Are the PAs really the ones causing a problem?

[Anastomoses]

---

Members don't see this ad.

A family friend hits me up online (knowing full well I'm not a doctor) to ask if I know anything about eye pus during a cold because it's hard to get doctor.

Him: they gave me amox for my ear infection; in my eye it's not like sinusitus puss
but sort of a whiter version of zit puss, but way stringier and the area above my upper tear duct is REALLY inflamed

me: You really ought to call them. If it's something related to the medicine, they'd be able to tell you. You went to an ENT specialist?

Him: it was just a PA. not a real doctor. she just said go to an opthomologist for steroid drops
she just thought it was excessive tearing

I asked why he was wasting time with a PA when he should see a proper doctor. He went on to complain at length that he calls medical doctors and gets an appt and then finds himself with a PA each time. He said this happened when he went to a urologist as well. He pointed out that to get an appointment with a doctor would require a week or more of wait.

Are we the ones creating this NP/PA problem? Because until this discussion I had no idea of these dynamics. From SDN I gathered that PA/NPs are encroaching on medical space - it never occurred to me that the public is having PA/NPs pushed on them by a paucity of doctors.

 

[Kaputt]

No, PAs are not the problem. They cannot practice independently of physicians. They are the Robin to our Batman.

 

[Awesome Sauceome]

Nor do PA's have a strong political structure to encroach significantly. Now NPs on the other hand have ridiculously strong backing; they are making ground that some people think in some situations over steps their practicing ability.

 

[Cytarabine]

They also fall under the board of medicine

 

[BestDoctorEver]

A family freind hits me up online (knowing full well me are not a doctor) to ask if me know anything about eye pus during a cold because it's hard to get doctor.

Him: they gave me amox for my ear infection; in my eye it's not like sinusitus puss
but sort of a whiter version of zit puss, but way stringeir and the area above my upper tear duct is REALLY inflamed

me: You really ought to call them. If it's something related to the medicine, they'd be able to tell you. You went to an ENT specialist?

Him: it was just a PA. not a real doctor. she just said go to an opthomologist for steroid drops
she just thought it was excessive tearing

me asked why he was wasting time with PAs when he should see a proper doctor. He went on to complain at length that he calls medical doctors and gets an appt and then finds himself with a PA each time. He said this happened when he went to a urologist as well. He pointed out that to get an appointment with a doctor would require a week or more of wait.

Are we the ones creating this NP/PA problem? Because until this discussion me had no idea of these dynamics. From SDN me gathered that PAs are encroaching on medical space - it never occurred to me that the public is having PAs pushed on them by a paucity of doctors.

Many physicians where I live are using PA/NP to increase their volume. My PCP (a DO) opened up 2 more clinics in my area and staffed them up with PA/NP. She has been my PCP for 5 years now and I saw her only once.

 

[mulberry]

That's why when scheduling an appointment you make sure to specify you only want to see the MD/DO. I was scheduling an appointment for a dermatologist and over the phone the receptionist was like "you will be seeing Mr. X". I pretty much said sorry, you can cancel my appointment or put me with the MD.

 

[KnuxNole]

There are also some populations that don't care about who they see, as long as they get FAST care without ever having to wait, as cheap as possible. This may not be the majority of peeps, but for those who don't care if they see a nurse as long as they don't have to wait for 15+ minutes and/or get a same day appointment, they might find a NP/PA vs. a MD/DO who is booked.

 

[Anastomoses]

Given that so many doctors are enabling them, I really don't see where we have room to whine when the NPs start feeling they can handle most things themselves.

 

[e30ftw]

wtf is going on here?

avast ye mateys. thar be a keeled hauled bunghole of a PA afoot

 

[DermViser]

Are we the ones creating this NP/PA problem? Because until this discussion I had no idea of these dynamics. From SDN I gathered that PAs are encroaching on medical space - it never occurred to me that the public is having PAs pushed on them by a paucity of doctors.

No PAs are not the problem. They work under a physician, period. NPs are being pushed on the public.

 

[Anastomoses]

wtf is going on here?

avast ye mateys. thar be a keeled hauled bunghole of a PA afoot

Why are you talking like a pirate? 😛

No PAs are not the problem. They work under a physician, period. NPs are being pushed on the public.

