Physician's Assistant v. MD/DO

[Coastie]

Scary, dangerous, huge liability.

Those poor patients. Not to mention, shame on that doctor for looking at a "percentage" and saying that they "looked okay overall". Should have his/her/its license revoked.

Not in all states. From what I heard, in one of the Carolinas it literally is just a discussion over the phone for 30 minutes twice a year.

In the state my aunt lives in, a doctor has to review charts every 4 months, but only a very small percentage and then the doctor just has to sign something saying that they looked okay overall.

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[deleted6669]

Not in all states. From what I heard, in one of the Carolinas it literally is just a discussion over the phone for 30 minutes twice a year.

In the state my aunt lives in, a doctor has to review charts every 4 months, but only a very small percentage and then the doctor just has to sign something saying that they looked okay overall.

FL- it's actually an in person mtg at the practice....please don't comment on pa issues if you don't know what you are talking about.....

 

[foreverLaur]

Wow. I never cease to be shocked by how ignorant the world is regarding the PA profession.

I've learned to do my research before opening my mouth.

 

[OTD]

I later found out the other two people were her fourth year resident and an PA. I had no idea that PA's did surgery right next to an MD! Super cool! She spends her OR days bouncing around to different surgeries - the day I was there she did two ortho cases, one CT case, and one gyn surgery. All scrubbed in and actually DOING surgery along with the MD.

You gotta laugh your butt off on this one. This had to some from someone that didn't have a clue what they were talking about.

There is a HUGE difference in ASSISTING with surgery, which is what PA's do, and DOING surgery.

PA's can do lots of things in the OR, but they can NOT perform the surgery, that is the responsibility of the surgeon, and no it's not even close to the same.

 

[foreverLaur]

You gotta laugh your butt off on this one. This had to some from someone that didn't have a clue what they were talking about.

There is a HUGE difference in ASSISTING with surgery, which is what PA's do, and DOING surgery.

PA's can do lots of things in the OR, but they can NOT perform the surgery, that is the responsibility of the surgeon, and no it's not even close to the same.

Actually, some do. My sister's orthopaedic surgeon has had the same PA for 20 some years. The PA does the routine simple procedures solo, usually with a resident first assisting. The doctor is in the OR, but not usually scrubbed in. For more complex cases, the PA is first assisting.

And assisting with surgery is doing surgery. The PA just isn't the primary on the case. The PA is still doing surgery. He/She isn't simply suctioning and retracting.

 

[skubdubdu]

I got similar advice prior to switching from teaching into medicine. I also got advice from an EMT turned PA turned ED physician that he wished he had gone straight to the end goal instead of all the stops in between.

Best advice given to me? Ask yourself what kind of individual you are. Will you be happy being the "assistant?" No knocks on assistants--they're badly needed--but not everyone is content assisting. After honestly answering this question for myself, though, I knew I should become an MD.

 

[clong]

I have attended several Military PA graduations in which it is commonly known and stated the Military found a need for the PA position in the War. PA was and started off as doctor substitutes. When a doctor is not available in the field a PA will act as the doctor in charge until one is present. They will then work along side by side until all are well.



The PA profession came into existence in the mid-1960s due to the shortage and uneven geographic distribution of primary care physicians in the United States. Dr. Eugene Stead of the Duke University Medical Center in North Carolina assembled the first class of PAs in 1965, composed of former U.S. Navy hospital corpsmen and U.S. Army combat medics, who had received considerable medical training during their military service and gained valuable experience during the Vietnam War.[2] He based the curriculum of the PA program in part on his first-hand knowledge of the fast-track training of medical doctors during World War II.
The Duke University Medical Center Archives has established the Physician Assistant History Center, dedicated to the study, preservation, and presentation of the history of the PA profession.[3]

http://en.wikipedia.org/wiki/Physician_assistant

 

[OTD]

Actually, some do. My sister's orthopaedic surgeon has had the same PA for 20 some years. The PA does the routine simple procedures solo, usually with a resident first assisting. The doctor is in the OR, but not usually scrubbed in. For more complex cases, the PA is first assisting.

