Seeking advice: Clinician Career Change at 45?

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To the OP:

If I were in your shoes I would go to law school or become an actuary (which you can do incrementally and earn while you learn.) Both fields earn good coin and will take you far less time to break into. If you decide health care is right for you, good luck.

Thanks for the suggestion AegriSomnia. I looked into law school. While it would be more expedient, there is significantly less job security in law than in healthcare.

Many of the lawyers we know are going back to school to become MDs or other roles in healthcare.

In fact, one of my kids' doctor is an ex-lawyer, the other is an ex-Wall St. finance analyst. Our Opthalmologist (sp?) is also an ex-lawyer.

In law, those that are between 21 and early 30s (at the latest) with LSATs that will get them into the top 14 law schools stand a chance to make good money.

My wife's in-law is a lawyer from a top 14 law school, and had been working for a top 20 U.S. law firm before his job was eliminated along with 2/3 of the staff in that department.

Our neighborhood is filled with lawyers, engineers, architects, and professionals of numerous fields whose jobs have been off-shored to places like India, China, etc. and/or replaced by H1B visas.

Most are looking at new careers that are more difficult to send overseas and are more accepting of an older workforce, hence three common areas are education, healthcare, and government.

For those with 2nd careers in education, there are problems with social security down the road.

Most opt to retrain for healthcare. Thus far, since 2008, of the people we know that had other professional degrees, 4 are now nurses, and 8-10 others are retraining mostly as RNs.

One thing in common that all of these professionals agree upon now that they're working as RNs, is how much easier to train and work in the profession compared to their previous professions.

I suspect that's why the waiting list around here has grown from 2 to 5yrs for some schools.

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I'm quite fascinated by this thread.

Firecloud, you seem to have done quite a bit of analysis. Have you calculated how Obamacare might throw a monkey wrench into your calculations?

If you go to some Asian countries where they have nationalized healthcare, people go into professions like nursing and medicine knowing that they will never make the big bucks. But there is not shortage of people wanting to go medical or nursing schools; they have more of a missionary mentality.

I'm thinking that if we ever get nationalized healthcare in this country like it is administered in Asia, we will see a lot of people quit (many the ones in it for pecuniary reasons), a generation's worth of staffing shortages, and then a re-staffing of the industry with new grads who have the missionary mentality I mentioned above.
 
the kink in the plan is that it will take 2 years to get the prereqs out of the way, and then who knows how long it will take for him to get into school. everyone thinks that they can get into pa school by taking the minimum prereqs, but that is only the beginning. schools expect you to have a decent enough science background to understand some heavy concepts. you dont get that just from prereqs. then, if you can get into a school you have to face 2 years of study. durring that time you have tuition you have to pay back, and 2 years of lost income. im not sure the poster has really thought about things beyond the fact that he hears "there are plenty of jobs in healthcare, come get them". even in healthcare, there are easier paths to take that cost less.
 
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the kink in the plan is that it will take 2 years to get the prereqs out of the way, and then who knows how long it will take for him to get into school. everyone thinks that they can get into pa school by taking the minimum prereqs, but that is only the beginning. schools expect you to have a decent enough science background to understand some heavy concepts. you dont get that just from prereqs. then, if you can get into a school you have to face 2 years of study. durring that time you have tuition you have to pay back, and 2 years of lost income. im not sure the poster has really thought about things beyond the fact that he hears "there are plenty of jobs in healthcare, come get them". even in healthcare, there are easier paths to take that cost less.

So Firecloud is doing PA? Interesting, I know a PA who is currently doing his ADN right now so he can eventually lateral over to CRNA. CRNA "make better bank than PA" according to him.
 
So Firecloud is doing PA? Interesting, I know a PA who is currently doing his ADN right now so he can eventually lateral over to CRNA. CRNA "make better bank than PA" according to him.

The average CRNA does make more than the average PA, but there are areas of the PA profession such as CV surgery where the salaries are comparable. I find it unlikely that someone is going to pay for an ADN, then work as a nurse (if they can find a nursing position) in an ICU for 1-2 years (usually needs a couple of years on the floor to get) all the while making less money than as a PA. All of this for a chance (not a guarantee) that they will get into PA school. If they really wanted to do anesthesia they could do AA in half the time with a better chance. Like I said, unlikely.

David Carpenter, PA-C
 
I'm quite fascinated by this thread.

Firecloud, you seem to have done quite a bit of analysis. Have you calculated how Obamacare might throw a monkey wrench into your calculations?

A concern, but not much of a disincentive. It's just a matter of perspective. If you were a programmer that lost their job to outsourcing year after year (not my case, but I've seen it happen to others) you may appreciate a profession with more relative stability.

Pamac, just 2 years of lost income eh? On this most recent downturn I'm 18 months in on lost income already. Yes, I just landed my next gig that'll be around for 2-3 years tops as the technology already exists to devastate that job category and eliminate it altogether. It's happening right now, recently HP announced 9,000 more job cuts and over the last few years went from 85 data centers employing thousands to 6 data centers. Break out your calculator and calculate for me the number of jobs lost there. Technology is a very "dynamic" field. Jobs are constantly lost in mergers, acquisitions, divestitures, offshoring, outsourcing, contractors, flex staff, consolidation, insourcing, etc. Ageism is also extremely active in IT. It's very rare to find programmers or other IT pros in their 50s and 60s, and most people need to work until 65 or 67.

In my opinion, 2 years of lost income in exchange for relative stability of work for the next 20yrs is well worth it.

even in healthcare, there are easier paths to take that cost less.

Pamac, I'm all ears. Fire away...

I'm taking pre-reqs, PA would likely be final destination, but it may come via RN route. I concur with the CRNA comments. We know one personally, and they came to it via a non-nursing profession. From another industry / profession that has been completely devastated by automation. More than a decade ago it was considered a profession and people made good money in that field. Today, while the training is the same, the pay is ~$30k +/- $5k. It's still considered a "professional" career.

core0,

True, but as was discussed in this thread, with an AA you can work in 18 states, with a CRNA you can work in all 50. AAs can't work in the state I live in.
 
Firecloud,

I'm glad that you got another gig recently. Going without money for 24 months is no fun. I'm confused about why you would want to get an RN before going to PA school though. Would it not be more beneficial for you to just apply for PA school right after you finish up your prereqs, so you can start bringing better money 2-3 years down the line? RN salary is about 1/2 PA salary too right?
 
core0,

True, but as was discussed in this thread, with an AA you can work in 18 states, with a CRNA you can work in all 50. AAs can't work in the state I live in.

My point is still the same. To expand the the PA salary range has considerable overlap with the CRNA salary range. If all someone wants to do is "make bank" it not hard to do as a PA. For example if someone drawing the "average" PA salary of $93k they could work an extra 10 hours per week at urgent care and be near MGMA median compensation for CRNAs. The other thing to remember about the CRNA data is that it is right shifted in age compared to PA salary profiles and that there is a bimodal distribution in CRNA salaries compared to PA salaries (the 25% of rural CRNAs make much more than the 75% of urban/suburban CRNAs). All of this means that the salaries that are "published" are generally not representative. For the most part an experienced PA in a specialty will make comparable money to a new grad CRNA outside of rural areas.

For example if the PA that adayatatime "knows" took the hours for ADN school and worked those in urgent care then their salary would far outstrip what they made as a CRNA. Basically its silly to take a well paying job that has the potential to "make bank" and take a chance a) getting into an ADN program b) the salary hit during the CRNA program c) trying to get into a very competitive CRNA program while d) taking another salary hit while in CRNA school only to make the same amount of money. On the other hand human populations are defined by the outer 2.5%. If someone is not really a good PA they might believe this is a good plan.

Its essentially the same reason that it would not make financial sense for most experienced PAs to go to medical school. The opportunity cost would take too long to pay back.

David Carpenter, PA-C
 
Its essentially the same reason that it would not make financial sense for most experienced PAs to go to medical school. The opportunity cost would take too long to pay back.

yup, tell me about it....I still keep thinking about it though, especially with the new bridge program....
 
