PAs work

[nev]

I think I see the light coming...I guess being a PA is what I will love to be.....
BUT FIRST...I gotta clear some cobwebs
These questions may sound stupid ...but I cant help it...so please adjust with it....
If I want to be a PA in internal medicine, how demanding is it in the US and how many hours will I have to work?

Thanks
Nev

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[deleted6669]

just like docs you can find a job with as many or as few hrs/week as desired. lots of parents work 20 hrs/week. lots of young go-getters work 60 hrs+/week.I have a colleague who works 300 hrs/month and makes more than most docs. it's up to you.the more you work, the more money you make. it's kind of like dial a salary.....ok with 40-50k/yr? work part time. want/need 75-130k+/yr? work full time with some overtime if you really want the big bucks. good luck.

 

[nev]

so r u saying that if i work for 40 hours a week(full time)...i can make at least 100K?
mmmmmmmmm..$$$$$$

 

[deleted6669]

so r u saying that if i work for 40 hours a week(full time)...i can make at least 100K?
mmmmmmmmm..$$$$$$

if you work er/ortho/surgery after 5 yrs or so, yes. starting in these specialties is around 80-85k with fairly rapid increase in salary as skills progress.

 

[nev]

when u say ortho...do u mean as a orthpaedic physician assistant or orthopaedic surgery physician assistant?.............sorry if i sound too dumb...i'm a beginner

 

[bkpa2med]

most ortho p.a.'s are also surgical p.a.'s ....

 

[deleted6669]

as above, most ortho pa's divide their time between clinic, hospital, and o.r.
there are a few optional pa residencies in ortho and many in general surgery(as well as other specialties) for a complete list with links see www.appap.org

 

[UMDeeMan]

emedpa, it's nice to see you here. PM me on the other board i have some questions for you and i need yoru guidance.

 

[nev]

I think I will work in the ER.......I just hope that ER PAs dont have to work for super-long hours

 

[Febrifuge]

I work alongside MD's and PA's in a nice big academic-center, county ED. The PA's tend to work closer to the hours they want. The residents work the hours they are assigned.

Or, you can look at it like this: the PA might never be the pit boss, because that's the 3rd-year resident's role... but the other side of that coin is that as long as there's a 1st-year around, the PA will never do a DRE.

 

[deleted6669]

I work alongside MD's and PA's in a nice big academic-center, county ED. The PA's tend to work closer to the hours they want. The residents work the hours they are assigned.

Or, you can look at it like this: the PA might never be the pit boss, because that's the 3rd-year resident's role... but the other side of that coin is that as long as there's a 1st-year around, the PA will never do a DRE.

or a medical student or a nursing student or a pa student.........

nev- hours for pa's are similar to the hours put in by er docs. you can always work part time if you want to work less. I work 18 shifts/month with a combination of 8 and 10 hr day shifts and 3 12 hr solo nights/month ( and no call!!!). some folks in the group work 10 shifts, some work 22. it all depends how much money you want/need to make.
if you are interested in the world of the em pa check out www.sempa.org our professional organization. also www.physicianassociate.com and click on the em forum.

 

[Febrifuge]

Hey, here's one for Emed and PACtoDOC (and others as appropriate), if it's not imposing. I'd like to hit you guys up for an opinion, and I think it relates to this topic. Input from others in the same boat would be cool as well.

I am among those who are bouncing back and forth, trying to get a handle on whether PA or MD/DO would be a better goal for me. I know that looking at the length of time the training takes is the wrong way to decide; it should be about the job, over the next 25 years. So I'm shadowing, talking to people, etc.

I know a lot more about what I want than I did before, and I have some rough ideas of how I'd like to practice, and what my preferences and priorities are going to be. At the moment, the world of PA is seeming pretty attractive.

But everytime I do research and learn something cool, I like to try to balance it out with perspective from people who have been there. So, if you're willing, I'd like to hear about why you've decided to move on from the PA world and go through med school and residency. I'd really appreciate any input. A reality check is always good. Thanks.

