Physician Assistant to MD bridge program

[Patholog]

Hello all,

Totally not a pathology (at least not directly) topic but one I have found interesting. I have had a bit of free time here and there and I came across some old forums on here about PA (physician assistant) to MD bridge programs. The most recent one finished up about a month or so ago on a different web site, but for the life of me, I cannot find it. I have included a couple of links below for StudentDoctor if anyone is interested.

The proponents (guess what the initials are after their names) for the most part think it is a good idea. I did not come across many posts from PAs who thought it was a bad idea. Some feel that they should receive advanced standing and/or special consideration for med school due to their "clinical experience". Some go so far as to say they should be allowed to start med school in the third year and perhaps skip USMLE Steps 1 (and some say 2, as well). Apparently, there may be some programs in the Caribbean that already have this. Leave it to the Caribbean to sort out all the pre-med applicant troubles. Maybe giving credit for experience is not a bad idea. Maybe Governor Spitzer's prostitute friend can hang up a shingle as a urologist based on her experience.

There are a lot of sweet discussions about midlevel providers on Student Doctor. I suggest you read some, if you want a good laugh/aneurysm rupture from rage. Basically as I see it, we are in the middle of a mid-level drift crisis, and we may not survive. As the "Generation X/Y/give me everything but I don't want to work as hard for it as you did" are coming of age, there is no end to what can be accomplished. Nurse practitioners, PAs, CRNAs, there is even an "anesthesiology assistant" nowadays that can make ~100K per annum. I can't keep up.

If someone (hopefully LADoc) doesn't put an end to this, we will all perish. It has already happened to PAs (physican assistant). Before you had to have a master's. Now they have bachelor's programs in PA. Pretty soon it will be associate's degree. Then it will be high school tech school. Hell, if they get a move on, I might be able to get my daughter a PA gig by the time she's in 4th grade.

I would find it insulting if it wasn't so sad. Thankfully the physician assistants probably didn't learn what a pathologist is in their 20 minutes of lectures, so we are probably safe.

Please, discuss. Hopefully I'm not just an *** who thinks this is something to talk about just a little.

http://forums.studentdoctor.net/showthread.php?t=202203

http://forums.studentdoctor.net/showthread.php?t=331625

---

Members don't see this ad.

 

[Patholog]

Oh, and I forgot, there is a DNP degree out there as well "Doctor of Nursing Practice". Apparently they are gaining some popularity. I wonder why.

 

[primadonna22274]

Oh gosh...where to begin.
Patholog, you're wrong on a few counts, but the most important I feel compelled to point out: PA has traditionally been a competency-based education. For a long time (probably the first decade of the 40-odd years we've been training PAs) the only credential awarded was a certificate, and those PAs were damn proud to have earned it. We always had to take the national certification exam (PANCE) and maintain certification by logging a required number of AMA-approved CME hours (100 every 2 years currently, at least 50 must be Cat I). We have to recertify nationally every six years to maintain certification in almost all states.
Only in the last 15 years or so has there been such a push for the master's degree and now we're talking about a Doctor of PA. How stupid is that? Where is the incentive for someone to become a PA if the entry-level degree is a doctorate? Granted those in the know state it would be some kind of a "clinical doctorate", whatever that means, along the lines of the 3-year PharmD or DNP (ugh, don't get me started). IMO it will just jack up the already exorbitant tuition and feed the greed for degree creep. Already it's become so expensive to train PAs that fewer and fewer of us are going into the rural/underserved communities we were in theory designed to be trained for because we can't afford to pay student loans and work in those settings at the relatively lower pay. There's a very nice rural clinic in Fossil, Oregon that's been trying to get a PA for the past several years. Know what they're offering? About $60k a year. That's $40k a year less than I've made the past few years, and this is a position that requires a seasoned PA who can handle all comers. Generally as we get older and gain experience we expect to be paid more, not less. Most of us couldn't afford to live and pay loans on $60k a year. (Now granted there is some state loan repayment available for that job but it probably doesn't offset the very low pay.)
But please, get your facts straight. I have no qualms with you debating the pros and cons of PA-to-MD/DO bridge but don't blindly misstate the educational process. Really it makes no difference what degree we're awarded because the educational process is standardized, so a certificate PA is the same as a bachelor's PA is the same as a master's PA. FWIW I have a master's but it's never made me any more money or gathered me any more respect, just one pretty thing to hang on my wall.
Lisa PA-C

. It has already happened to PAs (physican assistant). Before you had to have a master's. Now they have bachelor's programs in PA. Pretty soon it will be associate's degree. Then it will be high school tech school. Hell, if they get a move on, I might be able to get my daughter a PA gig by the time she's in 4th grade.
http://forums.studentdoctor.net/showthread.php?t=202203

http://forums.studentdoctor.net/showthread.php?t=331625

 

[Patholog]

Prima,

I apologize for getting the bachelor's to master's thing backwards. But in a way, doesn't that speak to what I was saying? That there is a midlevel drift? Especially in light of the fact that you can now get a doctorate in PA? It sounds like you are not a fan of this. Why not? And what is the proposed purpose of it?