Firecloud,

I'm glad that you got another gig recently. Going without money for 24 months is no fun. I'm confused about why you would want to get an RN before going to PA school though. Would it not be more beneficial for you to just apply for PA school right after you finish up your prereqs, so you can start bringing better money 2-3 years down the line? RN salary is about 1/2 PA salary too right?

Adayatatime,

I can understand the confusion. Here's the reason. If you, or anyone else reading this has a better suggestion / approach, I'd certainly be open to any reasonable advice.

It may help to understand the background basics. We live in northern California with 3 children under the age of 9. We have no relatives in this region.

If I were single, it'd be simple. Take ~ 4 pre-req classes, apply to 140 PA programs around the country, and go wherever I'm accepted. Take out student loans, graduate, get a job, pay them back.

With a family, home, and current economic environment, it's a bit more complex.

My wife is also retraining for RN from another industry. She's down to her last few non-nursing pre-reqs, has taken the TEAS, and is applying this year for an ABSN that's about a year long.

The program I'm gunning for has pretty strong clinical requirements. Here's the link. Sure, some people get in with minimal clinical experience and excellent background, but I'm trying to position myself as well as I possibly can. Will I apply once I meet the educational pre-reqs? Yes. Do I think I'll get in on that basis alone? No. For this school, the odds are best for those that bring the education, a second language, and 4,000+ hours of clinical experience. That's a couple of years of full-time work in healthcare.

With that being the case, and having a family to support, I'll likely have to do something else in healthcare to pay the bills and get the experience. EMT on weekends won't get it done, nor would most healthcare jobs - phlebotomy, CNA, EMT, etc. The pay is too low to support our family situation.

Around here, nurses are paid very well. We know more than a few. Yes, PAs make more, and like I said, that's my ultimate goal, but I don't have the clinical experience and the program is 27 months long. So I need to find something in healthcare to get the experience, and it has to pay well enough to support a family.

All that being said, the plan is for my wife to finish her 12 month ABSN while I work (in non-healthcare profession) and take pre-reqs for ABSN at night (6 done, and 8 to go). By the time I'm done with the pre-reqs, she'll be done with her ABSN and working full-time (hopefully), and if everything lines up I'll be entering an ABSN program at that time. A year later I'll have the RN (and hopefully a job).

While working as an RN I'll continue applying to the PA/FNP program. If accepted, I can potentially end up with MSN FNP and PA. If I get accepted before the ABSN (doubtful) then I just go straight into the program.

In the meantime, we'll both take EMT training, volunteer in clinical settings, etc. to beef up the resume.

I heard about the PA to DO bridge... maybe I should wait for the MBA to PA bridge - they both have an "A" - bridge me! :p
 
core0, emedpa,

That's exactly how I've always calculated whether to make a change or not. When I was accepted to a top 15 MBA program, I could have gone full-time, but I was already making six figures. The opportunity cost was too great, so I went to the top part-time program in the country in the evenings while working full-time during the day.

I don't regret the decision, but over the years I've wondered about it. I could have gone to a higher ranked full-time program (yes, at a very steep cost, specially since my employer paid for my MBA), and perhaps the outcome would have been different. It's not news that a Stanford, Harvard, Wharton, Columbia MBA is more highly paid than one coming out of lower ranked (relatively speaking) schools (though we're talking top 15 schools in the nation here) among the top 20.

All the years I was working my opportunity cost was simply too high to justify leaving a six figure paycheck for another career. Today, I don't have that problem. I'm a complete wild card! :)
 
that actually is a respectable plan, and a better one than banking on getting into a school with just the minimum prereqs, which is what i thought you were going to try to do. i think the pa route is better than trying to do np because of the education that a pa program would give you. i talked to a brand new np today and she told me how she was intimidated by what she was doing. she had several years experience in a tough field in nursing, so its not like she was even new to medicine. i can imagine how hard it would be to do something like an accelerated nursing program and then move into np right after and then start treating patients. but i do think nursing would be a good foundation for PA as long as you had some biology in there to bolster your knowlege base. if you are going to go into it, go in with both barrels through nursing. i get kind of tired of reading peoples comments about how they want to graduate from some unrelated or watered down near science degree then work as a cna for the minimum time and then get into PA school. who wants that person looking over thier charts?
 
I guess you put "knows" in quotation marks because you suspect I am making this up. I can't answer to why the PA doesn't do what you say and simply make bank in his current profession. What I have heard from him is that he has spoken to CRNAs that he knows and some that he works with, and their lifestyle appeals much more to him. Currently he still works full time as a PA while doing the ADN program, so the only hit would be CRNA school.

For example if the PA that adayatatime "knows" took the hours for ADN school and worked those in urgent care then their salary would far outstrip what they made as a CRNA. Basically its silly to take a well paying job that has the potential to "make bank" and take a chance a) getting into an ADN program b) the salary hit during the CRNA program c) trying to get into a very competitive CRNA program while d) taking another salary hit while in CRNA school only to make the same amount of money. On the other hand human populations are defined by the outer 2.5%. If someone is not really a good PA they might believe this is a good plan.
 
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We know a PA and CRNA and I understand what he means by "lifestyle".

The PA we know back east makes $85 base with OT and bonus in low six figures. The work approximately 12-14hr/day 5-6 days a week.

The CRNA we know makes six figures base. She works 3 days a week. Two days in the hospital and one day "on call" in which she is at home. As we understand it, she clocks 36 hrs. She is on the same medical plan as the doctors in the hospital and gets medical benefits coverage for life after 10yrs.

She tells us that the hospital where she works is not all that busy. She may have 1-2 patients a week on average. Sometimes it's busier, but not often. She also tells us that on her 12hr shift in the hospital, it's not 12hrs working. She sleeps there, and they wake her if they need her, which they don't on most days. Many days she has no patients and is just on standby at the hospital, so she reads quite a few books every week. Her hours are flexible with the ability to switch her schedule with other CRNAs and take a week off whenever desired.

On the lifestyle side, it's like watching lifestyles of the rich and famous with frequent trips, vacations and getaways. I doubt many doctors have as much free time. They may have the money, but week to week they just don't have (2) 12hr shifts (during which they get to read and sleep), (1) day at home (she has rarely ever been called in), and (4) days off.

I mean really, how many professions in America can one do this? Fireman perhaps? Police? They wouldn't make as much though, but they may be able to pull off the time.

So now my wife is retraining. All the other nurses kept telling my wife how difficult the path to be an RN would be - taking Chem, A&P, etc. - she's now completing her pre-reqs - every single class has been an 'A'. Not all that difficult compared to engineering and other coursework I suppose. Maybe they mean the 12 month nursing school itself?

Anyway, my wife also volunteers at a hospital and sees 1st hand the nurses chatting, not working, etc. Must be due to California's 4:1 ratio and/or the less densely populated area that we live in. We remember nursing in NYC and those nurses worked like there was no tomorrow.

We just can't think of other professions where so few hours are worked for the pay received in a nice, clean, hospitable, welcoming environment.

She also hears all the complaints nurses have, and always asks them, what career they had before nursing, those that had none were the ones that complained most, those that had other careers complained least, in fact, they rave about it. We guess that it's because they know what it's like outside the healthcare bubble.

Personally, if I was female, the RN / CRNA track may be more attractive. Don't misunderstand me, nothing wrong with being a male RN, and something like 40% of CRNAs are men, so I get it, and yes, I love women, but most women and I think very differently, so being in an environment (RN) that's 90% women, may not be best for me long term. My sense is that PA is a bit more balanced (closer to 50/50) which I would prefer, but I could be wrong.
 
I don't know what kind of hospital where the RNs just sit around. Everywhere I've been they work their @sses off. The CRNAs much less, but still more than 1-2 patients on average.

We know a PA and CRNA and I understand what he means by "lifestyle".

The PA we know back east makes $85 base with OT and bonus in low six figures. The work approximately 12-14hr/day 5-6 days a week.

