Advice: Hate my first attending job

[sawboned]

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Great discussion. OP hoping these posts assist in your exit to a better sit. When that is feasible. Check your contract if you haven't already it may have a clause for early release with adequate notice.

To lend yet another perspective on things.... We are six hour south of Canada, still within these United States, Midwest very small town, feels sort of like a mini Sedona. Cabin and stream minutes out of town. 30 mins to regional airport.

1 to 2 patients an hour during the day, 0.5 patients at night (sleep average 3-4 hours per night), can do 24s. Moderate acuity - admitting or transferring 30%. Reasonable amount of tubes, lines etc. Interesting cases, realistic and highly appreciative patients with low levels of drug seeking etc. Seems every single patient has a PCP (who are generally friendly, competent and responsive). Med-mal risk is very low.

$250/hr (based on total cash in-hand per year), plus the $18k matching etc.

And what I relish most - not uncommonly I am the only physician available within 30 miles at that moment to save this patient (who I often know).

More Narnia than Nirvana.

 

[Janders]

It's more along the lines of, if you double your income, you can either work half as much, or have your spouse, significant other, or whatever not have to work. It's more of a quality of life issue.
And if you only have to work 6 days a month in some town, the other 22-25 days you can spend somewhere else.

I agree that $ isn't the end-all-be-all. I'm sure I could move to Texas and make more than I make now. But I make plenty, enjoy my location and its benefits, my social network, etc etc etc.

That said, the difference between making $200k and getting shafted with scheduling, patients you don't enjoy, acuity you don't enjoy and, say, $350k working in a place you enjoy with fair scheduling is MASSIVE, compared to the more minimal difference of making $400k and $550k. The higher your salary goes, the more goes to taxes. You need a certain baseline amount to pay off student loans, save for retirement fully, etc. After a certain point, I fully agree more effort for more money is a chasing your tail and it has less and less merit.

 

[Brahnold]

Dude, I'm a resident who moonlights making about 200/h seeing under 2 pt/hr with about 20-30% admission. Your job sounds miserable.

Kind of curious about this. I've stalked this forum for a while and I've often heard it mentioned that midlevels function "at the level of a resident."

So why are residents being paid attending-level hourly rates for moonlighting? Why don't hospitals just fill these shifts with PAs or NPs for $80/hr instead? Is it because there currently exists even a shortage of ER trained midlevels, and if so, do you guys foresee that resident moonlighting at 150,200/hr will become a thing of the past as more and more midlevels come on the market? Is anyone already seeing a trend where hospitals are moving away from resident moonlighting in favor of midlevels?

 

[RustedFox]

Kind of curious about this. I've stalked this forum for a while and I've often heard it mentioned that midlevels function "at the level of a resident."

So why are residents being paid attending-level hourly rates for moonlighting? Why don't hospitals just fill these shifts with PAs or NPs for $80/hr instead? Is it because there currently exists even a shortage of ER trained midlevels, and if so, do you guys foresee that resident moonlighting at 150,200/hr will become a thing of the past as more and more midlevels come on the market? Is anyone already seeing a trend where hospitals are moving away from resident moonlighting in favor of midlevels?

You need a doc to run the show. Period. If you don't have one, the hospital has a rather interesting liability situation.

 

[deltamed]

Kind of curious about this. I've stalked this forum for a while and I've often heard it mentioned that midlevels function "at the level of a resident."

So why are residents being paid attending-level hourly rates for moonlighting? Why don't hospitals just fill these shifts with PAs or NPs for $80/hr instead? Is it because there currently exists even a shortage of ER trained midlevels, and if so, do you guys foresee that resident moonlighting at 150,200/hr will become a thing of the past as more and more midlevels come on the market? Is anyone already seeing a trend where hospitals are moving away from resident moonlighting in favor of midlevels?

