Physician Assistant Financial Education – The White Coat Investor

Today, we are interviewing PAs, Beth Macintire and Katie Bean. We know that most of our audience is physicians and dentists, but there is a healthy segment of you out there that are other medical professionals—such as PAs and nonmedical professionals. This group is still a six-figure income but maybe not the higher incomes that many doctors have. A lot of the information in this discussion applies not just to PAs, but to many of those other kinds of professionals as well, whether you are a pharmacist or attorney or small business owner. Today, we are going to talk about the challenges of PA school, the cost of school, how to handle debt, what kind of job opportunities are out there for PAs at what salaries, and what doing a fellowship or residency can do for you. We discuss if PAs can FIRE and if the cost of education is worth the investment. We think this interview will have something for everyone.


In This Show:
 
Dr. Jim Dahle:
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. Tell us about your upbringing and how it affected your views on money. Let’s start with you, Katie.
Katie Bean:
My father is an entrepreneur. He owns gun and knife shows. Growing up, I saw the opportunity that money has and that it offers, to creating the life of your dreams.
Beth Macintire:
My upbringing was a little bit different. My dad was in the military and, when I was a young kid, he actually went back to school full-time. My mom was working part-time and taking care of the kids. They moved around so they didn’t have childcare support and were pretty much on their own. When we were young, we were pretty financially poor until my dad got out of school. Because of that, my views on money were always kind of a scarcity view. We were big savers. We blame it on our Scottish heritage. But we were always big savers, and so we’re never big spenders. I had a lot of trouble actually spending money, and it was kind of the opposite of a lot of my peers. 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. I think that affected my views on money and what to spend money on.
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 investing and very much about long-term saving. My family was never hesitant to talk about money. I think a lot of people are hesitant to talk about money with their spouses or their kids. My parents were very open about it and taught us what saving money was and why it mattered. Even though I never took a finance class in college or in high school or anything like that, I was aware of what money is and how money works and how credit works from a young age. I think that gave me an advantage for financially planning my life now.
Dr. Jim Dahle:
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 learned nothing—at least nothing good—about money from their parents, and they had to learn it all as adults. Briefly run us through your education, training, and career so far.
Katie Bean:
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. I started at a jail system, and it was such an incredible mission field. I loved working with the inmates there. I saw a lot of medicine that you don’t usually see in general population. Then, I switched over to emergency medicine and worked as an ER PA for about a decade. Beth and I met actually about seven years ago when we both started on the very same day at a PA school. We’ve taught PAs for six or seven years now. I recently switched to aesthetics. Right when COVID happened, I was furloughed from the ER, moved over and transitioned into aesthetics, and worked there for a while, as well.
Beth Macintire:
I went to undergrad at Tennessee Tech University. My dad was military, and I was living overseas. I actually graduated from a high school overseas, but we had in-state residency. When 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. Academic scholarships and things like that paid for most of my undergraduate. Then, I decided to go to grad school at the University of Kentucky in Lexington. Then, I did a postgraduate fellowship in orthopedic surgery and got some extra training for that. After that, most of my experience has been in orthopedic surgery. First, assisting in the OR and then rounding clinics and taking call in the hospital, and things like that. It’s been a lot of fun because I get to work inpatient, outpatient hospital, outpatient surgery center, ER. We get to work in all the different areas. I think it’s a really fun career for a PA.
As Katie said, eventually I transitioned to mostly academia. I’m still teaching at PA schools. We went back a few years ago and got our doctorate in medical sciences, which is a doctorate degree specifically for PAs. We were actually the inaugural class. At that time, you had to be a PA who was either teaching or had worked in primary care for five years. It’s changed now, but that was the original intention of the degree. We graduated back in 2018.
 
Dr. Jim Dahle:
You two got together, and you started a side gig a few years ago called the Pre-PA Clinic. Is this a profitable business, or is this a labor of love? What do you do there?
Katie Bean:
It is all of the above. Getting into PA school is very competitive. The application process is very overwhelming. There are a bunch of PA schools out there, and each one requires something slightly different. Working on the academia side, we saw a lot of candidates make a lot of the same mistakes that prevented them from either getting an interview or landing a seat in a PA program. We started Pre-PA Clinic to help candidates create their most competitive application and 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.
Beth Macintire:
It’s expensive to apply to PA school. If anybody knows anything about PA school, you have CAPSA fees, you have supplemental application fees, you’ve got to fly for interviews. 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 reapplication. Our goal is to help students tailor their application and teach them about professionalism. We help them know what to wear, what to say, and how to comport themselves. We help them tweak their application if necessary and make sure it is professionally written. We help them with their resume. We can do a mock interview with them or just help provide information so they can make the right choice for them. That’s one of the goals of our business.
Dr. Jim Dahle:
Is it just a podcast or a coaching service as well?
Beth Macintire:
Yes. All of the above.
 
