybe not all PA's are free and able to do what he wanted, but I still think that with the amount of tiem we spend workin after we get out of school, we will know just as much as the doctors. Clinical work is all about observation and hands on learning. IMO, anybody can do it, regardless of how much they learned in medical school or not. 80% of the material is useless anyways. I would rather observe medicine and rely more on that with respect to treating my patients. Becoming a doctor was once my goal, (actually I have an interview for DO school soon) but I am beginning to reconsider it. I guess I will keep the acceptance letter to shut up all the ppl who think I wasnt smart enough to make it. Im doin PA for myself, not for everyone else. With DO, I think it would be more of what everybody else would see me as.

This is what I was talking about
DJ Quik
Pat

 

[djquick83]

LOL. No, unfortunately I am not a west coast gang banger. Still pretty funny thought. LOL. 🙂

 

[girlscallmepogi]

Can PAs be as autonomated as MDs?

 

[CVPA]

Can PAs be as autonomated as MDs?

The short answer is, no

The longer answer is that there are PAs who work inner city clinics or rural clinics who may have significant autonomy. Do they, however, have as much autonomy as physicians? I guess as soon as they consult a physician that answer becomes, no.

 

[emtp2pac]

while a pa will never have the autonomy of a md/do several states have increased pa autonomy considerably in recent years.
for example:

north carolina: supervision is defined as a 30 min meeting with md every 6 months to discuss the practice without chart review.

oregon: 10% total chart review.

california: only pts given a sch 2 narcotic require chart review. if one never writes for anything stronger than vicodin essentially no oversight is required.

 

[djquick83]

MDs are so busy that even though we think they tell PA's what to do, they really dont. Hell, there is not enough time to. Im not saying its always like that, but everybody is doing there own thing and they could care less if a PA is doin this or that. Everybody is a professional and has to go along with what they are responsible for. Im not saying its cool for a PA to screw up and not have anybody say anything about it, but its expected that they know their stuff and can handle situation without constant watch from MD.