WCI #285: Physician Assistant Financial Education

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All right, let's cover a few things.

Before we get into our interview today. First, let's do our quote of the day. This one's from Oscar Wilde and I love it. He said, experience is the hardest kind of teacher, gives you the test first and the lesson afterward. And I think that's true. Unfortunately, too many of us try to make all the mistakes ourselves rather than letting other people make mistakes and learning from their mistakes. I don't know what you're doing as you're listening to this. A lot of you are commuting, you're on your way home from work, you're on your way into work. Maybe you're working out, maybe you're walking. Whatever, whatever you may be doing, I want you to know that there are people who are grateful for what you are doing. I was talking to somebody last night who is so grateful. This is a neighbor of mine who just found hematologist, oncologist that he loves because he's, you know, being aggressive about the workup that he needs for his anemia. And you know, whatever specialty you're in, there are people that are appreciative of what you're doing. So if no one said thanks yet today for what you do, let me be the first. Okay, we are going to have a special edition for Thanksgiving on this podcast and we want you to call into the Speak pipe and just leave a short message of what you're grateful for this year. So if you'd be willing to do that, we'd love to share that with the WCI audience. That's@whitecoatinvestor.com speakpipe. You don't have to use the whole minute and a half. You can't go longer than a minute and a half. But just a few words about what you're grateful for this year and we'd like to share that with the audience. All right, we got a huge event. If you haven't heard, if you're not following the blog or whatever, maybe you missed this, but we are having a conference. It's WCICON 23, also known as the Physician, Wellness and Financial Literacy Conference. You can sign up for that@www.wcievents.com. right now we have early bird pricing that saves you about $300. I don't actually know because we're recording this in advance. It could already be sold out by the time you're hearing this. As far as the in person, but there's no limit on how many people can come virtually. And if you'd like to come in person, I'd suggest you register today because I don't know how long this is going to last. I have a feeling we're probably going to sell out this year. Our price didn't go up from last year. Despite everything else in your life going up in the last year, this conference did not. Early bird registration, same exact price as last year, and we'd love to see you there. This is a great conference. We divide the content into about three categories. First one is, you know, wellness criteria. This is generally qualifies for continuing medical education. So you can pay for this whole conference out of your CME budget or you can write it off, you know, if you're self employed. The next is for beginning investors, people who are still trying to figure this stuff out. Maybe don't have a financial plan in place. And we got some great material there. We have some awesome workshops planned, these two hour workshops where we can really get in depth on some of the material. You're going to love that. And then the third category is advanced advanced financial topics. And even those who come every year, they love these topics because we've always got something neat and new and different where we can really get into the weeds and really explore stuff. So wherever you are, whether you're struggling with burnout, whether you are trying to get your financial ducks in a row, or whether you just love getting together and meeting people that you know online in person, this is a great conference for you. I think it's the best medical conference of the year. We'll be in Phoenix the first week of March, which is a fantastic place to be and a fantastic time to be there. And we'd love to have you join us both for the conference and all the surrounding wellness activities that we have with that conference. Again, you can register WWW dot. All right, we got a great interview today. We got an interview today with a couple of PAs. Now, we know most of our audience isn't PAs. When we do surveys, we discover that about 75% or so of our audience is physicians and their trainees. About 10% is dentists and their trainees. And then we find that the other 10 to 15% are other medical professionals as well as non medical professionals. And so there's a significant segment of people out there that aren't doctors, and they typically have lower incomes than doctors, you know, often still a high income, still a six figure income, but maybe not the higher incomes that many doctors have. And so the information in this discussion, a lot of it applies not just to PAs, but to many of those other kinds of professionals as well, whether they're pharmacists or attorneys or small business owners, whatever they might be. So as you listen to it, think about the ways that it can apply in your life. And we'll chat more after the interview.

All right, my guests today on the White Coat Investor podcast are Katie Bean. Pac and Beth McIntyre. Pac, welcome to the White Coat Investor Podcast.

Thanks for having us.

Thank you so much for having us. Yes, we're excited.

Yeah. So today we're going to talk about money, but we're going to talk about money specifically for PAs and other people with similar incomes. Before we get into that topic, though, we want to learn a little bit more about each of you. So tell us about your upbringing and how it affected your views on money. Let's start with you, Katie.

My father is an entrepreneur. He owns gun and knife shows. And growing up, I saw the opportunity that money has and that it offers to creating the life of your dreams.

Cool, Beth.

Yeah. And so my upbringing was a little bit different. So my dad was in the military. And when I was a young kid and my brother and sister, there were three of us, he actually went back to school. School. I went back to school full time. And so my mom was working part time taking care of the kids. You know, they moved around, so they didn't have childcare support, and so they're pretty much on their own. And so when we were young, we were pretty financially poor, right? Until my dad got out of school. And because of that, my views on money were always kind of a scarcity view. Right. So we're big savers. We blame it on our Scottish genes, Right. And our Scottish heritage, but we're always big savers, and so we're never big spenders. And so growing up. I kind of had that saving modeled for me from a young early age. And so I had a lot of trouble actually spending money. And it was kind of the opposite of a lot of my peers. And I didn't grow up in the United States, and so I didn't grow up with the materialistic culture that they have here, too. And so I think that affected my views on money and then what to spend money on. And so my views on money were a little bit different than a lot of people. My grandfather on my dad's side actually had a master's degree in finance, and he was very much about, you know, investing and very much about long term and very much about saving. So I kind of got that from both sides of my parents. And just growing up, we were just a big saving family. And so I think there are some benefits and some cons that come with that type of lifestyle, too, but they were never hesitant to talk about money. So I think a lot of people are hesitant to talk about money with their spouses or maybe with their kids. And so my parents are very open about it. They're like, this is what saving is. This is what matching means. And so even though I never took a finance class in college or in high school or anything like that, like, I was aware of what money and how money works and how credit works a young age. And I think that gave me an advantage when it comes to now, like, financially planning my life just because I had that good background and what it means really to save.