And assisting with surgery is doing surgery. The PA just isn't the primary on the case. The PA is still doing surgery. He/She isn't simply suctioning and retracting.

Just because you bovie something doesn't mean you are "doing" the surgery. Matter of fact a good attending can make the intern THINK they are doing the surgery while in reality the intern is just running the bovie.

Yes PA's assist with surgery (that's what assistants do, and they are physicians ASSISTANTS.) They close without the surgeon present, but don't kid yourself it's skin closure. The surgeon does the surgery. If not the PA could bill for the surgery and they could go to the OR without surgeon ever being in the building. They can't. (not talking about a procedure here, a bonafide surgery, hip replacement, gallbladder etc).

PA's assist with surgery, they don't "do" surgery. Matter of fact many places they aren't even allowed to mark the surgical site with the new Joint Commission requirements (if hospital interpretations are correct), it has to be an independant licensed doc either attending or resident physician, but the PA or NP can NOT mark the site, even if they are participating in the surgery because they are not independant. Residents are MD's so they can mark the site.

Do many PA's have the ability to do the surgery? Yes, no doubt they do but they don't have that scope of practice.

If you are OK with only assisting with surgery then be a midlevel.

If you want to actually perform surgery then become a surgeon.

Don't try to get out the easy way and then overstep your training/abilities.

 

[foreverLaur]

I have shadowed enough surgeons and PAs to have personally seen what they do. Oh and my sister's torn meniscus was removed by a PA. The surgeon was in the next room with his resident doing a far more complex procedure. Maybe that isn't considered surgery? It is perfectly legal. A PA can do anything in the scope of practice of his/her supervising physician. Oh and PAs aren't possessive... they don't belong to the doctor. The name is very misleading.

 

[OTD]

I have shadowed enough surgeons and PAs to have personally seen what they do. Oh and my sister's torn meniscus was removed by a PA. The surgeon was in the next room with his resident doing a far more complex procedure. Maybe that isn't considered surgery? It is perfectly legal. A PA can do anything in the scope of practice of his/her supervising physician. Oh and PAs aren't possessive... they don't belong to the doctor. The name is very misleading.

I see that you are still Pre whatever you decide to do.

The following is with all due respect, don't take it wrong. You've "shadowed", I PERFORM surgery every day and have for years. I work with PAs every day. Some of the surgery I perform, some of them I don't because they are more complex than my level of training and I am in a surgical residency. Most of the time medical students don't even get the difference in assisting and performing the procedure, I wouldn't think a premed, pre PA or whatever would either. Most are fixated on the bovie and what it is doing. There is much, much, much more to surgery than the bovie.

Of course I realize laws are different in different states, but you would be wrong to think it wasn't illegal for PA's to perform surgery autonomously. It is not within their scope of practice for them to perform significant surgery without the attending, they can't take someone to the OR on their own. They can't even close more than skin technically, the body cavity has to be closed before the attending can officially leave the room.

Am I silly enough to believe it doesn't happen? No, I work in the OR every day and I know what the gubment has been cracking down on lately. THEY CAN'T EVEN MARK THE SITE anymore becasue they are not legally the "surgeon" they are legally the assistant (again likely subject to interpretation but this is the last joint commission craze). Believe me attendings aren't happy about this, that's what they hired the PA for was to give them more time to focus on more important things, and now they are saying their PA's can't mark the site, and it's going to get worse because JACHO has nothing to do but make up more and more BS in order to justify their existance.

As for them not "owning" the PA, well you would be 100% WRONG about that. There is possession and rightfully so. The doctor HIRES the PA, the PA works FOR the doctor, the doctor is the boss. Just like the factory owns the hourly employee, and the executive owns the secretary the doctor owns the PA because they pay the salary. (PA's that are hired by the hospital aside, but most PA's are hired by the physician/group they work for).

You are acting like one of those people that say "A PA is just like a doctor" (or surgeon in this case). If you go to PA school as a substitute for being a doctor cause it's eaiser and quicker you will be sorely dissappointed because they are not even close to the same.

