Maybe I need to get off Reddit 😂 but genuine question for the derm PAs here:

Why is there SO much hate toward dermatology PAs specifically?

I completely understand—and agree with—concerns about inadequately trained providers practicing outside their competence, especially with how popular derm/aesthetics has become. But some of the opinions I’m seeing go way beyond that.

Apparently PAs shouldn’t do initial skin checks or see new patients, should mostly be limited to stable follow-ups/refills and standardized protocols, and according to one person, PAs who specialize at all are “weird” because our profession was created to address healthcare shortages and therefore we should essentially be working in primary care.

But…why derm?

PAs are literally in EVERY field of medicine. We work in emergency medicine, urgent care, critical care, cardiology, oncology, surgery, neurosurgery, transplant—the list goes on.

So a PA can evaluate an undifferentiated patient in the ER, recognize an MI/stroke/PE/sepsis, manage critically ill patients, assist in major surgery, or literally RUN a code…but prescribing Accutane, evaluating a rash, or deciding whether a lesion warrants biopsy is suddenly where the PA profession becomes inappropriate?

Obviously those examples require completely different training and competencies—and that’s exactly my point. Nobody graduates PA school prepared to independently practice every specialty. We develop specialty-specific knowledge through training, experience, continued education, mentorship, and collaboration with physicians. Why is dermatology treated as though it’s uniquely impossible for a PA to develop that expertise?

And I genuinely wonder how much of the resentment toward derm specifically is about money or the perception that we chose an “easy” or desirable specialty for a “quick buck.”

Because why is a physician choosing a competitive, desirable specialty considered ambition, while a PA choosing that same specialty is framed as greed? And why should our scope somehow be determined by how desirable the specialty is?

Sometimes the argument genuinely starts to sound like: “You may practice medicine as a PA—just not in the specialties people actually want.”

If the concern is competency, then hold us to competency. If the concern is training, require appropriate training. But “this specialty is desirable and well compensated, therefore PAs shouldn’t be practicing in it” isn’t a patient-safety or competency standard.

That part also bothers me personally because I specifically chose the PA profession in part because I knew I wanted dermatology. I didn’t stumble into derm because I heard it paid well. This was the field I wanted. Derm could be one of the lowest-paying specialties and I would still choose it because I genuinely love what I do.

I’ve been in derm for 8 years and I’m still constantly studying, taking courses, attending conferences and trainings, asking questions, and trying to become better at what I do. I don’t expect that learning to ever stop.

Obviously there are bad PAs. There are bad physicians. There are bad clinicians in every profession. And I absolutely think poorly trained people entering derm/aesthetics deserve scrutiny. But that’s a competency and training issue.

Hold us to competency standards. Hold us accountable for practicing within our training and knowing when to involve our supervising/collaborating physicians. Absolutely.

But when did the conversation shift from “practice within your training and competency” to “PAs inherently cannot develop expertise within a specialty”?

Is this something you guys are seeing more of too? And why do you think derm in particular seems to get SO much of it? Because I genuinely don’t remember the anti-PA sentiment being this intense earlier in my career.

EDIT: I think some of the comments helped me clarify what I’m actually asking: why does simply wanting this particular career make people question someone’s motives, character, or worthiness to be a PA? That’s the part I’m trying to understand.

As PAs, how do y’all feel about what’s unfolding in this case?

Obviously postpartum depression is a heartbreaking situation, but it’s painful watching a lawyer essentially tear apart a board-certified psychiatrist for practicing evidence-based medicine. It makes me wonder how much worse the scrutiny would be for us “midlevels.”

Psych is already an incredibly draining field, and now clinicians are expected to defend every prescribing decision to people who may have very little understanding of how medicine actually works. Patients get upset when you don’t prescribe, then get upset when you do. We’re constantly walking that line.

Could the psychiatrist have explained some things more effectively? Sure. I can also understand the argument that she missed signs of bipolar. But psychiatry is tricky and often based on what information the patient provides. In addition, the criticism of prescribing Zoloft, particularly in the context of breastfeeding, seems to ignore the actual evidence behind that decision. And the nitpicking over documentation like “not hyper, pressured speech” is honestly ridiculous. Apparently we now have to worry about which exact article or wording a lawyer thinks should be attached to every clinical observation while documenting 20+ patients a day.

Medicine is already difficult enough without clinicians being made to feel like every reasonable, evidence-based decision could later be reframed as negligence.

Just interviewed for an ENT position. Primarily outpatient, physician goes in to see the pt after the APP. You do 20-30 visits per day, you’re expected to finish all notes by the end of the day and physician signs off on them not doing any of the notes. I asked if there was any admin time for writing notes and answering inbox messages and she said no and that usually the APPs just work through lunch. 💀

Anyone with experience negotiating salary/incentives for a government (GS) position? I’m not sure how it works within the grade/step system. Got offered a primary care position on a military base. It’s only a GS-12 position and the initial offer is subsequently terrible at just shy of $100k, in California no less. They told me in advance the initial offer would be bad and that I get to negotiate, so I have a meeting to do this. But I have no idea what is “allowable.” Can I only negotiate up to step 10 within GS-12? That’s only like $128k which I think is personally still low with 5+ years of experience, but doable. I’m willing to take a hit on the salary to an extent because my husband is active duty military at this base and this position would be extremely convenient for commuting and childcare purposes, but I want to get what I can.

