Can I work as a PA?

[Coastie]

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What if the MS 4 had that experience vs a new pa grad that did too? We can play these games forever. MS4 wins, everytime. I don't think the stereotypical pa nowadays is someone with tons of experience, anyway...Times have changed on that.

Even with the experience, you can't assume they are better with patients nor ahead in medical knowledge than a 26 year old M.S. 4. Everything is a case by case basis. I've worked with ARNP's with "20 years experience" who didn't have the clinical knowledge nor patient skills of a mature MS-3.

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.

 

[Faebinder]

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.

What if the new grad med student had been an icu nurse/paramedic/r.t. for 15 years before med school....they might have learned just a few clinical skills during that time and have a good idea about how to interact with patients, better I would say than someone who had not even started their residency or working as a pa.....

Scenarios can be flipped everywhere. Are you making it a requirement for PAs to become ICU nurses for 15 years before going to PA school?

 

[Dr JPH]

There is a fine line between defending a given profession and giving ridiculous scenarios to try and prove a point.

Are PAs necessary? In some cases yes.

Are they at the level of a physician? No...and thats why their education is dramatically truncated compared to that of a physician.

Real world experience does count for a lot. But you have to possess the rock solid foudnation of anatomy, physiology, biochemistry etc in order to deal with situation that are outside the lines and are not the typical case.

See one, do one, teach one works just fine as long as nothing changes among the three.

When it does change who is the one that has the education to make the changes necessary? The physician.

There is a different between a mid level practitioner reactionary and a physician.

JMHO

 

[mig26x]

on friday I saw a patient at my continuity clinic that her PCP was a NP, the patient kept calling her "my doctor". I was very close to telling her she's not a doctor but for some reason I didnt.

 

[Dr JPH]

on friday I saw a patient at my continuity clinic that her PCP was a NP, the patient kept calling her "my doctor". I was very close to telling her she's not a doctor but for some reason I didnt.

Its easier not to get into that conversation.

I wonder if that was the patients perception or if the NP/PA was introducing themselves as the doctor...or not correcting the patient when addressed as such. Either way its irresponsible and wrong.

 

[deleted6669]

"What if the MS 4 had that experience vs a new pa grad that did too? We can play these games forever. MS4 wins, everytime. I don't think the stereotypical pa nowadays is someone with tons of experience, anyway...Times have changed on that"

the average pa student at a quality program has prior medical experience, although as you say the duration and intensity of experience seems to be decreasing. it is a rare medical student who has significant prior medical experience beyond volunteering or maybe emt-1. yes, an ms 4 with significant prior medical experience is ahead of the game. a more typical ms 4 only has 2 yrs of clinical rotations as the sum total of their experience. trust me on this, I precept pgy1-3 fp residents and have for over 10 yrs. I know the clinical level of an avg new fp resident.

"There is a fine line between defending a given profession and giving ridiculous scenarios to try and prove a point."
until a few yrs ago a very experienced pa applicant was not a "ridiculous scenario" but an "avg applicant". this is still true at the top programs. look at university of washington/medex. their MINIMAL experience requirement is 4000 hrs. of those admitted the actual avg is 8000 hrs. I had 10 yrs experience as a medic and er tech when I started pa school and was on the low end for experience in my class. we had lots of 35-45 yr old nurses, paramedics, r.t.'s, etc

could an ms4 do the work of an avg new grad pa? sure. could they replace an experienced specialty pa? no. this is why specialty pa's precept residents.
could an avg pa new grad slide into an md primary care residency as a pgy 1 and function with competence equivalent to a recent ms4? yes. could they function as an attending? no. there are several pa residencies out there that train pa's alongside physicians for the pgy-1 yr. same responsibilities, call, etc. the difference is that after 1 yr the pa graduates with a good understanding of the specialty and the physician continues on to gain mastery of the specialty. it is the directed teaching experience of residency that sets the physician apart as the expert in their field. a new grad pa is qualified to practice medicine with the indirect supervision of an attending physician. a new grad md is ready to start training to become that attending.

fyi- recent prior experience poll at the pa forum:
No. of Paid Healthcare Exp Hours at the time of PA School Interview? #/%
Less than 100 hours 14 9.46%
100 - 250 hours 8 5.41%
251 - 500 Hours 2 1.35%
501 - 1000 Hours (3 - 6 months) 8 5.41%
1000 - 2000 Hours (6 months to a year) 14 9.46%
2000 - 4000 hours (1 - 2 years) 14 9.46%
4001 - 10,000 hours (2 - 5 years) 30 20.27%
10,001 - 20,000 hours (5 - 10 years) 28 18.92%
More than 20,000 hours (more than 10 years) 14 9.46%
No Paid Experience, Volunteer/Shadowing Only 16 10.81%
Voters: 148.

