Planning Finances as a PA with PA the FI Way

Are ya'll enjoying our recent focus on finances? Do you know what "financial independence" is? Kat from @pathefiway is on The Pre-PA Club podcast today to tell us about her journey to establishing a financial education and helping other PAs meet their financial goals through her podcast - PA the FI Way. It was a really fun conversation, and I'm actually on her podcast as well talking about my student loans and creative outlet through The PA Platform.

Kat: So my name is Katarina, but I often go by Kat. I am a PA that lives in the upper Midwest. And I went to a PA school at Des Moines University. 

Savanna: Awesome and you're practicing now? 

Kat: Correct! Yep, I started in family medicine for about six and a half years. And I recently switched over to outpatient psychiatry back in January. I still do have a casual position with my previous employer as a walk-in/Urgent Care PA role too, so I like to keep that generalized medicine still going on too.

Savanna: Nice! Are you doing in-person psychiatry or mainly telemedicine? 

Kat: When I first started, because of the COVID pandemic, it was mainly telemedicine, but just recently we switched back over to seeing people in person again too. 

Savanna: Okay, interesting. Yeah, that's what a lot of my PA friends who work in Psych have been doing - a lot of telemedicine. It's a specialty that definitely translates well to that. I'm in dermatology, and it's a little hard to see things over Zoom, when trying to look at skin lesions. We've made it work, but it was a little difficult. So, let's take it back a little bit and what made you interested in becoming a PA?

Kat: So back when I was in high school, I felt as though I needed to figure out what to do with my life, as I'm sure many people felt the need to do back then. And I really enjoyed science, and I hadn't really thought about different types of careers in medicine. So back then in high school, a lot of people only think of doctors or nurses, although there are so many other types of careers out there in medicine as well. I highly encourage anybody interested in medicine to research about and consider other careers as well. But when I was in eighth grade, I tore my ACL my first and last time skiing, because I was not a good skier haha. And in the ER, the provider who saw me was a PA, and I didn't necessarily register it at the time as a teenager. But a few years later when I was thinking about what to do for school, my mom reminded me that that provider was a PA, and so we researched the profession together. I just really liked the fact that you get to have less student loan debt, and a little bit less time in school as well. I also really enjoyed the lateral mobility of the profession, obviously as I've utilized, so those were the factors that prompted me to pursue the PA profession.

Savanna: Nice! Yeah I feel like everyone comes to it in a different way but those personal medical experiences tend to be a common theme where you figure out, oh there are people who can take care of me who aren't necessarily doctors, which is nice and a good path to take. So I've actually never had a PA who works in psychiatry on the podcast surprisingly because I feel like there aren't that many of y'all. There's definitely a need and I know in the area I'm in in Georgia, we definitely need more psychiatry providers. What does a typical day at your job look like? What is your schedule like in that specialty?

 Kat: Definitely, you're correct that there are definitely few PAs in psychiatry. When I was looking into switching into a specialty, the research I found at the time was that probably less than 1% of PAs work in psychiatry, so I thought that was very interesting. During a typical day right now, I will see either intake patients, or follow up patients. Intakes are new visits, and they are either self-referred, like some people just want to see a psychiatry provider for some reason, or family medicine may refer them, or a lot of times, they are follow-up from a recent inpatient hospitalization for psychiatric purposes, and we are seeing them once they've been stabilized in the hospital. As I mentioned too, it’s both currently a little bit of Telehealth visits, a little bit of in-person visits, so it's a little bit of both going on. We also manage their mental health medications, and we have to monitor labs with that. It's very weird, I'm sure you can relate as a derm PA, but it's very weird not to use the stethoscope anymore day-to-day. But that was something to get used to, but I still feel as though I'm helping people, and it's definitely a very interesting specialty for sure. You see a lot of different things, lots of different mental health illnesses, but it's very rewarding to try to help others feel better and try to help stabilize their mental health symptoms, so that they can improve. 

Savanna: So are there any limitations in your specialty? Because I don't know about where you're at, but as far as with medications you're able to prescribe, just being in a specialty where you may be prescribing drugs that are on different schedules? 

Kat: Sure, so that's a great question! At my company, they are very much trained on the job. So, the medical director is the supervising physician that we work with. In my state, we don't technically need the true supervising physician role anymore because of legislation changes. But every company keeps that role differently, right? So he's a psychiatrist, and he works with the PAs and is very hands on. So we have a weekly meeting with him where we ask all of our questions; we can send him messages all the time; we can go down the hall if he's in clinic. He oversees the PAs at other clinics as well which is really cool. So he's very hands on. We prescribe and manage all mental health meds. There's even one of the big gun antipsychotics called Clozaril (clozapine), you have to take some online training and then we manage that and prescribe that as well. A lot of injectable medications and controlled substances too, but I do appreciate that our company has a pretty strict controlled substance agreement policy. So we don't mix any controlled substances. Or if patients are using drugs like medical marijuana, depending on the situation, we often don't use controlled substances as well. So I do appreciate that support too. 

Savanna: That's awesome. That sounds like a really great work environment and set up, which should be a goal for anyone who wants to be a PA. I want to pivot a little bit. So the reason we connected was through Instagram, and I started seeing your posts pop up on your account PA the FI Way, which we'll explain a little bit about. but so can you just explain what got you interested in financial topics and what inspired you to kind of create your account and podcast?