Dr. Jim Dahle:
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 instate. It is about $89,000 for out of state, on average, and it’s $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-$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?
Beth Macintire:
I would say that’s probably pretty accurate. Most people we’ve talked to have a loan burden in that range. Now, that does not include if you have any undergraduate student loan burden, of course. For us, it’s a good investment. I was taught that whatever you borrow for school, it should be around what you’re going to make your first year out. As PAs, most of us know we’re going to be in a lot of student loan debt, and a lot of us, for example, can’t work during school. We had to sign an affidavit that we can’t work. Two and a half years of no work, and two and a half years of debt, but we come out as high-income earners.
When I first graduated, the average PA made something like $65,000 a year. It’s almost double that now. It’s over $100,000 a year. 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 of undergrad at 23, you get into PA school by 24. By 27, you’re out there earning your great income. I think one drawback is the fact that a lot of us start investing later. People who take longer for their education, they obviously lose those earlier investing years. But this profession is only expected to grow, like more healthcare jobs. I do think it’s worth it, but I think that you have to decide for yourself. We work with some clients looking at schools that are $180,000 just in tuition. As you said, some are $50,000 in tuition. I think you have to really be smart and really realistic and have a plan about how you’re going to pay it back before you just say, “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, “OK, why do I want to go to this PA school vs. 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 down the line?” Some students 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.
Dr. Jim Dahle:
You mentioned one school costs $180,000. When does the cost of education become not worth it? What level of debt burden is not worth it to become a PA, if you had to put a figure on it?
Beth Macintire:
I would say that if you were looking at $200,000 in debt total—like undergraduate, graduate school—then you probably either need to have a plan afterward saying, “I’m going to work for a nonprofit and I’m going to do the 10-year thing and have my student loans forgiven,” or you need to figure out a way to apply to different schools or apply to a school where you can work part-time or something like that. I personally would not take over $200,000 in debt because just the compound interest on that. They’re not doing subsidized graduate loans anymore. You’re going to come out with a whole bunch of interest. That’s probably my line in the sand, and I can’t give you any numbers about why. But that’s always been my number.
Katie Bean:
I would say if you don’t use your degree, it would be a pretty bad investment. 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 that for at least a decade, if not more, to make it beneficial.
Dr. Jim Dahle:
That’s interesting to think about it as how long you have to use it to make it beneficial. I mean, if you’re making $100,000 a year and you borrow $200,000, then working for a decade, you made $1 million. So, it costs 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?
Katie Bean:
PA school is divided up into didactic year, which is your first portion. It’s all the bookwork stuff. Then, your second part, which is your clinical year, is where 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. A lot of students don’t plan for that. There are 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. At the programs where we worked, we would tell them right upfront in their didactic year 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.
Dr. Jim Dahle:
Any other costs?
Beth Macintire:
There is the cost for medical equipment, for example, which is super expensive. We require certain types of stethoscopes, and if you don’t have one, it can get quite expensive, along with otoscopes and ophthalmoscopes. A lot of times, PA schools require you to buy those, too. We also require a certain computer that is not just a regular computer. You have to have a certain drive, and you have to have certain specs for this. A lot of our software that we use to lock down browsers for them to take their exams, for example, can only work with the newer systems. Books are really expensive. If you don’t get them through your library, you’re talking about $500 a semester for books. As Katie said, you might have to travel.
Then, there can be medical expenses. In some schools, for example, you can get student health insurance, but we worked at a school where they didn’t have student health insurance. If you can’t get on your parents’ insurance 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 TB tests, even if you’ve just had one. They want their own drug test and their own TB test, and they want to make sure that you’ve had chickenpox. They take all kinds of levels, and you have to give blood. There are a lot of these hidden costs that you would never think of. But if you have to pay for background checks twice and a couple drug tests for different hospitals, it can get pretty expensive when you’re talking about living on student loans. 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 and buying your scrubs that match your school are small things that add up. There are a lot of these hidden costs that you just wouldn’t know about until you get into school.
Dr. Jim Dahle:
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.
Beth Macintire:
I hope so. I was lucky, I went to a big public school at the University of Kentucky in Lexington. As part of the graduate program, we were able to have student health insurance, which at that time was super reasonable. I know that some of our students have been in the military in the past and they’ve been on military health insurance, but we have heard some students say, “Well, what are we supposed to do for health insurance?” 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. 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? Some of the smaller private schools don’t.
Dr. Jim Dahle:
What can PA students do to minimize their debt burden?
Katie Bean:
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. Living outside your means is definitely going to get students into trouble for sure.
Dr. Jim Dahle:
Of course, everything is outside your means when you don’t have any income at all. When you’re only living on loans, a Slurpee is outside your means. At a certain point you have to find some balance, right?
Beth Macintire:
I just think it’s a mindset thing. When I went to school, I broke my sunglasses. I was a big runner and I went to Target and got $8 sunglasses and everybody made fun of me for having the ugliest sunglasses ever. I was like, “Yeah, these are $8.” And then my friend said I should just buy a really nice pair of $300 ones and keep them forever. But I knew I could sit and break $300 sunglasses just as easily as I broke my $8 ones. In my mind, if I was a student, I was not going to buy a $300 pair of sunglasses. I didn’t even have a texting plan at the time. I refused to text anybody when I was in school because each text cost 25 cents. It seems like a little thing, but if you’re talking about Starbucks every morning, if you’re talking about running to fast food every lunch, if you’re talking about tons and tons of wine and beer after your big test. If you make similar choices every single month, it really adds up. I had a lot of friends that felt like because they were already borrowing so much, spending extra didn’t matter. I always like to think what the actual cost of the thing is. If I were to pay this off in five years, what was my actual cost? If I’m going to pay my loans off in 10 years, how much interest am I paying, and is it worth it to me?
Something like $300 sunglasses weren’t worth it to me. But I loved to run so I did a half-marathon during PA school. Signing up for that and paying the $100 entry fee felt worth it to me. I think it’s just a mindset and just deciding, as you said, on your 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. But I was super interested in joining a local running community. That was kind of the way I did my balance.
 