A lot of what I read from various PA postings was to the effect of, I do what a doctor does, so why should I not get paid as one?

I'm just curious about all of this midlevel stuff, especially with NPs, CRNAs, AAs, DNPs, etc because I hadn't heard much about them before. Obviously being in pathology, we don't experience them much first hand, although I did have some exposure to PAs during residency a little.


Patholog

 

[docbiohazard]

Totally not a pathology (at least not directly) topic but one I have found interesting.

I'm no mod, but doesn't this belong elsewhere? While scope of practice issues abound for all specialties, it seems like Pathologists have a lot more to worry about in terms of podlabs and medicare reimbursement. I don't care who sends me the specimen, MD or PA, so long as I can make a living billing for it (and, in my case, researching it).

BH

 

[primadonna22274]

Patholog,

No harm, no foul.
In PA school we had several pathophys lectures by a local pathologist who was just an excellent teacher. I've always had a bent towards pathophys so I'll be nice to you Just scared off an annoying drug rep by my disinterest to pay you due attention.

My beef with the DPA (actually it does not exist yet, but there are rumblings) is why??? Now, I enjoy teaching and hope to be a PA educator in the near future (as long as I don't go to med school first) and IMO the ONLY reason to get a doctorate in PA studies is to be one-up on the master's PA students we're teaching and to be eligible for tenure (always the elusive doctoral degree). PAs have traditionally had to seek doctoral preparation elsewhere; most get PhDs in something (I might be interested in PhD public health) or EdDs. There has recently been approved a DHSc.PA at Baylor but it's only for military PAs which I am not. I'm also not sure a DHSc interests me, although I'm interested in health policy.

My complaint is for those outspoken proponents of the DPA as an entry-level degree. It may just happen but I'll go kicking and screaming. Not because I'm opposed to advanced education, but to make a clinical doctorate the entry-level degree for PA disenfranchises more and more of the potential practitioners who would likely make excellent PAs.

The lack of a degree standard for PAs has long been a source of heated debate in our profession. Really, though, the degree does not matter, because what matters is that we attend and graduate from an accredited PA program and are eligible to take PANCE and become certified. We can't work without NCCPA certification in almost all states (there are a few stragglers where "grandfathered" PAs can still work but most of them are retiring soon if not already retired).

I don't think we should move to the clinical doctorate just because the NPs are doing it. I'm afraid that's what it will come down to--keeping up with the Joneses. Ohio has already capitulated to this by requiring master's degrees for any PA licensed after Jan 1 08 because the NPs had that in their practice language previously. So Ohio PAs have to give in to get prescriptive rights. Guess what? Their education didn't change. They didn't suddenly take a bunch more pharmacology--we already take a great deal of pharmacology, in most cases as much if not more than most medical students (yes, really). The laws just lagged far behind practice rights.

OK, back to work, patient care beckons.

L.

Prima,

I apologize for getting the bachelor's to master's thing backwards. But in a way, doesn't that speak to what I was saying? That there is a midlevel drift? Especially in light of the fact that you can now get a doctorate in PA? It sounds like you are not a fan of this. Why not? And what is the proposed purpose of it?

A lot of what I read from various PA postings was to the effect of, I do what a doctor does, so why should I not get paid as one?

I'm just curious about all of this midlevel stuff, especially with NPs, CRNAs, AAs, DNPs, etc because I hadn't heard much about them before. Obviously being in pathology, we don't experience them much first hand, although I did have some exposure to PAs during residency a little.


Patholog

 

[LADoc00]

Actually as I have pointed out before Pathology is uniquely situated to be essentially immune to midlevel creep in the sense that PAs can do the dirty work but the true slide reads and management will forever remain in our control.

To those financially ******ed pathology groups paying PAs 80k+ a year I have to laugh as I have home schooled a number of people with pretty much no education to gross nearly everything and they are making ~30K, saving me around 3-4 hours of my day to surf the internet and maintain La Revolution.

My next task is to train completely uneducated people to perform autopsies under my guidance, Im actually nearly 80% there already. Takes me roughly 50 or so man hours to train up someone who has a solid anatomy background, maybe double that if they dont (or I tell them to take Anatomy at the Jr College).

Basically, the more I can dissect the work that actually pays and focus on that, the better I can grow the biz.

 

[yaah]

I'm no mod, but doesn't this belong elsewhere?

I'm giving it a chance. Specific pathology questions and points were raised. If it deteriorates into a PA vs MD thread (as so many others have elsewhere on these forums), I will close it very quickly. Be warned!

 

[Patholog]

I'm giving it a chance. Specific pathology questions and points were raised. If it deteriorates into a PA vs MD thread (as so many others have elsewhere on these forums), I will close it very quickly. Be warned!

I wasn't planning on flaming on anyone, don't worry. It just seems that the medical infrastructure is more and more complicated. In my original post, the "we" to whom I was referring is physicians in general. More and more midlevels are cropping up and demanding more and more education. Case in point, a few years ago, speech pathologists were functional at a bachelor's level, now they have to have a master's or else be considered a speech implementor (my wife is a master's, so she has informed me.)