 

[Coastie]

I don't think a new pa student could "slide into" a pgy-1 spot and function at the level of a recent md grad.

Unless, of course, I thought PA school = MD/DO school, which you seem to think.

Come on man, we love PA's, but for goodness sakes already, they aren't doctors. That doesn't make them evil or less of a human being, it just makes them a PA.

 

[deleted6669]

I don't think a new pa student could "slide into" a pgy-1 spot and function at the level of a recent md grad.

Unless, of course, I thought PA school = MD/DO school, which you seem to think.

Come on man, we love PA's, but for goodness sakes already, they aren't doctors. That doesn't make them evil or less of a human being, it just makes them a PA.

I don't think pa school= md school.
I think the difference between a new pa and a new md is the md's better understanding of the basic medical sciences. some times this makes a difference clinically( say on a subspecialty internal medicine service) sometimes it doesn't (say in an avg fp or peds practice or urgent care setting).
medschool is 150 weeks in 4 yrs, pa school is 100 weeks in 2 years. we get 2/3 of the training that a new grad md gets. admit it, a lot of ms4 yr is scurrying around trying to arrange interviews and taking electives. there even used to be programs at several medschools allowing md's to skip ms4 and go right into an fp residency so that ms4 and pgy1 were the same yr. these folks did just as well as traditional students but the option was discontinued as the aafp didn't like the idea of folks thinking fp could be done as a 2 yr residency.
for all intents and purposes ms3=pa2. pa programs schedule pa students into slots that would otherwise be occupied by an ms3. as a 2nd yr pa student I was treated exactly like an ms3 in every regard. I have md evals that say "emedpa stood out as the finest student on this rotation among a large group of pa and medical students". are all pa students as motivated as I was? of course not. are pa's competent to deliver primary care services or assist in surgery the day they graduate? yes.
not trying to have an md vs pa war here, just trying to advocate for the competence of new grads, both md and pa, to start learning under direction as safe beginners.
peace-e

 

[Dr JPH]

Come on man, we love PA's, but for goodness sakes already, they aren't doctors. That doesn't make them evil or less of a human being, it just makes them a PA.

Agreed.

I dont think anyone is putting PAs down, but rather putting them in their place.

 

[drbon]

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.

Ok, i'm not arguing that most interns are clinically-challenged, but what about PAs in their first year of working after graduation? are they, at this point in their careers, better at clinical work than interns? i'm just asking, because in some of my med school clinical rotations there are PA students as well. and they do all the things the med students do, but the difference is, for example, their surgery rotation was a total of 5 weeks long while ours was 12. i can't see how they can graduate being better clinicians than us when their rotations are significantly shorter....

 

[Dr JPH]

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.

Are you for real?

The first few weeks of internship perhaps we struggle. Im nearly a month into my internship and I dont feel clinically useless. Ive already had my share of issues that I think I dealt quite well with. I also know the areas where I need to improve.

Dont take out your frustrations simply because we went to medical school and have greater autonomy one day after graduation than you will have in your entire career.

EDIT: And if you want to talk about clinically inept talk to me about the graduate nurse who, during a code, was more concerned with the fact that the patients foley had been dislodged than the absence of a pulse. "Foley is out! Foley is out!" She screamed as the educated people did compressions and pushed meds. 😀

 

[Dr JPH]

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

😕 😕 😕

Are you kidding me?

Tell me how thats so?

Tell me how my clinical education was less intense than a PA student who rotated at the SAME hospitals and on the SAME services as I did.

Not only that, but I did it TWICE as long.

How do they get a more "intensive" clinical experience?

Their clinical experience was more BRIEF and didnt cover all the areas that my education did.

PAs rotate through the basic areas:

FP
IM
Surgery
OB/GYN
Peds
Psych
EMED

And perhaps they get an elective.

I had TWICE as much FP and THREE times as much IM. I also had more than 6 times as much surgery. In fact I had as much ELECTIVE time as PAs have in core rotations.

More intensive? No way.

 

[docB]

Guys, seriously.

