Can I work as a PA?

[sarahs007]

---

Members do not see this ad.

All newly graduated PAs on the other hand can all place lines well and they are all experts in vent management. 🙄

What you think of interns is irrelevant, its the comparison that matters. And I'll take the average intern over the average new PA grad any day of the week. Note that I said AVERAGE because there are superstars and duds in every field. So spare me the irrelevant comparison of "I know this superstar PA who ran circles around every MD in the hospital and who was smarter than all of them" crap.

I personally said nothing of the sort and I am not sure how you gleaned that from my post. I don't work with PAs anymore.

My only beef with this thread is that interns don't have the clinical stuff under their belt and PA school is apparently more practical than M3 and M4. Hey, I really don't care. I'd trust an intern first (comparing average to average like you). I guess my first post here sounded mean and arrogant in regards to interns, but it was simply in response to what I perceive on this thread to be superiority complexes - a lot of people assuming they are more qualified to do something simply because they went to med school. Wrong. You're qualified to be docs - and no one else can say that. BUT the great thing about healthcare is that there is a never ending supply of "stuff" to discover and learn. If there is a really intelligent and ambitious nurse or PA or whomever out there, constantly reading and learning new things while accumulating years of experience -- well, that would be a great resource to have around, wouldn't it.

 

[MacGyver]

So what you are saying is that your claim that PA clinical training is stronger than MD is based on nothing more than conjecture with absolutely no evidence to back it up. As if an RN knows anything about MD vs PA training regardless.

Thats what I thought.

 

[sarahs007]

MacGyver,

You really are an abrasive, angry person. I discovered this by looking through the first couple of pages of your thousands of messages. What purpose did your response serve? Absolutely none. You're quite rude, insulting, depracating and your posts are pretty much useless. Why don't you take a look at yourself in the mirror instead of attacking half of the people on here. You have no idea who I am and if I've even fully disclosed all of the areas of healthcare I've worked in - or if I have an advanced degree (which I do, but I am not going to say which).

For someone who seems to spend multiple times per day on this very board, you seem awfully quick to judge people such as CRNAs, PAs, RNs - anyone you perceive to be lesser than you. But how great of a person are you, if you have the sort of life that involves posting thousands of messages here, many of which insult professions and people. Honestly, those CRNAs and PAs will have the last laugh - they are probably 100X better in the social skills department then you can ever hope to be. It's obvious your superiority complex is masking a vast pool of insecurity. My advice is to find another way to make yourself feel better besides attacking healthcare professions and what you call "wannabe MDs." They aren't wannabe MDs - they chose a better work life balance and for most, that is a conscious decision. Get over it.

 

[MacGyver]

MacGyver,

You really are an abrasive, angry person. I discovered this by looking through the first couple of pages of your thousands of messages. What purpose did your response serve? Absolutely none. You're quite rude, insulting, depracating and your posts are pretty much useless. Why don't you take a look at yourself in the mirror instead of attacking half of the people on here. You have no idea who I am and if I've even fully disclosed all of the areas of healthcare I've worked in - or if I have an advanced degree (which I do, but I am not going to say which).

For someone who seems to spend multiple times per day on this very board, you seem awfully quick to judge people such as CRNAs, PAs, RNs - anyone you perceive to be lesser than you. But how great of a person are you, if you have the sort of life that involves posting thousands of messages here, many of which insult professions and people. Honestly, those CRNAs and PAs will have the last laugh - they are probably 100X better in the social skills department then you can ever hope to be. It's obvious your superiority complex is masking a vast pool of insecurity. My advice is to find another way to make yourself feel better besides attacking healthcare professions and what you call "wannabe MDs." They aren't wannabe MDs - they chose a better work life balance and for most, that is a conscious decision. Get over it.

Your opinion is duly noted.

 

[Trifling Jester]

As healthcare workers, it is our responsiblity to RESPECT the different parts of the healthcare team, instead of trying to make our own part more important than the other team members.

The MD's job is more important than the nurse's or the PA's. The MD supervises both. The MD decides the treatment plan and is held responsible for it. Enough with the PC nonsense.

-The Trifling Jester

 

[RNtoMD2011]

The MD's job is more important than the nurse's or the PA's. The MD supervises both. The MD decides the treatment plan and is held responsible for it. Enough with the PC nonsense.

-The Trifling Jester

That may be your opinion, (to which you are entitled). However, in the real world nurses are held accountable for a body of knowledge and level of care for which nurses are responsible. The MD is never held responsible for the Nurse. (I can not speak to the PA). I am fortunate because in the critical care unit in which I work we work as a TEAM. No member of the team is MORE important than the other. Instead we function as a unit. As a result of this our patients recieve a high level of care and experience many positive outcomes. I do, however, understand that this may not be the case everywhere. (which is too bad.)

 

[docB]

The MD's job is more important than the nurse's or the PA's. The MD supervises both. The MD decides the treatment plan and is held responsible for it. Enough with the PC nonsense.

-The Trifling Jester

I disagree. A PA is a "physician extender" and is working under the supervision of the doc. When they're good they're really valuable.