Now there's talk about changes in reimbursement for PAs (pathology assistants). Whether that will go anywhere remains to be seen.

While the thrust of my post was on non-pathology mid levels, is it really a stretch to think that they might try and insinuate themselves into pathology? It seems like they could. Pathology is a much more controlled environment under which someone could be trained up to function at a decent level. If there's a question, they just show the slide to a pathologist.

If PAs, NPs, CRNAs, etc can directly have patient's lives under their care, what's to say they can't read some slides? As people have stated, they can do everything a doctor can do. Is there some law of which I am unaware that says a physician has to sign pathology slides out or could it feasibly be a mid-level? And if so, why would a pathologist not hire a couple, train them up, allow them to bill at whatever that particular state allows and pay them half the salary of a physician and pocket the rest just as is done in clinical medicine?

 

[docbiohazard]

Ok...

While the thrust of my post was on non-pathology mid levels, is it really a stretch to think that they might try and insinuate themselves into pathology?

I think so, and here's why... they're in no way prepared for it, and it probably doesn't make financial sense for them to delay getting a real job to get more pathology training to make them competent "mid-level pathology practioners" when there are other classes of technicians that already pretty much fill that niche (cytotechs?), and in general a seeming "oversupply" of pathologists.

PAs exploded to fill a need for PCP types... there's apparently no "undersupply" of pathologists, and plenty of "midlevel" helper types already (path asst's, lab techs, etc) and even MD pathologists who take the low paying path jobs... so plenty of MDs to do the work and there's literally no reason that I can think of that a PA would pass up a job they've been trained for post-graduation to go in a completely different direction, put off making that money, to make what would likely be even less money as some sort of Pathologist Physician Assistant...

Pathology has many bigger problems.

Just my random match week two cents, but makes sense to me...
BH

 

[LADoc00]

Now there's talk about changes in reimbursement for PAs (pathology assistants). Whether that will go anywhere remains to be seen.

While the thrust of my post was on non-pathology mid levels, is it really a stretch to think that they might try and insinuate themselves into pathology? It seems like they could. Pathology is a much more controlled environment under which someone could be trained up to function at a decent level. If there's a question, they just show the slide to a pathologist.

Um no. If there is a PA charge for grossing then I will laugh all the way to bank as I take it. PA's are salaried employees pure and simple, that will never change. They will never have ownership stake in Jack or Shiat. If PAs are able to sign out routine cases then i will have even more free time...the point is they lack and will forever lack the ability to independently bill for anything, the situation in pathology labs doesnt mirror what is happening with NP or clinical PAs in the community.

I thought long and hard about pathology before I did it and considered it to be one of the more insulated fields from nonMD creep in all of medicine.

If certified PAs demand to be able to start separately charging for services, then I simply wont hire them or better yet I will collect their fees, skim off admin charges, give them a lump sum as a subcontractor and NO benefits....LMAO.

Lesson: you cant out smart me (aside from govt and payors muscling me), period.

 

[pathdoc68]

To those financially ******ed pathology groups paying PAs 80k+ a year I have to laugh as I have home schooled a number of people with pretty much no education to gross nearly everything and they are making ~30K, saving me around 3-4 hours of my day to surf the internet and maintain La Revolution.

My next task is to train completely uneducated people to perform autopsies under my guidance, Im actually nearly 80% there already. Takes me roughly 50 or so man hours to train up someone who has a solid anatomy background, maybe double that if they dont (or I tell them to take Anatomy at the Jr College).

Basically, the more I can dissect the work that actually pays and focus on that, the better I can grow the biz.

LA- I'm pretty sure the federal register prescribes specific minimal educational requirements for individuals performing gross examinations of specimens.

 

[LADoc00]

LA- I'm pretty sure the federal register prescribes specific minimal educational requirements for individuals performing gross examinations of specimens.

Let me rephrase my position, I perform all gross examinations but I just dont touch all the meat...
Unsupervised grossing perhaps but really any min educational requirement would only pertain to histo labs that operate without Pathologist supervision (and I know quite a few). In terms of real day to day grossing, maybe aside from complex specimens, there is no federal guideline within a fully staffed Anatomic lab and I dont see that changing anytime soon or ever considering declining reimbursements.

 

[Dental Guy]

Actually as I have pointed out before Pathology is uniquely situated to be essentially immune to midlevel creep in the sense that PAs can do the dirty work but the true slide reads and management will forever remain in our control.

To those financially ******ed pathology groups paying PAs 80k+ a year I have to laugh as I have home schooled a number of people with pretty much no education to gross nearly everything and they are making ~30K, saving me around 3-4 hours of my day to surf the internet and maintain La Revolution.

My next task is to train completely uneducated people to perform autopsies under my guidance, Im actually nearly 80% there already. Takes me roughly 50 or so man hours to train up someone who has a solid anatomy background, maybe double that if they dont (or I tell them to take Anatomy at the Jr College).

Basically, the more I can dissect the work that actually pays and focus on that, the better I can grow the biz.

As someone entering into an APA program this fall. Reading what you have here and some of your other Dumb A$$ posts troubles me. Your in the field for all the wrong reasons. You Greedy S.O.B your lucky to get anyone to work for you. Get off your high horse before someone kicks you off.