Kat: Yeah that's a great question. So, I guess for financial topics… I really wasn't that into finances. My husband used to manage all the bills, so I just thought that he manages the bills and I didn’t really have to learn much about finances. As a PA, I was just learning so much that I didn’t necessarily mind. I was definitely trying to pay off my student loans, but now aggressively. Unfortunately, I started off working with a financial advisor, who was not the best fit, because some things that he suggested aren't necessarily sound wisdom, so we got burned a little bit right out of PA school. How I got into the topic of financial independence was through travel rewards or travel hacking. We were on our way to a friend’s wedding, and one of my friend’s husbands asked, “hey do you like traveling? have you heard of travel hacking?” And he introduced me to the Choose FI Podcast. That is the podcast I started listening to, and that's how I got hooked on financial independence. I became kind of frustrated with our training - about how much we get into debt. We do earn a fair income out of PA school, but how do you balance that? So, it made me want to try to educate other current and future PAs out there about the concept of financial independence. 

Savanna: I'd say in the last couple of years, that is something I learned about because they don't really teach us in school about debt or loans or investing or any of that. So it's a lot of self learning. But this concept of financial independence was new to me. Can you explain what that means on kind of a basic level for somebody who's never heard of it?

Kat: Sure, so financial independence is a very broad topic, but I will definitely do my best to try to explain it simply to those who are just kind of getting started. So financial independence, the abbreviation is FI (that's where PA the FI Way came from). And that's the first part of the acronym FIRE, or Financial Independence, Retire Early. Retire Early is actually optional, so once someone reaches the point of financial independence, they don't have to retire early. They certainly can continue working as a PA for many, many years to come if they would like to, but reaching that point provides many doors throughout your life, like you could consider cutting back on work or things like that. So, FI is the point at which a person (or a couple) reaches where they have invested savings equal to 25 times their expected annual expenses. So a lot of financial calculators look at your current income, but it's not really what you make that matters for retirement, it's what you expect to spend in retirement. For example, if a couple expects to spend $80,000 per year once they stop working, then they will need to have invested $2 million, or investments plus savings money. Otherwise, if they are able to live very frugally on only $40,000 a year, they would only need $1 million. Some people are really frugal and live on less than that as well. So financial independence is based on something called the Trinity Study, and what that study shows is that if you reach financial independence, you have a very high probability that you'll be able to last for 30 years with your finances. So if you are thinking about retiring really young, you probably should have more than 25 times your expected annual expenses saved up. 

Savanna: Okay, that's what I was just thinking. So you're saying if I had $2 million in the bank, I could just retire - that doesn't seem like that would work hahaha. I mean investing is so complicated with compounding and all that. I'm sure there are lots of calculators online where people can plug stuff in and all of that. So when we talk about investing and saving and paying off debt and all of these things - when there are so many different techniques and terms, what stood out about this concept of financial independence? Do you plan on retiring early? When you found out about this, what steps did you decide, like okay I'm gonna do these things to make this a reality for myself. 

Kat: So the two very condensed ways of achieving financial independence is trying to cut back on costs and save a lot, but then also try to invest throughout your career too. So you're trying to invest as much as possible for your future. In regards to whether I'll retire earlier or not, probably. I really don't want to work until I'm in my mid 60s or potentially even 70s. I'm not exactly sure when we will for sure retire, but again as I had previously mentioned, reaching financial independence or being close to it allows you the ability to really cut back on your work if you really want to. My husband and I don't have kiddos yet, but once we do, then that can help with a balance in our life at that point. Both my and my husband’s fathers passed away at relatively young ages. My dad was in his early 60s. and his dad was in his 50s. You hear all the time about how somebody reaches retirement age, and they’re so excited to retire and unfortunately something awful happens where a spouse passes away, or they get an illness, and they can’t do the things they planned for their retirement, whether that's traveling or other hobbies or activities. So that's why we're trying to pursue financial independence. 

Savanna: Yeah, those are great, great reasons. And that's so true. I mean, there is so much variation in the PA profession between our specialties, jobs, locations, life, and debt and all that. Is this a concept that you feel like most PAs would be able to achieve and pursue, or do you think you need to be in a certain place already before you consider making actions towards setting yourself up for financial independence?

Kat: Sure, that's a great question. I think that every PA and their family can reach financial independence, and there's a few reasons why. One is that PAs do make a pretty decent and good salary. There are many school teachers that reach financial independence on a salary that's way less than us as PAs. Again, it’s about those expenses, so you don't have to cut back everything and live super frugally. But you need to find the balance of finding those things that you value in life. You don't have to be married to a high income earner as well. You can be the primary breadwinner, but if you have a PA salary, then you can certainly reach financial independence. 

Savanna: Are there any resources that you use? I know there is Physician on FIRE, who talks about this who is a physician. There is also White Coat Investor; I feel like everybody knows about. What resources have you found to be the most helpful in just learning about finances?

Kat: Yeah! I absolutely love the White Coat Investor and Physician on FIRE; they're both excellent resources for those of us who practice in healthcare. As I mentioned before, Choose FI Podcast is great as well. And there's another PA on Instagram, Kristin Burton (@strivewithkristin). I recently interviewed her for my podcast as well. So she has tons of good resources too. There's so many good books too! The Simple Path to Wealth is an excellent book to start with, or Quit Like a Millionaire. It really depends upon what type of modality you want to learn from. There are podcasts, YouTube channels, books. I do have my podcast as well, PA the FI Way. I tried to really teach about these financial independence concepts, break it down in understandable pieces for peers and make it applicable to them as well. 

Savanna: Nice, and I love that it’s specific to PAs! As a PA, you can understand the education and everything that goes into it, the job, and all those factors as well. Let’s talk about the different stages. We have pre-PA students, PA school students, new grad PAs, and other PAs. What are some things that people can start doing at these stages to kind of set themselves up for financial success later on?