Dr. Jim Dahle:
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? If you had to say what the 25th percentile is and the 75th percentile is, what would you say those are?
Beth Macintire:
I would say it definitely varies by specialty. I think that if you are a new grad, primary care 25th percentile is probably around $80,000. I’ve known some CT surgery PAs who do vein harvesting who make over $150,000. 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. I know a PA who does intakes for psych patients at the hospital, because he is a primary care PA, whenever he wants to make more money. But I’d say probably $80,000 is probably the 25th. I’d say probably close to maybe $130,000 is 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. That can definitely increase that. But it’s amazing to see how much it’s changed. When we graduated, it was $65,000, I think, and now it’s $115,000. So, that’s amazing.
Dr. Jim Dahle:
It’s still a tight range compared to medicine where the range is extremely broad. The range within a specialty is far broader than the difference between the averages in the various specialties. Actually what you describe is a pretty tight range, I think, for salaries. I was surprised it was that tight.
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. They’re walking into their first job. What should they expect to make?
Katie Bean:
Again, just like Beth said, it varies tremendously by specialty, but a brand-new PA graduate, anywhere between $80,000 and $115,000-$120,000.
Dr. Jim Dahle:
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?
Katie Bean:
I think doing a fellowship like Beth did and advancing your education is definitely helpful. 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 did, 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.
Dr. Jim Dahle:
Let’s talk about those trainings. 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.
Beth Macintire:
When PAs graduate, they 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. There’s not a lot out there. When I graduated, most of the residencies were either in surgery subspecialties or emergency medicine. I think they had one in OB-GYN. You make a small income during those residencies, but it’s significantly below what I could have made as a PA. But for me, that was an investment in my future. Not only in my future earning potential but also for the job I wanted. I did an orthopedic rotation in PA school and absolutely loved it.
For me, I knew that doing this fellowship was going to be making less now, but the fellowship is equivalent to three years of practice. So, I would have that experience and I could start off at a higher pay scale, choose what specialty I want to work with and what job I want, because of that extra training. 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 was OK, 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 the Robert Jones and some of the more complicated types of dressings and castings. 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 also 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 “three years” of basic training.
Dr. Jim Dahle:
Are they all one year or are some of them longer?
Beth Macintire:
Some of them are longer. Some of them are 18 months. But most of them are a year. A couple years ago, they formalized the process and are trying to standardize them, I think, a little bit more now than they were back when I did it. A year is about average, but there were some, especially in the ER, that were 18 months at level 1 trauma centers, which was really interesting.
Dr. Jim Dahle:
And have you ever met a PA that regretted doing one?
Beth Macintire:
I’ve only known three PAs who’ve done it and so far, we’re all happy we did one. I guess the big regret would be if you decide that that’s not your specialty. I don’t know if the knowledge is ever wasted. But I think if you decide not to become a PA, maybe you start a family and not go back to work or if you decide that that’s not really your specialty, then those are the two scenarios I could think that maybe you would wish you hadn’t done that.
Dr. Jim Dahle:
Seems like the vast majority of PAs are employees. Do you know of any situations where they aren’t employees?
Katie Bean:
Definitely. We actually have a few friends who own their own practice. 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 just have to be on call for them by phone in case something comes up.
Dr. Jim Dahle:
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?
Beth Macintire:
There are some programs that will pay back your student loans if you go to certain regions, like rural regions. But I would say in general, your salary is going to be higher in the bigger cities. Especially surgical PAs, a lot of orthopedic groups are still private; they’re not hospital-based. If you work for an actual group themselves and not a hospital, I think you probably make more money, too. But most people we know that worked in rural areas did that either because 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. I would say the big city is where you’re going to make the money as a PA.
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Dr. Jim Dahle:
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 it’s going to change in their career, in their profession, that’s going to hurt them financially?
Beth Macintire:
I think, kind of like physicians, it is malpractice. We could get sued, as well. We worry about losing our jobs. Since we’re employed by hospitals or physicians, we aren’t in control of that. Just like during COVID. A lot of PAs got furloughed. I got furloughed from my orthopedic job because all the orthopedic clinics shut down. A lot of ER PAs got furloughed because no one was coming to the ER. I think that was surprising, in the middle of a healthcare crisis, to have certain providers no longer having jobs. It is something I never would’ve 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?
Katie Bean:
I was going to say the exact same thing. Malpractice for sure. That’s always a concern. And additionally, COVID just rocked everybody’s world, of course. I never would’ve thought that something would happen where I would lose my job or be furloughed, especially during a pandemic or a healthcare crisis. I definitely have some shell shock from that.
Dr. Jim Dahle:
What happened to you in the spring of 2020?
Katie Bean:
Our volumes in the ER dropped tremendously. We were seeing a fraction of the patients that we usually saw. I was furloughed for a good six months.
Dr. Jim Dahle:
They just said don’t come in.
Katie Bean:
Don’t come in.
Dr. Jim Dahle:
Any sort of pay or benefits you got during that time period?
Katie Bean:
Not at all.
Dr. Jim Dahle:
Nothing.
Katie Bean:
Nothing.
Dr. Jim Dahle:
It’s just basically your job is gone, maybe we’ll hire you back in a few months.
Katie Bean:
Yeah, good luck.
Dr. Jim Dahle:
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 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?
Katie Bean:
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 our profession is now seen in other countries of the world. That’s continuing to grow too. I don’t really necessarily worry about that too much. I think that our profession just has so much opportunity for growth. As you can see within the last decade, when Beth and I graduated, a lot of patients still had no clue what a PA was. We would have to tell them what our profession was and explain it to them, whereas now it was the No. 1 career, the No. 1 profession to go into. I think that was on USA Today or US News, something like that, a few years ago.
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Dr. Jim Dahle:
Lots of docs worry that PAs are taking their jobs. Do PAs worry that there’s going to be a backlash from that? That docs are going to start taking their jobs or that there’s going to be some sort of major loss of PA jobs due to that conflict, that turf war?
Beth Macintire:
I’ve never heard a PA worry that a doctor’s going to take their job. And maybe that’s because a lot of us are employed by physicians. 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, and do procedures. 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?” I think everybody worries about burnout, but I don’t know any PAs who are worried about physicians or someone else taking their jobs.
I’d say we probably have an optimistic view of that. Maybe it’s because we are growing, but I just don’t see that happening. I think we work really well together. We can work together to extend patient care and everybody can be happy. I think there’s always going to be enough patients. We’re not getting healthier as a country, and we’re having our population still expanding and people are living older. I just don’t see the need for healthcare providers to go down. But I do sometimes worry about the healthcare system itself, which is an entirely different conversation.
Dr. Jim Dahle:
How about the other APCs, the nurse practitioners? I feel like half of the nurses in my ER are enrolling or thinking about enrolling into an evening online nurse practitioner program. Do you feel a risk for your career from that direction?
Beth Macintire:
I think nurse practitioners do have something for them, the fact that they’re independent practitioners. I think that there are some ways that they’re more employable in that way.
Dr. Jim Dahle:
At least in some states.
Beth Macintire:
In some states, right. In some states, they don’t have to worry about supervising physicians and reboarding and things like that. I do think that there are some groups that like to hire nurse practitioners because of that. I personally think the education is a lot different. 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 surgery. I do think that there are some areas where they really shine and excel and there’re probably more nurse practitioners, for example in OB-GYN. If you look at all the MinuteClinics and things like that, 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 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. If you’re just looking to hire someone with the skills, I think PAs get trained in procedures better than nurse practitioners do.
Katie Bean:
Yeah, we are trained very differently. PAs are trained in the medical model, which is how docs are trained. I love nurse practitioners; they’re amazing. But just like Beth said, they are not trained procedure-based like PAs are. There is a little bit of that downside to it, but there’s a place for all of us in medicine.
 
Dr. Jim Dahle:
Let’s turn the page and talk about retirement. What are the differences between how PAs should save for retirement vs. docs?
Beth Macintire:
I love talking about money in retirement. One of the things I think about when I think about my retirement is what you want your retirement to look like and when do you want your retirement to be. I think that the hardest thing to account for is we don’t always know. We don’t know what healthcare costs are going to be like. We don’t know what inflation’s going to be like. I think PAs have to think long-term just like anybody else. 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 their health gets in the way.
You never really know what happens. 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 retire and then take in account your health status. Do you have kids? Your long-term goals. Do you want to save for grandkids, great grandkids? And really focus on the long term because we are high-income earners. We’re not like physician high-income earners, but compared to the average person in the United States, we’re high-income earners. I think where most people go wrong is they don’t have a plan. They’re going to think about it later, right? Because they’re so busy in the now and working now and they’re like, “Oh, I’ll make a lot of money, I’m always going to make a lot of money.” But again, we’ve had a lot of friends and people that we’ve known that are forced to retire for medical reasons or family reasons or something like that.
Dr. Jim Dahle:
How are you actually saving for retirement? What percentage of your income do you save for retirement? Where do you put it? What are you invested in?
Beth Macintire:
I work, I still teach, and I have a 403(b) through that. I max that out every year. I do Roth. We’re lucky we have a choice between traditional and Roth. 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 being able to grow tax-free is what I wanted. I put 20% of my income in Roth and then I also do a Roth IRA every year. Then, any other extra income I have monthly, 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 which ones I want to use. I go with the index and I go to the mutual funds. I love Vanguard, personally.
Katie Bean:
I put 15% away into a Roth and 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. I also invest in some real estate, as well.
Dr. Jim Dahle:
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 40s?
Beth Macintire:
I didn’t know that was a thing until I really started researching. I love the FIRE movement. I have about two other PAs I know that are really, really interested in it. I am interested in it more for the freedom than the not working. I love the freedom to travel or the freedom to leave your job for something else. 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. I think FIRE is amazing. I definitely can see myself hopefully retiring before the traditional retirement age. Whether that means retiring fully or retiring partly and doing something else and following my passion, I don’t know. But I definitely think PA is a good career 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, we have that lifestyle creep. Of course, it’s about how much you save. If you make $100,000 and you spend $100,000, you are never going to retire. I definitely think PAs are uniquely positioned because yes, we have some extra education, but we still get out in 2 1/2 years, unlike physicians. You guys are in school a lot longer. We still make a really good income. If the average is $115,000 a year, especially if you have a dual income and you make wise financial decisions, I think PAs are really positioned uniquely to be able to retire early or at least move down to part-time, whatever retirement looks like for you.
Dr. Jim Dahle:
What do you think, Katie? Besides Beth, do you know any PAs interested in FIRE?
Katie Bean:
Yeah, we actually did a podcast with somebody whose entire podcast is about being a PA and FIRE. I love the concept. I don’t necessarily know if I want to retire completely. I love work, I love my profession, I love patients, I love medicine. It may look different, 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. 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 I love the concept.
 