Nurses are a different animal. If medicine is about assessment, diagnostics and treatment nursing is about healthcare delivery. They are the ones putting the rubber to the road or the meds in the veins. Yeah, I decide on the meds and the amounts but they have to take care of the logistics of making that happen. Do any of you guys know which drugs are in the pyxis or have to be ordered from pharmacy? What has to go in push vs. piggyback vs. slow infusion? How do you set up a pump? Do you know how to actually give a patient X mcg/Kg/min of something? Do you know what is compatible with what in a line? What if that line is running D5W vs. NS vs. Bicarb (because it changes with each one)? Do you do all your own splinting and bandaging? Do you know who to instruct a patient about using crutches or taking care of a foley at home?

Nursing is a different skill set. Could a new grad do the work of a PA? Probably. Could they do the work of a nurse. No. Actually a paramedic would be better at playing nurse (not competent, just better) than a fresh out MD or DO.

 

[sarahs007]

The MD's job is more important than the nurse's or the PA's. The MD supervises both. The MD decides the treatment plan and is held responsible for it. Enough with the PC nonsense.

-The Trifling Jester

Huh? Nurses are not part of the medical hierarchy at all. They answer to the charge nurse, nurse manager, nursing supervisors all the way up until you reach the Director of Nursing.

I will also beg to differ that nurses are less important than doctors. In the ICU (my main background so i use it as example) who has their eyes and ears on the patient at all times? Who is looking through labs and pointing out to the resident (who often has 9-10 patients) any abnormal/critical labs? Who is titrating pressors, or adding pressors, or keeping the patient sedated properly so they'll ventilate, or asking respiratory to make vent changes if the ABG was poor...I don't know I mean I can go on and on...nurses and doctors need each other in order to do their jobs. If you think differently, you are pretty short sighted. No one is more important than the other, although it's often the case that patients are admitted to begin with mainly because they need the nursing care.

Anyway, I'm pretty sure your post was flame. I hope it was.

 

[southerndoc]

Huh? Nurses are not part of the medical hierarchy at all. They answer to the charge nurse, nurse manager, nursing supervisors all the way up until you reach the Director of Nursing.

I will also beg to differ that nurses are less important than doctors. In the ICU (my main background so i use it as example) who has their eyes and ears on the patient at all times? Who is looking through labs and pointing out to the resident (who often has 9-10 patients) any abnormal/critical labs? Who is titrating pressors, or adding pressors, or keeping the patient sedated properly so they'll ventilate, or asking respiratory to make vent changes if the ABG was poor...I don't know I mean I can go on and on...nurses and doctors need each other in order to do their jobs. If you think differently, you are pretty short sighted. No one is more important than the other, although it's often the case that patients are admitted to begin with mainly because they need the nursing care.

Anyway, I'm pretty sure your post was flame. I hope it was.

Even when I had 16 patients during a MICU rotation (unheard of now since they're capped at the number they can have), I still noted changes in labs, critical labs, etc. without a nurse pointing them out to me.

No nurse added a pressor without first speaking with me. That seems to be the standard of care at my institution. They titrated them of course. They also tirated sedation.

The residents order the vent changes, not the respiratory therapists. I have to admit there were plenty of times that I asked a respiratory therapist for advice until I became more comfortable with ventilatory management.

I don't want to sound like I'm dragging down your argument, but I do want to point out that not all institutions give nurses and RT's the freedom to hang additional pressors or other critical care management on their own.

I do not want to have this post be an anti-nurse post. Trust me, there are still times to this day that I learn a lot from the nurses.

 

[sarahs007]

Unfortunately, I've had such experiences. Also, since Im the one who sends the labs, I'm usually the first to see the results (since I only have 2 patients results to look out for) and for that reason only, I'll let the resident know.

The unit can get strenuously busy for the residents at night. There is no way in hell a resident can keep up with lab results of 9 or 10 patients if he is admitting another patient and trying to place all of that pts lines and write all the million admission orders and of course trying to diagnose etc. It would be nice if you doctors recognized that we are your eyes and ears in the ICU and you should be grateful that so many of us are vigilant, have good assessment skills, can easily pick up when someone is crashing and let you know. I'm sorry, that's the way it goes in the ICU - it's always the nurse who is in the room and picking up on nuances, not the doctor. We get to play. That's why I love my job. I wouldn't want the responsibility of diagnosing, dosing, writing tons of notes, placing lines, and all the other stuff...I give you guys a lot of credit for doing all you do. i wouldn't be a doctor in a million years - that's a lifetime of headaches. It seems like we hardly ever get credit for what we do. Oh well, I could care less in real life.

 

[sarahs007]

No no, residents write vent changes...not RTs....the nurses and RTs just make the vent changes then tell the resident.

This system works well since the RT is the vent expert (esp. on nights) and this way we don't have to burden the resident. This is never a problem, ever.

This is reality in some hospitals. Especially on night shift.

Act on a problem now, get the order later.

 

[Faebinder]

Unfortunately, I've had such experiences. Also, since Im the one who sends the labs, I'm usually the first to see the results (since I only have 2 patients results to look out for) and for that reason only, I'll let the resident know.