As I have said, nothing wrong with being a PA, PA's have a very important job and are very good at what they do. I WILL hire a PA in my practice, but they are NOT a doctor and are NOT a substitute for a doctor and they do NOT have nearly the same level of training or scope of practice and it's NOT "just like being a doctor" or "just like being a surgeon".


If you want to be an assistant, go to PA school.

If you want to be a doctor go to medical school.

 

[clong]

I see that you are still Pre whatever you decide to do.

The following is with all due respect, don't take it wrong. You've "shadowed", I PERFORM surgery every day and have for years. I work with PAs every day. Some of the surgery I perform, some of them I don't because they are more complex than my level of training and I am in a surgical residency. Most of the time medical students don't even get the difference in assisting and performing the procedure, I wouldn't think a premed, pre PA or whatever would either. Most are fixated on the bovie and what it is doing. There is much, much, much more to surgery than the bovie.

Of course I realize laws are different in different states, but you would be wrong to think it wasn't illegal for PA's to perform surgery autonomously. It is not within their scope of practice for them to perform significant surgery without the attending, they can't take someone to the OR on their own. They can't even close more than skin technically, the body cavity has to be closed before the attending can officially leave the room.

Am I silly enough to believe it doesn't happen? No, I work in the OR every day and I know what the gubment has been cracking down on lately. THEY CAN'T EVEN MARK THE SITE anymore becasue they are not legally the "surgeon" they are legally the assistant (again likely subject to interpretation but this is the last joint commission craze). Believe me attendings aren't happy about this, that's what they hired the PA for was to give them more time to focus on more important things, and now they are saying their PA's can't mark the site, and it's going to get worse because JACHO has nothing to do but make up more and more BS in order to justify their existance.

As for them not "owning" the PA, well you would be 100% WRONG about that. There is possession and rightfully so. The doctor HIRES the PA, the PA works FOR the doctor, the doctor is the boss. Just like the factory owns the hourly employee, and the executive owns the secretary the doctor owns the PA because they pay the salary. (PA's that are hired by the hospital aside, but most PA's are hired by the physician/group they work for).

You are acting like one of those people that say "A PA is just like a doctor" (or surgeon in this case). If you go to PA school as a substitute for being a doctor cause it's eaiser and quicker you will be sorely dissappointed because they are not even close to the same.

As I have said, nothing wrong with being a PA, PA's have a very important job and are very good at what they do. I WILL hire a PA in my practice, but they are NOT a doctor and are NOT a substitute for a doctor and they do NOT have nearly the same level of training or scope of practice and it's NOT "just like being a doctor" or "just like being a surgeon".


If you want to be an assistant, go to PA school.

If you want to be a doctor go to medical school.

So then does the patient own the doctor or is it the ins. company. Or Maybe both. Do you know PA's can buy into practice or run an office and hire a Doctor to work for them. With an attitude like that I hope no PA takes the job to work UNDER YOU, they are to work WITH YOU.

 

[dragonfly99]

So then does the patient own the doctor or is it the ins. company. Or Maybe both. Do you know PA's can buy into practice or run an office and hire a Doctor to work for them. With an attitude like that I hope no PA takes the job to work UNDER YOU, they are to work WITH YOU.

I mostly agree with the surgical resident's comments about the difference between doing surgery independently and assisting with surgery. As far as I know it isn't legal in any state for PA's to independently do surgery, and really that is good - I have done some surgical rotations during 3rd/4th year of medical school and it is super complex and I can tell you definitely than the surgical residents really need that 5+ years of residency to be able to do surgery...usually 7+ years. However, there may be some quibbling on this thread about what constitutes "doing surgery" ....I mean for sure PA's are participating in the surgical case (could be called "doing surgery"), and other people like the scrub nurse have important parts to play as well. I mean you could not turn a lone surgeon loose in the OR to do cases all day...he/she needs help. I really don't think that PA's should be doing any cases independently, because the patient and insurance company are really paying for an extensively trained surgeon to do the surgery...with appropriate assistance. I can't believe that it's legal in any state for an unsupervised PA to be taking out gallbladders, appendixes, etc. with no surgeon in the room at any point and no surgeon actively supervising. I'm not saying some surgeons might not be allowing PA's to do it if they can get away with it ...but I doubt that it's actually legal. Correct me if I am wrong.