I'm pretty sure the residents moonlighting are usually senior residents (probably pgy-4s) so its unlikely they are at the same level as a PA/NP. In addition, I bet that a shop paying 200/hr for a moonlighting resident probably pays their fully-boarded docs more. despite being a resident the docs have an unrestricted license to practice medicine and therefore are required for the liability piece as noted above.

Lastly, moonlighting residents are usually under their own benefits and liability coverage, so the difference between 80/hr for the midlevel and 150,200/hr is not as great as you think.

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[The White Coat Investor]

Great discussion. OP hoping these posts assist in your exit to a better sit. When that is feasible. Check your contract if you haven't already it may have a clause for early release with adequate notice.

To lend yet another perspective on things.... We are six hour south of Canada, still within these United States, Midwest very small town, feels sort of like a mini Sedona. Cabin and stream minutes out of town. 30 mins to regional airport.

1 to 2 patients an hour during the day, 0.5 patients at night (sleep average 3-4 hours per night), can do 24s. Moderate acuity - admitting or transferring 30%. Reasonable amount of tubes, lines etc. Interesting cases, realistic and highly appreciative patients with low levels of drug seeking etc. Seems every single patient has a PCP (who are generally friendly, competent and responsive). Med-mal risk is very low.

$250/hr (based on total cash in-hand per year), plus the $18k matching etc.

And what I relish most - not uncommonly I am the only physician available within 30 miles at that moment to save this patient (who I often know).

More Narnia than Nirvana.

View attachment 200769

There's nowhere in the Midwest like Sedona. Sounds like a nice place to practice though.

 

[hoot504]

There's nowhere in the Midwest like Sedona. Sounds like a nice place to practice though.

For what sawbones said, it could be Yuma for all I care. Sign me up.

 

[MSmentor018]

like what everyone else has said, that's kinda crappy but then that's academics for ya. got the same problem here in FL. the pay is just a few bucks more than yours with the same if not more hours....and that's regardless if you work with/out benefits! I dropped that faster than c diff in the bowl. I left for a level 2-3 community place still in the city making twice more, working 1/3 less, seeing <2/hr.

you're a new attending. no shame in leaving the gig, just do it on good terms. if the job market there is tight, move if you can. you want to come to this area? PM me. I'll give you all the stats and players. or if you're definitely not leaving then fly somewhere where you can make a ton like tx, or do locums, knock out 4-5 days then fly home then repeat.

sorry your job isn't what it should be. hang in there.

 

[deleted547339]

I'm pretty sure the residents moonlighting are usually senior residents (probably pgy-4s) so its unlikely they are at the same level as a PA/NP. In addition, I bet that a shop paying 200/hr for a moonlighting resident probably pays their fully-boarded docs more. despite being a resident the docs have an unrestricted license to practice medicine and therefore are required for the liability piece as noted above.

Lastly, moonlighting residents are usually under their own benefits and liability coverage, so the difference between 80/hr for the midlevel and 150,200/hr is not as great as you think.

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I'm definitely NOT paying for my own insurance. I do have to pay the self-employment tax, which sucks, but it's still great money - especially when places are really in a bind and up the pay. Pay is the same for boarded and moonlighters but this varies by site.

 

[deleted547339]

Kind of curious about this. I've stalked this forum for a while and I've often heard it mentioned that midlevels function "at the level of a resident."

So why are residents being paid attending-level hourly rates for moonlighting? Why don't hospitals just fill these shifts with PAs or NPs for $80/hr instead? Is it because there currently exists even a shortage of ER trained midlevels, and if so, do you guys foresee that resident moonlighting at 150,200/hr will become a thing of the past as more and more midlevels come on the market? Is anyone already seeing a trend where hospitals are moving away from resident moonlighting in favor of midlevels?

I can assure you that I don't function at the level of a midlevel. I've run codes, intubated patients, but in central lines and chest tubes, lysed massive PEs, sedated patients (including kids), resuscitated sick kids, diagnosed an epidural abscess, etc while moonlighting.