Dr. Jim Dahle:
What do you find that your peers don’t know about investing?
Katie Bean:
So much. We’re not trained in finances. We don’t take a business course. We don’t take a financial course. Even in undergrad, most of the students that go on to become PAs are on a science-based major. They don’t take those sorts of classes. 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. In PA school, we are 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. I would really try to have 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 was missing from our education. You really do have to learn on your own, self-directed learning later during school, after school, where to go with your finances and how to invest.
Dr. Jim Dahle:
A financial advisor costs thousands of dollars. If you want good financial advice, you’re going to pay $2,000, $3,000, $5,000, maybe $10,000 a year. PAs that are only making $100,000 or $120,000, can they afford to hire a financial advisor or are they forced to become do-it-yourself investors?
Beth Macintire:
I guess I’m a do-it-yourself investor. Maybe I’m biased, but I also am all about index funds and mutual funds. I guess I’ve known some PAs who have had financial advisors—not just for them, but for their families. It could help, too, if your spouse has an income to help cover the cost. I’ve never used one. I think that they definitely have their place. Especially like in medicine, we say know what you don’t know. Understand where your scope stops. Sometimes we think, “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 time to deciding about having a retirement plan, then I think it’s probably worth it to have someone at least map something out for you or keep you on track.
Katie Bean:
We have a financial advisor. 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. I thought that was super beneficial, and we continue to use them to this day, especially with the combination of my husband’s salary.
Dr. Jim Dahle:
Our time is getting short. This will eventually be listened to by between 30,000-40,000 people, only a small fraction of which are actually PAs. What have we not talked about that you think our audience should know?
Beth Macintire:
One really interesting thing that probably is worth mentioning is physicians in general are getting into more subspecialties. My last orthopedic job, every single doctor was fellowship-trained in hand or shoulder or something like that. It seems like physicians now, they’re not just doing orthopedic surgery, they’re doing hand fellowships. They’re getting more and more specialized. And PAs tend to follow physicians. It would not surprise me 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, which is a lot of physicians.
The potential for earning in those areas are going to be even higher if you specialize in some of these subspecialties. I know, for 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. It would not surprise me if the PA salary continues to grow, especially as we follow physicians into subspecialties. It’ll be interesting to see 10 years from now what the average salary for a PA will be. Of course, you have to take into account inflation, etc., but it has jumped so much just in the last decade that I just really see it expanding even more and especially as we tend to subspecialize even more.
Dr. Jim Dahle:
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.
I hope you enjoyed that interview as much as I did. There are 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. The truth is 95% of financial information is about the same for everybody. Four percent of what we talk about here is maybe applicable only to people in the highest tax brackets. And then only really 1% is probably truly physician-specific information. Let’s spread this information around the best we can to those who can be helped by it.
More information here:
Investing 101 for Beginners
 
This podcast is sponsored by Bob Bhayani at drdisabilityquotes.com. He is an independent provider of disability insurance planning solutions to the medical community in every state and a long-time White Coat Investor sponsor. He specializes in working with residents and fellows early in their careers to set up sound financial and insurance strategies. If you need to review your disability insurance coverage or to get this critical insurance in place, contact Bob at drdisabilityquotes.com today by email [email protected] or by calling (973) 771-9100.
 
Registration for WCICON23 is now open! Be sure to register early so you are assured to get a ticket! We expect this amazing event to sell out this year. Plus, if you register early, you get the early bird price of $1,699. That is a $300 savings. We have incredible speakers lined up as well as tons of wellness activities like golf, tennis, and pickleball. Plus, who doesn’t love sunny Phoenix in the winter? Don’t miss out on this incredible experience! Register today at www.wcievents.com.
 
Oscar Wilde said,
“Experience is the hardest kind of teacher. It gives you the test first and the lesson afterward.”
 
#88 — We love to showcase that no matter what your income is you can pay down your loans and build wealth! This doc demonstrates just that. By making good financial decisions and being consistent, you will find yourself on your way to financial independence.


