Photo: Alex McKnight
A Day in the Working Life
Health care and social assistance
» $71.05 billion
» 8.5% of Florida’s GDP
» GDP rank: No. 3
» Employment: 1.2 million
» 11% of total employment
» Employment rank: No. 2
More than half the workers in this category (565,674) provide predominantly outpatient services — “ambulatory care.” More employees work in either hospitals or nursing care facilities than in social assistance.
» Physician Assistant
20 Patients a Day
On a recent Tuesday morning, physician assistant Eric Smith got an abrupt greeting as he walked into an exam room.
“I’m mad as hell,” said the middle-aged patient who explained that she was upset because of the stress of caring for her elderly parents.
Smith patiently let her vent before performing a physical exam and ordering lab tests. He addressed her concerns about mental health counseling and suggested she take a short vacation, closing out their 20-minute session with a hug.
“The versatility of the PA profession is one of the things I love,” he says. “There might be things I haven’t seen come through this office, but I’d be hardpressed to tell you what they are.”
On a typical day as a physician assistant, Smith sees about 20 patients at a small family doctor’s office in Pinellas County. On that Tuesday, he handled cases ranging from pink eye and tendinitis to diabetes and hypertension.
Smith is part of a profession that Forbes magazine ranked as the most-promising job in 2015. Between 2009 and 2014, the number of physician assistants in Florida rose 30% to 5,020, according to the U.S. Bureau of Labor Statistics. Demand for physician assistants, also known as Pas, is growing amid an increased need for medical services from an aging population and patients newly insured under the Affordable Care Act.
Pas, who perform many of the same tasks as doctors, are seen as a costeffective way to provide the primary care that insurers consider essential to avoid more expensive medical interventions later: Insurance reimbursements for Pas are 85% of a physician’s fee, on average, and their median pay, at $92,000 in Florida, is lower than a typical doctor’s salary.
A native Floridian, Smith earned his bachelor’s degree from Florida State University in 1996. He planned to attend medical school, but his mother became gravely ill with chronic lung disease and he returned home to care for his family, including two younger siblings and his father, who suffered from addiction to pain pills.
After Smith’s mother died, he worked as an emergency medical technician. While accompanying his father to a doctor’s appointment, he met a PA who encouraged him to look into the profession. Smith liked that he could spend considerably less time and money to become a PA than a doctor.
In 1999, he enrolled in a 26-month PA program at Nova Southeastern University in Fort Lauderdale. In 2001, Allen Finkelstein, an osteopathic physician at Our Family Doctors in Seminole, hired Smith as a favor to a friend who taught at Nova.
“He turned out to be better than any physician I could have hired,” Finkelstein says of Smith. “I didn’t have to teach him a lot about treating patients. Now, I think I confer with him as much as he confers with me.”
Smith, who works 40 hours a week, sees patients on one side of the office; Finkelstein, who works 24 hours a week, sees patients on the other. (State law requires Pas to have a supervising physician, but the physician does not need to be on site.)
Smith is active in the Florida Academy of Physician Assistants (FAPA), a professional association that advocates for Pas. Among FAPA’s legislative priorities is a bill that would allow Pas to prescribe certain controlled substances — anti-anxiety drugs, narcotic painkillers, ADHD medications and codeine cough syrup. Florida is one of two states that prohibit Pas from prescribing and dispensing such drugs.
Smith says much has changed since he became a PA 15 years ago.
“In the beginning, there was a little reluctance and a lot of confusion about the PA profession, but there’s much more public awareness now,” he says. “People know who we are.”
Every now and then, however, a patient will ask him if he plans to go to medical school. “What’s the point?” he says. “I’d just incur more debt to continue doing what I’m doing.”
» Nursing Home Administrator, Hawthorne Village
Making His Rounds
Vernon Zeger is executive director of Hawthorne Village near Tampa, where he oversees a 10-acre retirement community with 69 independent-living residences, 64 assisted-living units and a 120-bed skilled nursing facility.