The CRNA we know makes six figures base. She works 3 days a week. Two days in the hospital and one day "on call" in which she is at home. As we understand it, she clocks 36 hrs. She is on the same medical plan as the doctors in the hospital and gets medical benefits coverage for life after 10yrs.

She tells us that the hospital where she works is not all that busy. She may have 1-2 patients a week on average. Sometimes it's busier, but not often. She also tells us that on her 12hr shift in the hospital, it's not 12hrs working. She sleeps there, and they wake her if they need her, which they don't on most days. Many days she has no patients and is just on standby at the hospital, so she reads quite a few books every week. Her hours are flexible with the ability to switch her schedule with other CRNAs and take a week off whenever desired.

On the lifestyle side, it's like watching lifestyles of the rich and famous with frequent trips, vacations and getaways. I doubt many doctors have as much free time. They may have the money, but week to week they just don't have (2) 12hr shifts (during which they get to read and sleep), (1) day at home (she has rarely ever been called in), and (4) days off.

I mean really, how many professions in America can one do this? Fireman perhaps? Police? They wouldn't make as much though, but they may be able to pull off the time.

So now my wife is retraining. All the other nurses kept telling my wife how difficult the path to be an RN would be - taking Chem, A&P, etc. - she's now completing her pre-reqs - every single class has been an 'A'. Not all that difficult compared to engineering and other coursework I suppose. Maybe they mean the 12 month nursing school itself?

Anyway, my wife also volunteers at a hospital and sees 1st hand the nurses chatting, not working, etc. Must be due to California's 4:1 ratio and/or the less densely populated area that we live in. We remember nursing in NYC and those nurses worked like there was no tomorrow.

We just can't think of other professions where so few hours are worked for the pay received in a nice, clean, hospitable, welcoming environment.

She also hears all the complaints nurses have, and always asks them, what career they had before nursing, those that had none were the ones that complained most, those that had other careers complained least, in fact, they rave about it. We guess that it's because they know what it's like outside the healthcare bubble.

Personally, if I was female, the RN / CRNA track may be more attractive. Don't misunderstand me, nothing wrong with being a male RN, and something like 40% of CRNAs are men, so I get it, and yes, I love women, but most women and I think very differently, so being in an environment (RN) that's 90% women, may not be best for me long term. My sense is that PA is a bit more balanced (closer to 50/50) which I would prefer, but I could be wrong.
 
"I mean really, how many professions in America can one do this? Fireman perhaps? Police? They wouldn't make as much though, but they may be able to pull off the time."

firemen, maybe... police, certainly not. my family is full of cops and they work thier butts off. thats not an easy job carrying 20 pounds of gear getting in and out of cars and running people down. the stress alone is like nothing else. but firemen... we should all be so lucky.

i also havent seen nurses sitting around much unless its between tasks, and even then they are at the beck and call of all sorts of things beyond thier control. the pa i shadowed this week didnt get a single break all day... she charted when she was able to sit. it probably looks like they are sitting around from your wifes position because she has no experience. i know i thought that before i started in healthcare.

before you jump into this, you have to understand that the bad and boring parts will likely be the norm and the relaxing book reading/sleeping will be the exception.
 
Pamac,

I doubt my wife is in error here. They weren't "charting", they were talking about their weekend, plans for next weekend, etc.

Besides, we've seen the difference between nurses working in NYC and CA. In NY they work like dogs - there is no 4:1 ratio. Here, it's very sweet.

In NY the times we've been in the hospital we were crammed into rooms with as many other patients as they could physically fit. Here, on the 2 occasions we were in the hospital, we had rooms all to ourselves. Rooms where they'd fit at least 6 patients had it been NYC.

We don't just observe it from working in the hospital or being a patient, but from being told 1st hand what it's like to be a nurse where we live from many others who are working nurses.

Maybe in L.A. or S.F. or other major cities throughout America it's that busy. Here's it's just not busy. I'll use the example of the birth of my children.

When our 1st was born in NYC. There were at least 50 babies in the nursery. By the end of the first 24hrs those 50 had largely cleared out and another 50 had taken their place (we were there longer than usual due to complications). During the actual birth (with the head showing), the doctor left to get the nurse who had left to get the anesthesiologist. It was just my wife and I - she was scared to push with my being the only one in the room, though I had no problem with it.

When our 2nd was born in CA, the doctor, nurse and anesthesiologist or CRNA whatever - all 3 were there during the whole process. When I went to check out the nursery there were 3 children in total. I walked around the whole floor with my wife and there was nothing but empty room after empty room. The whole thing was strange to us.

Our 3rd was born in a different CA hospital, same story as the 2nd birth. There were a few more babies in the nursery ~10, and they explained they'd been "really busy".

And from our perspective, there's absolutely no doubt for us, that the pace of life here is a lot slower. In NYC where we lived for over 30yrs it's frenetic - a quick hot dog or slice of pizza on the run / walk or standing is lunch. Here, people actually go to lunch - no hot dog on a sidewalk from a cart vendor, no slice of pizza, and we rarely if ever observe people eating while working at their desks.

Don't get me wrong, we love the slower lifestyle - even if it is as boring as watching paint dry sometimes, but there's no doubt nurses here have it a lot easier than nurses in NYC.
 
well, i live in a state that probably would seem even slower to you than california, and most days i dont even get lunch because I'm so busy. you may wonder how that can be since you know that there are laws against that kind of thing... well, because thats just how it is. do i like it? no. do i want to make a stink about it? nope. and my wife works in another coveted healthcare field completely separate from me and works her tail off as well. and we look at nurses and wonder why they want to go through all that for a job.

and that 4 to one ratio you keep talking about... that can keep you really busy. i dont know why you are stuck on it like its so weak sauce. i dont know that it even exists. all i can say is that i think you dont know much about healthcare, but hear a lot of stories and have a lot of anecdotal evidence you take as gospel.
 
healthcare is the new gold rush. right before i got out of school everyone was talking about how money and tons of options were out there. im still in a better spot than most, but its not like it was even a few years ago.

when a facility is empty, admin cuts back on hours. if it stays that way, they cut back on FTEs. someone not keeping busy is a tempting target for a doctor or an administrator. they dont pay you to do nothing. the money to justify an empoyee has to be there, it doesnt just rain down.
 
well, i live in a state that probably would seem even slower to you than california, and most days i dont even get lunch because I'm so busy. you may wonder how that can be since you know that there are laws against that kind of thing... well, because thats just how it is. do i like it? no. do i want to make a stink about it? nope. and my wife works in another coveted healthcare field completely separate from me and works her tail off as well. and we look at nurses and wonder why they want to go through all that for a job.

and that 4 to one ratio you keep talking about... that can keep you really busy. i dont know why you are stuck on it like its so weak sauce. i dont know that it even exists. all i can say is that i think you dont know much about healthcare, but hear a lot of stories and have a lot of anecdotal evidence you take as gospel.

A pace of life slower than northern California? I can't even imagine it....

You're right about that - I don't know much about healthcare - in fact, I know nothing about it - that's why I have to take the 1st hand accounts of RNs that we know. I have little reason to call them liars, and they are the ones that state before the ratios it was much worse to be a nurse.

What's the patient to nurse ratio in your state? Is there even a law in your state that mandates a ratio?


"In 1999, California became the first state in the nation to enact a mandatory Nurse:patient ratio law. The law became fully effective in 2004.

During the past decade, there have been naysayers, and attempts by lawmakers – including the “Governator,” Governor Arnold Schwarzenegger (R) – within California to suspend or even gut the law, citing costs, as a predominate factor. In 2005, the California Nurse’s Association even sued the Governor over the matter, and won!


But the news is in: Mandatory Nurse-to-Patient Ratio laws work and save lives. (‘Course now, we nurses knew that all along. It just took us some time to prove it to hard-headed administrators whom snuggle up with pencil-necked geeks wearing funny green visors.) As of today – Tuesday, 20 April 2010 – there are 14 states and the District of Columbia that “had enacted nurse staffing legislation and/or adopted regulations addressing nurse staffing and another 17 states had introduced legislation,” while California is the solitary state to have enacted laws regulating minimum Nurse-to-Patient ratios.


