r/physicianassistant

My understanding is that PAs specialize through on-the-job training at specialized sites post-graduation, rather than being formally educated and trained in that field. For example, I know someone who is an orthopedic PA, though this is because they were hired at an orthopedic site which agreed to train them, rather than them bringing prior education and training in the field.

In contrast, NPs are specifically educated and trained in a field in order to practice in that field. An example would be Psychiatric Mental Health Nurse Practitioners, must who complete a program specializing in psychiatric care and become certified in the field. This seems to differ from PAs, who are hired in psychiatric roles without formal education or training in psychiatric care. I looked at a job listing for a psychiatric NP/PA role, and they request that NPs bring the specific psych certification while PAs only need to be generally certified.

Other examples of providers who must be formally educated/trained in a field in order to practice as a specialist include physicians, dentists, veterinarians, and clinical psychologists (which applies to me). I recognize that these are all doctoral-level positions, with the exception of most NPs.

With this in mind, do you feel that PAs should be held to similar standards as other providers in the sense that they should have education and training in a field in order to specialize, rather than being hired without any particular education or training? In the world of healthcare, it seems that the PA situation is pretty unique.

(I am neither a PA nor NP and have no intention of pursuing either role, and completely recognize the purpose of these roles so please don’t think I’m being a “Noctor” or something. That is not my intention. This question popped into my mind while I was poking around job listings for a variety of roles.)

I work in family med so we pretty regularly have patients pass away from various causes. We often get calls from police officers demanding to know immediately if we will agree to sign the death certificate. The first time I ever got one of these calls I asked the officer for more information about the patient's death, and he was like "I dunno, he was found dead in his home tonight and we don't suspect foul play". I asked my colleagues about this and they told me you pretty much just have to agree to sign off on it even when you know next to nothing about the actual cause of death so that the police, funeral home, insurers, etc can move the process along.

It just feels weird to be basically making up bullshit on an official government document with my name and license attached to it..

Hi everyone,

I work in primary care at a company with various locations. I have 2 years of experience and have been with the same company since I graduated. I’m salaried exempt with a base pay of about 120k. I work 4x10s so I have an extra week day off.

Recently, a nearby location has a shortage of a APCs, and we are being offered 1.3x our base pay to pick up sessions.

If I were to pick up shifts, I would be responsible for the typical appointments I already am familiar with – a mix of annual physicals, chronic disease follow ups, acute visits. My company has a 40/20 minute template.

Do you think this is fair compensation? I would love to hear people’s opinion. Thanks!

I work at these “satellite ERs” basically urgent aides with IV, CT,XR,US, and labs. We can admit the sick ones to the main hospital.

I work 4-5 days a week 10-12 hour shifts. See around 30 per shift on average. Me and usually 1 doc at a time. The pay is decent but I feel like my off days are recovering from my on days. I have no joy, I don’t enjoy life anymore it’s just work and home. Im too exhausted for anything else. I’m 27 and did a 1.5y EM fellowship too. Graduated a year ago.

I’m burnt out, I barely have empathy for my patients. It just feels like unnecessary busy work because majority of them are not sick and just an annoying waste of time. I got offered a position in the main ER but the work is draining to me and much more chaotic.

I don’t know what to do or where to go from here. I used to like EM but now i see it as pure stress. I feel so tempted to quit but then like what do I do? All I know is EM

Can anyone relate? Any advice?

Any other new grad PAs who started their first job while pregnant? I’m looking for advice and reassurance.

I graduated in May, passed the PANCE in June, and got my dream job offer in July. I also found out I am pregnant! No, it was not planned but being that I am older and want kids, I did not want to abort. I am happy, my husband is happy, and my family are all happy.

When I start my job, I’ll be around 28 weeks pregnant (due to the long hospital credentialing process). I’ve already met my supervising physician and shadowed her & the team, and everyone seems wonderful. I’d be lying though if I said I wasn’t nervous to tell them about the pregnancy. I don’t want them to regret hiring me considering I have to go on maternity leave shortly after starting due to the long credentialing process.

For those who have been in a similar situation, any advice? How did you manage being a brand new provider and being pregnant? When did you disclose to your job that you were pregnant? How did your colleagues respond? Any tips on surviving the first few months?

I’d love to hear the good, bad and honest. Success stories are especially needed because I could use the encouragement ☺️

Planning to change EHR systems, work in outpatient pain management. Does anyone have experience with Eclinical works vs AdvancedMD? If so what are your thoughts? These are the two we are picking between.

Can anyone explain who requires a sole proprietor NPI vs not. What does a PA working for an organization require.

I just interviewed for a seasonal position in a school healthcare center. The position is part-time August through May with summers and holiday weeks off at the same time my kids are out of school. It feels like a great position that works well with my kids schedule where I don't have to take days off to be home with my kids when they are out of school and can still pick up and drop off my kids at school while making a little extra money for our family. However, they do not offer malpractice insurance coverage. The last provider they had acquired and paid for their own plan. I've never been in a job where I've had to think about this (this coverage was always included in my benefits) and if I get the offer, I would love to take it as long as paying for the malpractice insurance doesn't eat half my salary lol (the pay is significantly lower than average at $50 per hour). Would love other people's input and experience on if they had to acquire malpractice coverage themselves. Also, any recommendations for great malpractice insurance companies if I end up getting the offer. Thanks!