There is a paucity of EM docs around the country. You're probably not going to find great moonlighting gigs in Manhattan or San Fran, and I think moonlighting isn't reimbursed FL, but if you live within an hour or two of a rural area where the reimbursement allows, you can get paid.

 

[sawboned]

There's nowhere in the Midwest like Sedona. Sounds like a nice place to practice though.

Sure, I hear you re: Sedona. And ya from my best bud that lives there, obviously negatives to being Sedona as well.

Indeed this is the most rewarding shop I've worked in 20+ years for the above reasons and more The town, which is not very well known, is so fascinating to me. A peculiar and humble place, farm community pop. 5,000, turned hybrid between the 150 years of Norwegian old guard families and newcomers, many young family farmers, artisans and entrepreneurs, seeking something different, all mixed with an engaging Amish community et al. This area, for some, is an escape from the expectations of Western civilization. A tiny town that is in a state of expansion and renewal. Intoxicating geography, damp coulees and artesian well fed streams, dramatic Bluffs. This is a land that has never seen the flattening of ancient glaciers. A comfortable place to call home. And a funky tribe to call mine.


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[sawboned]

For what sawbones said, it could be Yuma for all I care. Sign me up.

You look me up when ready and I'll hook you up lol


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[delco714]

I can assure you that I don't function at the level of a midlevel. I've run codes, intubated patients, but in central lines and chest tubes, lysed massive PEs, sedated patients (including kids), resuscitated sick kids, diagnosed an epidural abscess, etc while moonlighting.

There is a paucity of EM docs around the country. You're probably not going to find great moonlighting gigs in Manhattan or San Fran, and I think moonlighting isn't reimbursed FL, but if you live within an hour or two of a rural area where the reimbursement allows, you can get paid.

Do you honestly think that there are not PAs that do this all over the country, especially in places where you doctor folk are too unwilling to habitate?

 

[emergentmd]

I made 125/hr as a resident moonlighting at a place seeing about 1.5/hr that I would consider low to moderate acuity. No benefits other than MedMal.

AND THAT WAS 15 Yrs ago.

I am not sure why you are staying. I really do not know why any of your colleagues are staying. I really really do not understand why your hospital can even staff that place. I know decent places where they are paying 300/hr and they STILL have to bring in locums b/c they cant find enough full time docs.

Can you please tell me which hospital this is so I can get a good laugh?

 

[deleted547339]

Do you honestly think that there are not PAs that do this all over the country, especially in places where you doctor folk are too unwilling to habitate?

<<Let me preface this by saying I have a ton of respect for PAs.>>

Oh boy, we're doing this again. Yes, I am better at practicing medicine than a PA. There is no question about it. This is not arrogance, this is just a fact. You can say whatever you want about being a great PA, but I would provide better care. I've spent an unbelievable amount of time and money to learn my craft, much more than a PA. I will not apologize for this. I spent every night and weekend studying my butt off in undergrad and med school to get damned near a 4.0 for 8 years. I lived in the library or on the wards during med school, regularly close to 100 hours a week for the better part of 4 years. While in residency, I've worked 60 hours per week on easy rotations, pushing 100h/wk on the more difficult ones. When I'm not either working or moonlighting, I'm reading or listening to medical podcasts. I've read Tintinalli's cover to cover, I read 5 to 10 medical journal articles a month and listen to many hours of medical podcasts every month.

Judging by the posts in your recent activity, it's obvious you have an inferiority complex. I'm sorry about that. But I won't apologize for the fact that I know I provide better care than PAs.

<<Again, I have tremendous respect for PAs. My post is not intended to be pejorative to PAs. Many are extremely sharp and provide excellent care. For those that feel their training is equivalent, they are just wrong. If this offends you, you lack objective reason.>>

 

[RustedFox]

Do you honestly think that there are not PAs that do this all over the country, especially in places where you doctor folk are too unwilling to habitate?

 

[RustedFox]

It didn't work again! WTF?!