The unit can get strenuously busy for the residents at night. There is no way in hell a resident can keep up with lab results of 9 or 10 patients if he is admitting another patient and trying to place all of that pts lines and write all the million admission orders and of course trying to diagnose etc. It would be nice if you doctors recognized that we are your eyes and ears in the ICU and you should be grateful that so many of us are vigilant, have good assessment skills, can easily pick up when someone is crashing and let you know. I'm sorry, that's the way it goes in the ICU - it's always the nurse who is in the room and picking up on nuances, not the doctor. We get to play. That's why I love my job. I wouldn't want the responsibility of diagnosing, dosing, writing tons of notes, placing lines, and all the other stuff...I give you guys a lot of credit for doing all you do. i wouldn't be a doctor in a million years - that's a lifetime of headaches. It seems like we hardly ever get credit for what we do. Oh well, I could care less in real life.

Really unsure why the thread continues to divert to MD doing the work of a nurse. They are absolutely different sets of mentality and require different information to grasp. I would never advocate that an MD be able to be to work as a nurse (maybe 20 years ago when nursing was less complicated?). The thread is about an MD trying to get work as a PA. The 2 years of clinicals the MD does more than qualifies them to act like the fresh PAs with 1 year of clinical training. PANCE exam vs USMLE? Please lets not go there. People who had acting internships in their fourth years? Come on, without a doubt there.

 

[deleted6669]

as soon as you give me credit for the md courses and rotations that are exactly the same as pa courses and let me do an abridged version of medschool then we can talk about md's working as pa's......ain't gonna happen either way.....

 

[Smurfette]

Really unsure why the thread continues to divert to MD doing the work of a nurse. They are absolutely different sets of mentality and require different information to grasp. I would never advocate that an MD be able to be to work as a nurse (maybe 20 years ago when nursing was less complicated?). The thread is about an MD trying to get work as a PA. The 2 years of clinicals the MD does more than qualifies them to act like the fresh PAs with 1 year of clinical training. PANCE exam vs USMLE? Please lets not go there. People who had acting internships in their fourth years? Come on, without a doubt there.

I have the utmost respect for nurses. To compare MDs with RNs is like comparing apples and oranges. Different roles and different training.

Regarding PAs: I have worked with PAs...both experienced and brand new. I have worked with med students of all years. I have worked with PA students and medical students on the same service simultaneously. Obviously, there are outstanding PA students and outstanding med students, just as there are crappy med students and crappy PA students. What I can say is that, generally speaking, the med students (I'm talking mid to late 3rd years here) are better, on average, than the PA students (in their final year of training). The knowledge base is different between the two groups, as the PA students have less understanding of the physiology behind medical conditions and more of a focus on diagnosis (symptoms x,y,z=A, B or C). This is due to a difference in schooling. Mostly though, I have found the med students more eager and motivated than the PA students [a 9 to 5 rotation is NOT realistic in surgery]. Others in this thread have talked about PA "clinical skills" and I am not sure what that means to others, because a lot of things qualify as "clinical skills". The PAs I've worked with do excellent H&Ps and patient interactions, but are lacking (IMO) in skills such as lab interpretation, minor procedures and so on (one very experienced PA I worked with had no idea how to do an ABG and had never seen one.). Obviously, this is variable with the PAs area of focus and school, as it varies with med students too, but after graduation, the med students-turned-interns will learn very quickly these skills (well, excluding the derms and ophthos, etc. 😛). I've never seen the PANCE exam, but I would think a med student could pass it (assuming it's based on medical knowledge and not legal "what a PA can and can't do" type of stuff); but I think a PA student would have a hard time passing USMLE step I with all the pathophys and obscure crap on there---step II would probably be easier since it's more clinical.

A graduated med student should be capable to do PA work as they have been adequately trained for it (2 years of clinical rotations under their belt and more medical knowledge comparatively)...just as a graduated PA student is capable of being a physician extender. Both interns and PAs have big learning curves and are supervised closely. Interns can learn a LOT from experienced PAs.

 

[southerndoc]

No no, residents write vent changes...not RTs....the nurses and RTs just make the vent changes then tell the resident.

This system works well since the RT is the vent expert (esp. on nights) and this way we don't have to burden the resident. This is never a problem, ever.

This is reality in some hospitals. Especially on night shift.

Act on a problem now, get the order later.

It probably works that way in most private hospitals where there are no residents, but I would think that RT's and RN's wouldn't be making vent or medicine changes (other than titrations) without a resident FIRST giving the order what to do. If they are making changes and then notifying the resident and asking for an order, then it robs a resident of learning opportunities. Vent management is complicated, and residents should learn this as early as possible during their residency.

Perhaps I wasn't clear in my previous post. Residents specify the vent changes BEFORE they are made. There is none of this notification stuff after a vent change. I don't think it's just my institution because it was this way during medical school as well (from what I remember of my critical care rotations).

Regarding residents not being able to look up labs with 12 patients while admitting patients, I never had a problem with this when I was cross-covering more than 25-30 patients and admitting 6-10 patients/night. Interns and residents that work together can accomplish this without any problem at all. Yes, you are correct, when a nurse has only 2 patients, he or she usually can find the labs first. I would hope that if I haven't acted on a critical lab by the time he or she sees it, then he or she will page me. However, not all hospital labs call the nurse for critical labs. I have received numerous pages during inpatient rotations and numerous phone calls while in the ED for critical labs. I think they should be reported directly to physicians, and I'm happy when the lab calls with a critical value.