What is the educational/training difference between a PA and a NP?

Why are we allowing PA's to see patients without a doctor even in the vicinity of the office? Is there a justification for this other than just money?

 

[cbrons]

Given that so many doctors are enabling them, I really don't see where we have room to whine when the NPs start feeling they can handle most things themselves.

There is no room to whine. And NPs are here to stay. And yes, you can write it down - pretty soon they will be practicing with complete autonomy, many if not most of them calling themselves "doctors" vis a vis completing the DNP online/non-clinical sociology programs.

And people should be allowed to see whoever they want. If they want to pay to see them, then good luck to them.

In reality though, the government will find the option of diploma-mill trained lookalikes to be a fairly convenient if not expeditious solution to the problem of care delivery. And since the government will be paying for the health care of 95+% of the population, you can be sure the perception of easy access to care via many cheaply trained fake doctors will be preferable to very difficult access to relatively fewer and much more expensively trained real ones. Thats political expediency, and thats what the majority of uneducated *****s in this country want because they (incorrectly) see it as a birthright. Well, as HL Mencken said, "Democracy is the theory that the common people know what they want, and deserve to get it good and hard."

 

[Dr. Zombie]

Why are you talking like a pirate? 😛


Why are we allowing PA's to see patients without a doctor even in the vicinity of the office? Is there a justification for this other than just money?

Funny you mention that. I'm seeing a PA for a simple issue. I never even met the doctor, seen his face or heard his voice, even though I booked the appointment with him. The PA is actually so good, he puts some MD's to shame.

This particular doctor has two PAs under his belt and about 3-4 clinics around the area. My PA unofficially completely runs the clinic I visit and I think he runs a second one too. He told me he's only seen the doctor maybe once throughout the month of March even though the doctor's name is the one representing these clinics.

To answer your question, I think its purely money. Why hire two doctors when you can hire two PAs for the price of 1 MD and cover more clinic time.

 

[primadonna22274]

PAs are the physician's ally--definitely NOT the enemy.

PAs learn and practice medicine--from physicians, with physicians, in numerous hospital, surgical and ambulatory settings. PAs are certified by ONE national organization, the National Commission on Certification of Physician Assistants (NCCPA), which has representatives from the AMA, AOA, and all major physician specialty organizations. PAs take ONE national board certification exam, the Physician Assistant National Certification Examination (PANCE) and maintain certification by the same CME standards that most physician boards require, and must recertify every 6-10 yr (just recently moved to 10 yr after initial recert) via the Physician Assistant National Recertification Examination (PANRE). PAs are licensed by individual states' Board of Medicine and each state has specific practice laws that mandate supervision requirements and define scope of practice for PAs in that state. A common theme is that a supervising physician (although we are trying to reshape that term to collaborating physician, which much more accurately defines the relationship) delegates whatever tasks s/he deems appropriate to the PA. PAs have been around for nearly 50 years and have a strong track record of safe and competent practice.

If you're not convinced, check out the curriculum at my program:

http://www.pacificu.edu/pa/programs/pasp/courses/index.cfm

Or one of the programs where I've taught:

http://www.gru.edu/alliedhealth/pa/

http://www.gannon.edu/academic-departments/physician-assistant-department/

I have been a PA since 2000 and have worked in FM, GYN, urgent care, and EM since that time. I returned to medical school in 2011 and will graduate (DO) in 8 weeks. While first year (core) medical school was definitely challenging, I had a significant advantage over my traditional route classmates and performed very well on all NBME shelf exams, COMLEX level 1 and level 2, have consistently impressed my preceptors, and had no trouble on the residency interview trail. All of the PDs where I interviewed were impressed with my previous career as a PA and I matched at my #1 program. I am not unique among the other 6 PAs in my graduating medical school class. My best estimate is that I knew about 45-50% of first year curriculum going in, easily 70% of M2, and 90% of clinical year material (I am in an accelerated 3-yr DO program specially designed for PAs, recognizing their previous training and knowledge base). I, and I suspect the other PAs in my cohort, chose to return to med school to finish what we started, to gain independence as a physician, and to improve respect from our peers and patients. None of us had to do this to continue to practice medicine safely and effectively--we were already doing that, like many thousands of other PAs.