 

[Patholog]

As someone entering into an APA program this fall. Reading what you have here and some of your other Dumb A$$ posts troubles me. Your in the field for all the wrong reasons. You Greedy S.O.B your lucky to get anyone to work for you. Get off your high horse before someone kicks you off.

Now, now...play nice...it is perhaps not in someone's best interests to be so mean to someone else...especially as someone who will depend on a pathologist for a living...

I think it's great that after taking the DAT at least once and apparently not doing so well (I read your previous posts), you have decided to go to a path assistant program. What are the right reasons, young PA student to be (maybe), for going into this field about which I am sure you know a great deal? And why did you even consider dental school in the first place?

 

[yaah]

Please refrain from personal attacks and insults. Responding to posts with civil language and tone is more effective anyway.

 

[physasst]

Um no. If there is a PA charge for grossing then I will laugh all the way to bank as I take it. PA's are salaried employees pure and simple, that will never change. They will never have ownership stake in Jack or Shiat. If PAs are able to sign out routine cases then i will have even more free time...the point is they lack and will forever lack the ability to independently bill for anything, the situation in pathology labs doesnt mirror what is happening with NP or clinical PAs in the community.

I thought long and hard about pathology before I did it and considered it to be one of the more insulated fields from nonMD creep in all of medicine.

If certified PAs demand to be able to start separately charging for services, then I simply wont hire them or better yet I will collect their fees, skim off admin charges, give them a lump sum as a subcontractor and NO benefits....LMAO.

Lesson: you cant out smart me (aside from govt and payors muscling me), period.

Not necessarily, I have 3 friends who own their own practices, and hire the supervising physicians to work for them.

Not always merely a salaried employee.

 

[mcfaddens]

I have a question. Is it possible for a PA or NP to obtain a FULL UNRESTRICTED LICENSE TO PRACTICE MEDICINE AND SURGERY anywhere in the USA and bill for it?

If not that should answer most of the questions being argued here.

I personally dont see anything wrong with having PA's and NP's help out, and if you happen to be in that line of work you should be happy. Why would you want to spend 4 yrs of med school and 4+ years of residency and have $300K in debt just to make a little more than you do now. If you have a problem with the pretty sweet situation mid level job you have because your not an MD then you have a serious inferiority complex and you shouldnt have anything to do with medicine IMO. Stop crying and be happy you have a good paying job!

This thread is moving into a place that is not related to path and should be closed. maybe move it to the pre-health forum.

 

[legend3747]

LADoc00, your comments are very uneducated. Think about what you are saying...you invested many years in order to get trained (I'm guessing as a pathologist) and you are admitting to being able to train someone at doing your job to a competent level in a fraction of the time it took you. What does that say????

PA and NPA education does not take away from your prestige or status or do you define yourself only by your education level?

You should respect what everyone brings to the table. I've been to places you couldn't imagine as a Corpsman with my Marines where doctors don't venture. When we are in the field, I'm it...they call me DOC! Now as a new PA's I bring a dimension to medicine that most MD's will not comprehend in their entire career.

Do me a favor pipe down if you don't have anything intelligent to say.

 

[Pathologee]

LADoc00, your comments are very uneducated. Think about what you are saying...you invested many years in order to get trained (I'm guessing as a pathologist) and you are admitting to being able to train someone at doing your job to a competent level in a fraction of the time it took you. What does that say????

PA and NPA education does not take away from your prestige or status or do you define yourself only by your education level?

You should respect what everyone brings to the table. I've been to places you couldn't imagine as a Corpsman with my Marines where doctors don't venture. When we are in the field, I'm it...they call me DOC! Now as a new PA's I bring a dimension to medicine that most MD's will not comprehend in their entire career.

Do me a favor pipe down if you don't have anything intelligent to say.

Spoken like a true social climber. Most of us don't define ourselves by our education level but you better believe state medical licensures do.

 

[EMPA]

Just to add some intelligent thought to this:

- Lake Erie College of Osteopathic Medicine does post a PA to DO bridge
- This program eliminates 1 year of clinical rotation
- By no means does this eliminate any of the sciences and still has the PA complete all of the didatic courses
- I agree with this, as clinical rotations due nothing more than expose med students to different aspects and areas of medicine
- If a physician assistant has 3-5 years of experince it is a waste of time to spend a year of clinical rotation.
- Typical pathology report "cannot exclude" what a science!
- Really though, What does a med student due other than look lost!

 

[KCShaw]

If a clinical rotation is doing "nothing more" than "exposing" a student to a different area of clinical medicine, then IMO it's a failure as a clinical rotation. Clinical rotations should include the active performance (unfortunately often called "practice") of medicine, following on from lectures, reading, theory, and other prior education, simply under structured supervision. Slowly taking on more responsibility, as part of the progression from medical student to resident to attending physician.

Previous medical &/or scientific training and/or experience help provide a very basic background and, importantly, a little more understanding of what one is getting into by going to medical school. But it's not a replacement.