Sponsor: CompHealth
 
Intro:
This is the White Coat Investor podcast, where we help those who wear the white coat get a fair shake on Wall Street. We’ve been helping doctors and other high-income professionals stop doing dumb things with their money since 2011.
Dr. Jim Dahle:
This is White Coat Investor podcast number 285 – Physician Assistant Financial Education.
Dr. Jim Dahle:
This podcast is sponsored by Bob Bhayani at drdisabilityquotes.com. He is an independent provider of disability insurance planning solutions to the medical community in every state and a long-time White Coat Investor sponsor.
Dr. Jim Dahle:
He specializes in working with residents and fellows early in their careers to set up sound financial and insurance strategies. If you need to review your disability insurance coverage, or to get this critical insurance in place, contact Bob at drdisabilityquotes.com today or by emailing in[email protected] or by calling (973) 771-9100.
Dr. Jim Dahle:
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 Wild, and I love it. He said, “Experience is the hardest kind of teacher. It gives you the test first and the lesson afterward.”
Dr. Jim Dahle:
And I think that’s true. Unfortunately, too many of us try to make all the mistakes ourselves rather than letting other people make the mistakes and learning from their mistakes.
Dr. Jim Dahle:
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.
Dr. Jim Dahle:
I was talking to somebody last night who is so grateful. This is a neighbor of mine who just found a hematologist oncologist that he loves because he is being aggressive about the workup that he needs for his anemia. And 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.
Dr. Jim Dahle:
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 to 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 at 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.
Dr. Jim Dahle:
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 WCICON23, also known as the Physician Wellness and Financial Literacy Conference.
Dr. Jim Dahle:
You can sign up for that at 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.
Dr. Jim Dahle:
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 cost in the last year, this conference did not. Early bird registration is the same exact price as last year. And we’d love to see you there.
Dr. Jim Dahle:
This is a great conference. We divided the content into about three categories. First one is wellness criteria. This 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 if you’re self-employed.
Dr. Jim Dahle:
The next third 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.
Dr. Jim Dahle:
And then the third category is 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.
Dr. Jim Dahle:
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.
Dr. Jim Dahle:
I think it’s the best Medical Conference of the year. It will be in Phoenix at 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.wcievents.com.
Dr. Jim Dahle:
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% are dentists and their trainees.
Dr. Jim Dahle:
And then we find that the other 10% to 15% are other medical professionals as well as nonmedical professionals. And so, there’s a significant segment of people out there that aren’t doctors, and they typically have lower incomes than doctors. Often still a high income, still a six-figure income, but maybe not the higher incomes that many doctors have.
Dr. Jim Dahle:
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. As you listen to it, think about the ways that it can apply in your life and we’ll chat more after the interview.
Dr. Jim Dahle:
All right, my guests today on the White Coat Investor podcast are Katie Bean, PA-C, and Beth Macintire, PA-C. Welcome to the White Coat Investor podcast.
Katie Bean:
Thanks for having us.
Beth Macintire:
Thank you so much for having us. Yes, we’re excited.
Dr. Jim Dahle:
Yeah. 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.
Katie Bean:
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.
Dr. Jim Dahle:
Cool. Beth?
Beth Macintire:
Yeah. My upbringing was a little bit different. 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 and went back to school full time. And so, my mom was working part-time taking care of the kids. They moved around so they didn’t have childcare support and so they were pretty much on their own.
Beth Macintire:
And so, when we were young, we were pretty financially poor until my dad got out of school. And because of that, my views on money were always kind of a scarcity view. So, we’re big savers. We blame it on our Scottish jeans, 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.
Beth Macintire:
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.
Beth Macintire:
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 investing and very much about long term and very much about saving. So, I kind of got that from both sides of my parents.
Beth Macintire:
And just growing up, we were 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. I think a lot of people are hesitant to talk about money with their spouses or maybe with their kids. And so, my parents were very open about it. They’re like, “This is what saving is. This is what matching means.”
Beth Macintire:
And so, even though I never took a finance class in college or in high school or anything like that, I was aware of what money and how money works and how credit works from a young age. And I think that gave me an advantage what it comes to, now, financially planning my life, just because I had that good background about money and what it means really to save.
Dr. Jim Dahle:
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 learned nothing, at least nothing good about money from their parents, and they had to learn it all as adults.
Dr. Jim Dahle:
All right. Briefly run us through your education, training and career so far.
Katie Bean:
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.
Katie Bean:
And then I switched over to emergency medicine and worked as an ER PA 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. Right when Covid happened, I was furloughed from the ER, moved over and transitioned into aesthetics and worked there for a while as well.
Dr. Jim Dahle:
Okay. And Beth, your career and your training and career?
Beth Macintire:
Yeah. 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.
Beth Macintire:
So, when 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.
Beth Macintire:
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, was because at the time in Tennessee there were only two PA schools and they were both private and they were both twice as expensive. Actually, going out of state was actually cheaper for me than actually going in state.
Beth Macintire:
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. 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 was kind of an investment in my future, kind of worth it for me. So, I did that.
Beth Macintire:
And then after that, most of my experience has been in orthopedic surgery. First assisting in the OR and then running clinics and taking call up in the hospital, rounding patients, etc. So, it’s been a lot of fun because I get to work inpatient, outpatient hospital, 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 a PA.
Beth Macintire:
As Katie said, eventually I transitioned to mostly academia. I taught at PA schools three years. I’m still teaching at PA schools. And we went back a few years ago and got our doctorate in 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 I guess we graduated back in 2018. So, that’s been a while now but yeah, that’s my educational career.
Dr. Jim Dahle:
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 profitable business or is this a labor of love and what do you do there?
Katie Bean:
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.
Katie Bean:
And so, we started Pre-PA 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.
Beth Macintire:
I was going to say it’s really important because it’s expensive to apply to the PA school. So, if anybody knows anything about PA school, you have CAPSA fees, you have supplemental application fees, you’ve got to fly for interviews and things.
Beth Macintire:
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 reapplicants. And so, our goal is to help students 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.
Beth Macintire:
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? Is it professionally written? Do we need to help them 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.
Dr. Jim Dahle:
And it’s a podcast and a coaching service, etc.
Beth Macintire:
Yes, yes. All of the above.
Dr. Jim Dahle:
All right. So, let’s talk about PA finances. A typical PA education last 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 instate. 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?
Beth Macintire:
I would say that’s probably pretty accurate. Most people we’ve talked to, that’s probably about what the student loan burden is. Now that does not include if you have any undergraduate student loan burden of course. And so, for us, it’s a good investment. I was taught that 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 $100,000 your first year out, that’s about how much you should borrow for school, realistically, in order to be able to pay it back in a timely fashion.
Beth Macintire:
And so, PAs, we know we’re going to be, a lot of us are in a lot of debt, a lot of student loan debt, and a lot of us, for example, can’t work during school. We had to sign this affidavit that we can’t work. Two and a half years of no work, two and a half years of debt, but we come out as high-income earners.
Beth Macintire:
And so, when we first started, when I first graduated, the average PA made something like $65,000 a year. And so, the average PA in the United States, it’s almost double that now. It’s over $100,000 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 into PA school by 24. By 27 you’re out there earning your great income.
Beth Macintire:
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, right? Long term. And so, people who take longer for their education, they obviously lose those earlier years. And so, I think 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 is expected to grow, most healthcare jobs.
Beth Macintire:
