Physician's assistant career. - Page 2

Dang, US healthcare professionals get paid a LOT

- a med student in socialist Euroland.

We also have to pay like 200K to go to school and have much worse hours, so pick your poison.


There's a general feeling of frustration with nurses/NPs trying to gain more autonomy and generally getting uppity. I've heard a couple physicians say they'll only be hiring PAs in their offices as a result. So perhaps that bodes well for you, Big Pun.

I imagine you have a lot more freedom over where - and especially whom - you work for though. I've pretty much got one choice of future employer: the NHS. Also, having the government decide how much you should earn (hint: it's a lot less than the market deems proper for private physicians) isn't much fun either.

When I was doing my rotations we had PA students rotating along with us in some of the core competencies. I think it's not a bad way to go. Sometimes I feel like I should have gone that route. Less schooling and "worry/responsibility" with still pretty good pay and high demand. However, I like having my autonomy and not having to work under someone (well I guess I still will have to but not nearly to as large an extent).

Like was mentioned above, there are different levels of people in the positions (my only experience being inpatient). Some of the PAs I come into contact with are pretty good and I'll ask them questions about their specialty/field and trust their answers and others I have learned I wouldn't trust to tell me which room a patient is in. I once told a surgical PA that a patient they were seeing in the ICU needed to be anticoagulated if it was okay with the surgical team and he told me, "He's on Protonix" as he dismissed my concern. Protonix is a PPI (like Nexium) which is used for people with GERD or in certain inpatient populations as stress ulcer prophylaxis/prevention. There are interactions of this class of medication with Plavix but I was telling him about Lovenox.

Again, there are different classes/levels of any specialty. There is a Neuro APN at my hospital who I am as comfortable with asking questions about patient management as I am the Neurologist.

The thing is that there most certainly is a difference between a PA and an actual physician in competency. For their day to day stuff that they're used to in their comfort zone, they can be quite effective (especially the more experienced ones who quite often know more than I do about their fixed sub-specialty) but throw them in a less familiar or critical circumstance and I've seen them fall apart. I went to a rapid response on a desaturating patient just last week and a Cardio PA happened to be there who quite frankly ended up pissing me off with useless suggestions to the point where she was getting in the way of what I needed the nursing staff to do. I'm usually a pretty polite person but quite frankly I felt that the patient care was being compromised and I got tired of having to say why I didn't want certain things done. I eventually told her that if she wanted to run the show that I could leave. Not a further peep out of her.

<--resident

All in all, a pretty good career choice I think. Not quite a doctor but can almost sub in for one in a lot of situations with a lot less time spent in formal education.

I was under the impression that your medical training would allow to move around within the EU? Couldn't you move to one of the countries that has private practices as well (Poland, off the top of my head definitely has it)?

In any case, I'm sure there are plenty of pros and cons on both sides of the pond. We have 20-40 million uninsured depending on who you ask, rampant lawsuits (some OB/GYN was successfully sued for 53 million dollars about a year ago), a lot of wasteful end-of-life care, etc etc.

As for lifestyle - money only goes so far. I did a short stint in Cardiothoracic Surgery - 85% of the department was divorced and varying degrees of unhappy with life. Then again, CT sucks and has one of the worst lifestyles but I don't think it's nearly as bad in the EU.

i know a PA personally and if you have any questions about it career wise feel free to pm me. Now a days PAs are used to fill the gap that residents are forbidden to cover with the new hour resitrictions in place. Most PAs are fully confident in what they do because just like residents if you do something enough and are motivated in learning you'll be just as skilled. The difference between PAs and NPs is that PAs are not independent health care providers(they cant open their own practice). There are many MDs who prefer PAs to fellows or residents or even other MDs because PAs after they are trained will know how a MD wants their practice to be run and will never be able to open their own practice and steal patients. They can prescribe their own meds and perform and assist in surgery which NP cannot do.

Pretty sure that's incorrect on all counts. In fact I think NPs are in a superior billing position vs. a PA for surgery and post-surgical follow up but am not 100% sure of that. I'm open to correction but I am pretty damn sure there are NP first assists.

I'm a couple years away from having to worry about it, so my understanding is imperfect, but I think that the only NPs who can assist in surgery are those who are trained as RNFAs (Registered Nurse First Assist). I'm pretty sure there are some programs that offer dual training for CRNP/RNFA, but if you're just trained as a CRNP I don't think you can assist in surgery. The re-imbursement for a PA in surgery is 15% of the professional fee. 25% for a surgeon. I doubt RNFAs are different than PAs when it comes to billing.

I think you are correct with the RNFA but that lets an NP be an FA (granted needs to have the double qualification there). Pretty sure the NP billing is 15% too but for some reason I'm thinking the NP is better for billing post-op but can't remember why I'm thinking this. The part about NPs not being able to prescribe like a PA though is total bull. Also I've found many an NP with various wound care certifications and they're doing surgical debridement, etc. solo all the time.

Bottom line though, if you're a late bloomer, I think PA or NP is a great bang for the buck in terms of time and money in school vs. possible income stream and the demand in the job market.

I think a slightly better bang for the buck is CRNA. They can make some pretty spectacular money for 6.5 years of school.

I completely agree with that. It's not like that career path never crossed my radar screen.

In the OR I always joke that I hope when I die I'll be re-incarnated as a CRNA.

Don't rub it in.

I'm 2 months away from graduating IM and going into the hospitalist gig for a couple years before doing traditional practice and it burns me no end that a CRNA can make as much or more than I do.

This country will never have enough primary care for this reason i.e. it doesn't make anything (relative to other fields in medicine). My buddy from med school is in upstate NY as chief in his anesthesia program going on to do pain in July. Told me he will pull in 6-700k easy in a couple years and close to a million if he busts his ass.

Interestingly enough Ontario acknowledged this problem several years ago and now actually pulls in GPs from the States to work in Ontario. No exact numbers but I've heard of GPs pulling 6-700k. Would be interesting to hear from an Ontario PCP if one reads this. Also, one way Canadian healthcare is certainly superior is the lack of the ABA paying off the President so docs have a much nicer environment to work in vs the US when it comes to litigation worries.

sorry typo on my part NPs can prescribe medications like PAs, i meant that i dont know if NPs can assist in the OR. PAs also once certified are not limited to one field ie ( Medicine pa, surgery pa, ent pa, emergenncy pa), they can pretty much havve a full time job as an orthopedics pa and work part time as an emergency  department PA without taking any additional tests.