One can debate the utility of certain parts of typical medical school education &/or testing, no doubt. But, again, debateable educational practices does not equal skipping them because one took a different class or has a different experience THEY think is at least as useful.. without really having a basis for comparison.

And, FWIW, due != do.

 

[Saldutti]

I think I am in a unique position to comment on this thread. To begin with, I am a physician Assistant, and VERY proud to be one. I am currently working on my doctorate, specifically a DHSc degree from A.T. Still University in Arizona. Yes, a real medical/DO school. What makes my experience unique is that I worked in the past as a Deaner/Pathology assistant. When I started my only degree was an associates in physical therapy (Physical Therapist Assistant, PTA). All of my training was on the job. I was taught by four pathologists on how to gross and start autopsies, and assist the pathologist during the autopsy. I made 12 dollars an hour (in 1998), essentially the same as I was making as a PTA. I learned a TON doing that work, and gross anatomy in PA school was a breeze due to that work. That being said, although I prepared slides (I actually enjoyed that), I never read them.....understandably. Now, since PA school, I have a MUCH better and bigger understanding of pathology.....however, I could never read a slide. I think it would be ludicrous for a PA to suggest that they could read and interpret slides. Truly, that is where the divide between PA and pathologist comes, is in the interpretation of slides. Now, and I am extrapolating here, but when a PA suggests that they do everything an MD does, I think they are referring to family medicine (which is the field I work in), and there is little to no difference in what a family medicine PA does to what a family medicine MD/DO does. However, I know of NO PAs who could honestly mean that they could do what a specialty MD/DO does, and to suggest otherwise is ludicrous (unless it's derm, he he). So, as off putting as the original poster was with the original post, I must agree with him, I think Path is pretty mid-level free.
Now, onto the financials of it. If I was able to essentially function as a pathology assistant making 12 dollars an hour, why on earth would I go into pathology now, as a physician assistant, making 75-80% less than I am now, and as one of the other posters pointed out, why would a pathologist pay a physician assistant 80-100,000 dollars a year when they could OJT someone with an associates degree and pay them 12 dollars an hour. Makes no sense.
Lastly, I seem to recall, that if a deaner/pathology assistant wanted to become a pathology physician assistant, there was no book work involved, just a detailed log of a certain amount of specimen that needed to be grossed/frozen sectioned, etc. This self made "physician assistant", however, would not be accepted into other areas of medicine as a physician assistant, for they were non traditional.

 

[redroses1100]

Just to add some intelligent thought to this:

- Lake Erie College of Osteopathic Medicine does post a PA to DO bridge
- This program eliminates 1 year of clinical rotation
- By no means does this eliminate any of the sciences and still has the PA complete all of the didatic courses
- I agree with this, as clinical rotations due nothing more than expose med students to different aspects and areas of medicine
- If a physician assistant has 3-5 years of experince it is a waste of time to spend a year of clinical rotation.
- Typical pathology report "cannot exclude" what a science!
- Really though, What does a med student due other than look lost!

I reply to this message in regard of Lake Erie College. I don't mean to offend whoever posted the thread. I think to do a PA to DO bridge program to just eliminate 1 yr of clinical rotation is not a good idea. Don't you think the more yrs you spend in residency the more experience you will gain?

 

[primadonna22274]

One year less of rotations (and not really a full year less, actually ~8mos less as my summers are spoken for in this track) does not obviate residency training. Your question misses the mark. We are awarded a year of clinical rotations credit for the year we spent in PA school. For me after 10+ yr in practice in diverse settings seeing a wide range of pathology I'm not too worried about that 8 mos, and the one year tuition/opportunity cost savings makes it worthwhile for me.

 

[KCShaw]

While not begrudging someone who takes an available short-track to an MD by accepting an offered opportunity to skip a year, because I would probably do the same thing, my opinion is that such an option simply shouldn't be available. Going through medical school one has new and different training and is moving towards additional and different responsibilities; I don't doubt that there are overlaps, particularly with basic clinical skills or in areas a given PA may have focused on or worked specifically in, but it's simply not the same as being a PA. Heck, I'm sure there are PA's teaching parts of some typical rotations, but I also don't think a PA in pediatrics, or OB/GYN, etc. should skip those either.

 

[celgrini]

OK guys, I need some good unbiased advice. I am debating about going for an MS in Physician Assistant Studies at South University and then later on pass the MCAT an on to Med school, or get a BS of health sciences, then MCAT, then Med School. Any informed, unbiased suggestions?

 

[Ombret]

OK guys, I need some good unbiased advice. I am debating about going for an MS in Physician Assistant Studies at South University and then later on pass the MCAT an on to Med school, or get a BS of health sciences, then MCAT, then Med School. Any informed, unbiased suggestions?

Hi celgrini, welcome to the forums. Re-post your question in a pre-med forum; this is actually the pathology area; this thread is kind of an anomaly.

 

[astoriamed]

Do you really think a PA grad could not take the USMLE 1 and pass it? First of all they take a CERT that is on the level of the USMLE 2. Finally, do you honestly think that in your first year of rotations that you know more that a PA with 4 years experience? Your are going to be one of those that hurts a patient with arrogance.