 

[Micah6:8]

If you check my post history, you will notice the small number. I usually do not post just for the sake of posting, but after following this for a while, I decided it was time.
At whatever risk here, it is not the same. If PA=MD/DO, then I, at the ripe old age of 39, would not be heading back to med school next month. There were(are) things I love about being a PA. I have been fortunate enough to have great supervising physicians who trust me and give me a lot of autonomy. I have my own patients who see me as their primary provider. However, at the end of the day, the physician is ultimately responsible. He or she is the one I turn to when I don't feel comfortable with the complexity.
In my essay for med school, I sited a 'desire to increase the depth and breadth of my medical practice' as a primary reason for returning to school. I also knew that I was not happy knowing that I would never have complete autonomy or be able to take my career in certain directions as a PA. My friends/collegues who are MD's or DO's were very encouraging and said it was the right step for me.
I respect the role of a mid-level and hope that I will always have the opportunity to work with other professionals, but it no longer worked for me and I knew I had to go further.
Yes, PA and med students train beside one another, but JP is correct, the length of exposure is longer for Med students and the didactic years are structured very differently.
I think the key is mutual respect and the willingness to understand each person's role in caring for the patient, which should be the ultimate goal.

 

[Dr JPH]

Guys, seriously.

Sometimes this is the only thing nurses understand. Constant repetition and a stern attitude. Although you may be tired of hearing the argument we need to keep repeating it so that everyone is on the same page.

 

[deleted87716]

Sometimes this is the only thing nurses understand. Constant repetition and a stern attitude.

Actually, I think that's dog training... 😉

 

[deleted6669]

"In fact I had as much ELECTIVE time as PAs have in core rotations."

you had 54 weeks/2200+ hrs of electives? why do I doubt that......and twice as much fp? you did 24 weeks of fp in preparation for your surgical residency? also unlikely.....


"Dont take out your frustrations simply because we went to medical school and have greater autonomy one day after graduation than you will have in your entire career."

last time I checked interns present all their pts to an attending, pa's don't. doesn't sound like more autonomy day 1. you will get there but you're not there yet.....

 

[docB]

Sometimes this is the only thing nurses understand. Constant repetition and a stern attitude. Although you may be tired of hearing the argument we need to keep repeating it so that everyone is on the same page.

That is honestly one of the most smug and arrogant comments I've heard. You're just being blatently offensive to nurses.

You've got to be able to work with people. I can definitively tell you that being able to lead a team in the ED, the OR or wherever is not a right bestowed by a piece of paper. You earn it by being respectful, competent, willing to conceed when it's not important and explaining why it's important when it is.

As for who is better fresh out of school, a PA or am MD/DO here's the answer: who cares? I teach both. They're both worthless until they've picked up some experience. I hire PAs and teach interns. Trust me. And who'll be better at the end of a month has more to do with the person than the degree.

 

[deleted6669]

"As for who is better fresh out of school, a PA or am MD/DO here's the answer: who cares? I teach both. They're both worthless until they've picked up some experience. I hire PAs and teach interns. Trust me. And who'll be better at the end of a month has more to do with the person than the degree."

thank you for adding some seasoned perspective on this topic docb.

 

[Dr JPH]

You're just being blatently offensive to nurses.

Perhaps. But I'm only returning the offensive comments that were made towards me as an intern. 👍

 

[Dr JPH]

"In fact I had as much ELECTIVE time as PAs have in core rotations."

you had 54 weeks/2200+ hrs of electives? why do I doubt that......and twice as much fp? you did 24 weeks of fp in preparation for your surgical residency? also unlikely.....

Perhaps a bit of an exaggeration but my point was I have twice as much time spent in clinical education as PAs, thereby rejecting the nurses claim that PAs have more a more intense clinical experience while in school.

For clarification I had 36 weeks of electives (where the total was at least 2200 hours) and 20 weeks of FP (core FP, rural clinic, urban clinic).

I also had Psychiatry,Cardiology, EMED, ICU, Surgery, Orthopedics, OB/GYN, Peds, IMED, Anesthesia, Surgical Sub-I and Radiology.

"Dont take out your frustrations simply because we went to medical school and have greater autonomy one day after graduation than you will have in your entire career."

last time I checked interns present all their pts to an attending, pa's don't. doesn't sound like more autonomy day 1. you will get there but you're not there yet.....

Well...at least I will get there.

Im all for PAs and Im glad youre standing up for the profession...but lets be real and compare apples to apples here.

 

[deleted6669]

"Well...at least I will get there. "

hey, sometimes interns just need to be shown their place.....🙂

 

[Dr JPH]

"Well...at least I will get there. "

hey, sometimes interns just need to be shown their place.....🙂

I gotta give you a 👍 for that one.