What does this mean?


The long and short of it is, that you or a loved one might actually LIVE after an in-hospital admission for a procedure! (Like one old-timer told me, “any day above ground beats the alternative.”)


Researchers examined deaths resulting from common surgeries in California in 2006, and compared them to deaths in New Jersey and Pennsylvania for the same procedures. They found that 14% FEWER deaths would have occurred from those general surgeries in New Jersey, and 10.6% FEWER deaths in Pennsylvania if hospitals in NJ & PA had staffed at CA’s levels of 1 Registered Nurse for 5 Patients.


California’s Patient : Nurse Ratios
Units _______ Patient:Nurse ratio
Medical/Surgical 5:1
Pediatric 4:1
Intensive Care Units 2:1
Telemetry 5:1
Oncology 5:1
Psychiatric 6:1
Labor/Delivery 3:1


The research was published today (Tuesday, 20 April 2010) in Health Services Research, a policy journal, and performed by the University of Pennsylvania School of Nursing.


(The University of Pennsylvania is sometimes known as Penn or UPenn, and is a private, research-based university in Philadelphia, PA, whose founder was Benjamin Franklin. It is NOT to be confused with “Penn State,” The Pennsylvania State University, in University Park, PA.)


In part, the study found that “… the higher the percentage compliance with benchmark based on California ratios, regardless of the hospital state location, the less likely nurses are to report complaints from patients or families, verbal abuse of nurses by staff or patients, [that] quality of care that is poor or only fair, and [express] lack of confidence that their patients can manage after discharge.“


Bottom line?


“Improved nurse staffing, however it is achieved, is associated with better outcomes for nurses and patients.”

Read more:
California Code of Regulations, Title 22, Section 70217, 2005."
 
healthcare is the new gold rush. right before i got out of school everyone was talking about how money and tons of options were out there. im still in a better spot than most, but its not like it was even a few years ago.

when a facility is empty, admin cuts back on hours. if it stays that way, they cut back on FTEs. someone not keeping busy is a tempting target for a doctor or an administrator. they dont pay you to do nothing. the money to justify an empoyee has to be there, it doesnt just rain down.

That's exactly what I thought - specially given that I'm a business major with MBA and over 20yrs experience in business. So I've asked about that.

If a "regular" private sector business (public or private company) is slow, they're very quick to dump people. It doesn't take much of a slow down - it can be as little as 1 month or a 1 quarter, and is rarely more than 6 months or a year.

As far as I can tell, and remember, this is clinicians providing input, doing their best to describe the admin business side, it's not as simple as other businesses.

While they have a greater degree of flexibility than a "regular" business due largely to a more "flexible" workforce, they have to adhere to certain regulatory restrictions, and union restrictions - neither of which you find much in the private sector outside healthcare, perhaps the automotive industry is similar in that regard.

So as I understand it, hospitals (at least in CA) are faced with workforce level constraints that are not present in other industries. Hence, those that they let go tend not to be medical practitioners / clinicians for the most part, but rather administrative, technology, and other support personnel.

Are there situations where clinicians and other medical practitioners may be laid off? Sure - hospitals that close down, or a merger and acquisition, etc.

But on a comparative basis to a "regular" business in other industries, there's just no comparison. And unlike other industries where the business functions are largely intangible, healthcare is quite tangible. It's not common practice to operate on people or dispense medication from overseas - the practitioner has to be there.

It's also more highly regulated than other industries and less competitive. How do we know this? The astronomical rising costs.

In competitive industries, businesses have to figure out way to cut costs because the market will not accept price increases, they just simply turn to a competitor with lower prices. So businesses cut costs by shipping as much work as possible overseas - hence an America where everything is made in China for example.

In perfect competition there is no place for cost increases, most readily observed with commodity goods.

Now, to the regulation. Lets take the patient to nurse ratio as an example. That's by law - hospitals in CA MUST adhere to the law.

In an unregulated industry where there's a function with a similar ratio, if costs increase, they just burden the employees with more responsibility with higher and higher ratios.

When I began one of my functions in my previous career, the client ratio was 3:1 and 10+ hr days (no OT), competition required cost cutting so they laid off my peers and increased it to 5:1 (these are not geographically co-located clients), a few years later 7:1, by the time I was let go it was 15:1 and a regular day was 12+ hrs (no OT).

I wouldn't call healthcare the gold rush - more like an ongoing and growing bubble just like the housing bubble and many other bubbles before it.

It's estimated that 20yrs healthcare will represent a full 1/3 of GDP - unsustainable, just like the housing bubble became unsustainable and burst, healthcare will too one day.
 
Good 'nuff for me, as I'll be nice and retired by that time. While they sort that mess out at that time, I'll have my savings and be taking cruise after cruise with the wife.

It's estimated that 20yrs healthcare will represent a full 1/3 of GDP - unsustainable, just like the housing bubble became unsustainable and burst, healthcare will too one day.
 
make sure throughout your essays and interviews you let the programs know how excited you are to break into the good life of getting paid to read novels and only have 4 patients assigned to you by law. your references should also be able to tell them how they understand that your passion for healthcare is rooted in taking it easy and that they know this from directly seeing you sit around all the time and relax. ask the programs or your bosses where they can send you after you graduate where the 4 patients you do see arent that sick and wont get in the way of your other plans. if they look at you funny, just tell them that you did your own firsthand research and give them some citations as well... so that they know for sure how to do thier jobs. you need to do this for pretty much everyone around you on or before your first day. do not neglect to tell them that you hold an mba from a top 15 university because that is your golden ticket.

.... i love reading your posts, but chuckle and shake my head when i do. maybe im just naive.... or maybe you are.
 
Pamac,

You may love reading my posts, but not as much as I love reading your witty and sarcastic commentaries.:D

I was naive in my teens and 20s... less so over the years, after the 30s whatever was left got washed away in the cynicism of my 40s, now more than halfway to my 50s.

Generally speaking:

An employer's objective is to get the most work out of you for the least pay.
An employee's objective is to get the most money for the least amount of work.

Call me a cynic, but it's readily observable. Just stand on any street corner and offer jobs at $100/hr to watch TV and eat donuts, and $8/hr to dig latrines and clean out porto-potties and see what kind of results you get.

I certainly learned to appreciate the economic laws of supply and demand, and truly enjoyed watching economics in action throughout my career.

Wherever there is a bubble, people gravitate to the bubble - whether it's the tulip mania, dot-com or real estate bubble. All bubbles eventually pop and most people move on. Healthcare is no different, hence the record numbers of students applying to nursing school for example.

Wouldn't it be funny if essays actually read the way you described?

Personally, I would suspect that more than 50% of doctors go into it for the money, not for altruistic reasons. I have no evidence to substantiate that figure, and I don't see how any study could be conducted because people lie all the time.

There is one easy (theoretical) way to determine if doctors do it for altruistic reasons and that would be to mandate by law that no doctor in the U.S. could make more than $100k. My guess would be that more than 50% would leave the profession, and they would likely look at other professions that have the potential to make more money. To think otherwise would be naive indeed.
 
Good 'nuff for me, as I'll be nice and retired by that time. While they sort that mess out at that time, I'll have my savings and be taking cruise after cruise with the wife.

Not so fast there buddy. :)

You don't expect to ever need healthcare in your old age? I'd rethink that one...

In 20yrs I'll be retiring as well, but fully expect that I'll need healthcare just like most of the older population.
 
Not so fast there buddy. :)

You don't expect to ever need healthcare in your old age? I'd rethink that one...

In 20yrs I'll be retiring as well, but fully expect that I'll need healthcare just like most of the older population.

Well, what I meant was that I'd mine the "bubble" for as long as it stable. If Asian countries like Japan and Korea at that time still have the excellent nationalized healthcare for a low price like they have now, I'll move over there and enjoy my retirement expat style.
 