 

[Enkidu]

Do you really think a PA grad could not take the USMLE 1 and pass it? First of all they take a CERT that is on the level of the USMLE 2.

This statement shows a lot of ignorance. USMLE step 1 is a test on basic science and pathological mechanisms of disease. This is the topic of the first two years of medical school. When would a PA learn this material?

Your are going to be one of those that hurts a patient with arrogance.

This is a pretty ironic thing to say, I think.

 

[KCShaw]

Yeah, arrogance can go both ways and carry a lot of different names.

Frankly, I don't care if a PA or PhD or someone off the street can or can't pass any or all parts of the USMLE. More power to them if they do. I'm not sure anyone in this thread even claimed a PA couldn't -- maybe they did, though I very quickly skimmed again looking for it. Still, when PA's start taking and passing USMLE at >70% of first time takers (around that of foreign medical grads) then yay, but also...so? USMLE is a rough gauge of academic ability and effort, not of being "a good (health care person)" per se.

For those who want to be a physician -- go, do, enjoy. Just don't assume that because you learn or do a part of the job having started it from a different background that it's the same thing, or that it's close enough to skip out on chunks of the process. We can argue all we want about the utility of the average 1st & 2nd years of medical school, but there is something to be said for slogging through, paying your dues so to speak, and gaining more than just from the books, the patients, the staff, the diseases, and so on. We can also argue about the overlap of the average 2nd & 3rd years of medical school, then residency, with some of what PA's learn and do. But they're still different.

There are a lot of nurses who know more about the clinical side of medicine than many medical students or new grads. There are also a lot who don't. Same with PA's. The responsibilities are different and the job is different, irrespective of overlaps. You learn from those who know more than you, teach the ones that don't, and watch out for the ones who think they do.

 

[Graymatter]

I've been reading this forum and intrigued by the perception of the PA-C role. I have been a PA/SA-C for 15 years and practice in Emergency Medicine. Gone are the days when the PA's are seeing earaches and minor things.
I see/take care of EVERYTHING my attending physicians see in the ER. As far as patient care, there is no difference in the roles we have.

As of late I have been the one teaching the newbie physicians things that they obviously didn't learn with all their training.
The seasoned attending will often leave the ER (to sleep in call room) leaving the PA in charge to run the ER.

I believe I would be able to skip "chunks of the (educational) process" and do well in a PA to DO/MD program. I have often thought of doing a bridge program so I could be compensated properly for the work I do and earn the respect I deserve. In Ohio, a emergency medicine PA-C makes 1/3 of the DO/MD salary but functions in the same exact role. And although we do the same job, the level of respect is not there.

 

[WEBB PINKERTON]

I've been reading this forum and intrigued by the perception of the PA-C role. I have been a PA/SA-C for 15 years and practice in Emergency Medicine. Gone are the days when the PA's are seeing earaches and minor things.
I see/take care of EVERYTHING my attending physicians see in the ER. As far as patient care, there is no difference in the roles we have.

As of late I have been the one teaching the newbie physicians things that they obviously didn't learn with all their training.
The seasoned attending will often leave the ER (to sleep in call room) leaving the PA in charge to run the ER.

I believe I would be able to skip "chunks of the (educational) process" and do well in a PA to DO/MD program. I have often thought of doing a bridge program so I could be compensated properly for the work I do and earn the respect I deserve. In Ohio, a emergency medicine PA-C makes 1/3 of the DO/MD salary but functions in the same exact role. And although we do the same job, the level of respect is not there.

Here's a crazy idea, if you wanna be compensated the same, go to medical school to begin with. Otherwise deal with it. Physicians that paid dues and went through "chunks of the (educational) process" deserve the respect for not taking shortcuts.

 

[Mochepoire]

true

 

[KCShaw]

Again, there are a lot of talented & knowledgeable PA's out there, and some not so much. The same can be said of MD's. But despite the overlaps there are still differences in the roles, the expectations, the responsibilities, and so on. And as I said before, we could certainly debate the utility of the current common structure of teaching medical students -- but, it still is what it is, and skipping out on that creates a different end product.

What we're starting to do is drift away from the initial discussion and more into a claim that PA's are basically medical doctors anyway, since hospital admins and some medical boards and some attending physicians allow PA's to practice a certain amount of medicine, if at some stage technically under the not-always-watchful-eye of a supervising physician. I think this is a different discussion. It would probably raise the point that in the old days learning medicine was basically an apprenticeship, and that today the bread & butter of medicine is largely templated and routine such that one really only needs to know what falls outside the routine before calling a specialist (many physicians do this anyway) -- so why not pass off ALL the bread & butter/routine stuff to someone cheaper like a PA, and trim the physician numbers down to a few supervisors and some specialists. There's a substantial financial argument to do that, or something much like it. Indeed, PhD's have already been replacing MD's in the laboratory setting. I'm not sure it's got the backing of evidenced based medicine yet in the clinical setting, but I suspect there are groups working on that data as we speak. The other side to the argument I suppose would be that an experienced qualified physician is best prepared to not only handle the routine, but also to improve on the routine, improve on efficiency, identify the zebras, and provide the highest level of overall care...though that may (or may not) be at a significantly higher total expense.

