DO/MD vs PA vs NP

[Dharma]

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A bit off topic, but somewhat relevant to the side discussions happening here, here's a quote from one of the attendings in the FM forums:

...if you think that you could be replaced by a mid-level, maybe you should be.

And another from a different attending (who is actually quoting someone else):

"I think primary care is probably the hardest place for nurse practitioners to work because there is such a wide variety of problems and conditions we have to deal with," Nelson said. "The common (problems) are easy to treat, but not everything is common."

Anyhow, just food for thought. Carry on...

 

[SpecterGT260]

A bit off topic, but somewhat relevant to the side discussions happening here, here's a quote from one of the attendings in the FM forums:



And another from a different attending (who is actually quoting someone else):



Anyhow, just food for thought. Carry on...

that second one matches my sentiments exactly. IMO primary care should come with REAL perks that make it as alluring as ROADS specialties. If the system was set up to encourage mass entry from med school via compensation, lifestyle and work load would also drop 👍 and those uncommon issues would have on average a more highly competitive physician working on on them rather than wasting the top scoring applicants in med school on boob jobs and skin creams (please forgive the gross over-generalization lol)

 

[DrMaximus]

and those uncommon issues would have on average a more highly competitive physician working on on them rather than wasting the top scoring applicants in med school on boob jobs and skin creams (please forgive the gross over-generalization lol)

👍👍

 

[mishaS]

that second one matches my sentiments exactly. IMO primary care should come with REAL perks that make it as alluring as ROADS specialties. If the system was set up to encourage mass entry from med school via compensation, lifestyle and work load would also drop 👍 and those uncommon issues would have on average a more highly competitive physician working on on them rather than wasting the top scoring applicants in med school on boob jobs and skin creams (please forgive the gross over-generalization lol)

This is what my GF has heard from the PAs she's spoken to and shadowed as well. If it's routine no problem. If it's complex it is deferred to the supervising physician. One thing I've actually wondered about independently practicing PAs that have a doc to sign off on their charts is who is at fault should the PA commit malpractice.

 

[deleted6669]

This is what my GF has heard from the PAs she's spoken to and shadowed as well. If it's routine no problem. If it's complex it is deferred to the supervising physician. One thing I've actually wondered about independently practicing PAs that have a doc to sign off on their charts is who is at fault should the PA commit malpractice.

ROUTINE and COMPLEX issues vary with the provider....many pa's routinely take care of patients who were sent into the hospital because community physicians were not comfortable with them.
The PA is at fault if they commit an act of malpractice regardless of whether they run the practice or work for a doc. Physicians and hospitals are generally also named in these suits as is anyone within 100 miles of the place where it occurred(yes, that is a joke). PA's who own their own practices and hire docs give them a malpractice policy as a standard benefit. Bottom line as a doc. if you don't know and trust a pa you work with you probably shouldn't agree to sign their charts. there are good and bad PA's just like there are good and bad docs. know who you work with. in the close to 25 years my group has used PA's (21 of us) there have been a total of 2 pa related suits, both settled out of court for minor issues with settlements less than 50k total.
in this same time our group has made the docs something like 25 million dollars in profits.

 

[deleted6669]

This includes the coveted ROAD specialties, minus rads, plastics, ect. ....If you live in a rural area, you might get to do more. I personally want to work in a larger city. I want to be able to have no restrictions.

actually there are pa's working for doc run groups in interventional rads, plastic surgery(one was on TV on that real life plastic surgery in beverly hills show). there are a few pa's who work in operative anesthesiology. the best known is sheppard stone who has been doing it for 30+ years. most folks who want to do anesthesia who do not want to go md/do become AA's or CRNA's. there are a few ophtho pa's out there but they mostly do pre-op h+p's, clinic, and hospital d/c's, not intraoperative first assist.
this will blow all of your minds: pa's doing diagnostic cardiac caths at Duke with results similar to cards fellows:
http://www.charitywire.com/charity280/04996.html
you are right about the rural vs urban issue. I have a good scope of practice but to get it I work rural and inner city, mostly night shifts. I couldn't do my current job during daytime hours without relocating.

 

[TriagePreMed]

as I said, this has been a practice model for over 30 years in many states. the vast majority of states do not require a physician be present when a pa delivers care so what we are talking about is opposition to pa's being practice owners. either way the doc is not seeing the pt. the only difference is who pays the bills.
state medical boards still have to approve these arrangements on a case by case basis and the vast majority of these practices are not in competition with physician practices, they are in places where there are no other practices for example a pa deciding to return to his home town in Appalachia and open a medical clinic with distant supervision. if they didn't do this there would be no clinic there at all. these are not practices in beverly hills or palm springs.
state practice plans always make clear that the physician has final say in medical matters regardless of who owns the practice.