I believe I touched on this in either this thread or one of your others. Those wanting to be physicians in some Asian countries with nationalized healthcare know that they will never become super rich. They have what I call a "missionary mentality" and truly want to heal people. A great many of these students, after finishing med school and residency in their own countries, even come to the US for many more years of fellowship at their own expense, and then they go back to help their own people.

Let's say the bubble pops in 20 years. It's not the end of the world, simply the beginning of a transition. All of the docs who can't live without a new Jaguar every couple years will retire while screaming about how unfair the system is, maybe they'll even play the blame Obama card. Anyhow, they'll leave. And hey, they got to enjoy their posh lifestyle for a bit and a great many of them probably did a darn good job. The "missionaries" will stay and say good riddance. The new crop of students who are in it for the humanitarian side will continue to compete fiercely to get into med school. After 40-50 years, we'll end up with mostly people who want to be docs sheerly for the humanitarian aspect.

I too am enjoying reading this thread. Pamac, why is it that we can't talk dollars and cents? Because Firecloud wants to secure his financial future doesn't mean that he won't put 110% into striving to become a competent PA. If he produces poor outcomes, he'll lose patients or get fired. So obviously, he's going to try and do a good job, make money, and keep the patients happy. All good, right?

Pamac,

Personally, I would suspect that more than 50% of doctors go into it for the money, not for altruistic reasons. I have no evidence to substantiate that figure, and I don't see how any study could be conducted because people lie all the time.

There is one easy (theoretical) way to determine if doctors do it for altruistic reasons and that would be to mandate by law that no doctor in the U.S. could make more than $100k. My guess would be that more than 50% would leave the profession, and they would likely look at other professions that have the potential to make more money. To think otherwise would be naive indeed.
 
All of the docs who can't live without a new Jaguar every couple years

Pamac, why is it that we can't talk dollars and cents? Because Firecloud wants to secure his financial future doesn't mean that he won't put 110% into striving to become a competent PA. If he produces poor outcomes, he'll lose patients or get fired. So obviously, he's going to try and do a good job, make money, and keep the patients happy. All good, right?

Whenever I see a Jaguar I wonder if the owner has ever read Consumer Reports...

Even if I won $1B in a lottery, I'd never buy a Jaguar. At a minimum, a car should be reliable.

As to the other comment, I've held numerous roles throughout my life, and if I felt I couldn't be better than average, I moved on on my own to do something else.

Personally, I'm not the Mother Teresa type, that's not what motivates me to action. If PA work was mindless paying $30k / yr then it wouldn't be for me.

I have a wife and kids to support, and living in a shack isn't doing the best I can for my wife or kids.

If it was just me, then it'd be a different story. I'd probably live in a shack then.

My wife and I were just talking about what kind of PA (specialty). I'd like to get exposure to ALL areas before making such a decision, and I figure that at my age, by the time I finish everything, become a PA, and work across different areas, my time will be up.

She thought given my personality (enjoy challenges and solving complex problems) and focus once I commit to something, that I may be interested in surgery.

And she's right, I would be interested in surgery, but I figure at my age it's probably too late for that route. I don't even know how PAs learn to perform surgery, but I suspect that it's lengthier than other training. Besides, my surgery days would probably be brief at best - once in mid 50s and 60s hands begin to shake, eyesight goes, etc.
 
For those preparing, entering or in the PA profession, which of these areas did you work and / or find most interesting?

01 Allergy/Immunology
02 Asthma/COPD
03 Cancer
04 Dermatology
05 Diabetes
06 Drug information
07 GI disorders
08 Heart disease
09 Hypertension
10 Infectious diseases
11 Mens health
12 Orthopedics
13 Pain management
14 Pediatrics
15 Psychiatric disorders
16 Urologic disorders
17 Vaccines
18 Womens health


And for California PAs which of these accredited programs did you choose and why?

CA Loma Linda University
CA Riverside Community College
CA Samuel Merritt College
CA San Joaquin Valley College
CA Stanford University
CA Touro University
CA University Of California-Davis
CA University Of Southern California (LA)
CA Western University Of Health Sciences

Anyone here subscribe to JAAPA? Know where I can get my hands on some old issues? (Part of my research into the PA profession).

Better yet, any PAs near the Sacramento area that wouldn't mind being shadowed for a day?
 
first of all, in my estimation, there are doctors that work for less than 100k a year... they are called PAs. i have a healthy respect for doctors and what they do, so im not really equating them with midlevels. but essentially, the workload is as full as a doctor if you look at the day to day. medical school is tremendously difficult, long, and stressful, so im really not prepared to say that a doctor that is just in it for the money doesnt deserve it. if they are out to make a fast buck, they took a big detour to get there. i dont care if they did it for the money as long as they are competant, because after simply the 7 years of medical training after the 4 years of undergrad, im willing to bet that the greedyness they may have in thier souls is balanced by high level ability. in the case of midlevels, i dont really respect that same quest for profit that a doctor may have because im not convinced that it always matches up with the training a PA gets. i feel that the fact that PA school is only two years makes it all the more important to get people in there that have the right kind of background. i dont think that what the profession needs is people who stumble across physician assisting and are drawn to it because it offers a path of less resistance. if your wondering why im annoyed enough to be sarcastic its because i read on here statements about how to do things the easiest and what the minimum amount of experience a program will take would be. there are so many people talking about retaking all thier classes and taking up some kind of job temporarily to get health care hours. then people put up narratives that are trying to make it look like they care/were born to be a PA/had amazing events happen that made PA a natural choice. i just got back from a wedding where a kid nearby was really excited to be a PA because it didnt have a lot of prerequisites and he could jump into it without too much trouble.

im not an idealist that feels like everyone needs to have the proper motivations that underlie thier decisions... i consider myself a pragmatist. but PA is my dream, and its my dream because i want the challenge and I feel like i bring something to the field. ive immersed myself in biology and healthcare. people are relying on thier PA to be as good as a doctor, and if they cant be, the PA needs to know where they are limited. the more knowlege you have, the more you understand when you are lacking, and the better you can take care of someone. its just lame when people sit there and say that they like the lifestyle of a PA, so that means they can put up with the job of a PA. it ignores the point that this job is all about the patient. yeah, we all have to live on something and get paid, and i respect that you guys dont want to let your kids go hungry. you are doing your best. but i dont want someone like you working on me in a healthcare setting, and you wouldnt want you either. go shadow a lot of different PAs before you ask any more questions on this or the PA forums. after you do that, ask yourself if you would do that job for 50k a year. if you wouldnt, then keep on looking for other ways to make money. if i get into the school i really want to, this path will cost me plenty. if i have to relocate, (which is likely that i will since the school i want to go to may not want me), it will cost me my wifes good job, my good job for two years, and some outrageous tuition. i will essentially be working for <50k a year for many years to follow just because of my education and our lost wages. and i will do it and not look back.

im not a jerk or a hater, and ive been influenced in the past by doubts about whether i could pull off getting into certain fields. a lot of that was just inner misgivings, and not paying attention to them is one of the best things anyone can do. its cool that you, firecloud, have a supportive wife that is on your team, and it reminds me of the support i have with mine. embrace medicine for the right reasons, and you will get farther in the application game than you will if you treat a healthcare job like dominos that will fall the way you plan them to. you have years of experience in one field, but if you try to wedge that into healthcare, they are going to clash. go see what PAs do and then try to tease out the details.
 
And she's right, I would be interested in surgery, but I figure at my age it's probably too late for that route. I don't even know how PAs learn to perform surgery, but I suspect that it's lengthier than other training. Besides, my surgery days would probably be brief at best - once in mid 50s and 60s hands begin to shake, eyesight goes, etc.

Its not the hands or eyes thats the problem; its the standing for hours stooped over the case holding the full weight of the limb in an odd position causing back strain that takes its toll on you in the 50s.
 
For those preparing, entering or in the PA profession, which of these areas did you work and / or find most interesting?