(Its the Robert Downey, Jr rolling eyes pic... just imagine that).

 

[delco714]

<<Let me preface this by saying I have a ton of respect for PAs.>>

Oh boy, we're doing this again. Yes, I am better at practicing medicine than a PA. There is no question about it. This is not arrogance, this is just a fact. You can say whatever you want about being a great PA, but I would provide better care. I've spent an unbelievable amount of time and money to learn my craft, much more than a PA. I will not apologize for this. I spent every night and weekend studying my butt off in undergrad and med school to get damned near a 4.0 for 8 years. I lived in the library or on the wards during med school, regularly close to 100 hours a week for the better part of 4 years. While in residency, I've worked 60 hours per week on easy rotations, pushing 100h/wk on the more difficult ones. When I'm not either working or moonlighting, I'm reading or listening to medical podcasts. I've read Tintinalli's cover to cover, I read 5 to 10 medical journal articles a month and listen to many hours of medical podcasts every month.

Judging by the posts in your recent activity, it's obvious you have an inferiority complex. I'm sorry about that. But I won't apologize for the fact that I know I provide better care than PAs.

<<Again, I have tremendous respect for PAs. My post is not intended to be pejorative to PAs. Many are extremely sharp and provide excellent care. For those that feel their training is equivalent, they are just wrong. If this offends you, you lack objective reason.>>

Never said training is equivalent. That's what the docs are for, especially in specialties. Majority of us are more or less thrown in to business hour residencies. I am aware md status comes with it the training that exceeds mine. In fact I don't have a inferiority complex, even though I sit here and watch doctors who are less dedicated and clever than I. I made a personal choice to go to PA school. M.D.was my back up. I had the grades and bells and whistles to get into upper tier md schools, not the point. The point is don't cluster us with NPs. Where not trying to escape AMA and md coworking like they are. We just want a little more respect and help doing our job and helping patients. Years into our career and we meet the same obstacles new graduates do..probably doesn't make sense.. As for CME and clinical? You realize we do about 3000hr non stop in rotations for 11-12 months no breaks, right? We do the same rotations..including the 80+ hour obgyn ones.. Sad part is..we don't escape to lecture or the library.

So that's what I have to say. Most of what pisses me off is premed and MS running their ignorant mouths. Unfortunately many of them will be schooled by seasoned PAs when they get into the real world.. Or perhaps they will rely on specialty PAa when their patients need care and the healthcare system in 2016 makes the life of the attending too clustered erratic. That's what being a team is all about. Sure there's some scut work involved, but that takes up a small amount of my day. Getting the patient access to excellent and time sensitive care is a much larger part.

End rant

 

[hoot504]

End rant

Highly doubt this.

 

[namethatsmell]

Never said training is equivalent. That's what the docs are for, especially in specialties.

What area of medicine isn't within a speciality? Hair restoration et al?

Or is this a tacit suggestion that EM isn't really a specialty?

 

[BoardingDoc]

What area of medicine isn't within a speciality? Hair restoration et al?

Or is this a tacit suggestion that EM isn't really a specialty?

Stop feeding the troll....

 

[deleted547339]

Stop feeding the troll....

Sorry. I spoke my peace and now I'm done.

 

[Makati2008]

Never said training is equivalent. That's what the docs are for, especially in specialties. Majority of us are more or less thrown in to business hour residencies. I am aware md status comes with it the training that exceeds mine. In fact I don't have a inferiority complex, even though I sit here and watch doctors who are less dedicated and clever than I. I made a personal choice to go to PA school. M.D.was my back up. I had the grades and bells and whistles to get into upper tier md schools, not the point. The point is don't cluster us with NPs. Where not trying to escape AMA and md coworking like they are. We just want a little more respect and help doing our job and helping patients. Years into our career and we meet the same obstacles new graduates do..probably doesn't make sense.. As for CME and clinical? You realize we do about 3000hr non stop in rotations for 11-12 months no breaks, right? We do the same rotations..including the 80+ hour obgyn ones.. Sad part is..we don't escape to lecture or the library.