As in the title.

Current job:
- gen surg at large academic center, employed by state
- no OR time. Inpatient rounding with residents, but mainly outpatient admin tasks, placing pre-op orders, handling post-op patients, and all of the attendings’ inbox
- 120k salary in MCOL area, no guaranteed yearly bonus. No COL adjustments. Very difficult to get raises
- ~10 minute commute, which could change as I plan to move
- schedule M-Th 4 x 10, no weekends, holidays, or call
- paid parental leave

Job offer:
- private practice IR
- 70% procedural, was promised extensive training and that I would be practicing at the top of my license in terms of scope of procedures I will be doing
- 140k starting salary, with guaranteed yearly raises over the next 3 years with opportunity to negotiate after year 3. Would be making 160k at that point
- 40 + minute commute currently, which will change as I plan to move. Likely before I start
- schedule M-F, 8-5 (try to get out at 4 most days), no weekends, holidays, or call
- no paid parental leave

There are obvious pros and cons to each job such as commute, salary, benefits. I’m planning on moving in the next few months and wouldnt start until the end of the year at the earliest due to credentialing. So my commute to the new job could be closer to 30 minutes, and commute to current job would be about 25 minutes if/when I move.

I do not plan to stay at my current job anyway for a variety of reasons. Mainly, I do not find it stimulating whatsoever and I feel like a glorified triage nurse/MA. Also, pay. Obviously you can’t beat the schedule and current commute.

I do not have children currently, but working on it. I can make the no paid parental leave work.

Thoughts? Would appreciate any and all thoughts on making the switch!

Family medicine PA here in Arizona. Even though recreational has been legal here for a while now, I still get patients asking me for medical marijuana cards pretty regularly.

Every time it happens, my internal reaction is basically, "You can literally just walk into a dispensary down the street," but they're still seeking out the medical route.

Do you actually do the certifications yourself, or just point them to one of those local pop-up card clinics?
Curious how you all handle this.

Hello everyone! I hope it is OK to post here. I posted to the nurse practitioner sub and it was deleted by the mods, I’m not sure why 🙁. Hoping to get some advice from other APPs.

Thank you for taking the time to read this. I am a newer (less than a year) nurse practitioner working primary care in a smaller office for a large corporation. Previously an RN in the hospital setting for several years. What is considered appropriate in terms of outside hang outs with MAs and office staff?

When I was an RN everyone would frequently have different get togethers. In my new office there has been an informal Christmas happy hour or something like that here or there I have attended (and was the only provider that did😬)

Have now been invited to smaller get together non work related (at the house of my MA, but daytime and no alcohol ) where not everyone from work is invited and I would be the only provider invited. This is a newer world for me and I’m trying to navigate what is professional and appropriate? It doesn’t appear that there are any official non fraternization rules in this company, but I am hoping to work with this organization for many years and don’t want to inadvertently do something viewed as unprofessional.

Thank you for reading!!

Edit: We are all women

Hi all, before you comment, please give me some grace as this is my first job lol.

Basically, I started my first job around 4 weeks ago in plastic surgery. It's a private practice with just one surgeon plus me. They assured me before I started that I would be under their malpractice insurance. On my first day, I asked for a copy of the insurance because I knew I needed to buy tail coverage on my own. The office manager (who is married to the surgeon and is also who hired me) said he will get it to me, but he never did. The following week, I mentioned to the secretary who ended up giving me the policy. Imagine my surprise to find out I am not covered AT ALL! (yes I called the insurance company on my own to confirm this!)

They tried to give me a run around answer that since I am not doing specific PA duties yet, I am covered like how an MA would be covered. Obviously I thought this was BS and demanded to be added ASAP. He promised he would start working on it.

In the meantime, I have refused to do any patient care or write notes until I am added. One week later, I am still not added. He says he is working on it, but I don't understand why this has taken so long and the secretary thinks he is procrastinating and has not even started the process.

Is this unheard of? Do I leave today? I am applying to other jobs and planning to leave as soon as I find something, but I obviously do not want my license at risk in the meantime.

New grad PA finding small joys in retiring my shoes from school and buying my first pair of work shoes! I think I’ll like the ease of clogs, not that I’ll never wear normal sneakers. There is so many new and cute clogs out like oofos, crocs, etc. Which do people like best?

edit: also birkenstock, hunter, bombas?!

Second year PA student interested in working in trauma surgery and being a part of trauma assessments, codes, placing chest tubes, intubating, first assisting, and rounding in the ICU.

What would be the best way to get to this level?

Apply straight into trauma surgery jobs at level II’s with no residents? Level I’s for the higher acuity cases?
Surgical fellowship/residency covering many subspecialties?
Crit care fellowship/residency?
EM fellowship/residency?