At any rate, I do not want to take away from the MD/PA discussion. Therefore, I will refrain from further commenting on the role of nurses. This is not meant to be an MD v. RN discussion. I am grateful for the work nurses do, and I respect their jobs. I have both learned from and taught nurses, RT's, and other medical personnel.

 

[sarahs007]

Wow, it's interesting how things are done differently in different regions and hospitals.

What I described is actually the status quo for my ICU in one of the best teaching hospitals in the country (I won't say which but top 3 or 4). The residents would not know what vent changes to make, frankly. The only people who write vent change orders are the attending, the pulm/crit. care fellow...they give sign off instructions to the night resident and interns stuck there, but they do not generally make independent decisions as to vent changes without RT input.

As for critical labs, that is called to the ICU, where the secretary takes the call and informs me (usually I've already seen it logged into the computer) and I immediately page the resident and tell him or her. Very rarely have, for instance, units of blood or platelets have been ordered and I am not up on what's happening - any nurse should be this involved.

We replete K and Mg overnight without orders and get the orders around 5 am from the intern. These aren't issues and it's quite efficient this way.

Things are different in different regions, that's for sure. You seem very paternalistic and that's a function of your training. And its great. You're right though - this discussion is pointless and off topic, so we'll end it now. 🙂

 

[Blade28]

This conversation is foolish. All three (RN,PA,MD/DO) have a different focus and goals of practice. Fresh out of school they all need direction and supervision.
...
As healthcare workers, it is our responsiblity to RESPECT the different parts of the healthcare team, instead of trying to make our own part more important than the other team members. As an experienced nurse (of many years), I have come to learn (in a hospital setting), that none of us can function one without the other.

Some sanity in this crazy thread! 👍

 

[primadonna22274]

I don't think any of us are debating whether a graduate physician can do the work of a PA--but politically speaking it won't happen. The AAPA and constituency groups made it clear years ago that there is no shortcut to becoming a PA, because we felt we had to protect ourselves from non-AMA-accredited-PA-program-trained persons trying to become licensed as PAs. This is supposed to ensure that you get a (somewhat) guaranteed product when you hire a certified PA. Now, of course, there are individual differences and absolutely I agree that there are brilliant PAs and substandard PAs as well.
But there you go. Like E said, ain't gonna happen.

 

[RNtoMD2011]

Unfortunately, I've had such experiences. Also, since Im the one who sends the labs, I'm usually the first to see the results (since I only have 2 patients results to look out for) and for that reason only, I'll let the resident know.

The unit can get strenuously busy for the residents at night. There is no way in hell a resident can keep up with lab results of 9 or 10 patients if he is admitting another patient and trying to place all of that pts lines and write all the million admission orders and of course trying to diagnose etc. It would be nice if you doctors recognized that we are your eyes and ears in the ICU and you should be grateful that so many of us are vigilant, have good assessment skills, can easily pick up when someone is crashing and let you know. I'm sorry, that's the way it goes in the ICU - it's always the nurse who is in the room and picking up on nuances, not the doctor. We get to play. That's why I love my job. I wouldn't want the responsibility of diagnosing, dosing, writing tons of notes, placing lines, and all the other stuff...I give you guys a lot of credit for doing all you do. i wouldn't be a doctor in a million years - that's a lifetime of headaches. It seems like we hardly ever get credit for what we do. Oh well, I could care less in real life.

I totally agree with you. (Even though I am going to become an MD.) One of my biggest sources of irritation is the first year intern who comes in trying to "teach a nurse" who has been on the unit for many years. It is beyond me when they don't realize/recognize that we know our stuff too. And while they learn more text book stuff than a nurse will ever need to know, clinically they should understand that in the begining they may be working with a nurse that can run circles around them. Instead of trying to challenge the nurse, (as many new interns and residents do) they should pay attention, and take advantage of the knowlegde the nurse may have to offer.

Every year, we deal with the "new batch" that comes in trying to show off for their superiors by challenging or being bossy towards the nurse. All I have to say is that it always turns out to be a BIG MISTAKE.

 

[jimmybee]

This whole thread is intriguing.

First of all, if you wanted to work as a PA, you should have went to PA school and not medical school. When I was in undergrad, I debated between the two, but ultimately, I thought that I wouldn't be happy working under the supervision of others my entire life and chose to go to medical school. This is probably the biggest reason people choose being a doctor over being an assistant.

Now that I am half way done with my residency, I am better able to evaluate the pros and cons between the two occupations. Overall, I think that I would have been better off choosing the assistant route due to my unforseen value on family life and free time. Ultimately, assistants normally get a large amount of autonomy (depends on the group/physician that you work for) but there is that glass ceiling. In my experience, the PAs don't normally function much more than a really strong senior resident in a particular field (after a couple years of on the job training) and then you stay at the level the rest of your life.
Being a physician, on the other hand, has made me somewhat jaded due to lack of adequate compensation for the long hours that I have put in during school and those that I do now. Like the original posts stated, I feel doopted (spelling?) out of 130K. Most of us our not happy with the returns that our student loan investments have gotten us.

Now, would I be happy as a PA? Well in the short term, definitely! I would be working 50-60 hours/week at the most (without call) and making more than double what I have now with half the amount of loans. Longterm, I still honestly do not know.

What's interesting is that my close friends (three undergrad classmates), who are all currently PAs, are more certain that going to medical school was the right play in the long run than I am. It's one of those things where you say "I wish I had that life. I bet you wish you had mine."