So that's what I have to say. Most of what pisses me off is premed and MS running their ignorant mouths. Unfortunately many of them will be schooled by seasoned PAs when they get into the real world.. Or perhaps they will rely on specialty PAa when their patients need care and the healthcare system in 2016 makes the life of the attending too clustered erratic. That's what being a team is all about. Sure there's some scut work involved, but that takes up a small amount of my day. Getting the patient access to excellent and time sensitive care is a much larger part.

End rant

As a former PA myself, you seem quite bitter. I would be careful calling physicians less clever than you especially in light of 27 months of training vs 7yrs+. You are also are exaggerating our clinical rotation training on average. Furthermore be careful biting the hand that feeds you....

Also your comment about "schooling" a medical student is odd. There are many times where I can see where my PA level training ends and my Physician level training comes into play. It's not a slap in the face but the truth.

I'm obviously pro midlevel but also about being honest.


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[Got Em]

That's a brutally raw deal.
you can haggle up to that rate here in Houston to babysit a "surgical hospital" that averages 0.9 pts per day.
I hope your location is so desirable that from your window you have a view of the mountains, the beach, a babbling brook, a nightly fireworks show, a vantage to see into the sports stadium of your favorite team, and can see a unicorn farm, otherwise it is not worth it. F-it, even then I don't think it's worth it.
-1234

Does anyone know if this is real?

$125/hr rate for surgical hospital that sees 1-2 pts/day sounds too good to be true even in Houston. For example, I've looked at TOPS and also a nearby Baytown surgical hospital that's paying $70-80 per hour.

 

[dav86]

In the Midwest I know of a group that staffs a "speciality" hospital that avgs 16 pts a day and make $150/hr. It is definitely not too good to be true. Depends on the need and how good your negotiation skills our with the hospital.

 

[Got Em]

In the Midwest I know of a group that staffs a "speciality" hospital that avgs 16 pts a day and make $150/hr. It is definitely not too good to be true. Depends on the need and how good your negotiation skills our with the hospital.

Sorry, I should have been more clear. I meant in a surgical hospital with 1 bed that sees 1-2 patients per day max. The above poster was saying his surgical hospital sees 0.9 pts/day.

 

[vengaaqui]

Thanks all. I talked to my boss and am trying to figure it out. Thinking about transitioning to another hospital with much higher acuity, better staffing, same hours, same pay versus jumping ship entirely and finding a new health care system to work for. Contract is up in July.

How many hours a month do you think is sustainable for longevity in emergency medicine? I've also thought about contracting down to 1200 versus 1400 per month which means even less pay but picking up some moonlighting on the side that pays better per hour in a higher acuity shop to make up for it while weighing my options and being home more with our young infant. That would mean leaving some incentive pay on the table.

 

[Old_Mil]

Thinking about transitioning to another hospital with much higher acuity, better staffing, same hours, same pay versus jumping ship entirely and finding a new health care system to work for.

Higher acuity for the same pay is not an improvement. More decision fatigue, more malpractice risk, more consults, more admits, more stress...no more money.

How many hours a month do you think is sustainable for longevity in emergency medicine?

120 a month is my personal max.

 

[Brahnold]

I can assure you that I don't function at the level of a midlevel. I've run codes, intubated patients, but in central lines and chest tubes, lysed massive PEs, sedated patients (including kids), resuscitated sick kids, diagnosed an epidural abscess, etc while moonlighting.

There is a paucity of EM docs around the country. You're probably not going to find great moonlighting gigs in Manhattan or San Fran, and I think moonlighting isn't reimbursed FL, but if you live within an hour or two of a rural area where the reimbursement allows, you can get paid.

I only mentioned the supposed equivalency between residents and midlevels because that has been the comparison I've seen attendings on this forum use on several occasions. As for myself, I'd certainly prefer to believe the 4 years of medical school allow a resident to function at a higher level than PAs and NPs, else it would be hard to motive myself to study all this trivia!