I'll let an NP tell you about NPs.

I hope you are now better informed.

[What is the educational/training difference between a PA and a NP?

Why are we allowing PA's to see patients without a doctor even in the vicinity of the office? Is there a justification for this other than just money?[/QUOTE]

 

[BestDoctorEver]

Funny you mention that. I'm seeing a PA for a simple issue. I never even met the doctor, seen his face or heard his voice, even though I booked the appointment with him. The PA is actually so good, he puts some MD's to shame.

This particular doctor has two PAs under his belt and about 3-4 clinics around the area. My PA unofficially completely runs the clinic I visit and I think he runs a second one too. He told me he's only seen the doctor maybe once throughout the month of March even though the doctor's name is the one representing these clinics.

To answer your question, I think its purely money. Why hire two doctors when you can hire two PAs for the price of 1 MD and cover more clinic time.

Basically physicians are using PA/NP to increase their revenue or to make a lot of money.

 

[SurgeDO]

why we hatin' on our PA bros?

 

[primadonna22274]

^^^Word.

 

[darklabel]

There is no room to whine. And NPs are here to stay. And yes, you can write it down - pretty soon they will be practicing with complete autonomy, many if not most of them calling themselves "doctors" vis a vis completing the DNP online/non-clinical sociology programs.

And people should be allowed to see whoever they want. If they want to pay to see them, then good luck to them.

In reality though, the government will find the option of diploma-mill trained lookalikes to be a fairly convenient if not expeditious solution to the problem of care delivery. And since the government will be paying for the health care of 95+% of the population, you can be sure the perception of easy access to care via many cheaply trained fake doctors will be preferable to very difficult access to relatively fewer and much more expensively trained real ones. Thats political expediency, and thats what the majority of uneducated *****s in this country want because they (incorrectly) see it as a birthright. Well, as HL Mencken said, "Democracy is the theory that the common people know what they want, and deserve to get it good and hard."

Funny you should say that, some people in the NP movement believe they should be compensated equally as a doctor. Why get paid less for the same visit when they think they deserve just as much since they are "doctors". I only know this since my fiance is a nurse and most nurses becoming an NP (or DNP as there seems to be a movement towards the doctorate degree) are saying they want to be NPs to earn the same salary as a physician since they can do "almost" anything a physician can do.

The government may want to pay NPs a lower wage to fill in the primary care void, but you can bet your ass that the NPs have something else in mind. Also, don't get me started on CRNA's vs anesthesiologists....

 

[Darth Doc]

(or DNP as there seems to be a movement towards the doctorate degree)

There's a requirement for all nurse practitioners for the minumum level of education to become a nurse practitioner is a doctorate degree starting in 2015.

My husband started this year getting his master's as a nurse practitioner with all online classes. PA's don't have that option. In fact, I took my medicine classes during PA school with medical students.

 

[Anastomoses]

why we hatin' on our PA bros?

We can't have it both ways. We can't utilize PAs as bonafide replacements for us and then whine that NPs are encroaching on our space.

Now that I understand these dynamics better, it's laughable that our greed created an issue that we complain about regularly.

Who needs to worry about more med schools opening and lowering the value of the average doctor when your fellow doctor is already taking up five times his patient viewing capability with these PAs. Why not open 20 centers and stock them all with PAs with your name on them all? You can visit each one day a month.

I could accept this if PAs had to have a doctor in office while they interact with patients, but this isn't even the case.

 

[DokterMom]

It's a business decision -- Just as lawyers use paralegals, doctors use PAs to stretch and/or leverage their capabilities. Hopefully, a well-trained PA (and I believe most are) will know when s/he reaches the limits of their judgement and bring the doctor in. On balance, I have seen PAs order more tests than the MD might have, but also spend more time with the patient. The PAs I have seen have also, as a rule, been better listeners -- which is easier to do when you get more than 10 minutes per patient.

 

[Elisabeth Kate]

We can't have it both ways. We can't utilize PAs as bonafide replacements for us and then whine that NPs are encroaching on our space.