Yeah, definitely some modeling and a little bit of education is a form of privilege that really shouldn't be discounted. It's pretty significant. I have a significant part of my audience that learn nothing, at least nothing good about money from their parents, and they had to learn it all as adults. All right, briefly run us through your education, training, and career so far.

So I did my undergraduate at Florida State University. I majored in psychology and then went to PA School at South College in Knoxville, Tennessee. I've been a PA for over 10 years now. I started out in correctional medicine, which I started at a jail system. And it was such an incredible mission field. I love working with the inmates there. I saw a lot of medicine that you don't usually see in general population. And then I switched over to emergency medicine and worked as an ERPA for about a decade. And Beth and I met, actually about seven years ago when we both started on the very same day at a PA school. And we've taught PAs for six, seven years now. And then I also switched to aesthetics. So right when Covid happened, I was furloughed from the er, moved over and transitioned into aesthetics and worked there for a while as well.

Okay. And Beth, your career and your training and career.

Yeah. So I went to undergrad at Tennessee Tech University, which is a college kind of down the road from here. Again, my dad was military, I was living overseas, and I actually graduated from a high school overseas, but we had in state residency. So in the military, you're allowed to choose which state you have in state residency in. So when applying to colleges, I applied in state to the state of Tennessee, even though I had never actually lived here, because that's where I would get the in state residency. And so mostly academic scholarships and things like that paid for my undergraduate. And then I decided to go to grad school. And so I actually went to University of Kentucky in Lexington for grad school. And the reason I did that because at the time in Tennessee, there was only two PA schools, and they were both private and they're both twice as expensive. So actually going out of state was actually cheaper for me than actually going in state. So I didn't even apply to any of the schools here in Tennessee. I applied out of state, went to Kentucky, graduated from there, and then I actually did a postgraduate fellowship in orthopedic surgery. So I took some extra time, got some extra training for that, and I did take, obviously, a big pay cut for that because I was still a pa and I was still paid, but not nearly like a regular salary. But the training for me, it was kind of investment in my future, kind of worth it for me. So I did that. And then after that, mostly most of my experience has been in orthopedic surgery, so first assisting in the OR and then running clinics and taking call at the hospital, rounding patients, etc. So it's been a lot of fun because I get to work inpatient, outpatient hospital, you know, outpatient surgery center, er. We get to kind of work in all the different areas. So I think it's a really fun career for. For a. As Katie said, eventually I transitioned to mostly academia, so taught at PA schools for years. I'm still teaching at PA schools. And we went back a few years ago and got our Doctorate of Medical Sciences, which is a doctorate degree specifically for PAs. We were actually the inaugural class. And so at that time, you had to be a PA who was either teaching or had worked in primary care for five years. And it's changed now, but that was kind of the original intention of the degree. And that was, I guess we graduated back in 2018. So that's been a while now, but, yeah, that's my educational career.

Okay. Now, you guys got together and you started kind of a side gig a few years ago called the Pre PA Clinic. Is this a, you know, is this a profitable business or is this a labor of love? And what do you do there?

It is, all of the above. Getting into PA school is very competitive. The application process is very overwhelming. There's a bunch of PA schools out there, and each one requires something slightly different. It's also, again, like I said, very competitive. So working on the academia side, we saw a lot of candidates make a lot of the same mistakes that prevented them from either getting in an interview or landing a seat in a PA program. And so we started Prep Clinic to help candidates create their most competitive application, to demystify and help with a lot of that misinformation that's out there so that they can get into PA school and start their dream career.

I was going to say it's really important because it's expensive to apply to PA school. So if anybody knows anything about PA school, you have CASPA fees, you have GRE fees, you have supplemental application fees. You've got to fly for interviews and things. And so if you can get in your first cycle, not only do you start making a great PA salary a year earlier, but you can also save all that money from RE applicants. And so our goal is to help students, you know, tailor their application, teach them about professionalism. Because as we talked about earlier, sometimes people have never had this modeled for them. They don't know what a professional is. And so in order to succeed in a professional interview, they're not really sure exactly. Well, what do I wear? What do I say? How do I comport myself? And so we kind of try and help them in any way possible. Do we need to tweak their application Application? Is it professionally written? Do we need help with the resume? Do we need to do a mock interview with them? Do they just need information so they can make the right choice for them? So that's kind of one of the goals of our business.

And it's a. It's a podcast and a coaching service, etc.

Yes, yes, all of the above.

All right, so let's talk about PA finances. A typical PA education lasts 27 months, and data shows that the average cost of a public school right now is about $50,000 for the course, for the whole 27 months for in state. And it's about $89,000 for out of state, on average, $92,000 if you go to a private school, add in $20,000 a year or so for living expenses and we're putting most people now between 100,000 and $150,000 in student loans. If you're borrowing the entire cost, do you think that's a good investment? And why or why not?