And yes, the insurance companies and patients do own all our a--es, and if you don't know it yet I think you are overly optimistic

 

[debalinacs]

Hi emedpa,
I just recently got accepted to PA school! For me, it was the best choice since i have a family. I was wondering your thoughts of the program at SLU vs. Butler?

Thanks!

 

[ceg]

Just FYI, there are some schools, Rush (Chicago), I believe (if I am remembering correctly), being one where you do not have to have a nursing degree to start working toward/accepted into a NP track. Believe it or not. It will take longer, like one of the previous posters mentioned. I am assuming they integrate clinical experience (for those with degrees other than nursing) in their curriculum.

QUOTE]


I think this is a generic masters program- so you graduate with an MSN but you are an RN not an NP. It requires a bachelors degree plus prerequisites so not as quick as it seems plus to be an NP you would still have to do a postmasters certificate which would be 2+ years.

To the OP, I did an accelerated NP program. Have a BA in liberal arts (4 years) took biology, chemistry, anatomy and physiology, microbiology, psychology, and statistics (2ish years part time) then did an 18 month RN licensure program and my masters degree took 3 years. So a total of 6.5 years for an accelerated NP program not counting my previous 4 year degree. May want to consider med school!

PA school is quicker but in the states I have practice as an NP we had greater autonomy. I'm sure that varies by state, though.

 

[deleted6669]

PA school is quicker but in the states I have practice as an NP we had greater autonomy. I'm sure that varies by state, though.[/QUOTE]

really depends on your path to pa. many applicants now have the same 4 yr bs/ba degree that you had plus a few yrs to become a paramedic/rn/etc plus required hce time(1000-8000 hrs) + a 2-3 yr pa program.
there are direct entry 3 yr np programs for those with a prior bs(yr 1 for rn, yr 2/3 for fnp) so 7 yrs is doable.
there are also (unfortunately) direct entry pa programs that can be done as 2 yrs post bs so 6 yrs.
it all depends on the path you take and your level of prior experience.
for example I am a former paramedic who became a pa with an ms and a post ms specialty certificate with a total of 10 yrs of post high school education

 

[ceg]

PA school is quicker but in the states I have practice as an NP we had greater autonomy. I'm sure that varies by state, though.

really depends on your path to pa. many applicants now have the same 4 yr bs/ba degree that you had plus a few yrs to become a paramedic/rn/etc plus required hce time(1000-8000 hrs) + a 2-3 yr pa program.
there are direct entry 3 yr np programs for those with a prior bs(yr 1 for rn, yr 2/3 for fnp) so 7 yrs is doable.
there are also (unfortunately) direct entry pa programs that can be done as 2 yrs post bs so 6 yrs.
it all depends on the path you take and your level of prior experience.
for example I am a former paramedic who became a pa with an ms and a post ms specialty certificate with a total of 10 yrs of post high school education[/QUOTE]

Thanks for the correction. To be honest the only PA I know had a 4-yr BS in a non-health field and then did a 2 year MS program to become a PA- I thought that was how it was done. I officially own up to my ignorance about PAs!

 

[FLsurferDPT]

If you want to be an assistant, go to PA school.

If you want to be a doctor go to medical school.

This sums up nicely this whole thread. Kudos to the writer.

 

[Miss July]

Hi everyone. I just finished my first year of PA school and it has been one of the hardest, most fun years of my life. Feel free to shoot me any questions you may have about the profession.

 

[prism74]

The only real con was that one of the areas I especially enjoy is a subspecialty of medicine that does not readily utilize PAs yet in the area of the country I wish to live.

Hi MyChoice--

Which subspecialty and which area of the country? Just curious.

Thanks.

 

[CaptainObvious]

Hi MyChoice--

Which subspecialty and which area of the country? Just curious.

Thanks.

You do realize that the post you are replying to is like 5 years old, right?