01 Allergy/Immunology
02 Asthma/COPD
03 Cancer
04 Dermatology
05 Diabetes
06 Drug information
07 GI disorders
08 Heart disease
09 Hypertension
10 Infectious diseases
11 Mens health
12 Orthopedics
13 Pain management
14 Pediatrics
15 Psychiatric disorders
16 Urologic disorders
17 Vaccines
18 Womens health


And for California PAs which of these accredited programs did you choose and why?

CA Loma Linda University
CA Riverside Community College
CA Samuel Merritt College
CA San Joaquin Valley College
CA Stanford University
CA Touro University
CA University Of California-Davis
CA University Of Southern California (LA)
CA Western University Of Health Sciences

Anyone here subscribe to JAAPA? Know where I can get my hands on some old issues? (Part of my research into the PA profession).

Better yet, any PAs near the Sacramento area that wouldn't mind being shadowed for a day?

I really like general internal medicine; I get to see and treat a wide variety of problems (including every one on your list), and learn something new every day (like one of my patients who was diagnosed with haley-haley's disease 6 months ago, gave me the chance to find out there was even such a disease).
 
Pamac,

Different personalities. Different perspectives. It's all relative. Perhaps corny, but true.

You consider yourself a pragmatist, I consider myself one as well, and from a pragmatist perspective, if one couldn't support their family making less than $50k, then they're not being a pragmatist by following a profession that paid that amount.

re your comment: "...but i dont want someone like you working on me in a healthcare setting, and you wouldnt want you either."

Au contraire! In a healthcare setting, I would want someone like me working on me! - and I have little doubt that has been the case with every major surgery I have ever had (several).

People are motivated by different things. It's great that you "love" healthcare, but there are many others that simply don't describe it that way. Perhaps they're motivated by knowledge, the challenge, or yes, money.

I want the best treating me - I don't care about their motivation. If what turns them on is figuring out how to cure an incurable disease, and they figure it out, more power to them.

This notion that people going into healthcare should be like Mother Teresa is not what I would describe as a pragmatic perspective, but more of an idealist.

From my perspective, a "love" of healthcare, doesn't sell me. We see people from all walks of life that "love" something - singing, dancing, etc. Just look at the people that show up on American Idol, and other shows like it. Just because they "love" it, doesn't mean they're any good at it. Ideally, people would "love" their profession and be good at it, but this is the real world.

Take bradt as an example of complex motivators. Would he be a PA for $20k/yr? Perhaps, perhaps not. But I can see that much like myself, he is intellectually curious, likes to learn and observe / treat new conditions / situations, and enjoys diversity and variety in his work. Absolutely nothing wrong with that.

The difference between someone that "loves" a profession, and someone like myself, is that when they fall out of love, they move on, while someone with more complex motivators will continue to be challenged, enjoy the diversity and variety, etc.

You could make the argument that when they start paying experienced PAs no more than $20-50k/yr, that someone like myself would be gone, and you'd be right, though I hardly doubt I'd be alone.

I really like general internal medicine; I get to see and treat a wide variety of problems (including every one on your list), and learn something new every day (like one of my patients who was diagnosed with haley-haley's disease 6 months ago, gave me the chance to find out there was even such a disease).

Bradt,

Was that through rotations?

Could you elaborate a bit further on the surgery? All the surgeries I've had, I've been strapped to the OR table, so this holding limb comment isn't all that clear to me.

How does a PA get into surgery?
 
Bradt,

Was that through rotations?

Could you elaborate a bit further on the surgery? All the surgeries I've had, I've been strapped to the OR table, so this holding limb comment isn't all that clear to me.

How does a PA get into surgery?

Not every surgery requires an OR table and propofol; opening up that infected sebacous cyst or doing a punch biopsy may not be glamorous, but its still surgery;).

And yes, holding the limb was from rotations in ortho (think about a knee arthroscopy, and what it takes to pull it off) which I went through at age 50; murder on your back.

There are plenty of surgical PAs that will do everything from holding that limb in position to harvesting vein for a bypass graft.
 
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If you are near the Sacto area, UCD appears to put out an excellent product.

Dont know anything about the program itself, just the graduates. I have worked with a few people from there, not in my specialty but in pulmonary dept and in primary care.

I don't know what the specialty was (out of the ones you listed).

I think if you are trying to put food on the table ASAP, this or the accelerated BSN are the best choices if you already have a strong science background.
 
Firecloud,

I'm curious if you know how much demand there is for FNPs. I ask because I'm not familiar with job sites targeted specifically to NPs; for RNs, you see ads all the time. The reason I ask is because the tone of this entire website seems to indicate very low regard for NPs and their skillset. If physicians who are running private practices have the same attitude toward NPs as many posters on this board (that the NPs are just not worth their salt), the employment opportunities for NPs seems pretty dim. Have you done any research into this, since you indicate that you might consider FNP as well?

Adayatatime,
While working as an RN I'll continue applying to the PA/FNP program. If accepted, I can potentially end up with MSN FNP and PA. If I get accepted before the ABSN (doubtful) then I just go straight into the program.

:p
 
I have sat and read this whole thread and quite frankly I find it interesting...keep the discussion going. I was a former pre-nursing student until I shadowed:scared: and it scared me to death. After volunteering a second time I did it in the Rehab dept. and that's how I found my love for Occupational Therapy. But when I was doing my pre-reqs, most of the students was only going into nursing for the stability and money and many of them are currently working as nurses now. I also live in the bay area and know first hand of the competitiveness of the programs. It took by BFF 3 yrs to finally get into one. Goodluck to the OP, it is important nowadays to be able to feed your family and you have to do what you have to do. I don't blame you for going into healthcare as long as you do a good job. Also ageism is alive and well. I hear so many older people that have tons of experience that have been laid off are having a hard time finding employment again. It has been the topic on numerous news stories.
 
I read the first two pages and saw it mentioned that a BSN was required for the CRNA programs. Just a FYI, that there is an exception for those already having a Bachelors in another field. There are some schools that will accept ADN RNs to its program, but Transition classes are necessary. Columbia University in NY is one.

From its website:


Admission criteria include:

  • Minimum of one year experience in an accepted intensive care setting
  • Satisfactory score on the Graduate Record Examination (GRE)
  • An undergraduate course in statistics
  • Current New York State nursing license or eligibility
  • Two semesters of Chemistry (at least one organic course)
  • A physical assessment course
  • Satisfactory score on the Graduate Record Examination (GRE)
  • Three references attesting to applicant's academic ability and potential
  • Bachelor's degree in nursing from an NLN or CCNE accredited program or a non-nursing bachelor's degree
  • Certification as Critical-Care Registered Nurse (CCRN) is highly recommended
*RN's with a non-nursing baccalaureate degree are required to complete 5 credits in community health in addition to the course requirement listed
 
Thanks for the tip 2ez.

Ironically, an ADN at any of the local colleges requires 2yrs while an ABSN around here only requires 14 months.

I wanted to thank those that provided all the great input. I keep referencing this thread as I move forward.

Finished Anatomy last fall. Boy there were lots of tears by those LPNs/LVNs/EMTs in class that didn't get an A in the class (The schools in the area are highly impacted so it's pretty much A or bust).

I also found out a nifty little benefit of being a veteran - priority registration. Now I'm set at 5 of the local colleges and already registered for the classes I need in 2011. So going into 2012 I'll only have 3 classes remaining. All of which I can do online if I go ABSN. If I go PA I'll only need 1 of those classes, though depending on PA program I could be looking at a lot more Chem.

My Anatomy prof. was trying to persuade me to go to med school... got me wondering how all my science classes would be counted since I'm doing them now. Would they just be averaged into my undergrad GPA? Anyone know?
 
Thanks for the tip 2ez.

Ironically, an ADN at any of the local colleges requires 2yrs while an ABSN around here only requires 14 months.

I wanted to thank those that provided all the great input. I keep referencing this thread as I move forward.

Finished Anatomy last fall. Boy there were lots of tears by those LPNs/LVNs/EMTs in class that didn't get an A in the class (The schools in the area are highly impacted so it's pretty much A or bust).