Now that I understand these dynamics better, it's laughable that our greed created an issue that we complain about regularly.

Who needs to worry about more med schools opening and lowering the value of the average doctor when your fellow doctor is already taking up five times his patient viewing capability with these PAs. Why not open 20 centers and stock them all with PAs with your name on them all? You can visit each one day a month.

I could accept this if PAs had to have a doctor in office while they interact with patients, but this isn't even the case.

As far as I know, PAs aren't taking online classes, their curriculum includes the basic sciences, not the fluffy classes many NP courses are loaded with, PAs aren't trying to call themselves doctors in clinical settings, they're not trying to insinuate their education is equivalent to that of a physician, and they're not lobbying for complete autonomy or to be paid the same. I agree that a doctor should be in the building if a PA is running a clinic, but I don't consider that PAs encroaching on anything. It's just them being hired by a physician to do a job.

 

[Anastomoses]

Funny you should say that, some people in the NP movement believe they should be compensated equally as a doctor. Why get paid less for the same visit when they think they deserve just as much since they are "doctors". I only know this since my fiance is a nurse and most nurses becoming an NP (or DNP as there seems to be a movement towards the doctorate degree) are saying they want to be NPs to earn the same salary as a physician since they can do "almost" anything a physician can do.

The government may want to pay NPs a lower wage to fill in the primary care void, but you can bet your ass that the NPs have something else in mind. Also, don't get me started on CRNA's vs anesthesiologists....

You know, the easy argument I can see them winning is..."I can handle all things under this less complicated umbrella, so I will be compensated for these types of patients just as a doctor would. In fact, I spend more time with each patient". They can let doctors handle the "complicated" stuff - oh, say the rare pathologies. Maybe family medicine really should be handed over to them entirely and they can triage from there?

I agree that a doctor should be in the building if a PA is running a clinic, but I don't consider that PAs encroaching on anything.

I think this should be a rule. A physician should be in the building. I could be satisfied with that. This business of 5 clinics and one doctor is nonsense.

 

[xenotype]

Funny you should say that, some people in the NP movement believe they should be compensated equally as a doctor. Why get paid less for the same visit when they think they deserve just as much since they are "doctors". I only know this since my fiance is a nurse and most nurses becoming an NP (or DNP as there seems to be a movement towards the doctorate degree) are saying they want to be NPs to earn the same salary as a physician since they can do "almost" anything a physician can do.

The government may want to pay NPs a lower wage to fill in the primary care void, but you can bet your ass that the NPs have something else in mind. Also, don't get me started on CRNA's vs anesthesiologists....

They may think they can get the higher wage that physicians make, but this is not going to happen. They tried to get 100% parity in Oregon, perhaps the single most nurse friendly state in the country with one of the biggest per capita nurse lobbies and failed as soon as insurance companies protested that it would cost them more money. The AMA and other physician groups as usual were useless. NPs cost 85% of the going rate. There are strong economic reasons this won't change. Why would insurance companies pay them more money? And if you think the nursing lobby is tough, the insurance lobby is a tank. NPs will remain second class citizens, and if a malpractice case due to one of these NPs with an online degree gets big publicity you will see half or more of the states take the independent practice away in a matter of months. Furthermore, corporate hospital groups will not automatically prefer NPs over physicians. If 65-70% of your billing goes to overhead with a small margin of 1-5% (which it most certainly does in many specialties), the 15% lost revenue for billing with midlevels is literally the salary difference between the MD and NP. Yes, you can bill at 100% under the physician name but incident to billing is complicated and an increasing number of fraud cases are filed over not following the strict guidelines (a physician has to be directly involved in the care of the patient.) When the market gets saturated, patients may prefer to see MDs leaving a lot of NPs without jobs. The government has every incentive to push NPs because they save money (atleast until a real study shows they cost more because of excess testing/referrals) and are trained fast enough to fill gaps in supply, but these advantages can change.

 

[BestDoctorEver]

You know, the easy argument I can see them winning is..."I can handle all things under this less complicated umbrella, so I will be compensated for these types of patients just as a doctor would. In fact, I spend more time with each patient". They can let doctors handle the "complicated" stuff - oh, say the rare pathologies. Maybe family medicine really should be handed over to them entirely and they can triage from there?