 

[Gfunk6]

medschool is 150 weeks in 4 yrs, pa school is 100 weeks in 2 years.

I don't know how I missed this absolute gem of a statement.

4 years = 208 weeks
208 - 150 = 58 weeks off

I wish I had 58 weeks off during medical school. Obviously I went to the wrong school . . .🙂

 

[deleted6669]

I don't know how I missed this absolute gem of a statement.

4 years = 208 weeks
208 - 150 = 58 weeks off

I wish I had 58 weeks off during medical school. Obviously I went to the wrong school . . .🙂

YOU DID....SUMMERS, XMAS, SPRING BREAK, INTERVIEW FLAKE TIME 4TH YR, ETC
those are widely accepted numbers- I didn't just make them up. if you add up didactic and clinical time from medschool you get 150 weeks at the vast majority of programs. DO schools do a bit more due to extra required time in OMT.

 

[Coastie]

Wow dude. We may agree on the PA not = MD/DO thing, but man, I've had great nurses my first month of intern year. Hopefully it's not subject to change, because we work as a team, round as a team, and they have really helped me climb the steep learning curve of intern year. Oh, and they are totally cute! They actually make coming to work really fun, and I'll miss this rotation in a week and a half.

Sometimes this is the only thing nurses understand. Constant repetition and a stern attitude. Although you may be tired of hearing the argument we need to keep repeating it so that everyone is on the same page.

 

[Coastie]

YOU DID....SUMMERS, XMAS, SPRING BREAK, INTERVIEW FLAKE TIME 4TH YR, ETC
those are widely accepted numbers- I didn't just make them up. if you add up didactic and clinical time from medschool you get 150 weeks at the vast majority of programs. DO schools do a bit more due to extra required time in OMT.

First Year Christmas: 3 weeks
First Year SB: 1 week
First Year Summer: 6 weeks
Second Year Christmas: 3 weeks
Second Year SB: 1 week
Second Year straight into Third Year straight into Fourth Year
Third Year Christmas: 3 weeks. NO SPRING BREAK
Fourth Year: 2 months for interviews, the rest must be filled with required rotations (4 months) and clinical electives (6 months). Add in two weeks for Christmas.

Time off: 3+1+6+3+1+3+8+2 = 27 weeks off in 4 years.

 

[Gfunk6]

YOU DID....SUMMERS, XMAS, SPRING BREAK, INTERVIEW FLAKE TIME 4TH YR, ETC

No, really, I didn't. I should know, right?

Did it ever occur to you that students perform research or other medically-related activities over their so-called "breaks?"

 

[deleted6669]

No, really, I didn't. I should know, right?

Did it ever occur to you that students perform research or other medically-related activities over their so-called "breaks?"

You can't really count optional research as required time. just as many students go on vacation as do these alternate(brown nosing trying to spiff the CV) activities. I know lots of students who go to europe , etc the summer after ms1

 

[chimichanga]

Perhaps. But I'm only returning the offensive comments that were made towards me as an intern. 👍

yes, lowering yourself to their level is the mark of the ultimate professional...

A good nurse recognizes his limitations, and defers to the education and knowledge of an MD/DO...

A good doc recognizes the contributions of a seasoned nurse (or any nurse for that matter; read - who spends the lionshare of the time with the pt)

let's all try and do our jobs without the other, and see who loses...

 

[deleted6669]

I don't know how I missed this absolute gem of a statement.

4 years = 208 weeks
208 - 150 = 58 weeks off

I wish I had 58 weeks off during medical school. Obviously I went to the wrong school . . .🙂

FROM THE UMDNJ/RUTGERS WEBSITE FAQ REGARDING DIFFERENCES BETWEEN PA VS MD/DO:

Education
There are 140 specially designed physician assistant programs located at medical colleges and universities, teaching hospitals, and through the Armed Forces. Due to the close working relationship PAs have with physicians, PA education was designed to complement that of physician education. The programs are accredited by one national, independent accrediting agency for allied health.

The typical PA student in 1995 had a bachelor's degree and over 4 years of health care experience prior to admission to the PA program. PA programs generally require applicants to have at least two years of college education and previous experience in health care. On average, PA education is usually 24 months in length and is approximately two-thirds that of medical students (100 weeks compared to 153). Physician assistants take some of their classes with medical students.

The first phase of PA education is in the classroom, providing students with an in-depth understanding of medical sciences. Additional subjects include differential diagnosis, medical ethics, and pharmacology. The second year is spent in clinical rotations. Each year, PA programs graduate approximately 2,500 men and women.