I guess what I am trying to say is that pre-professional students in undergrad really need to look into their options more than most of us did. What's difficult is that during that period of a students life, it's difficult to know what is going to be important to you. In my experience, I knew that q4 call for 3-4 years was going to be difficult, but you don't really know how difficult until you do it for a month or two in a row. As a pre-med and medical student, I just figured that everyone else got through it and therefore I would too. Well, I am getting through it, but I'm not happy doing so. Right now I am just hanging onto the promise that things will get better when I am done, but I still am not sure.

The safe play would have been to be a PA. Less financial and personal sacrifice for a gaurenteed well paying job that would allow me to live a more unrestricted lifestyle while still caring for people.

My long two cents worth....

 

[primadonna22274]

Yup jimmybee, you got it right. I know where your PA friends are because I'm right there with 'em.
Suffice it to say that I wasted no time in talking my baby sister OUT of ditching MD/DO for PA. I told her she should stick with the original plan and so far she has (but not a med student yet, finishing her BS and doing some cancer research at the moment).
Why does the grass always look greener? Cuz there's so much sewage on the other side!
(Goes both ways.)

 

[dutchman]

I feel some sanity creeping into this thread, which is unacceptable. Can we please focus on PA bashing. MacGyver, that’s your cue.

 

[RNtoMD2011]

I feel some sanity creeping into this thread, which is unacceptable. Can we please focus on PA bashing. MacGyver, that's your cue.

LOL!

 

[deleted6669]

I feel some sanity creeping into this thread, which is unacceptable. Can we please focus on PA bashing. MacGyver, that’s your cue.

here, I'll do it for you-
pa's are trying to take over the world
they are an unsafe menace to society and are killing patients left and right
every md in the world is better at everything than every pa
pa's and np's should only assist in surgery so a doc is watching them every minute because on their own they can't be trusted to do anything


did I misss anything.....🙂

 

[VFTW]

Would a PA be more functional than an intern at first start? Maybe - they have more intensive clinicals.

???

 

[chimichanga]

The MD's job is more important than the nurse's or the PA's. The MD supervises both. The MD decides the treatment plan and is held responsible for it. Enough with the PC nonsense.

-The Trifling Jester

laughable

 

[8744]

Oh please. Interns are clinically useless. They can't place lines to save their lives...how many pneumothoraxes have i seen...how many interns have I seen in a code, sitting there dumbfounded...I also loved the night I had a patient in horrific ARDS. I started propofol, fentanyl, nimbex, insulin drip and levophed on her before the intern went in the room because the intern was disappeared, thereby rendered useless.....respiratory therapist and I all own our own with the patient, playing with the vent to try to get her o2 sat past 80%, who turned into the sickest person I've ever taken care of.......oh nevermind, no pointing fingers. Anyway, interns are clinically inept...the humble (usually smarter ones) know this, the smug ones don't know this and trip on their face at some point later in the year. Book knowledge YES...they are veritable medical dictionaries. That doesn't equate clinical knowledge. Be humble. It's a key to success whether it makes sense to you know or not.

Yeah, but a PA fresh out of PA school would do better than an intern? I at least had two months of ICU rotations as a medical student. You kind of missed the point. The OP wants to work as a PA, not a physician. He is not saying he is ready to be an attending, just ready to be a PA which is not a stretch at all.

See the point? A PA fresh out of training can make 60-70K pretty easily with easy hours and an easy lifestyle. A resident suffers and toils hours that would be considered war crimes in most countries for 40K a year with a huge debt load and is better trained, by virtues of twice as much didactics and twice as much clinical experience as a PA.

It is an article of faith, blindly accepted by many mid-levels, that medical students don't learn anything of use in their four years of training. This is patently ridiculous. We had PA students rotating with us in medical school and they did less, worked fewer hours, and generally got a lot less head-****ing from the attendings and the system. If we weren't learning anything, by what magical power did the knowledge o'erleap us and fall unto those crafty PA student?

 

[chimichanga]

... A PA fresh out of training can make 60-70K pretty easily with easy hours and an easy lifestyle. A resident suffers and toils hours that would be considered war crimes in most countries for 40K a year with a huge debt load and is better trained, by virtues of twice as much didactics and twice as much clinical experience as a PA.

It is an article of faith, blindly accepted by many mid-levels, that medical students don't learn anything of use in their four years of training. This is patently ridiculous. We had PA students rotating with us in medical school and they did less, worked fewer hours, and generally got a lot less head-****ing from the attendings and the system. If we weren't learning anything, by what magical power did the knowledge o'erleap us and fall unto those crafty PA student?

I respect your knowledge, and defer to it...

However, you chose your lot in life...So please don't fuel this silly debate with your hardships...

We make our own realities...

You knew the sacrifice going in...

Don't begrudge someone for his/her choice...

Don't hate the player, hate the game...

Now, if the player (PA/NP student) thinks he is better than the teacher (likely a physician), then he is fair game...But, don't paint all of them with a broad brush...Most know their place, and are happy there...

I know I am

I wouldn't want med school, internship, and residency (from reading posts at SDN, you are a pawn and a slave)...BUT, my hats off to those who choose this route...