I also found out a nifty little benefit of being a veteran - priority registration. Now I'm set at 5 of the local colleges and already registered for the classes I need in 2011. So going into 2012 I'll only have 3 classes remaining. All of which I can do online if I go ABSN. If I go PA I'll only need 1 of those classes, though depending on PA program I could be looking at a lot more Chem.

My Anatomy prof. was trying to persuade me to go to med school... got me wondering how all my science classes would be counted since I'm doing them now. Would they just be averaged into my undergrad GPA? Anyone know?

Depends on how old your credits are. I think the limit is like 10 years. But yes essentially you have to list and provide transcripts for EVERY (example I went through fire academy at a CC, and had to list all of those "courses") college credit you've taken (again assuming it is still "good"). Then they calculate an over all GPA and a separate BCMP (Bio, Chem, Math, Phys) GPA that will get reported to the schools you apply to through AMCAS.
 
Thanks Atkinsje.

My undergrad and grad coursework is greater than 10yrs old.

From what I've observed so far in PA / RN programs, they only seem to care about the age of the science classes (which are the ones I'm taking now - A&P, Chem, etc.). I'm assuming that if they cared about all of your undergrad classes, then there wouldn't be anyone going to med school in their mid 30s and 40s as they would most likely have finished their undergrad greater than 10yrs back.

I'm in the process of getting pre-req exemptions to take some of the science courses. Doesn't seem to be a problem thus far. My classmates had all the pre-reqs and they didn't do any better. Same thing happened to my wife. They wanted her to take algebra again as a pre-req to Chem since her algebra class was more than 15yrs ago - instead she just got an exemption from the department head and took Chem without it.

By the way, why do some folks go for a pre-med post-bac if they can just take the classes without the post-bac?
 
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I just came across this thread today and find it interesting because I am in a similar boat. I am 44 and working in a dying profession. A lot of what I used to do has either been outsourced or just isn't done anymore and I know it's only a matter of time before I'm out of a job. I have a BA in psychology and I've thought about becoming an RN for many years, but never do it because I'm not sure if I have the patience to go back to school after being out of school for 20+ years. Plus, I can only go at night because I work full time during the day so I'm sure it'll take me years to finish and then I wonder if I'll be too old to even work in my new profession. See, I'm very good at talking myself out of this, lol. FireCloud, I think it's great you're doing this and I hope it works out for you. Do you have any issues with being the oldest in the class or do you just ignore the kids? I would have to do the pre-reqs at a CC and I'm fairly sure I'd be the old lady.
 
outnabout,

Robotics, automation, outsourcing, offshoring, H1-B visas, mergers, acquisitions, layoffs, etc. are all contributing to the decimation of entire industries. Then overlay factors like ageism and you'll quickly be driven from one industry to another that is more tolerant. For example, at 50 there are few working in advertising or programming, except for senior level executives. However, at 50 you're just getting started in education.

In addition to the above, there is a relatively new technological approach that experts and senior level executives estimate will eliminate 20-25% of jobs across most industries, and every new technological development has the potential to eliminate more jobs.

Healthcare, while not completely immune is somewhat resistant by virtue of patient interaction. Yes, they deal with H1-B visas just like other industries, and while Telemedicine could technically mean that your PCP is in India, in reality there are numerous regulatory issues that prevent that, so the jobs stay in the U.S.

One source you may find useful is jobbait. Yes, the site is targeted to the six figure job crowd (my job paid in that range before being split up into 4 and offshored to Brazil, Russia, India, and China (BRIC). Good for people in those emerging economies, not so good for me.

Here are a couple of industry level views from JobBait. One is for those considering career switches.

http://jobbait.com/switch/index.html

http://jobbait.com/targeting/index.html

There is one depiction that is similar to the targeting index where you can see every color coded for the last 20 years. However, it's for members only so you probably will not be able to access it. Take my word for it, it's a bloodbath of black and red with only the healthcare industry being spared. There are 2 other ok industries which have been holding the line - education and government. The rest is either a mixed bag depending on where you live in the country and your particular industry.

You're not alone. If it's any consolation, I'm older than you are. :) We have 3 young kids (all under 10), my wife is finishing up a few odds and ends, but has already been accepted at an accelerated bachelors of science in nursing (ABSN) program, and we have no relatives in the area so we take turns taking coursework.

For example, I'll be taking classes in the summer and fall, then her program begins so I'm limited to online courses next year.

I'm registered at 5 colleges and by the end of the year it'll be 7-8 colleges. You may wonder why. Well, classes begin/end at different times, so while some students attend spring/summer/fall, we attend overlapping semesters, take accelerated classes, attend simultaneously at different institutions (wherever the class you need is available) cramming in more classes in a single year than traditional students. Currently, I'm enrolled at 2 institutions for 19 credits (10 at one, 9 at the other) and work full-time.

I completely understand your reservations. Though here is the way I see it - at the earliest, retirement for me would be 67. I can't remember anyone either at my previous company or any of the numerous clients I visited, that held mid-level and senior non-executive positions and was past the age of 50. In fact, I'd long planned on being laid off at 50, though it caught be a bit off guard that it was earlier than that. My severance package has the position and ages of everyone that was impacted. I can count on a single hand the number under 35 out of the 200+ people affected, and over the past 20yrs, I'd been a survivor of 25+ workforce reductions. Basically, you're on the run for your life going from one job to the next every 6-12 months.

So if you think you're in a position to get from 44 to 62-67 without being shown the door, then you may be ok. Heck, I wish I'd started at your age instead of mine.

Regarding your question, I wouldn't know. I have yet to be the oldest in any of my classes. I can only take night classes as I work all day so there are usually older students there. My wife took day classes and while she is younger than I am, she was the oldest for most of her classes, but not all.

I won't lie to you, it's harder for some people than it is for others. I did my undergrad full-time at night and grad at night so for me it just seems normal to get home at 10:30-11pm and then go to work the next morning because that's what I have always done.

As for the kids in class, most wanted me on their teams when our anatomy professor had body part naming competitions. Prior to lab exams many students wanted me to go over the material with them.
From the beginning of the course, whenever the class could not answer a question, our professor would ask me to tell the class the answer. I didn't always know it, but more often than not I did simply because I always read 2-3 chapters ahead.

At the half way mark for the course, our anatomy professor affectionally referred to me as Dr., and by that time, the kids looked forward to my lab reviews with them.

It had been more than 20 years that I'd been in a science course, 15+ years since undergrad, and over a decade since any class. Everyone advised to take some easy required courses first, but that's the one that was available at the time so I took it. It wasn't that bad.

You have an advantage that today's young kids do not. You actually went to college back in a time when you learned something. Today, their study habits, discipline, knowledge base from high school, etc. is not as great.

To give you an example. I remember studying roman numerals in 3rd grade. In our anatomy class when we got to cranial nerves, the professor had to stop the class and explain what they are to about a third of the class.

Then there's the issue of grade inflation. I estimate that a C+ of 20-25yrs ago is about an A- today. Back then, as I recall, most of your grade relied upon a midterm and final exam with perhaps 10% on homework, reports, etc. Today, it's not as heavily weighted. It's perhaps 50-60% of your grade with the rest being quizzes, reports, homework, participation, etc.

Back then, you had to be "in the know" to find the best professor, and more often than not, you had little choice. Today, you have ratemyprofessor.com and you'll know exactly what to expect.

Back then, I simply do not recall any "accelerated" classes. Today, there are many. My wife took anatomy in 6 weeks and got an A.

Back then, you had to attend all classes. Today, you can take some of the classes online (be advised that not all institutions accept online classes and few accept online science classes with lab components).

You may not realize it because you take it for granted, but you have acquired a lot more knowledge from experience along the way than you may know.

About 20-30% of what was covered in anatomy, I recall from my biology of 20yrs ago. For example, I remember having to learn all the bones of the body and the reproductive system in biology. So some of the material was more review than new learning.

Give it some thought, check out the colleges by where you are and see what's available. You don't have to take anything if you don't want to - just look around and see what requirements you would need to fulfill.