 

[Coastie]

Rutgers data. Interesting. I gave you the weeks of vacation from my med school. Perhaps theirs is different?

I must say, though. I sat next to a freshly minted second year student-PA today at morning report (she's really cute), and she had some solid contributions to the differential diagnosis. The point is, though, that the freshly minted third year medical students run circles around her, and while they carry 5-6 patients on medicine, she is limited to 3. Great, cute, funny, smart gal, but not on the same level.

FROM THE UMDNJ/RUTGERS WEBSITE FAQ REGARDING DIFFERENCES BETWEEN PA VS MD/DO:

Education
There are 140 specially designed physician assistant programs located at medical colleges and universities, teaching hospitals, and through the Armed Forces. Due to the close working relationship PAs have with physicians, PA education was designed to complement that of physician education. The programs are accredited by one national, independent accrediting agency for allied health.

The typical PA student in 1995 had a bachelor's degree and over 4 years of health care experience prior to admission to the PA program. PA programs generally require applicants to have at least two years of college education and previous experience in health care. On average, PA education is usually 24 months in length and is approximately two-thirds that of medical students (100 weeks compared to 153). Physician assistants take some of their classes with medical students.

The first phase of PA education is in the classroom, providing students with an in-depth understanding of medical sciences. Additional subjects include differential diagnosis, medical ethics, and pharmacology. The second year is spent in clinical rotations. Each year, PA programs graduate approximately 2,500 men and women.

 

[deleted6669]

Once again anecdotal evidence....young/cute pa student most likely means no prior experience in healthcare. heres more anecdotal stories.... back when I was a pa student (in the dark ages when all pa students had experience) I ran circles around the ms3's on literally every rotation, both clinically and academically. maybe I just rotated with the dumbest medstudents of all time,it's possible. on my surgery rotation I was the only one of the students who knew virchows triad and could list risk factors for dvt/pe. isn't that pretty basic stuff? yet not one of 7 medstudents prsent knew it on direct pimping from the surgical attending. later that day the same group of students did not know what a greenfield filter was or the indications for placing one.....

 

[Coastie]

The weeks off at my med school were not 58 weeks. That cute PA story was an aside because she was a cute girl, and that's always a great story.

Once again anecdotal evidence....young/cute pa student most likely means no prior experience in healthcare. heres more anecdotal stories.... back when I was a pa student (in the dark ages when all pa students had experience) I ran circles around the ms3's on literally every rotation, both clinically and academically. maybe I just rotated with the dumbest medstudents of all time,it's possible. on my surgery rotation I was the only one of the students who knew virchows triad and could list risk factors for dvt/pe. isn't that pretty basic stuff? yet not one of 7 medstudents prsent knew it on direct pimping from the surgical attending. later that day the same group of students did not know what a greenfield filter was or the indications for placing one.....

 

[deleted6669]

"That cute PA story was an aside because she was a cute girl, and that's always a great story. "

AGREED....🙂

 

[Coastie]

See? We can be friends and agree to disagree.

" It is the hot PA that binds us. "

 

[deleted6669]

See? We can be friends and agree to disagree.

" It is the hot PA that binds us. "

much wisdom there is in this young jedi.....🙂

 

[Dr JPH]

Once again anecdotal evidence....young/cute pa student most likely means no prior experience in healthcare. heres more anecdotal stories.... back when I was a pa student (in the dark ages when all pa students had experience) I ran circles around the ms3's on literally every rotation, both clinically and academically. maybe I just rotated with the dumbest medstudents of all time,it's possible. on my surgery rotation I was the only one of the students who knew virchows triad and could list risk factors for dvt/pe. isn't that pretty basic stuff? yet not one of 7 medstudents prsent knew it on direct pimping from the surgical attending. later that day the same group of students did not know what a greenfield filter was or the indications for placing one.....

Are you sure you should be doing so much running at your age? 🙂

 

[funkless]

YOU DID....SUMMERS, XMAS, SPRING BREAK, INTERVIEW FLAKE TIME 4TH YR, ETC
those are widely accepted numbers- I didn't just make them up. if you add up didactic and clinical time from medschool you get 150 weeks at the vast majority of programs. DO schools do a bit more due to extra required time in OMT.

Are you high???



EDIT: btw, in your experience, do PAs or PA students routinely work 80 hour workweeks (NOT including study time or didactics)? If not, then the number of workweeks won't give an accurate comparison of total hours spent in the clinical situation, anyway.

 

[brainfreeze2007]

oops old thread