 

[deleted6669]

feb- there are really only 2 things holding me back right now from applying to a D.O. program
1. I have small kids and want to be around as their daddy
2. my "break even point" is around the time most people think about retiring:
figure em pa salary at 125k/yr x 7 yrs=875k plus cost of medschool and living expenses while in school totals around 200k=1, 075,000 minus residency salary of around 40k/yr x 3 yrs=955k. so I start practice as a doc around 1 million dollars in the red. let's say I make 200k/yr as a doc(75k more/yr than as pa). that's 13 years before I break even with where I would have been if I had stayed a pa.

I like my job but there ARE times I wish I was a doc just so I wouldn't have to deal with the hassles associated with being a midlevel. my current job is better than most so it's less of an issue now than it used to be. my scope of practice is essentially unlimited now( run codes, intubate, conscious sedation, etc) so my day to day practice would not be all that different as a doc. obviously I would "know more" and be a better clinician but for the reasons stated above I don't know if it's worth it. I might reconsider when my kids are school aged if I can figure a way to tweak the #'s a bit with a full nhsc scholarship like matt or if a DO school opens up in the pacific northwest so I wouldn't have to relocate.
I don't know your personal situation and finances but if you don't have a lot of debt or family committments at this point just do the md/do so you won't have to end up wondering "what if" for the rest of your life. don't get me wrong, pa is a great job and has worked out very well for me and allowed me to pay off all my debts and own my own house and a few cars free and clear but the top of the medical food chain will always be the physician.

 

[Febrifuge]

Good stuff, thank you. This is exactly the kind of thing.

I'll be 37 when I'm ready to apply to either type of school. I already have about $36k in loans from undergrad, though not much more debt than that, really. So my choice -- if I look just at the year 2011 -- is between being a 41-year-old intern with about $150k to $200k in debt, and being a PA with maybe $100k in debt, but one who's been working for 2 years already.

My "break-even point" (excellent concept, by the way) is a little different; even if medschool is way more expensive (and it is) it should still get paid for in the 25 or so years I'd practice... just not as soon as PA would. I figure the one thing I do not have the time to do is switch if I'm not happy the first time. So all the fretting and investigating now is to that purpose.

If kids are going to happen, it would be nice if it were sooner, like in my late 30s. It's not impossible to be a brand-new parent during residency, but it doesn't seem like the smartest thing ever.

I love EM enough that it's fair to think I am likely to stick with it. Everybody but one or two people in the ED at a given time has a supervisor, everyone consults with everyone anyway, so I guess the question mark is how important the food chain issue is going to be. Or how it would play out wherever I practice. It's unclear to me at this time, and maybe unknowable.

If I can safely assume a bunch of things: my clinical skills will improve every year; I'll be treated like a resident for a while, then treated like staff; I won't have totally ridiculous limitations placed on my pracice; I'll be able to do some teaching -- then that's one thing. But those are big "ifs," I know. But medicine in the 21st century is another animal, and PA job growth will be stupidly favorable.

When you mention hassles associated with being a midlevel, what sorts of things do you mean?

 

[nev]

thanks emedpa....now the hard part ..get into PA school!..I hope I can make that happen!

 

[ockhamsRzr]

I am wrestling with the exact same issues as Febrifuge, except that like emedpa, I too am Daddy to two baby boys and want to remain an active part of their lives.

Feb and I are the same age (34), are considering the same post-bacc program (Bennington), and seem torn between careers for many of the same reasons. Like you Feb, the list of "Ifs" you mention would seem to make my decision incredibly easy for PA (that is "IF" they are realistic, and I think they are). I too appreciate the roll of PA in patient care, love the schedule and specialty flexibility, and have an interest in teaching as well (and policy; maybe an MPH after PA).