 

[Tayce]

I find this interesting for several reasons. 1. I'm a PA who graduated with a BS, obtained a Master's, and now would like to go further because I love to learn. Ironically pathology is one of the areas I was searching for educational opportunities in, so this fascinates me in that regard as well.

I can argue the pros and cons of why PAs and NPs should and shouldn't make money. I know we do the same work, but in MY EXPERIENCE the outcome of a PA program and NP program are quite different, even when including DNPs. I find requiring a doctorate in PA ridiculous because why not go to medical school? I had already taken the MCATS and was going to go to medical school, but decided to go PA just because I wanted to be able to move specialities without re-doing residencies, and because in MY EXPERIENCE (only) I found a higher job satisfaction at that time with midlevels. So going to medical school would have actually been easier than going through all the work to get a bachelors to get into a PA program, complete a BS program, then get a Masters, then get a PhD. My college friends are doctors making awesome money so they in a sense had the shorter time route..NOT EASIER, just shorter. PAs should be well taught to fill the gap in rural areas, but if utilized appropriately, even in pathology, they are highly profitable.

My old roommate is now a FP physician who employs 5 midlevels (4 PA's, 1 NP) and he comes in for consults and patients one day a week. He spends the other 4 traveling and playing on Facebook. He makes A FORTUNE by paying his midlevels 80-120K a year while they see 15-25 pts a day each plus take ER call. If you calculate out the pay scale per visit he does A-OK. The role of a PA was to help the physician and somewhere along the lines people started storming the MD gates. I don't understand it. I had a chance to be an MD and chose PA. I don't want to be an MD but I also want to be able to further my education without it being a "threat" or "insult" to MDs, who are still in most situations, our superiors in the giant realms of things. As for pathology, I would love to purse a career in pathology to learn and assist a pathologist. As for now, I will continue to work FP/EM and do EXACTLY the same thing the doctors are doing, teaching the new residents, and smiling while I make less money....but not much less...

 

[Tayce]

P.S. " He comes in for consults and patients one day a week. He spends the other 4 traveling and playing on Facebook." I meant workdays for a total of 5. I am aware there are 7 days in the week. LOL

 

[belle54321]

I find this interesting for several reasons. 1. I'm a PA who graduated with a BS, obtained a Master's, and now would like to go further because I love to learn. Ironically pathology is one of the areas I was searching for educational opportunities in, so this fascinates me in that regard as well.

I can argue the pros and cons of why PAs and NPs should and shouldn't make money. I know we do the same work, but in MY EXPERIENCE the outcome of a PA program and NP program are quite different, even when including DNPs. I find requiring a doctorate in PA ridiculous because why not go to medical school? I had already taken the MCATS and was going to go to medical school, but decided to go PA just because I wanted to be able to move specialities without re-doing residencies, and because in MY EXPERIENCE (only) I found a higher job satisfaction at that time with midlevels. So going to medical school would have actually been easier than going through all the work to get a bachelors to get into a PA program, complete a BS program, then get a Masters, then get a PhD. My college friends are doctors making awesome money so they in a sense had the shorter time route..NOT EASIER, just shorter. PAs should be well taught to fill the gap in rural areas, but if utilized appropriately, even in pathology, they are highly profitable.

My old roommate is now a FP physician who employs 5 midlevels (4 PA's, 1 NP) and he comes in for consults and patients one day a week. He spends the other 4 traveling and playing on Facebook. He makes A FORTUNE by paying his midlevels 80-120K a year while they see 15-25 pts a day each plus take ER call. If you calculate out the pay scale per visit he does A-OK. The role of a PA was to help the physician and somewhere along the lines people started storming the MD gates. I don't understand it. I had a chance to be an MD and chose PA. I don't want to be an MD but I also want to be able to further my education without it being a "threat" or "insult" to MDs, who are still in most situations, our superiors in the giant realms of things. As for pathology, I would love to purse a career in pathology to learn and assist a pathologist. As for now, I will continue to work FP/EM and do EXACTLY the same thing the doctors are doing, teaching the new residents, and smiling while I make less money....but not much less...

Personally, I hate doctors like that. I understand to many being a doctor is about making money, but I am old fashioned and naive (though I have been an attending for almost 10years now), it just rubs me the wrong way.

 

[deleted6669]

there is now a 3 yr pa to DO bridge program at lecom. you should apply. you get credit for an entire clinical yr. I have a friend currently in the program who is enjoying it and doing every bit as well , if not better, than the traditional medstudents.

 

[2121115]

I think this only peripherally relates to pathology, at best. The pathology PA program is a distinct training track from the traditional PA track and requires a different master's degree - that is why it is formally called a "pathologist's assistant" program rather than a "physician assistant" program. I do not see how this thread really relates to pathology.

 

[coroner]

Agree, this was started with the o.p. saying this thread is not a pathology topic, and since then three other people have chimed in about how this is unrelated to a pathology. And here we are four years later with this thread still open. It's like a squashed cockroach with one leg still twitching...