Kat: Sure, yeah so this is a really deep question that you can go into many different branches, but I'm going to do my best to be concise here and try to give some actionable tips along each step here. In high school, try to keep your college costs low when planning for college. You can do that by taking AP or dual enrollment courses. I went to community college for my first two years of college too, so you can plan to apply to community college, and then start applying to tons of scholarships in high school. Then in college, you can also consider living at home that can keep your costs low, or you can become a resident assistant as well. You can use used textbooks and apply to more scholarships, and then try to obtain healthcare experience. You don't have to spend tons of money on your education to be able to start getting some of those healthcare experience hours. And then when you do apply to PA school, make sure that you are applying only to those programs that you have met all of those prereqs. Because as you know the cost of CASPA is pretty high. And if you aren't meeting all those prereq requirements, then it's probably not worth even applying to because you have to pay for every single PA program that you apply to. And then, in addition to applying for more scholarships, consider joining the military because you can get your debt paid back as a provider. The PA profession was founded in the military, so it's very fitting. In PA school, live below your means. So you're going to have your student loans that you're going to get, but it's really important to start budgeting. You need to start tracking, probably three to six months of every single dollar that you're spending. Keep your housing costs low, you don't need to spend money to buy fancy medical equipment. Just the simple medical equipment can do. Try to get rotations near your friends or family. 

As a new grad, try to live like a PA student for two to five years. So don't let your fancy new income as a PA cause you to have lifestyle creep, meaning that the more money you make, the more money you're spending. Then really try to plan out how you're going to pay back those student loans, you can consider programs like Public Service Loan Forgiveness (PSLF). You can consider refinancing loans, certainly after the current COVID federal student loan pause is over though, and then try to start investing ASAP. Many jobs will have a match for their 401k or retirement plan. So try to start investing even if you are paying off your debt because time is your friend when it comes to compound interest. Also try to track your net worth. It’s hard to know where you're going to be going, which number is your financial independence number, and then how far along you are in reaching that number if you don't know what your current net worth is. There's a tool called Personal Capital (https://www.personalcapital.com) that I really like to use, and that allows you to put in different types of accounts to see where you are at that moment in time.

Savanna: Yeah I use that too. That’s a really helpful way to visualize everything and see where you are at. Those are great tips! As you were saying those, it’s funny and it sounds bad, but I was thinking about people who stand out at every level, either myself or someone I know. Like there was someone in my class who ate out every single meal, and someone else who bought a new car when they graduated. I clearly did not do everything perfectly either!

Kat: Exactly, exactly. I definitely did not do things right out of PA school either. I only learned about financial independence five years out of PA school, and I've been practicing for seven years now, so I definitely made all of those mistakes as well. You bring up a good point with food and transportation. Food, transportation and housing combined comprise 61% of American budgets. So if you can really focus on cutting back in those three areas, then you'll be able to save more money and invest for your future.

Savanna: What advice would you give to somebody who wants to learn about this but is overwhelmed? Do you have a good episode that would be a good place to start? 

Kat: That's a great question Savanna! With my podcast, in those first couple of episodes, I talked about what the PA profession is if people aren't familiar with it, and then I do also talk about financial independence, and the different steps that I mentioned along the way there too. I also did recently create a free resource called PA the FI Way Beginners workbook that you can find on my website, http://pathefiway.com/, so you can you can sign up to get that resource to start. Otherwise, you can shoot me an email at Kat@pathefiway.com, and I'd be happy to send you a copy of that too. 

Savanna: Perfect, yes, that's awesome, and you're on social media as well. I've definitely seen your posts popping up. I see yours and Kristin’s posts a lot because it comes up on my Instagram all the time, which is great. I need the reminders! Oh, and I’ll put all that information in the description, so everybody can find everything. I definitely appreciate all of your insights and information, and hopefully this will be encouraging to some people to at least take a look at their finances and kind of see what changes they can make. 

Kat: Yeah, definitely. And I wanted to thank you so much Savanna for having me on. I’ve been following you for several years now. I think we graduated PA school right around the same time, so I think it's awesome what you've built over time since you've graduated from PA school! So thanks for all you do for current and future PAs too! 

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How are PAs Paid? Understanding the 3 Common Structures - Guest Post by Kasey D'Amato, PA-C

Thank you to Certified PA Consulting for sponsoring today’s post! Certified PA Consulting’s primary goal is to elevate Physician Assistants and Medical Professionals to new heights, and create a path toward a successful and fulfilling life and career. Be sure to tune into their FREE upcoming webinar on February 3rd to learn about salaries, negotiations, business and making 2021 your most successful year yet.

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“How to determine an appropriate PA salary?” This is a question that many PAs ask and many doctors ask when hiring a new PA, or when renegotiating their current PA’s contract. 

 The answer is: it depends.  

The salary range is wide, $60,000-over $200,000. 

The annual revenue collected is wide: $350,000-over $1,000,000.

There are a variety of factors that help determine an appropriate salary for a Physician Assistant.  Benefits such as health insurance, 401K, CME allowance, paid vacation, and malpractice insurance all represent a cost to the practice.  On the other hand, PA’s that attract their own patients, successfully market their practice, and contribute to practice management are often considered very valuable to their practice. So taking this all into consideration, how do you calculate a fair salary?  

The first thing to consider is that Physician Assistant salaries can be calculated utilizing a variety of different structures.  There is no published template or right or wrong way to perform these calculations and using “averages” can be dangerous because of the vast ranges listed above. The most successful physician/PA relationships occur when both parties feel that they are communicating well and working together towards the same professional goals both for themselves and the practice. 