Whether you do it or not, you'll still be 50 in 6 years. The question is whether you'll be 50 in a new career or 50 in the old one. :)

Feel free to ask anything else you may be curious about.
 
FireCloud9,

Wow! Thanks for all the information and advice. I will definitely check out jobbait.

I work in publishing, which is the only industry I've ever worked in. Due to technology (e-books, etc) the job I used to do no longer exists so I was moved to something else, but I can see where what I'm doing now will no longer exist in another year or so. That's my estimation. I work for a non-profit and we have many people who have worked there for 20+ years, so I could probably just hang on doing something there until I retire, but I would be extremely bored and would feel like a houseplant. I know that probably sounds strange to most people who would be happy with that arrangement, but that's not how I am. I've been at this company over 5 years now.

I would like to stay where I am for now and take some classes at night so if I do end up losing my job, at least I'll have a start on some of the classes. If it turns out that I stay at my company, then I can still go to school at night and maybe end up as an ASN. The accelerated BSN programs don't work for me because they are all during the day so I think if I did the ASN and then went into an ASN to BSN program, that would be the best route.

Thanks for the information on how colleges grade these days. I had no idea it was so easy now! That makes me feel better about returning to school. As you say, I could start out with an easy class and see how it goes. I don't have any kids, but I sometimes help my nephews with their homework (ages 12 and 9) and I'm amazed at how they are able to look up answers online and how homework takes so little effort in general compared to what I remember. I tell them how they have it so easy now, but they don't believe me.

Thanks again for the info.
 
The ASN programs by where we live are all in the day as well. If those were available to me as evening programs I'd probably go down that route too and do the BSN online.

Unfortunately, the choice for me is either 2yrs for the ASN or 1yr for the BSN both in the day.

I don't know what you do in publishing, but I'm aware of the changes taking place in that industry.

Lulu, BookSurge, ebooks/Kindle, iPad, isbn-us.com, CreateSpace, iUniverse, Xlibris, Author House, AuthorBuzz, Outskirts, RJ communications, distribution through Ingram or others...

For $99 (single ISBN cost) and a little paperwork, one can go toe-to-toe with any small publisher.

Just break out your word processor, type up a storm, format and edit, create a pdf, and go hunting for a front/back cover, bit of design, couple of distributors and whether you go ebook or paper copy you can be in business fairly quick nowadays - and quality of books and writing is not what it used to be.

I know journalists that get paid $5-6 an article. That industry, like many others is being torn apart by the effects of technology.

And that's the little I know about the industry. Authors no longer need to hope their work is selected by a publishing house to get it out there. If it's any good, it'll take off with a bit of online marketing.
 
Firecloud, it is really good to see that you are sticking with the gameplan. I had just decided to check SDN on a lark today and was happy to see this thread revived. You've got the right attitude. And yes, almost everything is going to pot in every industry nowadays. I remember reviewing resumes for job applicants at my old job. There were people who had graduated from namebrand schools, newly minted lawyers, etc., and they were competing for an entry-level secretarial position. I was sitting there thinking, "Why, WHY, are you applying for this?!" Probably because there's nothing else. The best of luck to you.
 
outnabout,

I forgot to mention two other ways that you can quickly "catch up" on some of the coursework though you'll have to know whether your target nursing or PA program will accept these methods.

In addition to:

1. Traditional classes
2. Online classes
3. Accelerated classes

4. Independent classes (my wife took Pharmacology in 30days using this method)
5. Challenge exams (test out of the course altogether - my wife is currently using this approach for one of her classes since she has already been accepted by a nursing program)

Hey adayatatime, how goes it? Did your PA friend finish up the ADN program en route to the CRNA?

To answer an old question you had, I see more openings in our area for NPs than for PAs. PAs here seem to be completely outnumbered by NPs.

Personally, in our region PAs seem to get less respect (and comp.) than NPs.

Still don't know exactly where I'll head with all this coursework, but I figure that it doesn't matter right now as I have to take most of those classes regardless of path that I choose.
 
For example if the PA that adayatatime "knows" took the hours for ADN school and worked those in urgent care then their salary would far outstrip what they made as a CRNA. Basically its silly to take a well paying job that has the potential to "make bank" and take a chance a) getting into an ADN program b) the salary hit during the CRNA program c) trying to get into a very competitive CRNA program while d) taking another salary hit while in CRNA school only to make the same amount of money.

Its essentially the same reason that it would not make financial sense for most experienced PAs to go to medical school. The opportunity cost would take too long to pay back.

David Carpenter, PA-C

I know this is an old post, but I thought I'd address it anyway.

David, it's not just about "making bank". The CRNA that we know works 3 days a week (one "on call" from home).

Here's the CRNA salary for our area in Northern California: $147-$186. $165 median. Total comp. $219k
http://swz.salary.com/SalaryWizard/Certified-Nurse-Anesthetist-Salary-Details-sacramento-ca.aspx.

PA salary in our area: $78-$112k. $95k median. Total comp. $131k.
http://swz.salary.com/SalaryWizard/Physician-Assistant-Medical-Salary-Details-sacramento-ca.aspx

Surgical PA in our area: $70-$110k. $92k median. Total comp. $127k.
http://swz.salary.com/SalaryWizard/Physician-Assistant-Surgical-Salary-Details-sacramento-ca.aspx

I realize that this isn't much of an analysis. However, the CRNAs seem to work 36hrs / wk for that money. As we understand it, they're considered "full-time" with much fewer hours than a PA.

The PAs seem to work many more hours for their comp. You stated that if he worked the hours spent on ADN training they'd make around the median wage of the CRNA. Perhaps, but as a CRNA a PA will make a lot more working less hours.

I'm curious, do PAs receive the same medical coverage as doctors? At Kaiser the CRNAs are on the same coverage and if they work there 10yrs they get med. benefits for life. Just wondering if that was the case where you're at.
 
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I read the first two pages and saw it mentioned that a BSN was required for the CRNA programs. Just a FYI, that there is an exception for those already having a Bachelors in another field. There are some schools that will accept ADN RNs to its program, but Transition classes are necessary. Columbia University in NY is one.

From its website:


Admission criteria include:

  • Minimum of one year experience in an accepted intensive care setting
  • Satisfactory score on the Graduate Record Examination (GRE)
  • An undergraduate course in statistics
  • Current New York State nursing license or eligibility
  • Two semesters of Chemistry (at least one organic course)
  • A physical assessment course
  • Three references attesting to applicant's academic ability and potential
  • Bachelor's degree in nursing from an NLN or CCNE accredited program or a non-nursing bachelor's degree
  • Certification as Critical-Care Registered Nurse (CCRN) is highly recommended
*RN's with a non-nursing baccalaureate degree are required to complete 5 credits in community health in addition to the course requirement listed

While intriguing, it doesn't save me any time. ADN programs around here are 2yrs. ABSN programs as short as 12 months. I wonder if they would accept a CA RN license... I thought CA and NY had reciprocity agreements?

Anyone know if there is such a thing as an accelerated CRNA program? :)
 
Unfortunately, due to family and work, he had to take an extended leave of absence from NS. An AA school has offered to let him take just a year of the AA curriculum to graduate, but he turned them down, because he felt that AAs did not have the flexibility of CRNAs. I recently met an AA working in Texas and he is doing just great--very satisfied both in terms of work content and salary. I really think that my friend should have done the 1 year, but I'm sure he has his reasons.

I think it's really great that you have all those academic resources near where you live. You are still working full time? I wouldn't mind seeing colleges provide some more classes such a O-chem, physics, calculus, biochem, and upper-division statistics on Saturdays or even Sundays. But they don't.



outnabout,


Hey adayatatime, how goes it? Did your PA friend finish up the ADN program en route to the CRNA?

To answer an old question you had, I see more openings in our area for NPs than for PAs. PAs here seem to be completely outnumbered by NPs.

Personally, in our region PAs seem to get less respect (and comp.) than NPs.

Still don't know exactly where I'll head with all this coursework, but I figure that it doesn't matter right now as I have to take most of those classes regardless of path that I choose.
 
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