Professional background: Initially, Zeger got his associate degree at Hillsborough Community College and pursued a short-lived career in radiation therapy. “I had to do radiation on a younger child, and I was like, ‘Uh, I don’t think this is for me.’ I went to the University of South Florida and got my bachelor’s degree in health care administration and business. I saw that people were getting older, and a career in long-term care seemed like it would provide job security. I’ve always gotten along with the older population, and it just seemed like a good fit.”
A typical workday: Zeger says he usually starts work at 7:30 a.m. and calls it quits around 6 p.m. He spends about 1½ hours each morning in meetings with his management team. “Afterward, I do my rounds and go out to the floors to say hi to the staff, visit residents and just kind of check things out. Then I go back to doing my paperwork and whatever meetings I have in the afternoon. I try to get out of my office at least three to four times a day. You could find yourself stuck in front of the computer doing reports all day long. But to be successful, you need to be out there. People need to see you.”
Biggest challenge: An ongoing shift to Medicare managed-care contracts means a host of new administrative requirements for nursing homes like Hawthorne Village. “Trying to provide the best quality of care for the patient in a shorter amount of time” has been a challenge, Zeger says.
Facing the future: In 2014, the state Legislature passed a bill temporarily lifting a 13-year moratorium on new certificates of need for nursing home beds in Florida. “We were eligible to increase our bed capacity by 10%. So we’re expanding our facility and doing a remodel. We’re going from 120 beds in our skilled nursing facility to 132 beds, with an anticipated open date of June,” Zeger says. “We’ve been around for over 20 years. It was time for a facelift.”
» Social Worker, Jewish Family Services of Greater Orlando
Juliette Wallens spent two years working as a full-time yoga instructor in Orlando before she decided to return to school to become a social worker. “I wanted to do more to help people,” she says.
Last year, after getting her bachelor’s degree in social work at the University of Central Florida, Wallens joined Jewish Family Services of Greater Orlando, a non-profit, non-sectarian human services agency based in Winter Park.
Wallens screens applicants for an emergency financial assistance program overseen by partner organization The Heart of Florida United Way. The program aims to help people get through a temporary financial crisis by giving them money to cover basic needs, such as rent and utilities.
She spends up to five hours of her day in face-to-face meetings with applicants to determine eligibility; the rest of her day is spent gathering documents and filling out forms for the United Way, which makes the final determination of aid amounts.
“I see about 60 clients a month, and I hear all kinds of stories,” she says. “In the beginning, I felt really bad if I couldn’t help someone. But I try to remember I’m not the one who got them into their situation.”
Wallens, who earns about $30,000 a year, says her heavy workload is one of the lingering effects of the recession. Nearly seven years after the recession ended, the economic recovery has yet to reach many Floridians. In 2014, the state’s poverty rate was 16.7%, up from 12.5% in 2007.
She says she gets many applicants who have found themselves laid off and unable to find full-time work. Others struggle with stagnant wages and rising housing costs, she says. “Rents are ridiculous.”
Wallens says the hardest part of her job is “facing that suffering every day and not feeling bad about where we are as a society.” She sees her job as a “stepping stone” toward a larger role helping people. “I hope to one day work on macro-policy change,” she says.
The median salary for physician assistants in Florida was $92,000 in 2015, according to the American Academy of Pas.
The Future of Nursing
According to Nursing Link, a job placement site, Florida will need just over 180,000 nurses by the beginning of 2017. The median salary in Florida is $24 per hour, according to Payscale.
More than 40% of Florida’s nurses are approaching retirement age within the next 10 years. The Florida Center for Nursing estimates “a shortage of about 5,900 RN full-time equivalents in 2010 will grow to more than 50,300 RN FTEs by 2025. Based on the average proportion of an FTE worked by Rns, this translates into an estimated 56,000 Rns that will be demanded but unavailable for employers in 2025.”
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