I understand it's been around, but that doesn't change my objections. And from the rest of your post, it sounds like my worries are credible: money is an incentive for the government and it sweeps the real problem of physician shortage under the rug.

 

[Temperature101]

For me it comes down to this: I dont patients to say that I dont wanna see the assistant, I wanna see the doctor. I dont wanna be the assistant that patient is reffering to.

 

[TriagePreMed]

For me it comes down to this: I dont patients to say that I dont wanna see the assistant, I wanna see the doctor. I dont wanna be the assistant that patient is reffering to.

English?

 

[Art3MiS]

English?

I understand what he said but it took 3 reads and the last was pretty slow lol.

I'm glad I brought up this topic as there's alot of information that has surfaced. I didn't know PAs could go that far and do that much pretty independently too.

Are NPs similar to PAs in that regard?

 

[deleted6669]

Are NPs similar to PAs in that regard?

Depends on the state. in something like 22 or 23 states np's can function completely independently of a doc and open their own practices without collaboration/supervision. in the other states they function much like pa's and must be associated with a doc to practice.

 

[MilitaryMed]

ROUTINE and COMPLEX issues vary with the provider....many pa's routinely take care of patients who were sent into the hospital because community physicians were not comfortable with them.

Doctors don't send patients to hospitals so that a PA can take care of them....

 

[deleted6669]

Doctors don't send patients to hospitals so that a PA can take care of them....

happens every shift, every day. welcome to 2012. A "large laceration" or "complex abscess" that "will require surgery" frequently is handled routinely by a pa or np in fast track at almost every emergency dept in the country. what is "large" or "complex" to a doctor in the community who doesn't routinely deal with them is routine to an em pa. ditto fractures and dislocations that will "require orthopedic consultation". ditto fb's in the eye, nose, or ear which will "require ophtho or ent ".
sure, some do (and we call them) but the vast majority get handled by an em pa without ever involving a physician of any type and sent home. this is our bread and butter case, what we do every day. your zebra is our shetland pony. if you want a specialist to see your pt make arrangements to send the pt to the specialists office, not the er.

 

[scotchtapetest]

happens every shift, every day. welcome to 2012. A "large laceration" or "complex abscess" that "will require surgery" frequently is handled routinely by a pa or np in fast track at almost every emergency dept in the country. what is "large" or "complex" to a doctor in the community who doesn't routinely deal with them is routine to an em pa. ditto fractures and dislocations that will "require orthopedic consultation". ditto fb's in the eye, nose, or ear which will "require ophtho or ent ".
sure, some do (and we call them) but the vast majority get handled by an em pa without ever involving a physician of any type and sent home. this is our bread and butter case, what we do every day. your zebra is our shetland pony. if you want a specialist to see your pt make arrangements to send the pt to the specialists office, not the er.

You started making some sense at the beginning of this thread but now you are just being ridiculous....

First of all there is nothing complex about an abscess that is treated in the ED by ED people (PA or physician) and there is one treatment for all of them; it's called I&D... A medical student can do that (and they do it all the time)... Some rare, life threatening abscesses (e.g. PTA) require skills above the ED people and ED is just a "holding" area until appropriate care can be arranged in such cases and none of them go or should go to Fast Track.... Anything that is treated in Fast Track can be treated as well, if not better, by a fourth year medical student (coincidentally that's the amount of training PAs get).... Private practice physicians send patients to Fast Track, not because they can't do it or don't know how to do it or to get a PA's opinion about an abscess or whatever, but because 1) Their office is not equipped and/or 2) The time commitment outweighs the reimbursement.... It is a lot easier to send it to Fast Track than have to do it yourself when you are not going to get paid for it as much in outpatient setting; same reason they send patients to podiatrists/nutritionist/etc.... Which goes back to our reimbursement model, which is a whole different thread....

And as far as othro/ophtho/ENT cases in Fast Track, they are not "consults"... For instance, if there is a possible fracture, they didn't send them to Fast Track for a consult or a PA's opinion; They send them there to get an emergent radiologic evaluation by a radiologist, to see if the condition actually requires a consult at which point the patient is given a list of physicians for the actual consult. If it is any serious fracture (e.g. femur), it never goes to Fast Track and is evaluated by an ED physician.

Also anything "that requires surgery" requires a surgeon and an OR.... That stuff is not done in the ED or without a physician's supervision.... Suturing is not "surgery"....

Having said all of that, I've worked with more than a few PAs and my impression has been that as long as they are supervised VERY CLOSELY, they, for the most part, do a good job and serve a function to some degree... Unfortunately, I can not say the same thing about NPs and they are the ones getting independent practice rights.....