Just remember, without the (collective) departments of engineering, housekeeping, medicine, nursing, PT, OT, RT, et freaking cetera, the hospital would fail...

signed, a MURSE

 

[dutchman]

I respect your knowledge, and defer to it...

However, you chose your lot in life...So please don't fuel this silly debate with your hardships...

We make our own realities...

You knew the sacrifice going in...

Don't begrudge someone for his/her choice...

Don't hate the player, hate the game...

Now, if the player (PA/NP student) thinks he is better than the teacher (likely a physician), then he is fair game...But, don't paint all of them with a broad brush...Most know their place, and are happy there...

I know I am

I wouldn't want med school, internship, and residency (from reading posts at SDN, you are a pawn and a slave)...BUT, my hats off to those who choose this route...

Just remember, without the (collective) departments of engineering, housekeeping, medicine, nursing, PT, OT, RT, et freaking cetera, the hospital would fail...

signed, a MURSE

Yet you show up with 50 gallons of gasoline.

 

[Trifling Jester]

If any of you want to really test out this whole namby-pamby "team" concept try this out. The next time you're presenting on morning report and the attending asks you why you chose those vent settings just tell him that you consulted the "vent experts" (AKA the respiratory techs according to some on here) and they told you the settings. See how that flies with your staff.

Your team's captain,
The Trifling Jester

 

[deleted6669]

If any of you want to really test out this whole namby-pamby "team" concept try this out. The next time you're presenting on morning report and the attending asks you why you chose those vent settings just tell him that you consulted the "vent experts" (AKA the respiratory techs according to some on here) and they told you the settings. See how that flies with your staff.

Your team's captain,
The Trifling Jester

....dude....aside from a pulmonologist or critical care intensivist r.t's are the experts at vent management. they spend 2 yrs doing almost nothing else.....ever taken a critical care course like FCCS? (fundamental critical care support). guess who teaches all the vent material....yup, r.t.'s.....

 

[Bitsy3221]

Another tired MD-PA debate. Sigh.

FWIW, I went to PA school, worked as PA, then went to an allopathic US med school, now I'm a resident in one of the rather demading specialties. So I think I have a fairly good perspective to weigh in here.

PA school, at least for me a few years ago before one popped up on every corner, was a very, very demanding two+ years. We used the same textbooks I later used in med school, and although we did not get into as much detail (since, obviously, we didn't have as much time), we did make it through them. I had more hours a day in lecture in PA school than I did in med school, and as such I had to study more hours at night than I did as a medical student. PA school had a bit less non-medical "fluff" than med school (i.e. ethics, medical humanities, etc.) So that is how we compensated for less time in the classroom.

On the wards, we did the exact same curriculum as the local medical school, and took old revised shelf exams at the end. I can't speak for other programs or the experiences some of you have had with "lazy" PA students, but I was taking in-house, overnight call q 3 with no going home post call. I worked my arse off. I had the same expectations as the third year medical students. I also had four months of elective time, which was spent in the ICU, again doing the same curriculum as the fourth year medical students.

Graduating, I was still scared s&$%less. I ended up working for a great group in an academic setting, so in addition to learning on the job, I was also able to attend (and eventually present at) the same lectures and rounds as residents, so I learned a lot. Still, I knew (especially in the ICU) that I did not have nearly the grasp of physiology that the physicians had but that was fine--that was not ever intended to be part of my training.

Med school was challenging but a lot less so, in part b/c I had done a lot of it before in PA school (mostly the second year) but also because I think med school, or at least my med school, had a lot of time consuming, low yield projects and lectures. I had far more free time in med school than I did as a PA student. I was still able to work as a PA an average of 20-24 hrs/week and I still graduated AOA and trust me--I am no genius.

Now to be honest, I do think that a new grad could work as a PA--they have all the same skills and the lack of instruction in the "role of the PA" could be learned easily. But to fair, at least in my experience, a motivated PA grad could probably do the work of an intern as well (they just don't want to). It is the steep learning curve in residency that really makes the physician.

 

[deleted6669]

bitsy- sounds like we had similar experiences in pa school. I also rotated with medstudents, took long call, worked 24+ hr shifts, covered the icu,etc
my 1st job was at an e.d. that also had an fp residency. my 1st yr they treated me like an intern with respect to pt load, responsibilities, etc
my 2nd yr and thereafter I precepted interns on a procedures rotation.
I know several pa's who have gone on to medschool who report similar comparisons to what you mention here. for instance pacmatt and bandit. matt aced his usmle's( >95%) while working 24 hrs/week as a pa and matahed at a competitive md em residency. bandit is an ms4 now and still working 24 hrs/week as a pa. he has already been offered an em spot outside the match.
also I agree with this statement:
"Now to be honest, I do think that a new grad could work as a PA--they have all the same skills and the lack of instruction in the "role of the PA" could be learned easily. But to fair, at least in my experience, a motivated PA grad could probably do the work of an intern as well (they just don't want to). It is the steep learning curve in residency that really makes the physician."

 

[MacGyver]

Now to be honest, I do think that a new grad could work as a PA--they have all the same skills and the lack of instruction in the "role of the PA" could be learned easily. But to fair, at least in my experience, a motivated PA grad could probably do the work of an intern as well (they just don't want to). It is the steep learning curve in residency that really makes the physician.