But will I feel a ceiling not being a Doc; being the leader of the team, able to private practice and define the character of my practice--and once the kids are a bit older will I regret having not pushed now, when the opportunity has laid itself right before me (though obviously not without massive sacrifice).
I am desperately torn betwen MD/DO and PA. Then I read emedpa's posts and think that PA was made for me (many thanks to you EMedPA for your excellent posts both here and at physicianassociates.com). Yes I want patient interaction; yes I want to feel a degree of autonomy along with the on-going intellectual challenge of medicine; and yes I think I NEED the family time that PA both immediately offers and can continue to offer throughout the next decade of my life. Add the evolving and inherent on-the-job-training, residencies, ability to change specialties, fine financials, lower liability and the career looks like almost a perfect fit. Then factor the looming dread I have about committing to med school which is basically, my innocent 2year old who still thinks that I can kiss and make it better will be a frighteningly independent 10 year old and my 10 month old's formative years will be a total blur for me. Can I do that?

But the doctor thought and my damn ego. Having had a successful run as a technology producer for broadcasters during the dotcom times and ending up with a horribly hollow feeling in my soul, I can't afford to make this decision not be the right one. Knowing (we all know it deep down right?) that I can make into and out of med school, can I deal with not doing it. Will it haunt me in my mid-forties that I could've done it only to feel like maybe it's too late. Of course if I'm first assist on surgeries or loving the relationships I have with my patients in either FP or peds (yes call me crazy but I have an affinity for peds), AND teaching or working on policy, will I be too busy and happy to care?

I'm sorry that this turned into a stream-o-consciousness rant. In some ways I love my wife for saying, "this is your decision" even though I know it's not. It's about the decision I need to make to maintain a felicitous homeostasis in my life--which includes my whole family. In some ways I wish she would tell me what she wishes I would do...alas.

emedpa, thanks again for all your posts...you are a terrific ambassador for the PA profession. And Feb, one way or the other we'll figure things out. For the time being though just know that when considering my options I greatly envy that you don't have kids...I love mine (amazing understatement) but this decision would be easier without their missed soccer games in the equation.

Leaning very much towards PA,

OckhamsRzr

 

[deleted6669]

feb-
hassles of being a midlevel:
1.some pts will refuse to see you no matter how good you are and no matter how long you have practiced. they would rather seen an intern day 1 of pgy 1 yr than see you(what's sweet is when the intern brings you in to ask how to do the procedure!)
2. some docs will refuse to talk to you on the phone:
pa: well dr smith , the pt has an appy confirmed by clinical exam, labs, and ct
dr smith(surgery): which md examined this pt?
pa: none of them
dr smith: have an md examine them and have them call me(slams phone)
3. paperwork: some forms must be signed by an md only(work comp, etc) even if the pa does the whole workup.
4. referals: similar to #2 above, some specialists refuse referals from midlevels
5. having to deal with the practice styles of multiple supervisors who disagree with each other but want you to practice like they do
6. scope of practice issues in some fields. md's always get the sick pts and fun procedures
7. lack of name recognition: pa? oh you mean like a medical assistant...my cousin bessie did a 3 month class at western business college and does that too....

those are the biggies. if you find the right practice you can minimize them quite a bit.after a few years as a pa in the same setting people get used to you and treat you like a doc.
as for your other questions. yes, you will improve every day. yes, you will be allowed to gradually increase your scope of practice as you demonstrate competence. yes, you will have students to teach( pa students, med students, and residents).you can teach acls and pals too if you so desire.
feb- either choice is a good one for you at this point. if you decide to go pa let me know and I can steer you towards the good programs and away from the crappy ones.
ockham- your situation sounds more like mine. tough choice, just don't shortchange the family. my dad was a doc and I never saw him until I was 12( in his defense he did get drafted after his intern year and had to serve for 3 years as a general medical officer before going back to finish residency). no baseball games, no throwing the ball in the yard,no school plays, squat. I kind of wish he had been a pa......

 

[Febrifuge]

Thanks! This is really helpful. So how realistic is it to think that the problems might have the following solutions...