But yeah, it's damn sweet that PGY-2 residents can moonlight at $150/hr. Just two shifts a month at that rate and you can already be broaching six figures when combined with your base resident salary. EM residency is short to begin with, but if you are at one of those programs where moonlighting is easy to come by it's almost like you only have to spend 1 year making peanuts and by your second year it's possible to start paying off those loans.

 

[Zebra Hunter]

I only mentioned the supposed equivalency between residents and midlevels because that has been the comparison I've seen attendings on this forum use on several occasions. As for myself, I'd certainly prefer to believe the 4 years of medical school allow a resident to function at a higher level than PAs and NPs, else it would be hard to motive myself to study all this trivia!

But yeah, it's damn sweet that PGY-2 residents can moonlight at $150/hr. Just two shifts a month at that rate and you can already be broaching six figures when combined with your base resident salary. EM residency is short to begin with, but if you are at one of those programs where moonlighting is easy to come by it's almost like you only have to spend 1 year making peanuts and by your second year it's possible to start paying off those loans.

I have never heard anyone state that mid-levels and residents are equivalent on this website other than trolls and bitter mid-levels. I, as well as most of my fellow interns, at this point in the year, are already operating at a higher level than most of the PAs and NPs we work with. Straight out of medical school, sure most seasoned mid-levels are operating well above us, but that quickly changes.

 

[Arcan57]

I only mentioned the supposed equivalency between residents and midlevels because that has been the comparison I've seen attendings on this forum use on several occasions. As for myself, I'd certainly prefer to believe the 4 years of medical school allow a resident to function at a higher level than PAs and NPs, else it would be hard to motive myself to study all this trivia!

But yeah, it's damn sweet that PGY-2 residents can moonlight at $150/hr. Just two shifts a month at that rate and you can already be broaching six figures when combined with your base resident salary. EM residency is short to begin with, but if you are at one of those programs where moonlighting is easy to come by it's almost like you only have to spend 1 year making peanuts and by your second year it's possible to start paying off those loans.

The four years of med school doesn't allow MDs to function at a higher level. It's the 9000+ hrs of residency.

 

[gro2001]

I only mentioned the supposed equivalency between residents and midlevels because that has been the comparison I've seen attendings on this forum use on several occasions. As for myself, I'd certainly prefer to believe the 4 years of medical school allow a resident to function at a higher level than PAs and NPs, else it would be hard to motive myself to study all this trivia!

But yeah, it's damn sweet that PGY-2 residents can moonlight at $150/hr. Just two shifts a month at that rate and you can already be broaching six figures when combined with your base resident salary. EM residency is short to begin with, but if you are at one of those programs where moonlighting is easy to come by it's almost like you only have to spend 1 year making peanuts and by your second year it's possible to start paying off those loans.

Don't expect this level of moonlighting during residency to be the norm. While this seems to be the experience of most people on this forum, this might be an SDN bias and not necessarily representative of the EM world at large. There are a lot of residency programs that do not allow moonlighting and there are many locales (ie the desirable ones) that don't really have regular opportunities for residents to moonlight for near attending level pay.

 

[gro2001]

I have never heard anyone state that mid-levels and residents are equivalent on this website other than trolls and bitter mid-levels. I, as well as most of my fellow interns, at this point in the year, are already operating at a higher level than most of the PAs and NPs we work with. Straight out of medical school, sure most seasoned mid-levels are operating well above us, but that quickly changes.

I am neither a troll nor a midlevel (bitter or otherwise) but I think that a reasonably experienced midlevel CAN often function at the level of a solid PGY2. We worked with/alongside PAs in residency. There were plenty of PAs that I would trust to the extent of a PGY2, which for me is: expect to see patients at about the same rate and with a similar level of diligence and awareness of most typical red flags as a PGY2, require direct supervision (PGY4/attending in the room) for advanced procedures such as central line placement but not for simpler/lower risk ones, and be very familiar with the hospital system/EMR, and be reasonably good with the ER diplomacy in calling consults/admitting/liasing with RN staff/etc.