I would say that's probably pretty accurate. Most people we've talked to, that's probably about what student loan burden. Now that does not include, if you have any undergraduate student loan burden, of course, us. It's a good investment. So I was taught that, you know, whatever you borrow for school, it should be around what you're going to make your first year out. So if you're going to make around 100 grand your first year out, that's about how much you should borrow for school, right? So realistically, in order to be able to pay it back in a timely fashion, and so PAs we know are going to be, a lot of us are in a lot of debt, a lot of student loan debt. And a lot of us, like for example, can't work during school. We had to sign this affidavit, so we can't work. So two and a half years of no work, two and a half years of debt, but we come out as high income earners. And so when we first started, when I first graduated, the average PA made something like 65 grand a year. And so the average pay in the United States is almost double that now. It's over 100 grand a year. And so we do come out as high income earners as well. So I do think that the ratio of debt is worth it. I think you put a lot of time and effort into your education and you can have a long career. As you said, it's 27 months. So typically, let's say you get out at 23, you get MPA school by 24, by 27, you're out there earning your great income. But I think one drawback is the fact that a lot of us start investing later. So if you don't graduate till 27, 28, investing is all about compound interest, long term. And so people who take longer for their education, they obviously lose those earlier years. And so I think that that's kind of the con of it. But I definitely think that the high income and being able to save and having this long term career, that if you look at any of the projections out there, they only expect the PA profession to grow really all healthcare, right. Is expected to grow most healthcare jobs. And so I do think it's worth it, but I that you have to decide for yourself. For example, we work with some clients. Some schools are 180 grand just in tuition, right? And as you said, some are 50 grand in tuition. So I think you have to really, really smart and really realistic and have a plan about how you're going to pay it back before you just say like, hey, I'm going to go to PA school, I'll figure it out later. I think you can make a lot of large mistakes that can be financially a detriment to you if you don't have a plan and really think about, okay, why do I want to go to this BA school versus this one? If it's three times as much, am I really going to get a difference in education? Is it really going to be a difference in my earning potential and down the line? And so I think that's one thing that some students don't think about. They just think student loans are student loans and they don't realize the differences in what they're going to have to pay for tuition.

So you mentioned one school that costs 180 grand. At what cost of education does it become not worth it? At what level of debt burden is it not worth it to become a pa? If you had to put a figure.

On, I would say that if you are looking at 200 grand in debt total, like undergraduate, graduate school, then you probably either need to have a plan afterwards saying like I'm going to work for a nonprofit and I'm going to do the ten year thing and have my student loans forgiven or you need to figure out a way that to apply to different school or work, apply to school, you can work part time or something like that. I probably personally would not take over 200 grand in debt because just the compound interest on that, right. They're not doing subsidized graduate loans anymore and so you're going to come out with a whole bunch of interest. And so that's probably, I guess, my line in the sand. And I can't give you any numbers about why, but that's kind of always what I had thought like hey, if I get that far in debt then probably need to do something. I don't know. What do you think, Katie?

I would say if you don't use your degree, you're going to be a pretty bad investment. So I didn't take out student loans, so I'm going to punt a lot of these Questions about loans to Beth. But I would say that if you're spending that much on an education, you should use it for at least a decade, if not more, to make it beneficial.

That's interesting to think about it as.

How long you gotta use it to make it beneficial.

I mean, if you're making round numbers, you're making 100 grand a year and you borrow $200,000 for a decade, you made a million dollars. So it cost you $200,000 to make a million. Maybe that's not a bad investment if you think about it that way. On your podcast you've talked about some of the hidden costs of PA school. What are the hidden costs of PA school?

So PA school is divided up into didactic year, which is your first portion, it's all the book, work stuff, and then your second part, which is your clinical year. And that's where like the rubber meets the road, the bread and butter of medicine. We send our students out for anywhere from six to eight week rotations. Programs try really, really hard to keep students in areas where they have family and can live at home, where they have housing situations, worked out, that sort of thing. But a lot of times we do have to send students away and a lot of students don't plan for that. There's the extra living costs, the housing, the transportation, just the logistics of going to those rotations that a lot of students don't plan for. So at the programs where we worked, we would tell them right up front, didactic year, first day of class, to go ahead and start setting aside money every single month in the anticipation that they're going to at least have one rotation away from home.

Any other costs?

Yeah. And then medical equipment for example, is super expensive. Like we require certain types of stethoscopes and if you don't have one, it can get quite expensive. Otoscopes, ophthalmic scopes. A lot of times PA schools require you to buy those. So that's also another expense. We also require certain like computer. And so it's not just a regular computer. You have to have a certain drive and you have to have certain specs for this. So a lot of people do have to buy new computers. A lot of our like, software that we use to like lock down browsers for them to take their exams, for example, can only work with the newer systems. Books, books are really expensive. So if you don't get them through your library, you're talking about $500 a semester for books. And when you're talking about seven semesters that can add up. As Katie said, you might have to travel gas costs. We actually had a student once who didn't even own a car. And so that's hard to do in our area. Maybe not in a place like New York with public transportation, but having to get a car as well and then medical expenses. So some schools, for examp, you can get student health insurance. But we worked at a school where they didn't have student health insurance. It was a private school. And so now you're thinking about, now I have to pay for health insurance, which is anybody who's been on the market. It's super expensive. And so if you can't get on your parents because you're old enough and you don't get it through your school, that can be a huge burden for students to have to pay that student health insurance. A lot of hospitals, for example, require like TB tests, even if you've just had one. Right. They want their own drug test and their own TB test and they want to take, you know, make sure that you've had the chickenpox. And so they take all kinds of levels and you have to give blood. And so there are a lot of these hidden costs that you would never think of. But if you have to pay for a background check twice and a couple drug tests for different hospitals, it can get pretty expensive. When you're talking about living on student loans, a lot of schools require certain apps. For example, like let's say you have to have an app to download your patients in. And so you have to have a phone that's compatible with that app. So there are a lot of things that you don't really think about in the day to day expenses. But it really can get expensive. Buying your white coats, buying your scrubs that match your school, there's a lot of these hidden costs that you just wouldn't know about until you get into school.

Now, I suppose the health insurance, if you're not making any money, you ought to be able to qualify for a pretty good subsidy on the Obamacare exchange. So these days, hopefully that part's a little bit easier than maybe it used to be.

