Are MD's happy about PA's and NP's?

[Smile'n'Wink MD]

I've always wondered if PA's or NP's hurt how much an MD makes. If they're capable of doing virtually what an MD can do, then hospitals will hire them more instead of MD's b/c they're cheaper?

Also, are they just as competant considering they may have not had as much schooling, training (residency) and certification (like passing boards).

I'd love to learn more about this working dynamic? Thanks!

---

Members don't see this ad.

 

[Kalel]

Those that are out in practice are very happy with NP's and PA's. They generate physician offices more income by doing a physician's job for less salary then hiring another physician. Ironically, the reason that there are even these "turf wars" (eg NP's opening up their own clinics, PA's doing more surgeries and being more autonomous, allied health professionals "stealing" MD procedures) is that MD's are training these allied professionals to do their jobs so that they (persoanlly) can make more money. Despite these turf wars, I think that most MD's will tell you that NP's and PA's are a very good thing for medicine because they take over a lot of the monotonous jobs and allow them to use their training more efficiently. Many specialty clinics have NP's and PA's that take their bread and butter cases (eg IBS clinics in GI run by NP's, Derm clinics having f/u visits run by PA's, NP's seeing cold sx, etc) while the physicians focus on the more complicated cases and they make initial management decisions while their employees follow up on their work and carry out the details. I think that it's good too, a low supply of providers may elevate a physician's income and make him or her more employable in certain areas, but I think that the improvement in efficiency does allow us to do our jobs more effectively. A lot of patients that go into see a physician do not need to see an MD, a lot of people with far less training can manage their chronic conditions very appropriately. The main downside that I see to PA's and NP's is how MD's can get sued for whatever mistakes they do as your employee (ie you can be sued if you co-sign a note where a PA saw a patient made a mistake, even though you never saw the patient yourself the day that the mistake was made).

 

[sambo]

I'm probably opening myself up for some major karma loss here, but oh well. In my opinion, NP's and PA's are very valuable as physician extenders, and as primary care providers in places that most physicians simply will not locate to. However, I do not like the way that these groups keep pushing and pushing for more independence, and trying to convince everyone that they can give the same quality of care as a physician for less cost. I think that this is having a negative affect on FP salaries (Even though I think that most of the decrease in income stems from low medicare/medicaid reimbursements and high malpractice premiums).

As far as competence, NP's and PA's simply do not have the advanced training that is required to detect and diagnose some of the less common diseases, or symptom variations in the common ones. In my opinion, this compromises their care by preventing early detection and referral for certain illnesses. This type of diagnostic ability comes only through training and experience, which newly graduated NP's and PA's do not have because they don't complete a residency. The playing field is leveled somewhat when dealing with PA's and NP's who have been in practice for many years, but I would still much rather receive my care from an M.D. or a D.O.

This impingement on the Primary care physician's scope of practice by mid-level providers is part of the reason why I am not pursuing a primary care residency. I feel that this problem will probably get worse in the future. Just my $.02.

 

[efex101]

Hence why I will more than likely avoid primary care specialties...

 

[MacGyver]

As you read this thread, take comfort in knowing that NPs and PAs are pushing for expanded scope of practice in all 50 states.

Many states have simply given in and allowed NPs to become replacement FP MDs.

 

[deleted6669]

to the o.p.
as far as salary, a good specialty pa can make > 125 k/yr which is more than some primary care md's, so we do ok. I do not mind the fact that the er docs I work with make twice my salary seeing the same pts. they have put in more time and have more debt to pay off.pa's who have been practicing a few years in a specialty do basically the same things as the docs they work with and have similar competence with procedures, etc.
also we do have a national certification exam to pass initially and every 6 years. it is very similar to the fp board exam.most of the docs I interact with treat me as a colleague and do not differentiate between how they deal with me and their md/do colleagues.

 

[Willamette]

I'm one future MD who is all for them! Of course, my wife is in PA school !!!

 

[wickliffe2]

This type of diagnostic ability comes only through training and experience, which newly graduated NP's and PA's do not have because they don't complete a residency.

Although they don't do a formal residency, PAs complete a full year of clincal rotations in several specialties. I'm not saying they know more than doctors, but I just wanted to make that clear.

 

[megsMS]

Although they don't do a formal residency, PAs complete a full year of clincal rotations in several specialties. I'm not saying they know more than doctors, but I just wanted to make that clear.

I admit that I do not know that much about the training that PAs receive, but if you mean that they complete only 1 total year of clinical rotations, then I can guarantee that they do not learn as much or know as much as MDs. One year simply does not compare to 2 clinical years during medical school plus 3-11+ years of residency. I would not go to a PA or an NP or send my family members to one either.

For the sake of clarity, could someone please state exactly what kind of training PAs receive, including undergrad and beyond?

 

[medic170]

As you read this thread, take comfort in knowing that NPs and PAs are pushing for expanded scope of practice in all 50 states.

Many states have simply given in and allowed NPs to become replacement FP MDs.