I think this should be a rule. A physician should be in the building. I could be satisfied with that. This business of 5 clinics and one doctor is nonsense.

When you are stranded with dreadful PCP salary, I guess that is a nice way to bring some extra income to pay these outrageous student loans. I am all for that...

 

[SurgeDO]

We can't have it both ways. We can't utilize PAs as bonafide replacements for us and then whine that NPs are encroaching on our space.

Now that I understand these dynamics better, it's laughable that our greed created an issue that we complain about regularly.

Who needs to worry about more med schools opening and lowering the value of the average doctor when your fellow doctor is already taking up five times his patient viewing capability with these PAs. Why not open 20 centers and stock them all with PAs with your name on them all? You can visit each one day a month.

I could accept this if PAs had to have a doctor in office while they interact with patients, but this isn't even the case.

i disagree. we need PAs to prevent NPs from encroaching on medicine.

one of the major reasons the NP encroachment has been so successful for them is due to the lack of physicians. NPs have been fulfilling a demand due to the lack of physician supply, and it is beginning to get out of control.

at least from my understanding, the AAPA is very content with their role in health care...unlike the NPs. because of this, i think they are a much better solution to the increase in demand for healthcare.

PAs are better trained than NPs, and they play an absolutely vital role in healthcare. i think as future physicians we should embrace this and support PAs.

 

[DokterMom]

i disagree. we need PAs to prevent NPs from encroaching on medicine.

one of the major reasons the NP encroachment has been so successful for them is due to the lack of physicians. NPs have been fulfilling a demand due to the lack of physician supply, and it is beginning to get out of control.

at least from my understanding, the AAPA is very content with their role in health care...unlike the NPs. because of this, i think they are a much better solution to the increase in demand for healthcare.

PAs are better trained than NPs, and they play an absolutely vital role in healthcare. i think as future physicians we should embrace this and support PAs.

Well said --

 

[primadonna22274]

^^^^^A-frickin-men!!!!!

 

[Quaero]

Does this mean primary care is pretty much dead for MDs?

 

[primadonna22274]

Does this mean primary care is pretty much dead for MDs?

Not at all. Primary care is the front line of medicine. Physicians will ALWAYS be needed at the front. We have expertise and a knowledge base much broader and deeper than even the most seasoned PA/NP. Our roles as physicians may change somewhat but somebody needs to be the expert.

 

[Anastomoses]

i disagree. we need PAs to prevent NPs from encroaching on medicine.

one of the major reasons the NP encroachment has been so successful for them is due to the lack of physicians. NPs have been fulfilling a demand due to the lack of physician supply, and it is beginning to get out of control.

at least from my understanding, the AAPA is very content with their role in health care...unlike the NPs. because of this, i think they are a much better solution to the increase in demand for healthcare.

PAs are better trained than NPs, and they play an absolutely vital role in healthcare. i think as future physicians we should embrace this and support PAs.

You're not addressing the stocking of PAs in clinics where no physician is present. The rest sounds good.

 

[Sephiroth]

You're not addressing the stocking of PAs in clinics where no physician is present. The rest sounds good.

I'd agree that that's a problem. I thought the point was that several PA's could see lots of patients, and the physician would review everything to make sure it checks out, or personally address more complicated issues that arose that would be beyond what the PA could take care of. If that issue were taken care of, then I'd say we should really be pushing for more PA use to do just this. There are still plenty of states where PAs arent that common, or maybe even not allowed yet.

I'm not sure I'd use the wording that they are "better" trained than nurses, just that their training and education is more appropriate for this type of role. What might be a good idea is to try to encourage lots of schools to create nurse-to-PA transition programs and part time PA-prereq programs (or maybe that would be included).

 

[ruedjgtc]

There is no room to whine. And NPs are here to stay. And yes, you can write it down - pretty soon they will be practicing with complete autonomy, many if not most of them calling themselves "doctors" vis a vis completing the DNP online/non-clinical sociology programs.