Looking for advice on a situation I’ve found myself in somewhat inspired by a recent post. I’m a PA with four year experience recently hired to a new practice and been here for about three months. I really enjoy the job and people I work with and our practice is expanding so we hired another PA. I’ve been training him and we get along very well but I’ve recently found out he is making almost 8k more than me and he is a new grad PA. Idk if it matters but he is a second career 40s male and I’m an early 30s female PA and this has been my only career besides PCE. I was fairly content with my salary prior to this info and it seemed to be in line with the AAPA average but now it’s been weighing on me and not great for my overall morale. I’ve asked some corporate friends for advice and they seem to think he just negotiated better than me and I shouldn’t say anything. I know I signed a contact to work at the amount and I’ve only just gotten off the three month “probationary period” for new hires so I feel like I don’t have a leg to stand on but I’m just feeling really taken advantage of. I don’t keep in touch with anyone from PA school so looking for advice from my PA peers on what you would do in my situation. Thanks in advance!

Hi everyone,

I'm a new grad PA and would really appreciate some advice from those who have been in a similar situation.

I recently received an orthopedic surgery job offer, but I'm struggling with whether I should accept it or continue searching.

The offer:

• 2 half-days/week in the OR and clinic the remainder of the week
• Trauma call with a newly hired orthopedic trauma surgeon (frequency unknown; nights and weekends)
• No compensation for call
• 12 days PTO (cannot be used during the first 6 months)
• No CME stipend

My biggest hesitation isn't the specialty itself—I really enjoyed my orthopedic rotation and like being hands-on in both the OR and clinic. At the same time, I've also been interviewing for OB/GYN positions because I enjoyed that specialty as well. I'm worried that if I accept this position, I'll always wonder whether I would have preferred OB/GYN, but if I decline it, I may pass up a solid first job while waiting for something that may not come.

If you were in my position as a new graduate, would you take the offer or continue looking? I'd especially appreciate hearing from anyone who had to choose between a good first offer and waiting for a position that felt like a better fit.

Has anyone negotiated salaries with hospital systems, and wants to share how it went and if they agreed on your salary request?

Apologies in advance, this feels like a "lobster too buttery" situation as I write it out, but here's where I'm at:

So I've been a Derm PA for 3.5 years, and recently changed jobs due to wanting to be closer to family. My first job was stressful but consistent, and the last year working I was seeing 35-50 pts 5 days a week, $150,000 salary and collecting 10% of all net receipts as a production bonus. Last year I ended up collecting just over $200,000.

The new company I joined was very up-front about the fact that I was joining a very saturated derm area, and that they were opening my position in hopes to expand their current business and help ease the other provider's schedule. They offered me $155,000 salary working Mon-Thu, but the bonus structure is very different from what I'm used to. Basically, they calculate 25% of my quarterly receipts, subtract my quarterly salary, and I receive the difference.

The problem. I think the company greatly overestimated how many patients they could get to fill my schedule. Typically I'm seeing 10-15 patients a day, but can go as low as 5, and I've been working here almost 8 months. I can see gradual but very slow patient load growth, and I do admit I'm getting impatient at the low work load. I have talked to the other provider in office, and others in town who all say they usually see close to 30 pts daily. The other provider I work with has been there for 10 years, but is very guarded on his specific pt numbers and receipts, so it is hard to gauge what I could potentially make in bonuses with enough time invested.

I just received the Q2 net receipt report, and was disappointed to see that not only did I not quality for a bonus, but I needed to bring in almost 4x the net receipts if I wanted to see a single penny of a bonus. So essentially, I'm feeling like I took a 25% pay cut moving here without any hope of bonus income. I know statistically this is a good salary for my area and field, and I feel silly complaining about it, but I am feeling the financial squeeze while trying to maintain investments, lifestyle, and saving for a house.

I had spoken to management, who said that my position is secured despite low patient loads, but I have been consistently anxious about being let go as I imagine I am not all that profitable to the company. That manager also left the company a couple weeks ago, so I cannot be sure about the new management's perspective.

Now my big question; I was planning on speaking to the higher ups about reworking my bonus structure to either a lower threshold or just a flat % of receipts at a much lower rate, using data points like patient numbers, trajectory, and unlikelihood of hitting bonus numbers anytime soon, but I am afraid that this will just put a target on me as an unproductive provider and make the case to cut me easier. I have also been softly networking with other providers to suss out possible openings at other clinics in case I can find a better option.

Before I take any actions to rock the boat, do you think it'd be advisable to bring this up to leadership, or is the risk too great to my professional standing? Would it be better to take my lumps until I hit the 1 year mark and re-evaluate my chances of bonuses, or should I not bring it up at all and just search for another opportunity? Thank you in advance for your perspectives.

About to graduate in December and am considering dropping off resumes at offices I’m interested in working for. I know this is an old school approach, but have read similar stories on this sub and am curious of what approach to take. Do you ask to speak to an office manager or just leave with the front desk staff? Doctor?