Why would anyone want to be a PA or NP?
Over the years, a lot of patients tell me about their kids who are pursuing a career as a Nurse Practitioner or Physician Assistant. Based on what you read on this blog, you would think I might start screaming “No! No! No!”I don’t scream that. I nod my head and note the advantages:
- A shorter education path with less school debt.
- A chance to start your career before you hit age 30.
- Many job opportunities.
- Decent pay.
- And, finally: No restrictive covenants.
Restrictive covenants are a big deal. Any doctor in practice for more than a few years has encountered, probably signed and later been hurt by a restrictive covenant. They are typically not negotiable. They are a weapon against doctors, often designed by other doctors to prevent competition. They are also used by big hospitals and medical systems.
It takes about three to six months to know if your new job was a mistake. At such a point, you have to make a decision: Stick it out and try to make it better or leave the job.
If you are a software engineer, you simply swap jobs. In fact, these folks swap jobs every three to five years. It is part of the culture. No big deal!
If you are a doctor, however, you usually have to leave town, uproot your family and start totally over. If you want to return to town, you serve your one or two years of exile beyond the mandated radius and then start over.
PA’s and NP’s? They just swap jobs and start over. They don’t traumatize their families with radical moves. They don’t go into exile. I have only heard of one PA having a restrictive covenant.
If you are a doctor, raise your hand if you have a restrictive covenant story. Be careful, though. You may have signed an agreement forbidding you to even discuss the matter.
In NC, NPs and PAs are also affected by non-compete clauses as well, just FYI.
Sorry to disappoint the doctors here but restrictive covenants (aka ‘non compete clauses’) are very much a fact of life for NPs. The typical time is one year after leaving an employer. So it is not easy to ‘skip around’ without moving to a new area for us either.
The bit about ‘starting a career before age 30’ is a sad reality. Unfortunately it takes more than 1 year as an RN to become a TRUE Master of Nursing in practice, even though that is the time period that is accepted for admittance to the Post Graduate programs. I was an RN for 36 years before entering my NP program and had worked in all areas from Critical Care to Home Health.
‘Many job opportunities’? Only if you are much younger and look good in the advertising for the practice.
‘Decent Pay?’ That depends. I made more money as a CCRN 30 years ago than what NPs are being offered in Georgia right now.
‘Less school debt?’ I suppose that is relative but I have student loans that will outlive me.
Unless one is a Federal employee (with the VA or military) or a dedicated contract traveler the licensing and credentialing aggravation is the same from state to state and job ‘security’ is non-existent.
It ain’t as easy as it looks!
About 30 years ago, a hospital system in New York State had difficulty recruiting FPs. They recruited several from Ireland and offered them more than the National Health Service did (or what ever the term was). They got glowing reviews largely because they spoke English with a favorable accent. The 2 years were up and they were replaced as they could not practice locally from the covenant and the immigration status.
I left an academic position 30 years ago for a mutlispecialty group. They had a restrictive covenant precluding working within 10 miles of any of their clinics. They had about 15 if I recall which saturated the Houston market.
New thing in Washington State, and I think other states did the same.
Foreign docs without USA training can come in for two years as “learning experience”.
https://lawfilesext.leg.wa.gov/biennium/2021-22/Pdf/Bills/Session%20Laws/House/1129-S.SL.pdf
I can see immediately how this will be used. The public aid clinics, the prisons, the farmworker clinics, etc., cannot recruit and retain USA docs because of bad pay and conditions. Rather than improve pay and conditions, after all, the administrators need million-dollar-a-year salaries, why not bring in a doc from Bangladesh? No USA residency, now no problem. Pay some “supervising” doc a big salary to be “responsible” for the foreign doc. Can only supervise two, well, unless the agency petitions the Medical Commission for more. Between yelling about “PHYSICIAN SHORTAGE” and whatever bribes the Commission takes nowadays, raise the number of docs supervised.
Oh, and those two year contracts can be extended on petition to the Commission. Or it can be terminated. As in, “Oh, you didn’t like the pay and conditions?” (that might be pretty hard to get a foreign doc to complain, but I bet they can pull it off) “Oh, well, I’m sorry”…….and now, no license to practice medicine. Even better if any visa is attached to the license.
Perfect way to screw healthcare professionals, maybe better than PA’s or ARNP’s. If you treat them badly, they can go somewhere else.