I hope so. You know, I was lucky. I went to a big public school and so at University of Kentucky in Lexington. And so as part of the graduate program, we were able to have student health insurance, which at that time, you know, was super reasonable. And so I know that some of our students have been like military in the past and they've been military health insurance. But we have heard some students Say, like, well, what am I supposed to do for health insurance? And I don't know if it's because they're still on their parents taxes or how that worked. But we have had some students who've had some struggles with that in the past. And I think it does vary some state to state, too, depending on what is available. And then again, school to school, do they have school health insurance? And some of the smaller private schools don't.

Yeah. So what can PA students do to minimize their debt burden?

I would say don't live outside your means. We have a lot of students. Not a lot, but we had students who on breaks from didactic care or in between clinical rotations, they would take a trip to Mexico or go up to Vegas. And so living outside of your means is definitely going to get students into trouble for sure.

Of course, everything's outside your means when you don't have any income at all, when you're only living on loans. I mean, a Slurpee's outside your means. So at a certain point, you got to find some balance. Right?

Right. And I just think it's a mindset thing. So, like, I went to school and I remember. I remember this vividly. I broke, like, my sunglasses, right? And I was a big runner. And so I went to Target and got like, $8 sunglasses, and everybody made fun of me. And they're like, those are the most ridiculous looking sunglasses ever. I was like, y', all, these are $8. And then my friend was like, you should just buy a really nice pair of $300 ones and just keep them forever. And I was like, I can sit and break $300 sunglasses just as easily as I broke my $8 ones. Right? And so in my mind, like, if I was a student, I was like, I'm not gonna buy a $300 pair of sunglasses. I don't even have a texting plan. I refused to text anybody when I was in school. Cause I was like, it's 25 cents a text. Like, I'm not texting you. Like, I mean, we could call each other for free. And so it seems like a little thing, but if you're talking about Starbucks every morning, if you're talking about, like, running to fast food every lunch, if you're talking about tons and tons of, you know, wine and beer after your big test, and then you're talking about buying cell phones, it's not just the $500 cell phone, right? It's the $500 cell phone plus the two and a half years of interest on that, maybe it takes you 10, 15 years to pay off your student loan. So that $500 cell phone is actually a $2,000 cell phone. And if you make similar choices every single month, I think that's what, that's what, it's kind of a mindset thing. And so a lot of my friends were like, I have to borrow so much anyways, I'm borrowing 100 grand, it doesn't matter. And in my mind I'd always think of like, okay, what is the actual cost of this? Like, if I were to pay this off in five years, what was my actual cost if I'm not to pay my loans off in 10 years? Like, how much interest am I paying on this? And is it it worth it to me? And so something like $300 sunglasses weren't worth it to me. Right. But I love to run. And so I did a half marathon during PA school. And so signing up for that and paying the hundred dollar entry fee, that was worth it to me because I was okay with realizing that, you know, this isn't $100, it's maybe $200 in the future. So I think it's just kind of a mindset and just deciding, as you said, you got to have a balance. But things like $300 sunglasses were never going to make me happy. They were never going to impact my life in a positive way. And so I wasn't interested in that, but I was super interested in joining A. And so that was kind of the way I did my balance.

Let's talk about incomes now. The 2021 AAPA Salary Survey says the median salary for a PA is $115,000. In your experience, what's the range around that? Like if you had to say what the 25th percentile is and the 75th percentile is, what would you say those are?

I would say it definitely varies by specialty. So I think that if you are a new grad, primary care 25th percentile is probably around 80,000. And I've known some CT surgery PAs who do vein harvesting who make over 150. And so I think the thing about PAs is a lot of times, since we can work in any specialty, a lot of PAs will pull extra shifts. Like I know a PA who does intakes for psych patients at the hospital because he's a primary care PA whenever he wants to make more money. But I'd say probably 80 grand is probably the 25th. And I'd say probably like close to maybe 130 is probably the 75th, just from my experience, but it does vary. Surgery specialties are going to be more aesthetics, like Katie works at is going to be more. ER is going to be more. Primary care is going to be less. Orthopedic surgery is pretty up there too, especially if you take a lot of call. So some PAs take a lot of call for their physicians and their physician groups and that can definitely increase that. But it's amazing to see how much it's changed. Like when we graduated with 65, I think, and now it's 115. So that's amazing.

Yeah, it's still a tight range compared to medicine, where the range is extremely broad. I mean, the range within a specialty is far broader than the difference between the averages and the various specialties. So actually what you describe is a pretty tight range, I think, for salaries. I was actually surprised it was that tight.

Yeah, I don't know. I guess I've never thought about it.

Yeah. What about a brand new pa? What should they expect to make? They're walking out of school, no fellowship, no residency, no extra training, walking into their first job. What should they expect to make?

Yeah, again, just like Beth said, it varies tremendously by specialty, but between a brand new PA, new graduate, anywhere between 80 and 115, 120.

So what can PAs do to be paid more? You've mentioned a few things. You've mentioned specialties where you work, taking call, working more shifts. But what else can they do to be paid more?

I think doing a fellowship like Beth did and advancing your education is definitely helpful. So like Beth mentioned earlier, we went back and received our Doctor of Medical Science degrees and that gave us a bump. And then doing a fellowship like Beth does, which she can talk about a little bit more, I think it also just helps you to be more competitive with the other candidates for the same position.

Yeah, definitely. I think experience.

Yeah, let's talk about that. Those training, I mean, most of them are one year. I think some are two years. Tell us about those for the various specialties and whether you think they're worthwhile.