Woah back up a minute. Are you honestly trying to tell me that a PA with 3 years of experience after graduating does not get the same training that a MD + 3 year IM residency gets?

That cant be right. I've heard emedpa and a bunch of other PAs swear up and down that their work experience after graduating was identical to a resident.

So lets get you on record here. Is it your position that an AVERAGE 3rd year resident is better trained or superior to an AVERAGE PA grad with 3 years of experience?

Think about what you say carefully the PA apologists are watching you. 🙄




P.S. Whether PA = MD education is an argument that I'll leave for another day. But I'm not going to sit here and listen to a bunch of fools tell me that a 2 year PA education is SUPERIOR to a 4 year MD program. Thats just BS and you know it.

 

[BlackSails]

So lets get you on record here. Is it your position that an AVERAGE 3rd year resident is better trained or superior to an AVERAGE PA grad with 3 years of experience?

In those 3 years of experience, a resident will work many more hours than a PA.

 

[deleted6669]

"Now to be honest, I do think that a new grad could work as a PA--they have all the same skills and the lack of instruction in the "role of the PA" could be learned easily. But to fair, at least in my experience, a motivated PA grad could probably do the work of an intern as well (they just don't want to). It is the steep learning curve in residency that really makes the physician"

she said nothing about someone who had completed a residency. she was speaking of a new pa grad vs a new md grad. read the above.
of course on average an em residency grad( for example) would know more em than a pa who had worked for 3 yrs in em right after graduation. no one is arguing that.
that em pa would know more em though than an fp or im doc who had just completed 3 yrs of residency. people know what they do every day. If you do the same thing every day for years you get good at it. I can run circles around any physician in the e.d. who is not an e.d. attending.
we have a few FP and IM attendings who work in the e.d. a few shifts a month. they are much less productive than all the pa's in our group.the last shift I worked with 1 I saw 35 pts to her 9( similar acuity taken from the same rack).
I know guys who have been em pa's for 20+ yrs who know more em than a new em residency grad but the em doc with 20+ yrs knows as much or more than they do.

 

[Coastie]

MS-3 knowledge at the end of 3rd year should be vastly ahead of a PA in his or her final year.

If not, they are in trouble for Step II.

PA's have their roles, and like I've said before, I have some good friends who just graduated PA school. However, on helping them prep for their boards, the answer to this PA grad vs MD grad became overwhelmingly obvious.

I have the utmost respect for nurses. To compare MDs with RNs is like comparing apples and oranges. Different roles and different training.

Regarding PAs: I have worked with PAs...both experienced and brand new. I have worked with med students of all years. I have worked with PA students and medical students on the same service simultaneously. Obviously, there are outstanding PA students and outstanding med students, just as there are crappy med students and crappy PA students. What I can say is that, generally speaking, the med students (I'm talking mid to late 3rd years here) are better, on average, than the PA students (in their final year of training). The knowledge base is different between the two groups, as the PA students have less understanding of the physiology behind medical conditions and more of a focus on diagnosis (symptoms x,y,z=A, B or C). This is due to a difference in schooling. Mostly though, I have found the med students more eager and motivated than the PA students [a 9 to 5 rotation is NOT realistic in surgery]. Others in this thread have talked about PA "clinical skills" and I am not sure what that means to others, because a lot of things qualify as "clinical skills". The PAs I've worked with do excellent H&Ps and patient interactions, but are lacking (IMO) in skills such as lab interpretation, minor procedures and so on (one very experienced PA I worked with had no idea how to do an ABG and had never seen one.). Obviously, this is variable with the PAs area of focus and school, as it varies with med students too, but after graduation, the med students-turned-interns will learn very quickly these skills (well, excluding the derms and ophthos, etc. 😛). I've never seen the PANCE exam, but I would think a med student could pass it (assuming it's based on medical knowledge and not legal "what a PA can and can't do" type of stuff); but I think a PA student would have a hard time passing USMLE step I with all the pathophys and obscure crap on there---step II would probably be easier since it's more clinical.

A graduated med student should be capable to do PA work as they have been adequately trained for it (2 years of clinical rotations under their belt and more medical knowledge comparatively)...just as a graduated PA student is capable of being a physician extender. Both interns and PAs have big learning curves and are supervised closely. Interns can learn a LOT from experienced PAs.

 

[Trifling Jester]

....dude....aside from a pulmonologist or critical care intensivist r.t's are the experts at vent management. they spend 2 yrs doing almost nothing else.....ever taken a critical care course like FCCS? (fundamental critical care support). guess who teaches all the vent material....yup, r.t.'s.....

Good. Then you should have no problems approaching a resident and convincing him/her to pursue the scenario I've outlined above. Let me know how it turns out.

-The Trifling Jester

 

[DebDynamite]

deleted- wring thread

 

[chimichanga]

If any of you want to really test out this whole namby-pamby "team" concept try this out. The next time you're presenting on morning report and the attending asks you why you chose those vent settings just tell him that you consulted the "vent experts" (AKA the respiratory techs according to some on here) and they told you the settings. See how that flies with your staff.

Your team's captain,
The Trifling Jester

just my experience in many years in ER/ICU in many hospitals (n>15):

Doc's written orders: Vent settings per RT; RT then writes settings as a verbal order...