Scott- I would correspond with you privately, but my computer does not load a reply link. This is the way things have become. The physician extender is basically part of the physician of record. There is no discount you are entitled to. There are no new physicians settling in these areas. Another reason for me and my family to stay healthy. Going to the ER is a crapshoot. At least i am thankful that my physician education has taught me that when i go to the dermatologist I specify that the doctor needs to be the one who examines my skin and does any procedure. Should i need a cardiologist he had better have a stethoscope on hand. I am in rural central Florida. I am a dinosaur/unicorn. Most all patients enter the health care system via a mid-level assessment. Yes we are a lot better trained and we do not need to order a gazillion tests to figure out what is wrong. If you LISTEN to the patient as I have for the last 45 years, I can generally figure out what is wrong. Of course there are customer service issues- the patient who demands a shot of PCN or a brain scan……those you need to figure out how to handle on your own. Social media has made those patients worrisome as they can seriously damage your reputation even though you are practicing perfect medicine, just like the inherent complications of any procedure- I just pray it does not happen to someone who is media savvy.. I am almost ready to throw in the towel and let Dr Google take over. Patients can take selfies of themselves and email them to their “doctor”. And so many patients can decide what medicines they need from the TV ads or via GET ROMAN. And those new spectacular dry eyedrops……nobody ever says what they cost. I freely prescribe them, but so few of the prescriptions are filled after people realize they cost $500/month! It makes those OTC lubricating drops at $15/bottle sound wonderful. Hate to be a pessimist about health care, but i am..
Hand me a stethoscope and blood pressure cuff and an EKG machine. I’ll figure out what’s wrong with you in two minutes flat. And yes, I’m a nurse practitioner who’s been practicing for approximately 10 years.
Non-competes: reason #109 why physicians should not be employees.
I think you missed the worst effect. The power of the powers that be that results from docs having such a hard path to leave. I mean why else would it apply only to physicians?
Dear Sir;
As a PA-C FOR 44 YEARS I BECAME A PA TO BE #2 TAKING CARE OF ROUTINE PROBLEMS IN A FAMILY PRACTICE. FOR 44 YEARS I HAVE INTRODUCED MYSELF AS JESSE BELVILLE,PA-C OR AS A PA.. NEVER AS A PHYSICIAN. I know a lot but not as much as a physician. NO PA OR NP DOES EVEN IF THEY HAVE A PhD IN
MEDICAL STUDIES.. No comparison. Not the comprehensive science of 4 years pre med 4 years med school and 3 to 5 plus years training in their speciality… PA’s and NP’s DO NOT HAVE THAT. Many new pa’s or np’s need 3 to 5 years of PHYSICIAN supervision so they do not harm anyone.. Theyhave no professional judgement as yet after 2 years of PA school or 6 months to 3 years of On line NP school for their masters or doctorate/ PhD.. Many want to teach or do research.
I became a PA because I love helping one person at a time as a PA. Supplementing the physician,taking care of routine cases while he handles the more difficult ones. That way he gets time for studies,CME, Family, vacations.. Enjoy his life and the practice of medicine.. 1974 to 1976 pa school.. My how that has changed and the reality was I got used and abused as a Cheap Physician to improve the bottom line. So I adapted and referred more often,took good care of my patients,and got them appropriate care if Icould not provide it..
Was not always appreciated but I DO NOT CARE. My job was to do medicine at the lefvel of sa PA. That is what I did. In my last long term contract I did a Walk In Same day clinic 7AM to 5pm 5 days a week and 3 hours every 5th Saturday. Now that same clinic has 3 PA’s 7am to 630pm and sees less people. Not walk ins all call ahead and get a scheduled time to be seen. I would crank thru 20 to 35 people in one day.. All charts done by 530 pm every day.. Now they have 3 people doing the same work I did and seeing 10 people a day… Most Amazing…cost them 3 times as much as I cost. No have not been sued,stopped a coup
le of suits on what I picked up. Most Delightful the cost of untrained people…
Gary, I had an NFP charge my daughter as a specialist even though my daughter saw her for a routine exam. When I contested it, the NFP relayed through her office, that since she worked under a (real) specialist, she could bill as one herself. I consider that insurance fraud as my daughter had to pay the specialist copay, but the insurance carrier didn’t seem to care when I reported it.
Here’s another one, in Seattle by the way.
https://www.bizjournals.com/seattle/blog/health-care-inc/2015/09/heres-how-one-doctor-freed-herself-from-a-non.html
University of Washington uses noncompetes, and the noncompete pushes you out of metro Seattle.
She spent two weeks in Cleveland Ohio practicing there, two weeks in Seattle as Mom. She did that for a year, to work off her noncompete.
I’ve seen restrictive covenants exercised in small towns, where the los of the one affected doctor really did cause significant harm to health care access in the rural community. Local media noticed. And that’s plural, I’ve seen this more than once.
Secondly, these NP’s and PA’s do practice medicine and are frequently mistaken for us. The patients think they are doctors and they begin believing they are doctors. I would judge them to be half a doctor (not stereotyping them all), but they typically have a fraction of the education we have, provide a fraction of the service we provide, and get paid the same per CPT code.
To be honest, approximately 99% of us make it ultimately and completely clear that we are not physicians. Repeatedly, that is. We do not compete, no claim to be doctors. But we do claim to be confident and competent. It said patients would like to see if physician, they are free to go elsewhere. No hard feelings. Get over yourself. You’re not the end-all, be-all…I honestly can’t tell you the amount of times I’ve been told “I’d rather deal with a nurse practitioner than a doctor. You guys are way more thorough in caring than a physician could ever be.” Figure that one out.
That is why I chose solo practice. I have seen a lot of docs hurt by these covenants.