There are 3 common salary structures for PAs to consider:

#1. The first structure, often for new grads or PA’s with minimal experience, is a trial period with a base salary only. The trial period is generally 6 months to 1 year, and a common base salary for full time (35-40 hour/week) PA with minimal experience could range from $70,000-$100,000 per year.  This PA needs to spend time shadowing and learning from their Supervising Physician (SP).  A new PA may receive some benefits including: paid time off, health insurance, malpractice insurance, CME allowance, or 401K.  After the 6 month-1 year trial period, the Physician Assistant should be very comfortable in the practice. This is when the PA can become more valuable to the practice because they can start to attract their own patient referrals and they have earned the trust of the support staff and community.  At this time, it is common to renegotiate the PA’s compensation to a salary + percentage based structure.

#2 .The base salary + percentage structure is the most common structure for PA’s with more clinical experience.  This formula can be structured in multiple ways. One example is a base salary of $80,000 + 15-20% of collections after the PA doubles their base salary in collected revenue. This system can be appealing for a SP because it allows the PA to “reimburse” the SP for their base salary, before rewarding the PA a commission for their increasing revenue.  Here is an example, assuming a PA generated $350,000 in collected revenue.

The PA would receive a base salary of $80,000 per year.  In addition, the PA would be paid 20% of their collected revenue, after deducting $160,000 (double their base salary) from the total collected revenue.  If their total collections are $350K, $350K - $160K = $190K.  20% of $190K is $38,000.  For that fiscal year, that PA would earn a salary of $118,000.00

Another variation of this structure is adding tiered incentive steps to the percentage formula,  where the PA's commission percentage would increase as his/her collections increase. This is mutually beneficial for both parties and is a common structure that rewards the PA as he/she grows in your practice.       

#3. Physician Assistants with over 3 years of experience often negotiate a salary based on straight percentage of collections.  At this stage of the PA’s career, he/she should be experiencing a full patient schedule and should be generating significant revenue for the practice (over $500,000/yr).  Experienced PA’s usually attract their own patient following and are able to practice without a lot of supervision from their SP which frees up time for the SP to see their own patients, perform more surgeries, etc.  The negotiated percentage can vary greatly, and is influenced by many factors. 

Straight percentage salaries usually range from 30% - 40% of the PA’s collected revenue depending on the benefit package.  The following list illustrates some of the factors that affect where a PA falls in the percentage range:

PA’s Expenses to the Practice (Lowers The Percentage Range)

• Paid Vacation

• Paid CME

• 401K

• Malpractice Insurance

• MA(s) dedicated solely to the  PA

PA’s Contributions to the Practice (Highers The Percentage Range)

• Independence

• Attracting own patients

• Taking Calls

• Marketing/Networking for the practice

• Office Managerial/Administrative duties

This list provides only a few of the many factors that are involved when determining a straight percentage salary. PA’s that receive percentage based salaries are generally paid monthly, and occasionally, quarterly.  It is important for a SP and a PA to have open communication when reviewing the PA’s monthly billing and collection patterns.  SPs and PAs can become great partners when they can openly discuss any concerns with each other, and the PA can learn from their SP how to bill the most effectively for the practice.  A PA that is knowledgeable about their collections can be a strong asset to a practice. It is in their best interest to maintain their patient load, generate more revenue, and bill efficiently in order to maximize their collections and salary percentage.
There is a wide range when it comes to dermatology PA salaries because there is a wide range of collections and practice settings that utilize a PA.  PA salaries will be higher if their collections are high. This should mirror the pattern of the physician community. A full time, experienced Physician Assistant can generate anywhere from $500,000-over $1M depending on the specialty.  It is very easy for the billing office to create a separate category to track a PA’s billing and collections (even though PA’s may or may not bill “incident-to” through their SP). 
Physician Assistants are increasing in numbers every year and can be a huge asset to any practice. The relationship between a PA and their SP is a unique partnership based on trust and mutual respect.  It is vital that the PA and the practice have the same goals for the role of the PA and are working towards the same long term professional goals and each supporting each other. The relationship is magical and leads to extreme job satisfaction when both parties feel respected and aligned and gain financial success together.

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How to Pay for PA School

I am really excited about this post because it is highly requested -- learning more about the financial part of paying for PA school. I brought on one of our interview coaches, Hanna, to share her experience with you because we have different experiences as far as the type of PA schools we went to, the cost associated and how we each paid for it. My hope is that this episode will help you plan for the future and understand the process of how people pay for these HUGE price tags that come with PA school. 

Before we do a deep dive, I want to point out that this is a very extensive topic, there's a lot that goes into this. We are not experts, we are not financial advisors. We're not going to share logistics of how to apply for these things or what exactly a certain program covers. For that you need to go to your registrar's office program websites. A lot of times your school will have this information, they'll tell you how much a program cost, what's involved, the fees, tuition, etc… and how to apply for aide and whatnot. Just know that everyone’s situation is different and this is a very personalized topic. 

Savanna (S): Hanna's going to start us off with talking about just what does it cost to go to PA school? What are the fees involved?

