The highest paid and most in-demand job by state

[MillCreek]

https://www.marketwatch.com/story/heres-the-no-1-highest-paid-and-fastest-growing-job-in-every-us-state-2019-08-20

We should all be either a software developer, physician assistant or nurse practitioner.

[Brad Johnson]

Friend of mine was a LifeFlight nurse for more than 20 years. Decided it was time to up his game and became a nurse prac a few years back. Doubled his salary, back to a normal work schedule, and has much better benefits.

Brad

[Hawkmoon]

I clearly chose the wrong profession.

[Angel Eyes]

Read Dale Gilbert's comment about software developers.

[MechAg94]

I would be curious what it would be if they looked only at non-degreed jobs or maybe 2 years college at most.

I have been told that high voltage electricians make very very good money.

[BobR]

I wonder if the reason they are looking for PAs and NPs is because the Physicians are all specializing and there isn't enough of them to provide general health care. Plus it is MUCH cheaper for an organization to hire NPs and PAs than it is a Dr. You can get 2-3 of the mid-levels (they hate being called that, so I do) for the price of one Physician in a lot of areas. In some places (rural) you can't even get a Physician.

bob

[MillCreek]

I wonder if the reason they are looking for PAs and NPs is because the Physicians are all specializing and there isn't enough of them to provide general health care. Plus it is MUCH cheaper for an organization to hire NPs and PAs than it is a Dr. You can get 2-3 of the mid-levels (they hate being called that, so I do) for the price of one Physician in a lot of areas. In some places (rural) you can't even get a Physician.

bob

Plus, mid-levels are generally money makers for the practice.  What you pay them vs. what they generate in revenue ratio typically earns more for the practice than a primary care physician.

[Ben]

In some places (rural) you can't even get a Physician.

bob

Yup. My "primary doctor" is a PA at the little clinic in town. They just can't get doctors out this way. I haven't seen her for anything yet, but I'm due for my annual physical in a couple of months here so will be interested to see how it goes. My doctors over the last decade or so really haven't done the kind of full physicals I got as "standard" when I was younger. Pretty much just talk to me, do some basic health checks, then send me out for bloodwork.

I'll be interested to see how the annual prostate exam is handled - as in, will the PA do it or will they send me to the city?

[TechMan]

Yup. My "primary doctor" is a PA at the little clinic in town. They just can't get doctors out this way. I haven't seen her for anything yet, but I'm due for my annual physical in a couple of months here so will be interested to see how it goes. My doctors over the last decade or so really haven't done the kind of full physicals I got as "standard" when I was younger. Pretty much just talk to me, do some basic health checks, then send me out for bloodwork.

I'll be interested to see how the annual prostate exam is handled - as in, will the PA do it or will they send me to the city?

What Kroger company store is it in?

[brimic]

As I mentioned in another thread about rural healthcare, PAs have been in high demand in my state at least since I went to college 25ish years ago. They pushed any Biology/pre-med students to take a hard look at because of the demand.

[BobR]

As I mentioned in another thread about rural healthcare, PAs have been in high demand in my state at least since I went to college 25ish years ago. They pushed any Biology/pre-med students to take a hard look at because of the demand.

PAs are are good gap stop but they are tied to a Physician. In some states the Physician has to be physically present in the building for the PA to see patients. A NP on the other hand does have to option to open an independent practice in some states and just have a Physician they can consult with if needed. The biggest difference is the medicine model they use, a PA is more of a medical (like Dr) approach and a NP is often more holistic because of the Nursing background. Kind of like the PA will give meds because you are always coughing but the NP will try to look at your social/economic/whole health picture to figure out why, (maybe you have an allergy to chickens?) and then give you meds.

bob

[Ben]

NP is often more holistic because of the Nursing background. Kind of like the PA will give meds because you are always coughing but the NP will try to look at your social/economic/whole health picture to figure out why, (maybe you have an allergy to chickens?) and then give you meds.

bob

I would prefer that to the PA approach, in the same way you guys talked me into the DO over the MD.

[MillCreek]

A DRE (digital rectal exam) of the prostate is entirely within the scope of practice of a mid-level provider.  If you decide to have a PSA done, do so before the DRE.  The physical contact of a prostate exam can increase the PSA level.

[Ben]

A DRE (digital rectal exam) of the prostate is entirely within the scope of practice of a mid-level provider.  If you decide to have a PSA done, do so before the DRE.  The physical contact of a prostate exam can increase the PSA level.

Learn something new every day. I get a PSA test every year.  Interestingly, all my doctors in the past have given me the finger, then sent me to the lab (I always fast before a physical). Is this somewhat new info?

[MillCreek]

Learn something new every day. I get a PSA test every year.  Interestingly, all my doctors in the past have given me the finger, then sent me to the lab (I always fast before a physical). Is this somewhat new info?

There has been a debate about short-term rising of the PSA level after a DRE for quite a few years now.  There is literature on both sides, although I will say a lot of the more recent literature is not finding a rise.  This may have to do with increasing sensitivity and accuracy of the PSA test.  There is also literature showing short-term rises after ejaculating.

More to Ben's point, however, is using the PSA at all for routine screening.  Many reputable professional organizations in recent years have come out against PSA testing as surveillance for low-risk individuals.  They feel the risks and mortality of testing outweigh the benefit, since the typical male will die of something else before dying of prostate cancer.  Many equally reputable professional organizations still recommend PSA as routine surveillance for all men.  It is recommended that the patient make his own choice after consulting with his healthcare provider.

Speaking only for myself, as I have synthesized the literature, recommendations and standard of care, I am getting a PSA at five year intervals and I have the blood draw done before I go in for the annual visit and have the DRE, and will avoid ejaculating within 48 hours before the blood draw.  I have decided that if I have an elevated level with this approach, it is more likely to be a true elevation, instead of a false elevation artifact from DRE or ejaculation, thus requiring a repeat test to find out if it is a true elevation.

As a general rule, I have my internist send in the lab orders a week or so before my visit and I have the blood and urine specimens done before the visit.  That way, if there is anything interesting on the labwork requiring followup, we can discuss it and do so at the actual annual exam visit, as opposed to making a followup appointment after the annual exam.

Having said all this, there are still lots and lots of providers who do the PSA every year, and after the DRE.  This is within the standard of care.

[Ben]

Having said all this, there are still lots and lots of providers who do the PSA every year, and after the DRE.  This is within the standard of care.

I should add that I get the tests every year because my dad had prostate cancer.

Man, can we drift a thread, or what? 

[HeroHog]

10 years ago, as a Sr Programmer/analyst, I was making JUST under $100,000/yr is all I can tell you.

[Boomhauer]

Well all those woke laid-off journalists should have no problem finding jobs after they learn to code, yes?

[RocketMan]

I should add that I get the tests every year because my dad had prostate cancer.

Man, can we drift a thread, or what? 

I've read where every man will eventually get prostate cancer if he lives long enough.

[BobR]

Prostate cancer is one of those use it or lose type of things I believe. Who gets prostate cancer, the old guys who don't empty it out. BTW, a lot of docs don't even bother with a DRE unless the PSA is up or creeping up.

“While our findings should be confirmed in studies that evaluate the potential biological mechanisms underlying the observed associations, the results of our study suggest that ejaculation and safe sexual activity throughout adulthood could be a beneficial strategy for reducing the risk of prostate cancer,” Rider, now at Boston University, added by email.

https://www.reuters.com/article/us-health-ejaculation-prostate-cancer-idUSKCN0XJ1YC

bob