Yeah. So PAs, when they graduate can obviously go straight into the workforce. And that's what the majority of PAs do. But we also have an option to do residencies, which are basically extra training. And so it's not required like it is for a lot of physicians, but for us it's kind of a choice and there's not a lot out there. So when I graduated the most, the residencies were either in a surgery subspecialties or were in emergency Medicine. And those were kind of the big things. I think they had one in ob gyn, but the rest were in those specialties. And so the thought process is your pa, you have to have your license, you have to have your certification exam. They bill for you your first assist, just like you would in the real world. But they know that you're there for training. And so you get. So I got paid something like $2,000 a month. Right. So it's significant below what I could have made as a pa. But for me, that was an investment in my future. So not only in my future earning potential, but also in the job I wanted. Right. So I did a orthopedic rotation in PA school. Absolutely loved it. Loved being in the or, loved just working. I was a big athlete. I love sports medicine. Patients love the way that they usually want to get better and kind of listen to what you say and just a good patient population to work with. And so for me, I knew that doing this fellowship was like, yes, I'm going to make less now. But the fellowship, they say is like equivalent to three years of practice. So I'm coming out and it's like I have three years of experience and so I can start off at a higher pay scale and then I can also choose like where what specialty I want to work with and what job because I have training. So for me, I wouldn't do it any other way. I think it really worked out for me. I think that there are a lot of people who get trained on the job. I mean, if you did one rotation in orthopedics, like, I mean, I was okay, but I wasn't super fast at suturing. I wasn't super efficient at a lot of joint injections. I had done some casting, but I hadn't done a lot of like the Robert Jones and some of the more complicated type of dressings and castings. And so for me to get that exposure and that experience and then be able to have that, not only is it confidence in knowing what you're doing, but it's also, you know, you can get the job that you want in the city you want, you can afford to be a little bit more picky because you do have that quote unquote, three years of basic of training. So for me, I think it was worth it to take a little step back financially to know in the future that going to be able to make that up because I'm going to start off at a higher pay grade because I have this experience. And then also just for the lifestyle Right. So I could kind of choose where I wanted to work, what I wanted to work in. And so I think for me, it was worth it. I had another friend in my class who did a fellowship in surgery, and she ended up where she wanted to work at Children's up in Cincinnati. And she ended up, like, pediatric neurosurgery in Children's. So, you know, her thing was like, I know I wanted to work here, but I needed experience. And so doing this fellowship got her the job that she wanted. So that's kind of what she saw out of it, too. So it wasn't just the financial considerations. It was also the kind of the job training and then what you can do with it in the future and the flexibility you could have.

Are they all one year or some of them longer?

Some of them are longer. So some of them are like 18 months, some of them. I think most of them are a year. I think some of them were shorter, some of them are longer. It really just depends on the individual institution. And a couple years ago, they had to go back and they. They more formalized it, like it was a formalized process, but they went back and so some fell away and some came up. So they're trying to standardize them, I think a little bit more now than they were back when I did it. But a year is about average. But there were some, especially like in the ER that were 18 months at level one trauma centers, which was really interesting.

And have you ever met a PA that regretted doing one?

I've only known three PAs, and so far we're all happy we did one. I guess the big regret would be is if you decide that that's not your. So you do an 18 month ER, you know, and then five, as Katie said, three. Five years later, you're like, burn out of the ER. You know, if you don't get your time in that specialty, is it really worth it? But the good thing is, is, you know, that kind of thing. Primary care, you still might see some emergence, you know, might see appendicitis, you might see these things. So I don't know if the knowledge is ever wasted, but I think if you're. If you decide not to become a pa, maybe you start a family and don't go back to work, or if you decide that that's not really your specialty, then. And those are the two scenarios, I could think that maybe you're like, I wish I hadn't done that. Probably wasn't a good move.

Seems like the vast majority of PAs are employees. Do you know of any situations where they aren't employees?

Definitely. We actually have a few friends who own their own practice and the supervising physician. Rules for PAS vary by state, but in our state, PAs can own their own practice. They just have to have a supervising physician sign off on a certain percentage of their charts. But they don't have to be in the building. They, they don't have to, you know, they just have to be on call for them by phone in case something comes up. So yeah, we have actually several friends who own their own practices.

All right. Physicians often get paid more by avoiding big cities on the coast. Is that the case for PAs as well? Do you get paid more to live in a smaller city or even go to a rural town?

There are some programs that will like pay back your student loans if you go to certain, like AHEC regions, like rural regions. But I would say in general your salary just to be salary is going to be higher in the bigger cities. They're going to pay you more in the bigger cities. A lot of, especially like surgical pas, like a lot of orthopedic groups are still private. They're not hospital based. And so if you work for like an actual group themselves and not a hospital, I think you probably make more money too. But most people we know worked in rural areas. The reasons they did that, either they were from that area or they had a passion for medicine there or it's because they got their student loans paid back by working a certain amount there. But I would, I would say it's kind of the opposite. I would say the big city is where you're going to make the money as a people pa.

So what do you see as the financial risks of a PA career? What do PAs worry about? What do they lay awake at night worrying is going to change in their career in their profession that's going to.

Hurt them financially, I think. Kind of like physicians malpractice. Right. So, you know, we could get sued as well. I guess that's probably a big financial thing, losing our jobs. And so since we're employed by hospitals or physicians, if they ever decide, like in Covid. Right. So a lot of PAs got furloughed. So I got furloughed from my orthopedic job because all the clinics, orthopedic clinics shut down. A lot of ERs, PAs got furloughed because the, you know, the ER, no one was coming to the ER. And so I think that that was surprising to, in the middle of a healthcare crisis to have certain providers that are just such need like ICU providers, et cetera. And then other places we got totally furloughed because we do a lot of outpatient elective surgeries and they lost 85% of revenue overnight, is what they said, because they had to shut down their surgery center, which is something I never would have thought. Thought, to be honest, before the pandemic. But now I think that's going to be on my radar forever. I don't know. What about you, Katie?