And since the government will be paying for the health care of 95+% of the population, you can be sure the perception of easy access to care via many cheaply trained fake doctors will be preferable to very difficult access to relatively fewer and much more expensively trained real ones.

Can you clarify when the government will be paying for 95+% of the population? The only time the government pays out of pocket would be medical and medicare, and both of these aren't available to 95+% of the population, nor has it been expanded in many states (on that, we can leave the politics for another thread). Even if it were expanded, 95% of the population wouldn't qualify for either. Furthermore, ACA doesn't provide insurance, it mandates people go out and get it. Was this just supposed to be a hyperbole, and I looked too far into this? If it's the latter explanation, then whoops on me.

 

[touchpause13]

PAs are legit. They are not attempting to misrepresent themselves to be doctors or trying to practice independently.

 

[BestDoctorEver]

What might be a good idea is to try to encourage lots of schools to create nurse-to-PA transition programs and part time PA-prereq programs (or maybe that would be included).

That would be a great way to marginalize these DNP programs....

 

[CLETUS.the.FETUS]

I asked why he was wasting time with a PA when he should see a proper doctor. He went on to complain at length that he calls medical doctors and gets an appt and then finds himself with a PA each time. He said this happened when he went to a urologist as well. He pointed out that to get an appointment with a doctor would require a week or more of wait.

Are we the ones creating this NP/PA problem? Because until this discussion I had no idea of these dynamics. From SDN I gathered that PA/NPs are encroaching on medical space - it never occurred to me that the public is having PA/NPs pushed on them by a paucity of doctors.

First of all, when you become an MD you can be part of the "we." Secondly, and related to that, when you start practicing and you have actual interactions with PA's and NP's you'll learn that you have to temper that condescending attitude. These people are professionals and important components to delivering care and seeing many of the cases that you yourself will not want to deal with so you will be happy to have a good number of your patients "wasting their time" with midlevel providers so now is the time for you to get the idea out of your head. They are not "fake doctors" or "doctor wannabes" so have some regard. Besides, not everyone is privileged enough to attend medical school nor do they all want to.

 

[BestDoctorEver]

By the way, should people address these DNP using 'Dr. X' in clinical settings?

 

[Psai]

Not at all. Primary care is the front line of medicine. Physicians will ALWAYS be needed at the front. We have expertise and a knowledge base much broader and deeper than even the most seasoned PA/NP. Our roles as physicians may change somewhat but somebody needs to be the expert.

I totally agree. It's really a shame that doctors don't get paid to think. Primary care should be the focus in my opinion and I feel like really smart people that go into fields like infectious disease are getting hosed. Then again these things are supposedly cyclical so we will see if it comes around. Back in the day, orthopedic surgery was for the people at the bottom of the class but now it's among the highest paid fields.

 

[CLETUS.the.FETUS]

By the way, should people address these DNP using 'Dr. X' in clinical settings?

This is a different issue altogether. The assumption when one presents themselves as "Dr So & So" is that they are a licensed medical professional holding a degree of MD, DO or DDS. Considerable confusion exists among patients when people who are not licensed as such present themselves as such since the term "doctor" in this setting has become synonymous with an individual trained medically.
http://www.ama-assn.org/resources/doc/arc/tia-campaign-resources.pdf

 

[Anastomoses]

First of all, when you become an MD you can be part of the "we." Secondly, and related to that, when you start practicing and you have actual interactions with PA's and NP's you'll learn that you have to temper that condescending attitude. These people are professionals and important components to delivering care and seeing many of the cases that you yourself will not want to deal with. You will be happy to have a good number of your patients "wasting their time" with midlevel providers so now is the time for you to get the idea out of your head. They are not "fake doctors" or "doctor wannabes" so have some regard. Besides, not everyone is privileged enough to attend medical school nor do they all want to.

You are so off topic.
1. Whether either is professional or not is completely irrelevant to the point we're discussing. The point is whether the doctors giving the public PAs as perfectly good replacements to themselves are creating the environment which makes it seem as if they are replaceable by much less educated staff aka PAs or NPs.
2. I have no trouble conceding that it is sensible to have a PA dealing with patients in the next room whose problems need immediate attention but are not complicated whatsoever.
3. If PAs can practice in clinics with no doctor in the area, why shouldn't NPs push for autonomy to have their own clinics and they can merely do exactly what PAs are doing...which is refer someone to a specialist if they can't help the individual with their problem?