ER pt just tubed by doc...doc to RT: "What settings do you want"
RT gives settings, doc transcribes them to admit orders...


Not to say that pulmonologists and intensivists don't set vents, BUT in most hospitals, RT makes the settings...

It's the teaching hospitals that the pulmos, residents, etc. make the settings...In the rest, RT does...

 

[deleted6669]

Good. Then you should have no problems approaching a resident and convincing him/her to pursue the scenario I've outlined above. Let me know how it turns out.

-The Trifling Jester

our residents already consult r.t. for the vast majority of vent changes and issues.

 

[deleted6669]

MS-3 knowledge at the end of 3rd year should be vastly ahead of a PA in his or her final year.

If not, they are in trouble for Step II.

PA's have their roles, and like I've said before, I have some good friends who just graduated PA school. However, on helping them prep for their boards, the answer to this PA grad vs MD grad became overwhelmingly obvious.

sorry to break this to you but performance on a written test has nothing to do with clinical competence. the resident at my local program with the highest step 3 scores almost got kicked out of the program for being clinically incompetent with actual breathing patients.....

 

[fab4fan]

I disagree. A PA is a "physician extender" and is working under the supervision of the doc. When they're good they're really valuable.

Nurses are a different animal. If medicine is about assessment, diagnostics and treatment nursing is about healthcare delivery. They are the ones putting the rubber to the road or the meds in the veins. Yeah, I decide on the meds and the amounts but they have to take care of the logistics of making that happen. Do any of you guys know which drugs are in the pyxis or have to be ordered from pharmacy? What has to go in push vs. piggyback vs. slow infusion? How do you set up a pump? Do you know how to actually give a patient X mcg/Kg/min of something? Do you know what is compatible with what in a line? What if that line is running D5W vs. NS vs. Bicarb (because it changes with each one)? Do you do all your own splinting and bandaging? Do you know who to instruct a patient about using crutches or taking care of a foley at home?

Nursing is a different skill set. Could a new grad do the work of a PA? Probably. Could they do the work of a nurse. No. Actually a paramedic would be better at playing nurse (not competent, just better) than a fresh out MD or DO.

Thank you, docB.

 

[billydoc]

Yeap, I can certainly attest to that about RTs b/c of observing it many times. BTW same goes for nursing and the rehab disceplines. Many times the RN will run it by doc just to get an O.K on the order. But essentially it's the RN who came up with that Tx plan, not b/c s/he is so briliant. But just like emedpa said, if you do something for a long time (generally speaking) you become quite good at it. That's all there is to it.

But as usual SDN thing is that we are waaaaaaaaaaaay off topic, and and. I think the OP asked if he or she could work as PA after graduating a med school. I think it's been answered ad nauseum here. Yes, you have the ability, and the knowledge, but NO, you won't be allowed b/c you are a doctor (albeit w/o residency) and not a PA. End of story. Case closed. Can we all just let this thread die already?

Thank You.

just my experience in many years in ER/ICU in many hospitals (n>15):

Doc's written orders: Vent settings per RT; RT then writes settings as a verbal order...

ER pt just tubed by doc...doc to RT: "What settings do you want"
RT gives settings, doc transcribes them to admit orders...


Not to say that pulmonologists and intensivists don't set vents, BUT in most hospitals, RT makes the settings...

It's the teaching hospitals that the pulmos, residents, etc. make the settings...In the rest, RT does...

 

[Tired]

sorry to break this to you but performance on a written test has nothing to do with clinical competence. the resident at my local program with the highest step 3 scores almost got kicked out of the program for being clinically incompetent with actual breathing patients.....

You know that this is an aberation. Most people who are brilliant on exams are also brilliant in clinical practice. Both require pattern recognition and application of acquired knowledge.

 

[Dr JPH]

We all know that PAs are better than doctors so cant we move on to another issue? 😉

 

[Blade28]

It's the teaching hospitals that the pulmos, residents, etc. make the settings...In the rest, RT does...

Probably true in the vast majority of hospitals. Well-put.

 

[Coastie]

Dude, I said should be, not always is.

Highest step 3 scores..Are you kidding me? Nobody cares about Step 3.

Seriously, a brand new pa grad vs a brand new MS-4? The MS-4 should win everytime.

sorry to break this to you but performance on a written test has nothing to do with clinical competence. the resident at my local program with the highest step 3 scores almost got kicked out of the program for being clinically incompetent with actual breathing patients.....

 

[Dr JPH]

Dude, I said should be, not always is.

Highest step 3 scores..Are you kidding me? Nobody cares about Step 3.

Seriously, a brand new pa grad vs a brand new MS-4? The MS-4 should win everytime.

I agree with this.

 

[deleted6669]

Dude, I said should be, not always is.

Highest step 3 scores..Are you kidding me? Nobody cares about Step 3.

Seriously, a brand new pa grad vs a brand new MS-4? The MS-4 should win everytime.

what if the new grad pa had been an icu nurse/paramedic/r.t. for 15 yrs before pa school....they might have learned just a few clinical skills during that time and have a good idea about how to interact with pts, better I would say than someone who had not even started their residency.....
the traditional pa school applicant is already a seasoned medical professional. if we are talking about the new wave of 22 yr old bio majors without any medical experience going to pa school then you are right, the ms4 should win every time.