There are obviously some PAs that I would not trust AT ALL. Mostly these were very fresh ones, but not exclusively. Conversely, there were PAs that I would legitimately ask for advice/opinions on some things. Mostly these were very experienced and smart ones. This was similar to my experience with PAs on consult services. There were PAs that essentially ran their services and the subspecialty attendings would defer to them on many decisions (burn, derm, some of the onc services). I've met hospitalist PAs that are almost indistinguishable from many MD hospitalists. And there are hospitalist PAs that I think have somehow made it through with learning disabilities.

The difference between PAs and MDs is variability. I almost always know what I am getting with a resident/attending of a particular specialty if I know where in their training they are. An EM attending is an EM attending. An EM PGY2 is and EM PGY2. I can not make the same assumption with PAs.

As to the point of iterns... The only thing more dangerous in a hospital than an intern in July is an intern in February. It seems to be the time that interns start getting cocky, start taking shortcuts, stop running things by their seniors...

 

[Brahnold]

I am neither a troll nor a midlevel (bitter or otherwise) but I think that a reasonably experienced midlevel CAN often function at the level of a solid PGY2. We worked with/alongside PAs in residency. There were plenty of PAs that I would trust to the extent of a PGY2, which for me is: expect to see patients at about the same rate and with a similar level of diligence and awareness of most typical red flags as a PGY2, require direct supervision (PGY4/attending in the room) for advanced procedures such as central line placement but not for simpler/lower risk ones, and be very familiar with the hospital system/EMR, and be reasonably good with the ER diplomacy in calling consults/admitting/liasing with RN staff/etc.

There are obviously some PAs that I would not trust AT ALL. Mostly these were very fresh ones, but not exclusively. Conversely, there were PAs that I would legitimately ask for advice/opinions on some things. Mostly these were very experienced and smart ones. This was similar to my experience with PAs on consult services. There were PAs that essentially ran their services and the subspecialty attendings would defer to them on many decisions (burn, derm, some of the onc services). I've met hospitalist PAs that are almost indistinguishable from many MD hospitalists. And there are hospitalist PAs that I think have somehow made it through with learning disabilities.

The difference between PAs and MDs is variability. I almost always know what I am getting with a resident/attending of a particular specialty if I know where in their training they are. An EM attending is an EM attending. An EM PGY2 is and EM PGY2. I can not make the same assumption with PAs.

As to the point of iterns... The only thing more dangerous in a hospital than an intern in July is an intern in February. It seems to be the time that interns start getting cocky, start taking shortcuts, stop running things by their seniors...

That's a bit of a downer. If it's true that a PA can achieve the same level of clinical effectiveness as an attending physician, then you'd almost think it's not so much the superior training that MDs receive that make them superior as a whole, but rather the stricter quality control on who enters the MD track compared to the PA track. As someone who is about to start medical school, it's a bit dispiriting to think that taking your average MD caliber student and putting him into 2 years of PA school + residency would result in an equivalent product to 4 years of med school + residency.

So I guess the lesson here is that spending 2 extra years to learn the names of all the Krebs cycle enzymes doesn't necessarily make you a better clinician than someone who doesn't know the names of those enzymes. lol.

 

[gro2001]

That's a bit of a downer. If it's true that a PA can achieve the same level of clinical effectiveness as an attending physician, then you'd almost think it's not so much the superior training that MDs receive that make them superior as a whole, but rather the stricter quality control on who enters the MD track compared to the PA track. As someone who is about to start medical school, it's a bit dispiriting to think that taking your average MD caliber student and putting him into 2 years of PA school + residency would result in an equivalent product to 4 years of med school + residency.

So I guess the lesson here is that spending 2 extra years to learn the names of all the Krebs cycle enzymes doesn't necessarily make you a better clinician than someone who doesn't know the names of those enzymes. lol.