PA's will never replace FP physicians. They have a defined role in health care(which, I grant you, can be independent when needs arise, such as in rural areas, but they still are subject to review by the physician) and are great in that role. However, I can't see how 1 year of courses and 1 year of rotations can ever be considered a replacement for 2 years of courses, 2 years of rotations, and 3-7 years of residency. PA's are excellent in their role, but they are no replacement for a licensed physician. Its like comparing apples to oranges, they are two different professions with different roles, so PA's will not "take over for FP physicians" Just my opinion, feel free and encouraged to disagree

 

[deleted6669]

for most, pa is a second career so they had years of prior experience as paramedics, nurses, physical therapists, or resp. therapists.undergrad is similar to premed with many science majors in a typical pa class.pa school is usually described as the first 3 years of medschool crammed into 2 years minus biochem, histology, embryology, and a few other basic science courses. many of these courses(microbio, a+p, etc)are pa school prereqs.pa school is 2 years +/- a month or so including summers so the # weeks = approx 3 years with summers off.(104-108 weeks for pa school vs 152 weeks for medschool last time I checked). there is a full year of clinical rotations equivalent to ms3. many schools schedule the pa students at the same sites as ms3 students with the same responsibilities, call, pt load ,etc. before some bozo posts something saying" pa students at my school just follow nurses around "or some similar drivel remember that there are good and bad students in every profession and the motivated students will make the most of any opportunity while some folks will seek out the lowest acceptable level of interaction. I have seen medstudents follow attendings around like sheep and do nothing as well as pa/np students.on a personal level I can assure you that I worked side by side with medical students throughout my training doing exactly the same things as the ms 3's and often similar to the ms4/intern folks.I was a paramedic in a former life so my attendings let me do adv. procedures not normally done by ms3's such as full participation in trauma codes, etc.
typical prereqs:http://www.ohsu.edu/pa/prereq.html#generalrequirements
typical academic yr:http://www.ohsu.edu/pa/academic.html
typical clinical year:http://www.ohsu.edu/pa/clinical.html
typical job postings:http://www.ohsu.edu/pa/joblist.html#er

 

[wickliffe2]

Thanks to EMEDPA for standing up for the PAs! He does it so much better than me!

 

[Docgeorge]

I just TA'ed a surgery Lab for PA's at my school. They are really quite variable. I think your accrediting associations need to get more stringent about the pre recs to make sure that applicants were actually Paramedics or Nurses or repertory therapist in their previous life. Most were fine, but a couple of those kids were quite scary.

I think though we need to not forget that PA school course work is not like Med school class work. For example the Micro course taken by med students is not the same course taken by medial students. At least this is my suppositon, I?ll stop by the Micro dept monday and ask just to be sure. But there simply cant be time. One of my close friends is a PA he told me he was just a little sacred as to how much more he has learned in his 1st year in med school compared to PA school. He said that he really didn?t appreciate what he didn?t know until now.

I look foreword to hearing you thoughts concerning your training as PA vs. your training as a Physician in the subsequent years. For you never really know until you?ve walked on both sides of the fence. I?ll ask my other PA and NP classmates what they think.

 

[deleted6669]

docgeorge- you are correct, pa program quality is highly variable. some pa programs at medschools have their students taking the exact same classes with medstudents(micro, a+p, pharm, etc), just fewer classes as discussed in my prior post. other programs teach a watered down version such as concepts in physiology, etc
as an employer looking at a new grad your best bet is to choose someone from a program with a long hx of producing excellent grads like duke, emory, drexel,cornell, u. of wa. etc and avoid grads from noname community college(not all programs are masters level yet but they will be by the end of the decade).

 

[Docgeorge]

EMEDPA, I know that you were applying to med school earlier have you decided where you will be going?

 

[deleted6669]

une-com is my first choice

 

[Jasminegab]

As a MA who is now a medical student, I can say that I worked with many NP and PA's. I think that people think that NP and PA's don't have to be supervised, they do. Everything they do, a MD has to sign off. I know this for a fact. So yes, even as they are allowed to see patient and come up with a treatment plan for disorders, it must be followed up with a MD signature.

When I worked with a NP in a woman's clinic, He would do the follow-up care after surgery when the patients would come back for their check-up. He often prescribed medication for pain. However, later that week, the doctor would read each chart and sign off on them. The was true with another clinic that I worked at which the doctor was never there. Although, she was a MD who was licensed as a PA (don't ask the details...she just couldn't pass her boards). Anywho, she was given the authority to run the office. She saw patients and determined treatment plans. Once a day or every other day, the doctor would come and sign off on the charts.

I'm not sure about other states, but here in PA, no PA or NP can practice without the supervision of a MD-meaning that they can't just open up shop and become FP's without being supervised by an MD. Dosen't mean it doesnt' happen. But that's the law here in PA.

Just my 2 cents.

 

[MacGyver]

As a MA who is now a medical student, I can say that I worked with many NP and PA's. I think that people think that NP and PA's don't have to be supervised, they do. Everything they do, a MD has to sign off. I know this for a fact. So yes, even as they are allowed to see patient and come up with a treatment plan for disorders, it must be followed up with a MD signature.