Yeah, I was going to say the exact same thing. So malpractice for sure. So that's always a concern. And additionally, like Covid just rocked everybody's world, of course. And I never would have thought that something would happen where I would lose my job or be furloughed, especially during a pandemic or a healthcare crisis. Crisis. So, yeah, that definitely have some shell shock from that.

What happened to you in spring of 2020?

Sure. So our volumes in the ER dropped tremendously. I mean, we were seeing a fraction of the patients that we usually saw. So I was furloughed for, gosh, a good six months.

They just said, don't come in.

Don't come in.

Any sort of pay or benefits you got during that time period?

Not at all. All.

Nothing.

Nothing.

It's just basically, your job's gone. Maybe we'll hire you back in a few months.

Yeah, good luck.

Now there's this sense among doctors. Lots of doctors feel like they missed the golden age of medicine or that everything's going to hell in a handbasket or, you know, that, you know, they're going to make half as much five years from now as they're making now. Do PAs have that hanging over their head? Is that a worry, or are they generally pretty optimistic?

I would say we're pretty optimistic. Our career has grown tremendously and it continues to grow every single day. I don't know how much you keep up with the PA profession, but we're now. Our profession is now seen in other countries of the world, and that's continuing to grow, too. So, no, I don't really necessarily worry about that too much. I don't know, maybe I should, but I don't. I think that our profession just has so much opportunity for growth, as you can see within the last decade, you know, when Beth and I graduated, a lot of patients still had no clue what a PA was and we would have to tell them what our profession was and explain it to them. Whereas now it was like the number one career, the number one profession to go into As I think that was on what, USA Today or US News, something like that a few years ago.

Now, lots of docs worry that PAs are taking their jobs. Do PAs worry that there's going to be a backlash from that, the docs are going to start taking their jobs, or that there's going to be some sort of, you know, major loss of PA jobs due to that conflict, that turf war.

I've never heard a PA worry that a doctor is going to take their job. And maybe that's because a lot of us are employed by physicians. And so, and again, I can only speak from the surgical PA aspect, but a lot of surgeons love PAs because they can really extend their practice. They can make a lot more money because they're more efficient in the. Or they can see a lot more patients in clinic where, you know, and do procedures. And so we can bill pretty highly for procedures. And so I've never, I've never seen it that I think everybody worries a little bit about medicine in our country, about can we sustain this healthcare growth, what's going to happen when we run out of money? And I think, you know, everybody worries about burnout and kind of worries about these things, but I don't know any PAs who are worried about, like, physicians or someone else taking their jobs. So I'd say we probably have an optimistic view of that and maybe it's because we are growing, but I don't, I just, I just don't see that happening. I think we work really well together. And I, and I don't see, you know, I don't see why, you know, we can work together to extend patient care and so everybody can be happy and everybody. I think there's always gonna be enough patients, right? So we're not getting healthier, you know, as a, as a, as a country and, you know, we're having, our population is still expanding and people are living older. And so I just don't see that the need for healthcare providers to go down. But I do sometimes worry about the healthcare system itself, which, which is, you know, entire different conversation.

But how about the other APCs, the nurse practitioners? I feel like half of the nurses in my ER are, you know, enrolling or thinking about enrolling into, you know, evening online nurse practitioner program. Do you feel risk for your career from that direction?

I think nurse practitioners do have something for them, the fact that they're independent practitioners. And so I think that there are some ways that they're more employable in.

That way, at least in some states.

In some States, right? Yeah. And so in some states it's like, oh, we don't have to worry about supervising physicians and you don't have to worry about reboarding and you don't have to worry about all these things. So I do think that there are some groups that like to hire nurse practitioners because of that. I personally think, though, the education is a lot different. So a lot of nurse practitioners come out and they don't know how to suture, they don't know how to do joint injections, they don't know how to first assist in surgery. So I do think that there's some areas where they really shine and excel and they're probably more nurse practitioners. For example, in OB gyn, if you look at all the minute clinics and things like that at the Walgreens, those are almost exclusively staffed by nurse practitioners. But when you look at things like surgery, I think PAs are more common in surgery. I think things like ER and Katie can speak to this, that they come in and they haven't been trained in a lot of the procedure base that PAs are trained in. So they do need that extra training. So I think in some ways they're more employable because in a lot of states they do have that independent practice and they don't need that supervising position. It's one less thing. But I think our training is superior in certain areas of the training. So if you're just looking to hire someone with the skills, I think PAs get trained in procedures better than nurse practitioners do.

Yeah, we are trained very differently. PAs are trained in the medical model, which is how docs are trained. And I love nurse practitioners, they're amazing. But just like Beth said, they are not trained procedure based like PAs are. And so there is a little bit of that downside to it, but there's a place for all of us in medicine.

Let's turn the page and talk about retirement. What are the differences between how PAs should save for retirement versus docs?