I am not saying that it is common for a PA to achieve the same level of clinical skills and knowledge as an attending physician. In fact, it is very very uncommon (in my experience). But some very motivated, talented and hardworking PAs can eventually get to a level where they function at an (essentially) attending level (minus the research, teaching and mentorship roles). It is not common and is not the point of PAs. I was using those examples to counter what a previous poster said who was questioning whether PAs can function even at a resident level.

Also, perhaps I did not make this clear, but my point was that the results of PA training seems to be highly variable compared to results of MD training. Someone completing the PA training may one day function at a high (attending) level and will likely at least function at an appropriate level. Someone completing MD training (med school + residency) will almost certainly one day function at a high (attending) level.

 

[deltamed]

That's a bit of a downer. If it's true that a PA can achieve the same level of clinical effectiveness as an attending physician, then you'd almost think it's not so much the superior training that MDs receive that make them superior as a whole, but rather the stricter quality control on who enters the MD track compared to the PA track. As someone who is about to start medical school, it's a bit dispiriting to think that taking your average MD caliber student and putting him into 2 years of PA school + residency would result in an equivalent product to 4 years of med school + residency.

So I guess the lesson here is that spending 2 extra years to learn the names of all the Krebs cycle enzymes doesn't necessarily make you a better clinician than someone who doesn't know the names of those enzymes. lol.

Experienced PAs can "seem" to be operating at the level of an attending but they rarely are. They can be very competent for bread and butter cases but when rarer cases present the difference is apparent. The problem is, contrary to popular belief, rare presentations are mixed in with everything else and are NOT easy to spot and it's likely they will NOT realize when to consult you. See my disaster case In this thread:

http://www-forums.studentdoctor.net/index.php?threads/EM-PAs.1156261/


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[gman33]

Experienced PAs can "seem" to be operating at the level of an attending but they rarely are. They can be very competent for bread and butter cases but when rarer cases present the difference is apparent. The problem is, contrary to popular belief, rare presentations are mixed in with everything else and are NOT easy to spot and it's likely they will NOT realize when to consult you. See my disaster case In this thread:

http://www-forums.studentdoctor.net/index.php?threads/EM-PAs.1156261/


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The variability in MLPs can be a problem for the consulting services as well.
Usually when I consult someone from the ER, I have a plan I would like executed.
Sometimes this plan is not in line with what the consulting service would recommend.
If I am getting this recommendation from a MLP, I have a harder time accepting their recommendation when it is out of line with my expectation.

In these cases, I ask what attending is covering the service, and ask them to call that attending and call me back with recommendations.

I do this for a few reasons.
#1 I want to do what is best for the patient. My plan may not be the best.
#2 If I am truly asking for advice on management (not usual), I am consulting the attending. not a MLP. I don't mean this is a demeaning manner, I just mean that I want expert advice from the best possible source.
#3 As in your example above, the attending is the one on the hook, along with myself, if there is a bad outcome. I don't want somebody coming back to me later saying they were unaware of the case and they would have recommended x,y,z. This is extra liability for myself as well as the consulting service.

If I can't this done for whatever reason, that patient gets put in OBS, admitted or just left in the ED until that can happen.
If it something emergent, I will page the attending or another group if needed.

 

[BoardingDoc]

Experienced PAs can "seem" to be operating at the level of an attending but they rarely are. They can be very competent for bread and butter cases but when rarer cases present the difference is apparent. The problem is, contrary to popular belief, rare presentations are mixed in with everything else and are NOT easy to spot and it's likely they will NOT realize when to consult you. See my disaster case In this thread:

http://www-forums.studentdoctor.net/index.php?threads/EM-PAs.1156261/


Sent from my iPhone using SDN mobile app

Use this link instead to get to the actual case and not just the thread: http://www-forums.studentdoctor.net/threads/em-pas.1156261/#post-16827260