1.some pts will refuse to see you no matter how good you are and no matter how long you have practiced. they would rather seen an intern day 1 of pgy 1 yr than see you(what's sweet is when the intern brings you in to ask how to do the procedure!)

Annoying and insulting, but then again it seems like maybe these would be among the more bothersome patients to deal with, if they did stick with you. So maybe they just self-selected out of the PA's care, and thus lowered the average Gomertonin-per-pt level in that PA's day. Right?

2. some docs will refuse to talk to you on the phone: ...
dr smith: have an md examine them and have them call me(slams phone)

I work in a hospital where the EM docs have automatic admitting privileges, so it's already a totally different world. Is what you're describing too much worse than the typical argument EM docs have with the service that needs to "accept" the pt? And surely the docs and the PAs are all in the same pack, and can exact vengeance on the worst offenders. I don't like running to mommy when there are conflicts, but my impression is the bull$#!t turf war stuff is something a PA can choose to wade into or shrug off. Sounds like you're saying it's unavoidable, huh?

3. paperwork: some forms must be signed by an md only(work comp, etc) even if the pa does the whole workup.

That's a drag, but just means a rubber stamp from the doc, right?

4. referals: similar to #2 above, some specialists refuse referals from midlevels

I think my response to this would be unprofessional and immature, but heartfelt. But again, hopefully the MD/DO's in the same practice would develop a street sense about who plays well with others and who's a weenie.

5. having to deal with the practice styles of multiple supervisors who disagree with each other but want you to practice like they do

I get this now, when the nurses change shifts. Yeah, it's lame.

6. scope of practice issues in some fields. md's always get the sick pts and fun procedures

That definitely bites. Something I'll need to ask around about. But don't you do some solo overnights? I bet there's a way in any schedule to finagle some of the 'good' shifts. And sometimes our PA's pick up a new ambulance pt because they were there first. If that turns out to be the fascinating case of the day, c'est la vie.

7. lack of name recognition: pa? oh you mean like a medical assistant...my cousin bessie did a 3 month class at western business college and does that too....

I hear that loud and clear. But I guess DO's have a different version of that speech ("no, I'm a doctor; I went to med school"), and lots of people don't even know EM is a "real" specialty. I imagine everyone has to do this, at least a little. I wonder if PA's get less of the "hey, I have this rash" phenomenon?

 

[Bandit]

"2. some docs will refuse to talk to you on the phone:
pa: well dr smith , the pt has an appy confirmed by clinical exam, labs, and ct
dr smith(surgery): which md examined this pt?
pa: none of them
dr smith: have an md examine them and have them call me(slams phone)"


E--I get this allot as well. Actually, probably not a good idea--but I haVE BEEN TAKING A STAND AS OF LATRE. "dr. SO SO---THAT IS NOT HOW IT WORKS HERE. I am a credentialed provider in this er--just spent 2 hours of critical care time with your patient, now do you want to hear this or not?

The other day this PMD sent a 5 year old in for eval. Simple ****--102 temp blah blah blah X 24 hours.

I saw the child and gave her a courtisy call. "I--a DOCTOR--did not send my patient to be evaluated by an assistant." I informed her that her patient was to be follewed up toimorrow by her and if she didnt care for this discharge plan I would simply transfer her care to service. I desperatly wanted to tell her that my clinical emergency skills probably shame hers and from what I have seen out of her patients befor--they are getting better care from me.

I saw an elderly woman in her 80`s with an impressive pneumonia requiring hospitalization and the PMD told me to dischage her on keflex!

Nope, she is a keeper--I will write the holding orders for you untill morning unless you want to speak to a nurse for orders and oh yes--Keflex huh? interesting choice pal.

I have gotten grief from all these docs and from our own staff in meetings, but what the hell. I like to kick it up every now and then!