Thats only true for a few states. Besides, the NPs and PAs in your state are actively fighting against those regulations where they do exist.

When I worked with a NP in a woman's clinic, He would do the follow-up care after surgery when the patients would come back for their check-up. He often prescribed medication for pain. However, later that week, the doctor would read each chart and sign off on them. The was true with another clinic that I worked at which the doctor was never there. Although, she was a MD who was licensed as a PA (don't ask the details...she just couldn't pass her boards). Anywho, she was given the authority to run the office. She saw patients and determined treatment plans. Once a day or every other day, the doctor would come and sign off on the charts.

I'm not sure about other states, but here in PA, no PA or NP can practice without the supervision of a MD-meaning that they can't just open up shop and become FP's without being supervised by an MD. Dosen't mean it doesnt' happen. But that's the law here in PA.

Two points:

1) Even if what you say is true in PA, its just one state. Most states dont operate like that at ALL.

2) Continue to stick your head in the sand if you dont think PAs/NPs are fighting against those regulations. I guarantee you there are PAs and NPs RIGHT NOW in PA lobbying the state legislatures and medical boards to change the rules allowing them more independence.

 

[Zweihander]

Do some searches -- there have been several threads that discuss this topic at some length, and you'll find several good points in them that address your question.

 

[Jasminegab]

Can someone tell me why I should feel threathen by NP and PA? As I said previously, I don't have a problem with NP nor PA's. They do a valueable service.

Regardless if I have my head stuck in the sand or not. I have no problem with NP or PA's. And if they are allowed to open up shop as FP's, no problem, just find a specialty which NP or PA's can't not move into without full supervision if you feel that they will take over opportunities you may want.

This whole thread is like the debate on Naturopathic physician's taking over FP's. I don't understand what the issue is when only a hand full of SDNer's will go to medical school to become FP's. Very few will work in area's which there is a great need for doctors and the pay is averaging around $80-90k a year. Even fewer will join NHSC to travel to other countries to work on refugee camps. So, what's the big deal? If your interested in a specialty that requires at least 4yrs Post Graduate Education then you will never even see the likes of what those who are interested in FP will go through, why be concerned?

Again just my 2 cents.

 

[MacGyver]

Regardless if I have my head stuck in the sand or not. I have no problem with NP or PA's. And if they are allowed to open up shop as FP's, no problem, just find a specialty which NP or PA's can't not move into without full supervision if you feel that they will take over opportunities you may want.

What in this world suggests to you that once PAs and NPs take over FP, that they'll simply stop there and wont push for independence in other specialties?

You are very naive if you think this ends with FP.

 

[Blade28]

pa school is usually described as the first 3 years of medschool crammed into 2 years minus biochem, histology, embryology, and a few other basic science courses. many of these courses(microbio, a+p, etc)are pa school prereqs.pa school is 2 years +/- a month or so including summers so the # weeks = approx 3 years with summers off.(104-108 weeks for pa school vs 152 weeks for medschool last time I checked). there is a full year of clinical rotations equivalent to ms3.

OK, I'm a little confused. The first 2 years of PA school are like the first 3 years of med school? Is it 2 years basic science + 1 year clinical rotations, or is everything compressed into 2 years?

BTW, many med schools don't have summer vacation. We work all year 'round (minus a week off here and there for Christmas, etc.).

But good info nonetheless. Always appreciated.

 

[Blade28]

What in this world suggests to you that once PAs and NPs take over FP, that they'll simply stop there and wont push for independence in other specialties?

You are very naive if you think this ends with FP.

It's true, PAs don't just work in FP-related specialties. At a Kaiser hospital here, PAs routinely assist in surgeries with surgical attendings and residents.

Having said that, the PAs that I've seen do an excellent job. They assist the attending surgeon and can close, teach residents, etc.

 

[Jasminegab]

What in this world suggests to you that once PAs and NPs take over FP, that they'll simply stop there and wont push for independence in other specialties?

You are very naive if you think this ends with FP.

The only person that is being naive right now is you. Your the one who is living in fear that your job will be taken over by people you feel that is less than you, because you spent 4yrs busing you butt to get into medical school, and another 4yrs trying to make it through medical; only to have your hard earned work result in someone with less years of schooling than you take over your well deserved job. How dare they. And you call me naive?

 

[GreenT]

Just wanted to throw my 2 cents in. At our undergrad student health clinic, the first person you see when you are sick is a NP. I feel like I really have to push to get the right tests done sometimes. I had a mole that needed to be removed but when the NP first saw it she asked if skin cancer ran in my family. I said that no one in my family had had skin cancer but pointed out that skin cancer has more to do with UV exposure and the erosion of the earth's ozone layer. My grandmother and mother did not have skin cancer but they grew up in England and I grew up in Texas.
When I am out of undergrad I will do anything to avoid having a NP as my primary care person. Also had a friend with who was told she just "had a cold" by an NP and a few days later in the ER she was diagnosed with leukemia.