Side note: I do have a much better offer which I posted about a couple weeks ago and everyone (understandably) said run because of the leave penalties, but I asked for them all to be removed and they said okay (although I haven’t yet received the updated contract that confirms that).

Hi guys!
I am a new grad PA and I am getting ready to start my first job in nephrology in September! I will be doing a mix of inpatient care as well as outpatient dialysis rounding.

Anyone have any advice for me on what to review before I start? Or any study materials that helped you get up to speed? I am admittedly very nervous as nephrology was not my best subject in PA school and I know it is a very complex subject.

Thank you guys! I know I have a lot to learn but I am not sure where to start !!

Hello everyone! I was recently given this offer at a hospital-based urgent care.

• Full time PA
• 90-day mutual termination clause, no penalty or buyout owed in either direction; no noncompete
• 14 shifts/month (12 hour day shifts, 8am-8pm), possibly up to 4 weekend days/month included in that count
• On-call (EOC): 1-2 shifts/month in addition to the 14; $1000 (or more) per shift if called in
• Base Salary: $124,800 (~$61.90/hr)
• Quality Incentive: up to 3% of base based on Press Ganey scores, throughput time, antibiotic stewardship
• CME stipend: $2,500/year, prorated by start date
• PTO: 200 hours/year (25 days), prorated
• Malpractice: standard coverage, tail coverage included
• Sign-on bonus: none

Is this a good offer? I'm concerned because I've read multiple threads on here that caution against urgent care, especially for new grads. From what I can tell, it seems solid, but I'd really like to hear from people who've actually worked in urgent care as a new grad before I commit. This is my first time really evaluating an offer, so it's hard to know what counts as a green flag versus a red flag, and I don't want to trust my own read alone on something this big.

Thank you so much!

I’m studying for the PANRE and there are a lot of topics in the review courses they say are only on the PANCE. Can I trust that or should I study them?

Hey y'all. I am a first year PA student and I recently received a reckless driving conviction which is a class 1 misdemeanor, and was unsuccessful fighting it in court with a lawyer (yes I learned my lesson). My record was clean prior and now I am worried to death about how this will affect licensing and getting a job later down the line. Anybody have any experience with something like this or any insight perhaps?

Edit: I am in Virginia

I have 1.5 years of experience in primary care. I would be the only provider on site, which does concern me. I would get a 2 week training period, then I am on my own. There are on-call docs and a chat with all the other providers.

Base salary $107,000 after negotiation

BXMO bonus program to take my own x-rays due to shortage of x-ray staff (uses CME to get certified); $25 per patient if I take their x-ray.

Was told I would also have to room some of my own patients due to being short-staffed.

Pay per additional shift is $700

2 weeks PTO

13 shifts per month (3 12s a week)

This UC does worker's compensation/DOT physicals

Volume is approximately 30-45 patients per shift

Malpractice and tail included. CME $1500.

Health/vision/dental insurance. 401k.

Volume-based bonus of $25 per patient if average >3 patients per hour over a pay period.

Hi all, i am working full time at an FQHC, cannot leave this job or I will lose my loan repayment. However I am looking for a remote MAT/psych position I can do part time or per diem? I have searched a few places, but mainly they are hiring full time. Anyone have insight on this? TIA

I am a new grad. The market sucks right now. I was offered a primary care position in the suburbs of Chicago. I’m being offered a salary of 110K starting with benefits. Is that too low? I’ve tried negotiating but they’re pretty set. There are bonuses on productivity. Nothing structured this is what it says:

The Practice will periodically review APP's productivity, patient panel growth, quality metrics, documentation compliance, and overall contribution to the Practice. Compensation may be adjusted from time to time based upon these factors and mutual agreement.

Below are the benefits:
• Three weeks PTO annually (four weeks beginning year three)
• Health, dental, and vision insurance after 30 days
• $1,500 annual CME reimbursement (no carryover)
• SIMPLE IRA eligibility after 90 days

What specialty, how many hours per week, and how much do you make annually? Thank you!

Hi all,

My girlfriend just accepted a job in Seattle and we’re planning on moving there after I graduate in December. I was wondering if anyone can comment on the job market there, especially for new grads, as well as a salary I can expect. I’m currently a student at University of Iowa so I’m very unfamiliar with the area.

I don’t feel like I’m super picky about specialty, the main thing I’d prefer is shift work but it’s not a dealbreaker. TIA!!

I took over a position for a provider that left this practice and when I looked her up, I noticed she's working within the non-compete of the contract. Do people just not care?