Hanna (H): In regards to cost a PA school and just as you just said, this is super expensive, there's a lot of different aspects to take into consideration. With the 223 programs, and varying private versus public programs in state versus out of the state that in general, right there is going to really bring down or hike up the cost of your program. I'm at the median cost going back to 2015/16 school year was about $89,000, for a private PA program. That, in comparison to where I went to school, it was a private program -- I was at $102,000 and that was six years ago. Clearly, that's kind of under marketing some of the programs out there. We also looked at the public median cost, and that was about 52,000. Stepping back, really look what schools are you applying to and doing your research on their website. Most schools have a wonderful cost breakdown of their tuition, the cost expected for fees and lab coats, didactic versus clinical years, and really getting a true idea of what the basis is going to be for your specific program. 

S: Just to jump in, you're $102k was for your total tuition for the whole time your in PA school? 

H: Correct. 

S: That's what these numbers are referring to , i.e., $89,000 as a median cost is your entire tuition fee for the two/three years, you're in school. Because schools are different lengths, you're going to have different amounts you owe each semester. In comparison to Hanna's private program, I went to a public in state program as an in-state resident. My final tuition was around $45,000 for my 27 months program. That's a pretty big difference. But hey, we're both PA. 

H: That's another great point that you mentioned in regards to length of program, my program was a 26 month program. Definitely something else to consider is how long are you going to be in the program, because that will definitely change the cost. 

S: Yeah, and I think also, just for people who are maybe in the process right now of deciding what school to go to, I think cost should be a factor -- I don't think it should be the only factor because you should choose somewhere where you're going to be happy. Also think about when you start school, especially going into application season -- if you're able to start a program in January compared to September, and then you're going to potentially graduate earlier, and especially if it's a shorter program, that can essentially give you eight extra months of income. It might make it more financial sense to go with the program that starts sooner if you're just looking at the cost of everything.

I thought this was interesting, the PAEA did a survey in 2015 of students starting PA school and one question was, “What do you expect your total debt from PA school to be, not including personal debt just from school?” 21.9% said they expected $100k to $125k, 20.8% said $75k to $100k, 14.5% said $50k to $75k. That's a pretty good spread and a lot of money. I know it sounds like a lot of money and something to mention, coming out of school right now, the average salary for a new grad PA is around $75k to $80k. There are a lot of factors that go into that, such as where you live, cost of living and specialty and all that. This is just an average. 

Let's talk in-state versus out-of-state program costs. I decided to go in-state and the cost was part of it. That price tag looked a lot better than another program I was considering that was four times as expensive when it came to tuition and cost of living and all that. 

H: I knew that I wanted to go out of state and there was a big push for me to stay in. I grew up in Georgia from Atlanta. I've always wanted to go out of state and I made that decision applying to graduate school programs, specifically out of state. One of my biggest regrets was not taking into account the finance, the process, and not really having a full grasp of how the various costs of the PA schools. And I didn't realize that much further into my application process. Ultimately I didn't end up taking that into consideration with my school choice. And I'm paying that off now. 

S: I think a lot of people are at this point are so eager to get in that they don’t look at that and it’s ok! Like I mentioned earlier, I don’t think it should be the biggest deciding factor, but it should play a role. One question we got on The Pre-PA Club Facebook group is, “Can you switch from out-of-state to  in-state, so if you apply to a school that has a cheaper option for in-state residents, can you technically become a resident?” You know, for Georgia, I think there were a few people who were able to do this, I think you have to live in Georgia for over a year and have a good amount of documentation in your name, you have a license and bills, to show that you're truly a Georgia resident. Now, if you're only gonna be there another year, is it worth it? I mean, you're probably saving $10-15,000 but then you're gonna have to move and do all that again, most likely. Each state's going to have their own rules. Hanna, your school didn't have an in state option?

H: Correct. A lot of the states are very happy to have lived in that state for one year client, Most states and again, a very, that you have to live there for one year prior to starting your program. With that being said, most of us are finding out that we're getting into a program until under that one year mark, and it's very specific in regards to one year, so not, a school year but rather one full year. In many schools, once you've come in as an out of state resident, you cannot switch to an end state further along in the years. Schools have become very strict on following this, looking at where you're paying your taxes with, where you're registered to vote. It's not so much “Oh, my grandmother, or my sister who lived in New York”, which is where I went to school. It is definitely something that you really have to take the time to look at what your state requirements are and to talking to the school because some of them are willing to help make it work, especially it's, you know, come close to qualify. 

S: Yeah, and I think that, again, is something to look at. Just from an application standpoint, if you're applying to schools, because that process is expensive, too. That's a whole other post. If you are applying to schools, I strongly discourage applying to in-state programs, if you are not a resident of that state or if you don't have an extremely competitive application, and you know, some of these schools, they set 90% in state residents. At my school, we had 44 people, and it was 90% in state residents, we had, I think four or five people who are out of state. That wasn't something that was negotiable, they had a certain number of spots, because they got public funding. You could apply there if you're out-of-state, but your chances compared to an in state resident were so, so much less. You don't really want to waste your time and money applying to a bunch of programs that you are really only competing for a few spots. 

H: One thing that I found really interesting that I didn't know existed when I applied to PA school. and now that I'm living on the West Coast I have been interested in because I've been helping do mock interviews, and watching these acceptances start to roll in, which is very exciting, is that a lot of states participate in regional programs. Although you may be from California, I know that there's a Western Regional graduate program that allows Western applicants to apply to other schools within the region and your aren’t stuck to just your home state and still get in-state tuition. There's a regional one for the southern region,  Western, New England that I was able to find. These do apply for graduate school. I would definitely recommend looking into these and seeing if you qualify for those qualifications.

S: My school kind of did that because we're right on the border of Georgia and South Carolina, I went to Augusta University -- if you were from a few certain counties in South Carolina, you were considered an in-state resident for tuition purposes which was awesome for them. 