 

[KCShaw]

..snip..
My old roommate is now a FP physician who employs 5 midlevels (4 PA's, 1 NP) and he comes in for consults and patients one day a week. He spends the other 4 traveling and playing on Facebook. He makes A FORTUNE by paying his midlevels 80-120K a year while they see 15-25 pts a day each plus take ER call.
..snip..
As for now, I will continue to work FP/EM and do EXACTLY the same thing the doctors are doing, teaching the new residents, and smiling while I make less money....but not much less...

Personally, I hate doctors like that. I understand to many being a doctor is about making money, but I am old fashioned and naive (though I have been an attending for almost 10years now), it just rubs me the wrong way.

Both of those feelings and approaches may be out there, but the former is the one which I would expect to thrive in today's system -- which is one of business, not idealism. So-called "mid levels" are in, aren't likely to go away, and are almost guaranteed to further change the future of "medicine," more rapidly in conjunction with the financial problems plaguing everyone, including health care institutions and the cost of an MD.

 

[Patholog]

I posted this 4 years ago. It's still open?

 

[absolutdokta]

I posted this 4 years ago. It's still open?

indeed....so what have you done with your life in those 4 long years?

 

[ysl]

This statement shows a lot of ignorance. USMLE step 1 is a test on basic science and pathological mechanisms of disease. This is the topic of the first two years of medical school. When would a PA learn this material?



This is a pretty ironic thing to say, I think.

Actually, I studied from a USMLE step 1 book for my certification exam. I can confidently say that most of what I read there I had already seen in PA school. Maybe MDs don't know this, but many if not all PA schools use medical school books and very similar curriculums. The didactic portion is just more condensed and very rigorous. I don't presume that my training is as thorough as that of a physician, but please do not underestimate the skill, knowledge and medical contributions PAs and nurse practitioners can offer.

 

[2121115]

Again, this thread has nothing to do with pathology.

 

[Tayce]

I went to a PA Program on a Medical School campus. We attended Medical school classes (mandatory) from 8-2 then the med students went to the library. We crossed campus and attended PA classes from 2:30-5:30 then went to the library. We had the same tests as the med students but they had an extra 9 months of classes while we started clinicals. So yes, I do feel like we had exposure to what would prepare us to attend a bridge program, but in all reality, what would be the benefit? The entire time you'd be treated differently all to save a year of education? Not worth the headache.

And no, has nothing to do with pathology.

 

[alamo4]

Actually as I have pointed out before Pathology is uniquely situated to be essentially immune to midlevel creep in the sense that PAs can do the dirty work but the true slide reads and management will forever remain in our control.

This old thread has been resurrected, so it might be worth mentioning that technology may be making the reading of slides much more commoditized and automated in the future:

For example:
http://stm.sciencemag.org/content/3/108/108ra113.short

Systematic Analysis of Breast Cancer Morphology Uncovers Stromal
Features Associated with Survival
Andrew H. Beck et al.
Sci Transl Med 3, 108ra113 (2011); DOI: 10.1126/scitranslmed.3002564

Editor's Summary
An Automated Pathologist Reads Cancer Biopsies

"How is a camera different from the human eye? Only the eye's images undergo extensive secondary processing as they are interpreted by the human brain. But what if we could program a computer to do the secondary processing? A pathologist reading a cancer biopsy slide matches his or her brain's memory of certain cancer-related features (tubules, atypical nuclei, and mitosis) against the tissue. This decades-old scoring system is still standard in most places for prognosis and treatment of cancer, despite its variability and often unreliability. Now, Beck et al. have created an automated pathologist by replacing the human brain with sophisticated image processing software and instructing it to find quantitative aspects of breast cancer tissue that predict prognosis. The software located a set of features that strongly predicted breast cancer outcome in both training and validation samples.

With an image analysis protocol they termed C-Path, the authors set their program loose on a set of samples from patients in the Netherlands. From more than 6000 features, the software found a set that were associated with samples from patients who had died sooner. The key aspect of this analysis was that these features were not predefined by a pathologist as being relevant to cancer; instead, the software itself found the cancer-related features among the very large set of measurements of the image. Classifying the tissue as epithelial or stromal, an important part of cancer diagnosis, took a bit of extra work: The authors needed to provide the software with some hand-marked samples so it could learn the difference. The C-Path score yielded information above and beyond that from many other measures of cancer severity including pathology grade, estrogen receptor status, tumor size, and lymph node status. In another, completely independent group of women from Vancouver, the C-Path score was also associated with overall survival.

An unexpected finding was that the features that were the best predictors of patient survival were not from the cancer itself but were from the adjacent stromal tissue. Women with worse outcomes tended to have thin cords of epithelial cells infiltrating the stroma, which resulted in high-risk stromal matrix variability scores. These patients also tended to have more inflammatory cells in the stroma (picked up as dark areas by the software). Replacing the human brain with an unbiased image processing system can extract more information from microcopy images and discover new biological aspects of cancer tissue."

 

[Enkidu]

This is BS, I think.

 

[Path or bust]

please do not underestimate the skill, knowledge and medical contributions PAs and nurse practitioners can offer.

The danger lies in the overestimation of said skills.