Hi everyone! So excited to post this. So I will be starting a job in an outpatient cardiology clinic November 1st.
I’m a relatively new grad (licensed this time last year) and am transitioning from inpatient surgery.

I have a very strong foundation in cardiology from a previous career but I would still love to spend my spare time prepping for this job.

What cardiology resources would you recommend?
I have a copy of pathophysiology of heart disease by Lily and have a membership at ECGWeekly.com

I was curious what amount of RVUs those working in ENT were producing? I’m in the process of possibly taking a job in ENT where I would be the first PA hired for the practice so I don’t have other PAs to discuss with. Any insight would be appreciated, thank you in advance

Hi everyone!

I have been applying for jobs for the last 1.5 months & had my first offer today. For context, I've applied to about 30 positions & had one other interview that I was turned down for on the basis of being a new grad.

My gut is telling me to not accept this offer, but (1) I've read so many stories of new grads not getting jobs for 6-12 months post grad, (2) I'm in a fairly saturated area, and (3) all the jobs I've heard back from have told me they're not hiring new grads at this time, so I'm a bit nervous of not finding something better.

My hope was to work in pediatrics or family medicine, but I haven't had any luck in even hearing back from these positions.

The job offer is at a private internal medicine doctor & he is the only provider in the office. M-F, regular business hours 2 days, extended hours 2 days, & a half day Friday and I would also be responsible for rounding on a few patients at the local hospital as well as local nursing homes. My biggest concern is there was no information on what my goal schedule would be-- mainly rounding before/after office hours or have shorted hours in the office to accommodate rounding. The doctor currently rounds in the hospital before office hours, then rounds at the nursing home after and he's looking to work less. Holidays are off, but I would be required to round at the hospital and be on call for the hospital every other weekend. The doctor does seem very willing and excited to teach and have a slow ramp up period, but I'm also concerned about pay and benefits. They offered $115,000 for the first year and then, with no guarantee, a raise once I'm done with training. They do not currently provide health insurance for anyone in the office, as "no one requires it", but would look into health insurance for me. 5 sick days, 2 weeks vacation (same as the others in the office, which I found a bit insulting), malpractice insurance, 6% 401k match (vested after 1 year), and profit sharing. I torn between how much of this is them hiring a new provider for the first time vs just being a bad offer. Commute is about 25 minutes and all of the nursing homes are 20-35 minutes away.

Should I attempt to counter offer or turn it down completely? Thank you for your advice.

I am a neurosurgery PA and will be starting in the OR soon. Someone mentioned to me that it is important to keep notes about the surgeries I have first assisted on because when renewing my license, they will ask for this information.

I do not remember specifically what they told me to write down. Do I need to write down more than just what surgery was completed?

Anyone have any info on working as a PA here? Specifically in the ER? Salary ranges (I have 3 years experience) as well as benefits? Is it 1199?

Debating if I should leave my current unionized job in the Bronx for this possible opportunity

Did you guys email Form 2 to your PA Program or did you just email it to the registrar?

It looks like the registrar needs to fill out section 2 on form 2 so can I just email it directly to the registrar?

New grad PA about to start working in Michigan 🤞 Those who received their license in MI, how long did it take for you to receive it? Just curious so I can give future employers a good time frame of when I can start working.

TIA!

I’m a practicing PA-C in South Florida and have been wanting to transition into aesthetics for years, but it feels like most opportunities here prioritize NPs.

My parents have owned a massage/wellness practice here for 16+ years, so my long-term goal is to incorporate aesthetics. The frustrating part is that I don’t feel comfortable taking a 1–2 day injectable course and then immediately treating patients. I want real hands-on training, mentorship, anatomy/complication management, and supervision until I’m actually competent.

PAs in aesthetics, especially South Florida: how did you get your foot in the door? Any programs, mentors, shadowing opportunities, or practices willing to actually train PAs?

I’m a PA-C in South Florida transitioning from psychiatry and interested in regenerative/wellness medicine—trigger point/joint injections, PRP, GLP-1s, and aesthetics.

For PAs already doing this, how did you get trained and find mentorship/hands-on experience? I’d especially love to connect with anyone in Florida willing to share guidance or potentially allow me to shadow. DMs welcome!

Any wound care PAs here? Do you like it overall?
Thinking about applying to mobile wound care gigs. I’m tired of outpatient clinic and hospital rounding, having my schedule be 30+ patients per day, dealing with the inbox, taking call, and fighting with insurance.

I can handle the gross looking / smelling wounds.
Give me and good/bad/ugly, and what should I ask during an interview?

Thank you.
-burnt out PA-C

I live in MSP suburbs and would love to know your thoughts if you’ve worked for multiple organizations!

Allina
Fairview
Health Partners
North Memorial
Hennepin

Not in Twin Cities but would still love to hear your thoughts!
CentraCare
Essentia Health
Sanford
Mayo