This was something that I thought was worth talking about, switching to in-state, if that's an option for you, you're going to try to become an in-resident, if you are still being filed on your parents taxes, you may not be able to switch. My parents claimed me on their taxes until I got married and I was 23. They were helping out with my school. As a parent helping out with my school, they got a little bit of tax benefit from that. They wanted me on their taxes to be able to write that off and get that reimbursement or whatever they got, I don't really understand taxes. They would not have probably let me switch or wanting me to unless I wanted to start buying my own taxes and paying for the rest of my school, which I did not. 

H: Definitely communication is key with that one with your parents. I know my parents and I went back and forth on that for a little bit because they can save I think it's up to like $2,500 per tax season so that can definitely add up pretty quickly. You also don't want to get caught doing tax fraud by both trying to file for that. Definitely having good communication is key. 

S: Definitely. Okay, so how do people pay for PA school? 

H: The number one thing you need to do is you need to apply for FAFSA. For FAFSA, that's your federal aid for for students across the board. It's that kind of the best way to start and it's broken down into direct subsidized loans and unsubsidized They have a great website called FAFSA forecaster that predicts your expected contribution of your fees to graduate school. In graduate school, you don't actually qualify for direct subsidized loans, that's no longer available, they cut it out in 2012. Basically, in a lot of applicants, probably do have loans from undergraduate but during undergrad when you got these loans, all that meant was the government was helping pay for the interest on these loans, so that was not accruing. This is a really big deal and would be really nice to have for graduate school but now for graduate school, you can only apply for direct unsubsidized loans, also known as Stafford loans. What that means is that you can take up to $20,000- $20,500 for a year, I believe. As soon as you take out that money, you start to accrue interest on that money and you're responsible for paying that once you get out of that program. You get a six month leeway with that, but the interest is accruing the moment that you receive that loan. 

With that, let's talk a little bit in terms of what that money does. When you go through the FAFSA application, which I don’t know about you, Savanna, but I felt like it, it's very straightforward. Name, DOB, --  very straightforward application. Once you get approved, which is relatively easy, that money goes directly to your program. You don't ever touch the money that goes directly into your program. It gets immediately applied to tuition and fees. If there's money left over from that, it falls into your room and board if you are rooming with the school, then after that they reach out to you for permission to put it towards other charges that may come with the program. If there's still money left over from that point, then you get a check, or somehow receive that money back and use that towards your education costs. Savanna, I’ll let you take it over for a little talk about your experience with FAFSA and a scholarship. 

S: I applied for FAFSA, I didn't have any debt from undergrad, which was great. Georgia has something called the HOPE Scholarship where if you qualified, and it’s changed a little bit since I got it, but they essentially cover all of your tuition and fees. The only thing that I had to pay for, or my parents helped me pay for, in undergrad was living expenses, which was amazing. I had to obviously keep my grades up and all kinds of other qualifications but going into grad school, I did have to take out loans.  I took out these Stafford loans, I filled out FAFSA. I was actually the last or at the tail end of when you got subsidized loans. I had one semester where I got a little portion that was subsidized, which I'm thankful for but the rest of my loans were unsubsidized. I took out the $20,500 for the year. Now my tuition for the year was a little bit and fees was a little bit more than this. I ended up taking out total $45,000 in I guess I took $40,100 but my tuition was $45,000. My parents did help out with you few thousand here and there, which I appreciate and I was living with them which helped save on expenses. These loans did end up getting interest right away. Now, you put the current rate here, which is 6.6% -- that is a very high interest rate. Just FYI, I think mine was around that, too. My supervisor physician talks about her loans from medical school and her percentage was like 1% -- it's so so low, and it has changed so much since then. 

I'll talk a little bit about my experience FAFSA, because when I applied, I was awarded a scholarship randomly, and I didn't know that I was applying for scholarships, but some of them do pull your information from FAFSA. About a semester into PA school, I got a check in the mail for $1,500 dollars and a little letter saying I was part of this Lettie Pate Whitehead Scholarship, and a few other people in my class also got it. I received those checks, I think three times during school, which was crazy -- it was just out of nowhere. It was one of those things where you get the check in the mail and you kind of question it, is this real? Is this a scam? What is it? When I looked it up, it was a real thing. It's a special scholarship for women in the Southeast who are pursuing medical degrees -- that was awesome. That helped out a ton with my fees and extra expenses here in there -- you've got to pay for equipment, all kinds of things. Luckily for me, I didn't have to take out any additional loans. Just to clear things up, the way that most people pay for PA School is loans and that's okay. I mean, I would say there are a few extremely lucky people who maybe their parents can help them out completely, or they were able to save a ton of money, but for the most part, everyone's going to have loans. Would you agree, Hanna? 

H: Absolutely. I think one, you know, the bright light at the end of the tunnel is that we're going into a career where we should be making money to pay back those loans. That's incredibly rewarding and exciting, because a lot of people do not have, necessarily that guarantee when they get out of graduate school. I do think that it's you know, and most people have already made this decision that it is an investment that is worth making. You definitely have to make sure that you're ready for that because it is a lot of money. If you're not going to follow through on it, you don't even want that first $20,000 of debt sitting on you. 

S: I mentioned that at the beginning, before we started that, I was just getting my loan money went straight to my tuition and fees. I never saw a penny of that. I did not check my interest before or throughout school -- I just didn't want to know, I didn't want to look. I knew it was accruing interest. By the time I graduated that $40,000ish had turned into $75,000 that I owed and that was a little shocking to me. That is what it is what it is.