So I love talking about money in retirement. So one of the things I think about when I think about my retirement is that you have to think about what you want your retirement to look like and when you want your retirement to be. So I've known so many PAs that have worked until like 70, 75 years old and like three months after retirement, they have a heart attack on the trail and they're gone. Right. And so I think, you know, you have to have a realistic view of what retirement means for you. And it's all about, you know, how much money you plan on spending in retirement. And I think that the hardest thing to account for is we don't know like we don't know what health care costs are going to be like, we don't know what inflation is going to be like. And so it's one of those things, you don't want to run out of money. So if you're doing like the 4% rule or whatever, then you have to kind of estimate for part of that. So I think PAs have to think long term just like anybody else, just like doctors, anybody else in the health care. And I think, I think most people plan to work to like 65, 70, they'll say I'll just work longer, it's fine, I won't save as much. But sometimes health gets in the way. And we've known even healthcare providers where they just can't work as long as they want to because of their health gets in the way. And so you never really know what happens. So I'm all about planning for the long term. I'm all about the positive scenario. Let's figure out what you want retirement to look like. Let's figure out what is a reasonable age that you want to and then taking account your health status, do you have kids, your long term goals, do you want to save for grant great grandkids and really focus on the long term. Because we are high income earners, right? We don't, we're not like physician high income earners but compared to the average person in the United States, we're high income earners. And so if you get used to living a lifestyle at a certain number and then you have to realize like, hey, if you don't make that in retirement then you're not going to be able to live that lifestyle. So it's just having I think good expectations about what you expect it to look like and then planning for it. So if you're going to plan to like how much you have a plan and I think most people where they go wrong is they don't have a plan plan. They're going to think about that later, right? Because they're so busy in the now and, and working now and they're like, oh, I make a lot of money, I'll always gonna make a lot of money. But again, we've had a lot of friends and people that we've known that just are forced to retire for medical reasons or family reasons or something like that. So always kind of keeping that in the back of your mind that it's not always the best case scenario.

So how are you actually saving for retirement? I mean, what percentage of your income do you save for retirement? Where do you put it? What are you invested in?

Okay, cool. Well, I'll go first, Katie, and then you can go. Because, you know, I love talking about money. So for me, I work, still teach, and I have a 403B through that. And so I max that out. So there's a certain amount you can put in every single year through that. And so. And I do Roth. We have a. We're lucky. We have a choice between traditional and Roth. And so, again, I'm not a financial guru like you, but I've just done a lot of reading, and what I decided is that Roth and able to grow tax free is what I wanted. So I put 20 of my percent of my income in Roth. And then I also do a Roth IRA every year, which is, I think 6,500 this year is what you can put in that. So I do that. And then any other extra income I have monthly, I have, like a monthly spreadsheet. And so if I have extra at the end of the month that I'm not going to use, I invest that in index funds and mutual funds. I don't do individual stocks because I just don't feel like I have enough time to really look at individual stocks and really figure out, you know, which ones I want to use. So I just, I go with the index and I go to mutual funds. And I love Vanguard personally because they have kind of low fees. And so I use a lot of Vanguard funds for. For any of the that. And so that's kind of my investing profile.

Cool. Now, before anybody sends me hate mail about IRA contribution limits, if you're under 50, it's 6,000 this year. If you're over 50 or 50 plus, it's 7,000 this year. Don't send me hate mail asking how you can put 6,500 in. But next year wouldn't surprise me if it's up that high or even higher, given what inflation's been this year. So. All right, how about you? How are you saving for retirement?

So I put 15% away into a Roth. And then I also love Vanguard, and I do play around with individual stocks. I think that's super fun. Whatever tickles my fancy and whatever I feel like is going to be successful. And then I also invest in some real estate as well.

Okay. Now, FIRE is financial independence. Retire early. Have you found that there are very many PAs interested in fire? And is it a good field for someone who wants to fire in their 30s or for.

Yeah, so I didn't know that like that was a thing until I really started researching and I was like, oh my gosh, like, I'm not the only person out there. Like, so I love the fire. And so I have about two other PAs I know that are really, really interested in it. And one of them was actually a former student. And, and she's, she's doing great. So she estimates that she will only have to work seven years because she has a husband who also has a high income. They live very low beneath their means. Like her mom has a house, house, but she travels a lot. And so they say rent free in the house and they watch the house and so they have very low overhead. And so she's probably the best. I know because I mean, seven years is pretty legitimate from graduation to possibly being able to retire. It helps that she's a dual income. Right. So her husband's an engineer and so he pulls in a pretty good salary too. So they're like dinks. Right. Dual income, no kids right now. And so, and then I have one other PA friend that just. We talk about it a lot. We're super interested in it. You know, we read the same blogs, et cetera. So I'm totally interested in it. And more for the, like, the freedom than not work. Just the freedom to, you know, if you have a job and you want to leave the job, you can, you kind of have the power of that. I think we'll always still be working in healthcare and always do something. But I would love, Katie and I both love to travel, so that's a huge passion of ours. And I, you know, again, I lived overseas as a kid. I've got a lot of friends in other places of the world that I would love to have time to go visit. So I'm super interested in fire. I think it's amazing. I think that if I maybe had found kind of that a little bit earlier, maybe I wouldn't have made some financial mistakes or maybe if I had taken a finance class or just kind of knew. Knew a little bit more about finances. I do think I've made some mistakes, but I definitely can see myself hopefully retiring before, you know, the traditional retirement age. And whether that means retiring fully or retiring partly and doing something else following my passion, I don't know. But I definitely think PA is a good career. That if you're interested in that. Because we are high income earners, I think the con is that sometimes since we are high income earners, earners Sometimes we have that lifestyle creep with that. And then of course, you know, it's. It's about how much you save. Right. So if you make 100 grand, but you spend 100 grand, never going to retire. Right. And so I think that that's kind of the. The downside from it. But I definitely think PAs are uniquely positioned because, yes, we have some extra education, but we still get out in two and a half years, unlike physicians. Right. You guys are in school a lot longer, and then we still make a really good income. So if the average is $115,000 a year, you, you know, especially if you have a dual income and you make wise financial decisions that I think PAs are really positioned uniquely to be able to retire early or at least, you know, move down to part time, whatever retirement looks like for you because of the high income.

What do you think, Katie? Besides Beth, do you know any PAs interested in fire?