And so, I do think it’s worth it, but I think that you have to decide for yourself. For example, we work with some clients, some schools are $180,000 just in tuition. And as you said, some are $50,000 in tuition. So, I think you have to really be smart and really realistic and have a plan about how you’re going to pay it back before you just say, “Hey, I’m going to go to PA school, I’ll figure it out later.”
Beth Macintire:
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 PA 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?”
Beth Macintire:
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.
Dr. Jim Dahle:
So, you mentioned one school it costs $180,000. What cost of education does it become not worth it? What level of debt burden is it not worth it to become a PA if you had to put a figure on it?
Beth Macintire:
I would say that if you were looking at $200,000 in debt total, like undergraduate, graduate school, then you probably either need to have a plan afterwards saying, “I’m going to work for a nonprofit and I’m going to do the 10-year thing and have my student loans forgiven.” Or you need to figure out a way to apply to different school or apply to school we can work part-time or something like that.
Beth Macintire:
I probably personally would not take over $200,000 in debt because just the compound interest on that. 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 I probably need to do something.” I don’t know. What do you think Katie?
Katie Bean:
I would say if you don’t use your degree it would be a pretty bad investment. 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 that for at least a decade, if not more to make it beneficial.
Dr. Jim Dahle:
That’s interesting to think about it as how long you got to use it to make it beneficial. I mean, if you’re making, round numbers, you’re making $100,000 a year and you borrow $200,000 for a decade, you made a million dollars. So, it costs you $200,000 to make a million. Maybe that’s not a bad investment if you think about it that way.
Dr. Jim Dahle:
On your podcast, you’ve talked about some of the hidden costs of PA school. What are the hidden costs of PA school?
Katie Bean:
Sure. 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 the rubber meets the road, the bread and butter of medicine. We send our students out or anywhere from six to eight week rotations.
Katie Bean:
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. So, 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.
Katie Bean:
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.
Dr. Jim Dahle:
Any other costs?
Beth Macintire:
Yeah. And then medical equipment, for example, is super expensive. We require certain types of stethoscopes and if you don’t have one it can get quite expensive. Otoscopes, ophthalmoscopes. A lot of times PA schools require you to buy those. So, that’s also another expense.
Beth Macintire:
We also require a certain 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 software that we use to lock down browsers for them to take their exams, for example, can only work with the newer systems.
Beth Macintire:
Books. Books are really expensive. 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.
Beth Macintire:
As Katie said, you might have to travel, gas costs. We actually had a student once who didn’t even own a car. 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.
Beth Macintire:
And then medical expenses. In some schools, for example, 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 to 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.
Beth Macintire:
A lot of hospitals, for example, require 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 make sure that you’ve had the chickenpox. And so, they take all kinds of levels and you have to give blood.
Beth Macintire:
And so, there are a lot of these hidden costs that you would never think of. But if you have to pay for 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. 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.
Beth Macintire:
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.
Dr. Jim Dahle:
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.
Beth Macintire:
I hope so. I was lucky, I went to a big public school 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 was super reasonable. I know that some of our students have been in the military in the past and they’ve been military health insurance, but we have heard some students say, “Well, what are we supposed to do for health insurance?”
Beth Macintire:
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? Some of the smaller private schools don’t.
Dr. Jim Dahle:
Yeah. So, what can PA students do to minimize their debt burden?
Katie Bean:
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 your means is definitely going to get students into trouble for sure.
Dr. Jim Dahle:
Of course, everything is outside your means when you don’t have any income at all. When you’re only living on loans, a slurpee is outside your means. At a certain point you got to find some balance, right?
Beth Macintire:
Right. And I just think it’s a mindset thing. When I went to school, I remember this vividly. I broke my sunglasses. I was a big runner and so I went to Target and got $8 sunglasses and everybody made fun of me and they’re like, “Those are the most ridiculous looking sunglasses ever.” I was like, “Yeah, 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.” And so, in my mind, if I was a student, I was like, “I’m not going to buy a $300 pair of sunglasses.” I didn’t even have a texting plan. I refused to text anybody when I was in school because I was like, “It’s 25 cents a text. I’m not texting you. I mean we could call each other for free.”
Beth Macintire:
And so, it seems like a little thing, but if you’re talking about Starbucks every morning, if you’re talking about running to fast food every lunch, if you’re talking about tons and tons of 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 cellphone plus the two and a half years of interest on that. Plus, the fact 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.
Beth Macintire:
And if you make similar choices every single month, I think it’s kind of a mindset thing. And so, a lot of my friends were like, “I have to borrow so much anyways that borrowing $100,000 it doesn’t matter.”
Beth Macintire:
And in my mind, I’d always think of, “Okay, what is the actual cost of this? 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, how much interest am I paying on this and is it worth it to me?”
Beth Macintire:
And so, something like $300 sunglasses weren’t worth it to me. But I loved to run and so I did a half marathon during PA school. And so signing up for that and paying the $100 dollars entry fee, that was worth it to me because I was okay with realizing that this isn’t $100, it’s maybe $200 in the future.
Beth Macintire:
So, I think it’s just kind of a mindset and just deciding, as you said, you’ve 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 was interested in that but I was super interested in joining a local running community. And so, that was kind of the way I did my balance.
Dr. Jim Dahle:
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? If you had to say what the 25th percentile is and the 75th percentile is, what would you say those are?
Beth Macintire:
I would say it definitely varies by specialty. 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 $150,000.
Beth Macintire:
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. I know a PA who does intakes for psych patients at the hospital because he is a primary care PA whenever he wants to make more money. But I’d say probably $80,000 is probably the 25th. And I’d say probably close to maybe $130,000 is probably the 75th just from my experience. But it does vary.
Beth Macintire:
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. 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. When we graduated it was $65,000 I think, and now it’s $115,000. So, that’s amazing.
Dr. Jim Dahle:
Yeah. It’s still a tight range compared to medicine where the range is extremely broad. The range within a specialty is far broader than the difference between the averages in the various specialties. Actually what you describe is a pretty tight range I think for salaries. I was actually surprised it was that tight.
Beth Macintire:
Yeah, I don’t know. I guess I’ve never thought about it.
Dr. Jim Dahle:
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. They’re walking into their first job. What should they expect to make?
Katie Bean:
Yeah. Again, just like Beth said, it varies tremendously by specialty, but between a brand-new PA, new graduate, anywhere between $80,000 and $115,000 – $120,000.
Dr. Jim Dahle:
Okay. What can PAs do to be paid more? You’ve mentioned a few things. You’ve mentioned specialties where you work, taking calls, working more shifts. But what else can they do to be paid more?
Katie Bean:
I think doing a fellowship like Beth did and advancing your education is definitely helpful. 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.
Beth Macintire:
Yeah, definitely. I think the experience.
Dr. Jim Dahle:
Yeah. Let’s talk about those training. 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.
Beth Macintire:
Yeah. 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.
Beth Macintire:
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. When I graduated, most of the residencies were either in 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.
Beth Macintire:
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, I got paid something like $2,000 a month.
Beth Macintire:
It’s significantly below what I could have made as a PA but for me that was an investment in my future. Not only in my future earning potential, but also in the job I wanted. I did an orthopedic rotation in PA school, absolutely loved it, loved being in the OR. I loved just working. I was a big athlete. I love sports medicine patients. I 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.
Beth Macintire:
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 equivalent to three years of practice.” So, I’m coming out and it’s like I have three years of experience and I can start off at a higher pay scale and then I can also choose what specialty I want to work with and what job because I have training.
Beth Macintire:
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. If you did one rotation in orthopedics, 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 the Robert Jones and some of the more complicated types of dressings and castings.
Beth Macintire:
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 also 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 “three years” of basic training.
Beth Macintire:
For me, I think it was worth it to take a little step back financially to know in the future that I’m 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. 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.
Beth Macintire:
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 pediatric neurosurgery in children’s. Her thing was, “I know I wanted to work here, but I needed experience.” And so doing this fellowship, got her the job that she wanted. That’s kind of what she saw out of it too. 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.
Dr. Jim Dahle:
Are they all one year or some of them longer?
Beth Macintire:
Some of them are longer. Some of them are like 18 months. 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 more formalized it. It was a formalized process, but they went back and so some fell away and some came up.
Beth Macintire:
They’re trying to standardize them I think a little bit more now than they were back when I did it. A year is about average, but there were some, especially in the ER that were 18 months at level one trauma centers, which was really interesting.
Dr. Jim Dahle:
And have you ever met a PA that regretted doing one?
Beth Macintire:
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 specialty. So, you do an 18-month ER and then as Katie said, three, five years later, you’re like, burn out of the ER. If you don’t get your time in that specialty, is it really worth it? But the good thing is that kind of thing, primary care, you still might see some emergent, might see appendicitis or you might see these things.
Beth Macintire:
I don’t know if the knowledge is ever wasted, but I think if you decide not to become a PA, maybe you start a family and to go back to work or if you decide that that’s not really your specialty, then those are the two scenarios I could think that maybe you’re like, “I wish I hadn’t done that. It probably wasn’t a good move.”
Dr. Jim Dahle:
Seems like the vast majority of PAs are employees. Do you know of any situations where they aren’t employees?
Katie Bean:
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 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.
Dr. Jim Dahle:
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?
Beth Macintire:
There are some programs that will pay back your student loans if you go to certain 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 surgical PAs, a lot of orthopedic groups are still private, they’re not hospital based. And so, if you work for an actual group themselves and not a hospital, I think you probably make more money too.
Beth Macintire:
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 say it’s kind of the opposite. I would say the big city is where you’re going to make the money as a PA.
Dr. Jim Dahle:
What do you see as the financial risks of a PA career? What a PA’s worry about? What do they lay awake at night worrying it’s going to change in their career, in their profession that’s going to hurt them financially?
Beth Macintire:
I think kind of like physicians’ malpractice. We could get sued as well. I guess that’s probably a big financial thing. Losing our jobs. Since we’re employed by hospitals or physicians, if they ever decide like in COVID, right? A lot of PAs got furloughed. I got furloughed from my orthopedic job because all the clinics, orthopedic clinics shut down. A lot of ERs PAs got furloughed because no one was coming to the ER.
Beth Macintire:
And so, I think that was surprising, in the middle of a healthcare crisis, to have certain providers that are just such need like ICU providers, etc. And then other places we got totally furlough 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’ve 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?
Katie Bean:
Yeah, I was going to say the exact same thing. Malpractice for sure. That’s always a concern. And additionally, like COVID just rocked everybody’s world, of course. And I never would’ve thought that something would happen where I would lose my job or be furloughed, especially during a pandemic or a healthcare crisis. So yeah, that it definitely has some shell shock from that.
Dr. Jim Dahle:
What happened to you in spring of 2020?
Katie Bean:
Our volumes in the ER dropped tremendously. We were seeing a fraction of the patients that we usually saw. I was furloughed for, gosh, a good six months.
Dr. Jim Dahle:
They just said don’t come in.
Katie Bean:
Don’t come in.
Dr. Jim Dahle:
Any sort of pay or benefits you got during that time period?
Katie Bean:
Not at all.
Dr. Jim Dahle:
Nothing.
Katie Bean:
Nothing.
Dr. Jim Dahle:
It’s just basically your job is gone, maybe we’ll hire you back in a few months.
Katie Bean:
Yeah, good luck.
Dr. Jim Dahle:
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 hand basket or 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?
Katie Bean:
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 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.
Katie Bean:
I think that our profession just has so much opportunity for growth. As you can see within the last decade, 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 the number one career, the number one profession to go into. I think that was on USA Today or US News, something like that a few years ago.
Dr. Jim Dahle:
Now lots of docs worry that PAs are taking their jobs. Do PAs worry that there’s going to be a backlash from that? That docs are going to start taking their jobs or that there’s going to be some sort of major loss of PA jobs due to that conflict that, turf war?
Beth Macintire:
I’ve never heard of PA worry that a doctor’s going to take their job. And maybe that’s because a lot of us are employed by physicians. 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 and do procedures. And so, we can bill pretty highly for procedures.
Beth Macintire:
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 everybody worries about burnout and kind of worries about these things, but I don’t know any PAs who are worried about physicians or someone else taking their jobs.
Beth Macintire:
I’d say we probably have an optimistic view of that. Maybe it’s because we are growing, but I just don’t see that happening. I think we work really well together and I don’t see why. We can work together to extend patient care and so everybody can be happy.
Beth Macintire:
I think there’s always going to be enough patients. We’re not getting healthier as a country and we’re having our population 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 is entire different conversation.
Dr. Jim Dahle:
How about the other APCs, the nurse practitioners? I feel like half of the nurses in my ER are enrolling or thinking about enrolling into evening online nurse practitioner program. Do you feel a risk for your career from that direction?
Beth Macintire:
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.
Dr. Jim Dahle:
At least in some states.
Beth Macintire:
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 practitioner because of that. I personally think the education is a lot different. 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 assistant surgery.
Beth Macintire:
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 MinuteClinics and things like that at the Walgreens, those are almost exclusively staff by nurse practitioners. But when you look at things like surgery, I think PAs are more common in surgery.
Beth Macintire:
I think things like ER and Katie can speak to this, they come in and they haven’t been trained in a lot of the procedure based that PAs are trained in. So, they do need that extra training. I think it 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.
Beth Macintire:
But I think our training is superior in certain areas of the training. If you’re just looking to hire someone with the skills, I think PAs get trained and procedures better than nurse practitioners do.
Katie Bean:
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.
Dr. Jim Dahle:
Let’s turn the page and talk about retirement. What are the differences between how PAs should save for retirement versus docs?
Beth Macintire:
I love talking about money in retirement. 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.
Beth Macintire:
I’ve known so many PAs that have worked until like 70, 75 years old and three months after retirement they have a heart attack on the trail and they’re gone. And so, I think you have to have a realistic view of what retirement means for you. And it’s all about how much money you plan on spending in retirement.
Beth Macintire:
And I think that the hardest thing to account for is we don’t know. We don’t know what healthcare costs are going to be like, we don’t know what inflation’s going to be like. And so, it’s one of those things you don’t want to run out of money. If you’re doing like the 4% rule or whatever, then you have to kind of estimate for part of that.
Beth Macintire:
I think PAs have to think long term just like anybody else, just like doctors, anybody else in the healthcare. And 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.
Beth Macintire:
And so, you never really know what happens. 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 grandkids, great grandkids? And really focus on the long term because we are high income earners. We’re not like physician high income earners, but compared to the average person in the United States, we’re high income earners.
Beth Macintire:
And so, if you get used to living a lifestyle at a certain number and then you have to realize, “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 good expectations about what you expect it to look like and then planning for it. So, if you’re going to plan to how much you have a plan.
Beth Macintire:
And I think most people where they go wrong is they don’t have a plan. They’re going to think about that later, right? Because they’re so busy in the now and working now and they’re like, “Oh, I’ll make a lot of money, I’ll always going to make a lot of money.” But again, we’ve had a lot of friends and people that we’ve known that are forced to retire for medical reasons or family reasons or something like that. Always keeping that in the back of your mind that it’s not always the best-case scenario.
Dr. Jim Dahle:
So how are you actually saving for retirement? What percentage of your income do you save for retirement? Where do you put it? What are you invested in?