H:  It definitely stings and is motivation to get that job. 

S: Oh, yeah, I went to work right away. I was like no vacations here, put me to work! 

One question was, how do you know what to do? How do you know how to get these loans? How do you know how to pay for this stuff? Is this something that schools help with? 

H: I would head to the financial aid office, they're definitely going to point you in the direction of FASFA first. They may also be aware of certain scholarships, it really depends on how involved the financial aid section of your schools involved in the graduate program, I felt where I went to school, it was not as involved as it was in the undergrad program, because they had a massive undergrad program. You're really able to find some better systems online, and they can definitely at least point you in the right direction. I think it's a great place to start. How about you? How did you go with that? 

S: I felt like our school was very helpful. The first thing they tell you to do is fill out FAFSA. They kind of tell you that and then give you a little bit direction as far as loans after that. What would what would be the next step after you got your Stafford loans, they paid for your tuition fees, but now how are you going to pay for living expenses? 

H: Absolutely. So definitely, with the cost of my program, the $20,500 did not cover my tuition and fees so that's when I started to look at grad PLUS loans. Those loans are at a higher interest rate, they are at a higher fee, I believe the interest rate is about 7.12% don't quote me on that, but it is still high, but it's not 12-13%, which you may see some private loans at, and this is going to change year to year. With the with the grad PLUS loans, they will cover for the rest of your fees for your program, minus of course, they take a look at what other loans you've already received and subtract that from what they will finally get to you. That can be used towards living expenses. For example, I was living in New York, paying for a studio apartment in Manhattan is not cheap. My sister shared the studio apartment for a little while because of expenses, and really just did whatever we could to get the costs down. But you know, those loans went towards that and for food and those coffees that I probably should have cut out a little bit more, but they just surviving PA school. 

S: When people ask, how much should they took out loans. In my mind, you want to take out the most minimal amount possible. Everyone's going to be a little bit different in their kind of thoughts on this because I definitely had people in my class who ate out every single meal, and I knew that they were living on loans. Then after school, usually they were the first ones to go buy a brand new car. You have to make your own I think financial decisions but you want to make sure you have enough money to live on to.

H: I think you just kind of have to learn semester to semester, I know that some of my really close friends in PA school, we talked about this a lot. It was like how much are you taking out? Calculating our rent and our expenses? I think it should be an open conversation because it you know, it is the same cost to attend this program across the board. Are you kind of keeping in mind but like, are you paying $2,000 more per rent than your friend? Do you need a roommate? Should you save those expenses, but also just making sure, like the cost of your stethoscope and your books and other fees are kind of keeping in line and holding each other accountable for some sort of budget to figure out what you should be taking out and trying to live off.

S: I agree. Plus, you can always take out money and then give it back. You don't have to use it all or you don't have to let it sit there. If it's in your savings account that makes what like 0.05% interest rates, like those that nickel you make over six months is not going to counteract the interest that you paid on it. This is not money that you want to take out and try to invest. It's not fair investing, your return is not going to be higher than your interest rates. Again, I'm not a financial advisor, but I've read enough White Coat Investor to know that that is not a good idea. 

I don't know what your thoughts are or if you have any experience, but do you know if people are paying back loans for undergrad, if they go into deferment?  I feel like this is going to depend on where that came from? 

H: Exactly. So This is definitely dependent on where the loan came from.  We're talking about the terms of the subsidized loans earlier meaning government's paying your interest. If you are enrolled in school, at least half time, those direct loans will be placed into different banks. You don't have to make any payments on those until six months, just kind of like your other your first a new loans give you this grace period. If they're private loans, if you're not sure what type of loan they are, you kind of need to do the research. These things are changing constantly. In regards to something we didn't mention earlier, but there was a Federal Perkins loan for a while and that no longer exists. So laws come in and out based on the year. You really have to do your due diligence, following up on what's going to happen with your student loans. 

S: I love Google who doesn't. I mean, just kind of searching for things, you can find stuff on the PA forums, and there's a lot of information out there. But again, your school is going to be the best person to talk to, and talk to the class above you and see what advice they have as far as what they've done and maybe mistakes they made just so you can try to avoid that. 

H: We want to close off This episode in regards to talking about refinancing. After you've made it through PA school, and you've got multiple different types of loans, possibly public and private, really looking over those loans and more specifically, the interest that you've accrued on them and the interest rate at which they're accruing. So for myself, I think I had six or seven different loans come after the completion of PA school. The loans really varied year by year. I might have had one that was kind of had a 4%, 6%, 7%, I had a 12% and a 15%. Then I had another one that was relatively low, 4-5%. The first thing that I did was sat down and talked with my parents about them and again. This is an important aspect to remind you guys that we're not financial advisors, you really should consider speaking to someone about this, but knowing that you can refinance these loans and basically group them together as one specific, total sum of money and reduce the overall interest rate. That way, you're paying maybe 6% on all of your loans rather than possibly the high 12-15% loan. That's really going to change year to year. If you guys want to really follow this market, you've seen that this year, interest rates have gone up quite a bit, last year they were much lower. Watching to see what they do over the course of your PA school career. SOFI is one of the refinancing tools and there's Earnest and Common Bond, there are so many out there, but a lot of these specific businesses, they look at graduate students who are coming out of programs that they know are going to make a good salary.

The reason why that they aim their businesses towards us, because they know if you're making a good salary, you should be able to pay off your debt, that you shouldn't become bankrupt and go out on your loans. With that, they're really willing to work with you and set a low interest rate in comparison to what you've been sitting on for the past, let's say 26-27 months. So it's definitely something to look at multiple at these different options and companies to see what the lowest possible interest rate you can get. So that you can ultimately start paying off these loans and paying off as little interest as possible. 