 

[deleted6669]

bandit and feb- I started a new job a few years ago with great docs, great scope of practice, etc which avoids most of the problems discussed above. when I get the occassional flack from some community hack pcp who never did a residency I have been taking a hard line as well: IF YOU DON'T LIKE MY ASSESSMENT AND PLAN YOU CAN COME EXAMINE YOUR PT YOURSELF AND CHANGE THE ODERS, OTHERWISE I AM GOING TO XYZ.
they then just agree to the plan and roll over in bed and go back to sleep. when they complain in writing to my chief he has backed me 100% of the time. one internist wanted me to do a syncope workup on every young slip and fall pt of his seen in the er even those without indication of syncope. sure...I'll do a 2 hr workup on every ankle sprain at a cost of several thousand dollars and waste the time of the entire staff doing unneccessary ekg, lab work, etc
aint happening.
way to go with the hard line attitude bandit. we have to draw the line somewhere and it sounds like you picked a worthy fight.

 

[nev]

ok.......do PAs actually have fights with doctors? I mean...is the PA some kind of a servant?

 

[Bandit]

this is actually one of the hidden truths about the profession.

First, getting physicians to agree is like hurding cats. not gonna happen. When two docs disagree---well, medicine is an art and each his/her own ptractice. If a doc disagrees with a PA it is BECAUSE he/she is a PA and they are "auotmatically" correct. Never mind that you referenced tintinalli/ sanfords guide and already ran it by ID.

 

[bemused]

First, getting physicians to agree is like hurding cats. not gonna happen.

Hadn't heard that phrase before, but it definitely fits...

 

[djquick83]

feb-
hassles of being a midlevel:
1.some pts will refuse to see you no matter how good you are and no matter how long you have practiced. they would rather seen an intern day 1 of pgy 1 yr than see you(what's sweet is when the intern brings you in to ask how to do the procedure!)
2. some docs will refuse to talk to you on the phone:
pa: well dr smith , the pt has an appy confirmed by clinical exam, labs, and ct
dr smith(surgery): which md examined this pt?
pa: none of them
dr smith: have an md examine them and have them call me(slams phone)
3. paperwork: some forms must be signed by an md only(work comp, etc) even if the pa does the whole workup.
4. referals: similar to #2 above, some specialists refuse referals from midlevels
5. having to deal with the practice styles of multiple supervisors who disagree with each other but want you to practice like they do
6. scope of practice issues in some fields. md's always get the sick pts and fun procedures
7. lack of name recognition: pa? oh you mean like a medical assistant...my cousin bessie did a 3 month class at western business college and does that too....

those are the biggies. if you find the right practice you can minimize them quite a bit.after a few years as a pa in the same setting people get used to you and treat you like a doc.
as for your other questions. yes, you will improve every day. yes, you will be allowed to gradually increase your scope of practice as you demonstrate competence. yes, you will have students to teach( pa students, med students, and residents).you can teach acls and pals too if you so desire.
feb- either choice is a good one for you at this point. if you decide to go pa let me know and I can steer you towards the good programs and away from the crappy ones.
ockham- your situation sounds more like mine. tough choice, just don't shortchange the family. my dad was a doc and I never saw him until I was 12( in his defense he did get drafted after his intern year and had to serve for 3 years as a general medical officer before going back to finish residency). no baseball games, no throwing the ball in the yard,no school plays, squat. I kind of wish he had been a pa......

Couldnt have said it better. Thats why I chose DO, even though I was hoping for PA school to workout and was prepared to become a future PA. But luckily, I got into DO school and after talking with my good friend who is a PA and another nurse, they said do it. Its a once in a lifetime opportunity that almost a thousand other ppl would kill to be in my position. Then, I realized if i had the potential to get in, I would have enough to finish and be a future doc. Im glad it worked out that way. But I learned one thing, never treat a PA like **** and same goes for nurses. We may be doctors, but we are all people with one common goal. TO TREAT PATIENTS. I have learned to respect that and give everybody the respect which I would wanna be treated with.

 

[nev]

u r a good man djquck