Yeah, we actually did a podcast with somebody whose entire podcast is about being a PA and fire. And I love the concept. Again, I was kind of late to the game, just like Beth, I think, feels like she was. And I don't necessarily know if I want to retire completely. I love work, I love my profession, I love patients, I love medicine. So it may look differently, though, as I get older, like dropping down to part time. Beth made a really great point on. It may look differently for different people depending on where they are in life. So part time. Yeah. Or PRN work. Yeah. But I don't know if I ever want to actually retire ever. And that may change. That's just where I am right now in life. But, yeah, love the concept.

What do you find that your peers don't know about investing so much?

So we're not trained in finances. We don't take a business course, we don't take a financial course. And most, even in undergrad, most of the students that go on to become PAs are on a science based major, like in a science based major. So they don't take those sorts of classes. So really they don't know anything, myself included. I didn't take a financial class, I didn't take a business class. When I was an undergrad PA school, we're so focused on medicine that there's not time to add that in. At one of the programs I worked at, I was the clinical coordinator. And so I had a little bit more flexibility to introduce that to students. And so I would really try to have like, you know, an hour seminar here and there for the students so that they could learn a little bit more about that because I do feel like that that was missing from our education. And you really do have to learn, learn on your own. Self directed learning later, during school, after school, where to go with your finances and how to invest.

You know, a financial advisor costs thousands of dollars. If you want good financial advice, you're going to pay 2, 3, 5,000, maybe $10,000 a year. Can PAs that are only making 100 or $120,000, can they afford to hire a financial advisor or are they kind of forced to become do it yourself investors?

I guess I'm a do it yourself investor, so maybe I'm biased, but I also am all about index funds and mutual funds. So I don't do things like Katie, you know, I don't have real estate and I don't have specific stocks. I guess I've known some PAs who have had financial advisors and not just for them, but for like their families. And so it could help too if your spouse has an income, could help pay for that. I've never used one. I think that they definitely have their place. And especially, you know, like in medicine we say like, you know, know what you don't know, right? Understand where your scope stops, understand when you need to refer and everything. And I think that sometimes we're like, well, we're smart, we can figure this out ourselves. But if we don't have the time or the energy or really even want to devote, you know, time to deciding, like having a retirement plan, then I think it's probably worth it to have someone at least, you know, kind of map something out for you or keep you on track. I prefer to do it myself because I like the hands on control. But you know, I don't think it's a, it's a bad thing to have financial advisor, especially if you're not willing to put the time and effort in or not able to for whatever reason, life commitments, family commitments, because I think you just need to be smart with your money. And if you, if you aren't trained or willing to be trained or whatever, then I think it's smart to find someone who has been trained in that. Because yes, we're smart and yes, we could learn it, but do we really want to and do we have the time to. Like Katie said, I've never took a financial class in my life and everything I learned, I didn't even know what a four, okay, one was when I graduated. I was like a 400. What, like what is this? And so I didn't know Roth and traditional. I didn't know any of that stuff. Stuff, right. And then I started reading and I was like, oh, well, this makes sense now. But if I hadn't started reading, I mean, I know some people that just like, oh, I checked whatever box they said and whatever they match and that's what I put in. I'm like, well, how much is it a month? And they have no idea. Like, you know, they just, they just don't know. They don't, they're not interested. And so I think if you're not interested yourself in learning, then probably a financial advisor would be, would be smart, but it would, it would be hard to pay 10% of your salary, you know, pre tax salary in a financial advisor. So, so that would motivate me, I think, to maybe get a little bit of literature and start to read and start to invest. I don't know, what do you guys do? Katie?

We have a financial advisor. And especially when I first graduated PA school and had a significant jump to my income, I wanted somebody to provide a little bit of guidance. So I thought that that was super beneficial. And we continue to use them to this day, especially with the combination of my husband's.

All right, well, our time is getting short. This will eventually be listened to by between 30 and 40,000 people, only a small fraction of which are actually PAs. What have we not talked about that you think our audience should know?

I think one really interesting thing that probably is worth mentioning is physicians in general are more subspecialties. So my last orthopedic job, every single doctor was fellowship trained in hand or shoulder or something like. So it seems like physicians now, they're not just doing like orthopedic surgery, right? They're doing like hand fellowships. And so they're getting more and more specialized and PAs tend to follow physicians. And so it would not surprise me as if in the future PAs become even more and more specialized in these subspecialties too, because we tend to follow the people who hire us, right. Which is a lot of physicians. And so, you know, I think the potential for earning in those areas are going to be even higher if you specialize in some of these subspecialties because I know, for example, example, my hand surgeon can bill more for a certain procedure than a general orthopedic does for the same procedure because he's got that extra training. So it would not surprise me if the PA salary continues to grow, especially as we follow physicians into subspecialties. And so it'll be interesting to see kind of what the 10 years from now what the average salary for a PA will be. Of course you have to take into account inflation, et cetera. But it has jumped so much just in the last decade that I just really see it expanding even more and especially, especially as we tend to subspecialize even more.

Well, we appreciate both of you coming on the podcast and talking about the finances of PAs. If you want to learn more about Katie and Beth's work, you can find them. As I mentioned earlier, they have a podcast called the Pre PA Clinic. They do coaching there for Pre PA students. And if that's you and you're interested in getting some help getting into PA school, you can look them up there. Thanks again for for your time.

Thank you for having us.

Thank you.

All right.

I hope you enjoyed that interview as.

Much as I did.

There's a lot of lessons that can be learned there. No matter what your profession, no matter what your specialty, no matter where you're at financially. You know, the truth is 95% of financial information is about the same for everybody. 4% of what we talk about here is maybe applicable only to people in the highest tax brackets and then only really 1% is probably true. Truly physician specific information. And so let's spread this information around as best we can to those who can be helped by it. If you're finding our podcasts informative and helpful, we would encourage you to sign.

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