S: I only have federal loans so I was not able to refinance, I have looked into it. With some of the kind of repayment or federal programs, if you do end up refinancing your loans, they kind of lose eligibility for some of that. So you really have to look at it and think about it, talk to someone who knows what they're talking about, like a financial advisor before you decide to do that. I have heard really good things about the SOFI. 

Anyway, another thing that people sometimes talk about is, and this is just a way to pay back your loans afterwards is, will jobs pay for your loans? Is there a way for your employer or your supervising position to pay back your loans or help you out with those? It's not out of the question, I've heard of that happening. In my mind, you never know until you ask and so when you're in your contract negotiations, why not throw it out there you know, see if there's options for some loan repayment. Usually the way I've heard it work use you know, through there for a year you get a certain amount or two years or three years that go straight towards your loans, or it's given as a bonus for your loans, essentially. That's something to think about. It doesn't happen that often, I don't think so. Didn't happen for me, you never know. 

Thank you so much, Hanna for taking the time to share your experience!

Make sure to check out my Youtube channel to learn about more ways to pay for PA school! Here are some videos you may be interested in: Student Loan Options for PA School, How to Afford to Pay for PA School, Learn How to pay for PA School with Stride Funding, and How to pay for PA School.

To listen to this interview as a podcast, click here!

Let us know other topics you would like for The PA Platform to cover in the comments below.

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Guest Post from PA Cents: Should You Do a PA Residency?

You’re in the final stretch of Physician Assistant school: graduation, PANCE, new job, it’s in your sights. You’ve been looking online at job openings and are not sure if you’re ready to join the workforce and be a full-fledged certified PA, practicing real medicine on real patients; so you think maybe a residency might be a good choice.

Possibly you’ve been looking for a job in a competitive area and can’t find a job in the specialty that you want so you want to gain more experience. There is a lot to consider if you’re thinking about applying to a residency.

I went to PA school in Southern California where there are a number of PA schools and a large pool of PA graduates to choose from to fill positions. The hospital where my orthopedics rotation was at had a lot of medical students, residents, PA students and PA residents. I asked one of them why they chose to do the residency and she said she was not able to find a job in that location in orthopedics.

If you’re tied to a certain area and really want to be in a specific specialty then more training in that area could be helpful and might help you find a job in that specialty. You will get a lot more training and might feel more competent after a residency.

A residency is by no means a necessity to get a job in any specialty. After I graduated from PA school I had multiple job offers that were all in different specialties. I interviewed for jobs in orthopedics, neurosurgery, and endocrinology. I ended up accepting a job in general surgery.

Surgeons all use different techniques and they all think the way they do it is the best way. My first job was with a surgeon who was getting older, there were four surgeons in the practice and only one used a PA at the time.

The surgeon I worked with saw the value of having a PA in the OR, as well as in the office, and with hospital rounds and wanted to hire one too. By the time I left the practice the PA that was working there before me had already left and one of the other surgeons also hired a PA. All of the PAs they hired, including the one that replaced me, were new graduates.

An advantage of hiring a new PA rather than one that has been doing it for a while is that they could train them to do things how they wanted it done. They did not have to teach old dogs new tricks. If someone else has trained you then you might have “bad habits” or just do things differently than they are used to.

More education is never a bad thing and doing a residency does let you learn more. If you know you never want to do another specialty than taking a year to learn more in that specific specialty can help you learn a lot and possibly be a better clinician.

The first year out of PA school is like PA school part II - PA school prepares you to take the board exam and the first year of being a PA teaches you how to be a PA. When you’re looking at a first job you should look for something that is still going to help you along in your education and where there is a good learning environment.

This does not need to be a residency. There are plenty of jobs that provide a good learning environment without having to do a residency. The job that I currently work at allows new Primary Care PAs to rotate through different clinics and with different specialties before they start seeing their own patients.

Learning is also somewhat dependent on your supervising physician. The surgeon I worked with for my first job didn’t mind teaching/explaining things, but I had to ask questions a lot of the time to get him going.

There was another surgeon in our practice who was recently out of fellowship and did a better job of naturally explaining things. I think a part of this was he was just in the habit of doing it as he was used to working with residents and students at a teaching hospital, whereas the further out from training you get the less you’re in that thought process.

As a PA we have been trained as generalist and one of the beauties of being a PA is that you can change specialties without having to do more training. My first job was in general surgery and when I was ready to move on I had offers from other places in all different specialties. I was not stuck working in general surgery forever. If some people are doing residencies that may soon become the norm and with residency training for PAs if that becomes the standard we will no longer be generalist and the benefit of being able to switch specialties without more training will go away.

If you feel like residency is your only option as you’re not able to find a regular position as a PA, it’s good to know that you’ll probably have to take less money as residencies usually pay less than a regular position.

At the 2017 AAPA conference I did talk to a residency for general surgery and they were offering $75,000 which is better than the $40,000 I’ve seen in the past but it is much less than what you could get in a regular position.

Whenever you’re looking at a job you always have to weigh the pros and cons. There are some benefits, such as more training and ability to network while you’re in the residency. If you can afford to take less and invest the time to do the extra training it may help you with your skills before taking a regular position. If you’re looking at a first job and have decided to take a regular position be sure that it is a place that supports learning and is going to help you as grow as a new PA.

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This article was written by the author of PA-Cents a personal finance blog for PAs; to contact the author or for information on PA personal finance visit www.pacents.com.