 

[Anastomoses]

I totally agree. It's really a shame that doctors don't get paid to think. Primary care should be the focus in my opinion and I feel like really smart people that go into fields like infectious disease are getting hosed. Then again these things are supposedly cyclical so we will see if it comes around. Back in the day, orthopedic surgery was for the people at the bottom of the class but now it's among the highest paid fields.

I'm actually starting to wonder if FM isn't the right place to be given you can stock these clinics with PAs, you can creep into the cosmetic dermatology, etc. If it's money...this sounds much less risky and you don't stand around performing procedures all day.

 

[CLETUS.the.FETUS]

You are so off topic.
1. Whether either is professional or not is completely irrelevant to the point we're discussing. The point is whether the doctors giving the public PAs as perfectly good replacements to themselves are creating the environment which makes it seem as if they are replaceable by much less educated staff aka PAs or NPs.
2. I have no trouble conceding that it is sensible to have a PA dealing with patients in the next room whose problems need immediate attention but are not complicated whatsoever.
3. If PAs can practice in clinics with no doctor in the area, why shouldn't NPs push for autonomy to have their own clinics and they can merely do exactly what PAs are doing...which is refer someone to a specialist if they can't help the individual with their problem?

I was addressing your subtle condescension towards midlevel providers of which you may not feel that way overtly but your comments give it away.
"I asked why he was wasting time with a PA when he should see a proper doctor."
"Are we the ones creating this NP/PA problem?"
My comment is coming from a place of experience whereas yours is coming from conjecture. You are not even a graduate yet you're already creating a mental barricade between your prospective profession and someone else's. Access to quality care is a problem that has to be addressed but it is hardly a contentious issue like it's been made out to be here. Just trying to get you to see that and evaluate your own biases.

 

[BestDoctorEver]

This is a different issue altogether. The assumption when one presents themselves as "Dr So & So" is that they are a licensed medical professional holding a degree of MD, DO or DDS. Considerable confusion exists among patients when people who are not licensed as such present themselves as such since the term "doctor" in this setting has become synonymous with an individual trained medically.
http://www.ama-assn.org/resources/doc/arc/tia-campaign-resources.pdf

How about DPM? They call them Dr. where I work.

 

[CLETUS.the.FETUS]

How about DPM? They call them Dr. where I work.

My bad, they're included in that list as well I believe.

 

[boogaloo]

PAs are cool. The ones I've worked with work really, really hard and are highly valued. NPs have been okay. I feel like they fight with each other too. We should have a medical professional royal rumble.

 

[Elisabeth Kate]

Sorry to derail the thread, but just a quick question. Does anyone know why a medical student who doesn't match into residency but graduates, can't be hired to do the job a PA does?

 

[Dr. Zombie]

Sorry to derail the thread, but just a quick question. Does anyone know why a medical student who doesn't match into residency but graduates, can't be hired to do the job a PA does?

You gotta get licensing I believe. To get licensing, you need to at least complete a 1 year traditional.

 

[Winged Scapula]

Sorry to derail the thread, but just a quick question. Does anyone know why a medical student who doesn't match into residency but graduates, can't be hired to do the job a PA does?

Because they'd be practicing medicine without a license.

 

[Elisabeth Kate]

Because they'd be practicing medicine without a license.

I get that, but if PAs can be licensed after PA school, I don't get why doctors can't get a limited license (as they would during intern year) if they don't match. They'd have to practice under an attending, of course, but they'd be lumped in with PAs at least and have some income to pay back their loans.

 

[Winged Scapula]

I get that, but if PAs can be licensed after PA school, I don't get why doctors can't get a limited license (as they would during intern year) if they don't match. They'd have to practice under an attending, of course, but they'd be lumped in with PAs at least and have some income to pay back their loans.

Probably protectionism from the PA standpoint as their licensing requires graduation from an accredited PA school and liability concerns (ie, being held to a physician standard even if not practicing in that capacity).