Beth Macintire:
Okay, cool. Well, I’ll go first, Katie, and then you can go because I love talking about money. For me, I work, I still teach, and I have a 403(b) through that. And so, I max that out. So, there’s a certain amount you can put in every single year through that. And I do Roth. We’re lucky we have a choice between traditional and Roth.
Beth Macintire:
Again, I’m not a financial agree 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. 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.
Beth Macintire:
And then any other extra income I have monthly, I have 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 which ones I want to use. I go with the index and I go to the mutual funds. And I love Vanguard personally, because I have kind of low fees and so I use a lot of Vanguard funds for any of that. And so, that’s kind of my investing profile.
Dr. Jim Dahle:
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.
Beth Macintire:
Oh, sorry.
Dr. Jim Dahle:
Next year wouldn’t surprise me if it’s up that high or even higher given what inflation’s been this year. All right, how about you? How are you saving for retirement?
Katie Bean:
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.
Dr. Jim Dahle:
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 40s?
Beth Macintire:
Yeah. I didn’t know that was a thing until I really started researching. And I was like, “Oh my gosh, I’m not the only person out there.” 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 she’s doing great. She estimates that she will only have to work seven years because she has a husband who also has a high income.
Beth Macintire:
They live very well below their means. Her mom has a house, but she travels a lot and so they stay rent free in the house and they watch the house. And so, they have very low overhead. And she’s probably the best I know, because seven years is pretty legitimate from graduation to possibly being able to retire. It helps that she’s a dual income. Her husband’s an engineer and so he pulls in a pretty good salary too. They’re DINKs, Dual Income, No Kids right now.
Beth Macintire:
And then I have one other PA friend that we talk about it a lot. We’re super interested in it. We read the same blogs, etc. I’m totally interested in it. And more for the freedom than not work. Just the freedom if you have a job and you want to leave the job, you can, you 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.
Beth Macintire:
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. 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 a little bit more about finances.
Beth Macintire:
I do think I’ve made some mistakes, but I definitely can see myself hopefully retiring before the traditional retirement age. And whether that means retiring fully or retiring partly and doing something else and following my passion, I don’t know. But I definitely think PA is a good career if you’re interested in that because we are high income earners.
Beth Macintire:
I think the con is that sometimes since we are high income earners, sometimes we have that lifestyle creep with that. And then of course, it’s about how much you save. If you make $100,000 and you spend $100,000, you are never going to retire. And so, I think that’s kind of the downside from it.
Beth Macintire:
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. 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, especially if you have a dual income and you make wise financial decisions, I think PAs are really positioned uniquely to be able to retire early or at least move down to part-time, whatever retirement looks like for you, because of the high income.
Dr. Jim Dahle:
What do you think, Katie? Besides Beth, do you know any PAs interested in FIRE?
Katie Bean:
Yeah, we actually did a podcast with somebody whose entire podcast is about being a PA and FIRE. 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, 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, I love the concept.
Dr. Jim Dahle:
What do you find that your peers don’t know about investing?
Katie Bean:
Yeah, so much. We’re not trained in finances. We don’t take a business course. We don’t take a financial course. Even in undergrad, most of the students go on to become PAs are on a science based major. So, they don’t take those sorts of classes. 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. In PA school we are so focused on medicine that there’s not time to add that in.
Katie Bean:
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 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 was missing from our education. And you really do have to learn on your own, self-directed learning later during school, after school, where to go with your finances and how to invest.
Dr. Jim Dahle:
A financial advisor costs thousands of dollars. If you want good financial advice, you’re going to pay $2,000, $3,000, $5,000, maybe $10,000 a year. PAs that are only making $100,000 or $120,000, can they afford to hire a financial advisor or are they kind of forced to become do-it-yourself investors?
Beth Macintire:
I guess I’m a do-it-yourself investor. Maybe I’m biased, but I also am all about index funds and mutual funds. So, I don’t do things like Katie. 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 their families. And so, it could help too if your spouse has an income, could help pay for that.
Beth Macintire:
I’ve never used one. I think that they definitely have their place and especially like in medicine we say know what you don’t know. 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 time to deciding having a retirement plan, then I think it’s probably worth it to have someone at least map something out for you or keep you on track.
Beth Macintire:
I prefer to do it myself because I like the hands-on control, but I don’t think it’s a bad thing to have a 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 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.
Beth Macintire:
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 401(k) was when I graduated. I was like “A 40-what? What is this?” I didn’t know Roth and traditional. I didn’t know any of that stuff. And then I started reading and I was like, “Oh, well, this makes sense now.”
Beth Macintire:
I know some people that are just like, “Oh, I checked whatever box they said and whatever they matched and that’s what I put in.” I’m like, “Well, how much is it a month?” And they have no idea. They just don’t know. They’re not interested. And so, I think if you’re not interested yourself in learning, then probably a financial advisor would be smart, but it would be hard to pay 10% of your pretax salary to a financial advisor. So, that would motivate me 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?
Katie Bean:
We have a financial advisor. 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. I thought that was super beneficial and we continued to use them to this day, especially with the combination of my husband’s salary.
Dr. Jim Dahle:
All right. Well, our time is getting short. This will eventually be listened to by between 30,000 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?
Beth Macintire:
I think one really interesting thing that probably is worth mentioning is physicians in general are more subspecialties. My last orthopedic job, every single doctor was fellowship trained in hand or shoulder or something like that. So, it seems like physicians now, they’re not just doing orthopedic surgery, they’re doing hand fellowships. And so, they’re getting more and more specialized.
Beth Macintire:
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, which is a lot of physicians.
Beth Macintire:
And so, 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, 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.
Beth Macintire:
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 PA will be. Of course, you have to take into account inflation, etc, but it has jumped so much just in the last decade that I just really see it expanding even more and especially as we tend to subspecialize even more.
Dr. Jim Dahle:
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 your time.
Katie Bean:
Thank you for having us.
Beth Macintire:
Thank you.
Dr. Jim Dahle:
All right. I hope you enjoyed that interview as much as I did. There’s a lot of lessons it can be learned there no matter what’s your profession, no matter what’s your specialty, no matter where you’re at financially.
Dr. Jim Dahle:
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 truly physician specific information. And so, let’s spread this information around as best we can to those who can be helped by it.
Dr. Jim Dahle:
This podcast is sponsored by Bob Bhayani at drdisabilityquotes.com. One listener sent us this review. “Bob has been absolutely terrific to work with. Bob has always quickly and clearly communicated with me by both email and or telephone with responses to my inquiries usually coming the same day. I’m in somewhat of a unique situation and Bob has been able to help explain the implications and underwriting process in a clear and professional manner.”
Dr. Jim Dahle:
You can contact Bob at the website drdisabilityquotes.com. You can email [email protected] or you can just pick up the phone and call (973) 771-9100. However you contact them, you need to get your disability insurance in place today.
Dr. Jim Dahle:
Don’t forget to register for WCICON, www.wcievents.com. That early bird pricing, assuming seats stay available, goes through November 7th.
Dr. Jim Dahle:
Thanks for those of you who are leaving us five star reviews and telling your friends about the podcast. Our recent one came in from h_smith21 who said “Great, actionable information. The podcast has a lot of great variety, reviewing a wide range of personal financial topics. WCI is the first place I go to seek out answers. Thanks Dr. Dahle and WCI Team!” Five stars. We appreciate those reviews.
Dr. Jim Dahle:
Keep your head up, your shoulders back. You’ve got this and we can help. We’ll see you next time on the White Coat Investor podcast.
Disclaimer:
The hosts of the White Coat Investor podcast are not licensed accountants, attorneys, or financial advisors. This podcast is for your entertainment and information only. It should not be considered professional or personalized financial advice. You should consult the appropriate professional for specific advice relating to your situation.

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