In both cases, independent practice is just ridiculous; This doesn't mean they are not smart enough to be physicians but means that the training they get is inadequate in breadth and depth due to their model of training, to allow them independent practice of medicine.

 

[gators21]

actually there are pa's working for doc run groups in interventional rads, plastic surgery(one was on TV on that real life plastic surgery in beverly hills show). there are a few pa's who work in operative anesthesiology. the best known is sheppard stone who has been doing it for 30+ years. most folks who want to do anesthesia who do not want to go md/do become AA's or CRNA's. there are a few ophtho pa's out there but they mostly do pre-op h+p's, clinic, and hospital d/c's, not intraoperative first assist.
this will blow all of your minds: pa's doing diagnostic cardiac caths at Duke with results similar to cards fellows:
http://www.charitywire.com/charity280/04996.html
you are right about the rural vs urban issue. I have a good scope of practice but to get it I work rural and inner city, mostly night shifts. I couldn't do my current job during daytime hours without relocating.

we are actually saying the same thing. Should have put (except rads). My bad.

Just because a community hosp/doc tx a pt, doesn't mean they were tx because they were "uncomfotable". Most of the times its a) political/financial b) service is not offered c) if there happens to be a complication, the facility has the equipment to handle it.
There is not a shot in hell that a doc is tx a pt so a PA can handle it. you lost a lot of credibility with that statement

 

[scotchtapetest]

actually there are pa's working for doc run groups in interventional rads, plastic surgery(one was on TV on that real life plastic surgery in beverly hills show). there are a few pa's who work in operative anesthesiology. the best known is sheppard stone who has been doing it for 30+ years. most folks who want to do anesthesia who do not want to go md/do become AA's or CRNA's. there are a few ophtho pa's out there but they mostly do pre-op h+p's, clinic, and hospital d/c's, not intraoperative first assist.
this will blow all of your minds: pa's doing diagnostic cardiac caths at Duke with results similar to cards fellows:
http://www.charitywire.com/charity280/04996.html
you are right about the rural vs urban issue. I have a good scope of practice but to get it I work rural and inner city, mostly night shifts. I couldn't do my current job during daytime hours without relocating.

With regards to your study... What are you saying? That fellows (who are by definition NOT cardiologists but physicians in TRAINING) can do it as good as a PA who has completed the training (whatever that entails)....

Also I found some interesting stuff in your article (full text):

Krasuski, R. A., Wang, A., Ross, C., Bolles, J. F., Moloney, E. L., Kelly, L. P., Harrison, J. K., Bashore, T. M. and Sketch, M. H. (2003), Trained and supervised physician assistants can safely perform diagnostic cardiac catheterization with coronary angiography. Cathet. Cardiovasc. Intervent., 59: 157–160.

"We compared the results of 929 diagnostic cardiac catheterizations performed by three different PAs during an 18-month period (August 1998 to April 2000) with 4,521 catheterizations performed by 21 different cardiology fellows with similar supervision during the same period."

So even assuming they both were at the same level at the beginning, by the end of the study, on average each PA had done >300 PCIs while each fellow had done about 215, leading to increased proficiency for the PA cohort.

"There was a higher prevalence of class 3 and 4 New York Heart Association (NYHA) heart failure among patients undergoing procedures by cardiology fellows (19.5% vs. 13.2%; P = 0.001). In addition, serum creatinine levels were slightly higher in patients studied by cardiology fellows; creatinine was > 1.3 ng/dL in 7.4% of the fellow cases and in 5.5% of the PA cases"....

The heart failure rates were statistically significant while the creatinine levels were not. Obviously, the healthier the patient, less risk for complications...

"Cardiology fellows progress rapidly through their training and are all level 1 or level 2 trained (per ACC/AHA guidelines [8]) by the end of 6 consecutive months in the laboratory. The PA training period is generally twice this length, with frequent repetition (educational sessions are repeated with each 6-month fellow rotation)."

"As our institution is a training facility for cardiology fellows, some patient selection bias is unavoidable. In general, more complicated patients (i.e., patients with heart failure) are assigned to physicians and not to the PAs."

Not exactly apples to apples....

 

[deleted6669]

Just because a community hosp/doc tx a pt, doesn't mean they were tx because they were "uncomfortable". Most of the times its a) political/financial b) service is not offered c) if there happens to be a complication, the facility has the equipment to handle it.
There is not a shot in hell that a doc is tx a pt so a PA can handle it.

we do see a lot of patients that community docs are not comfortable with for procedural issues. I know they were not sent in specifically to see a pa but that is the end result. I have talked to many on the phone who state they don't feel comfortable with xyz because it is not something they deal with frequently. granted some of these come in because the community doc doesn't have a slit lamp or capacity to do procedural sedation, etc but I have had some community docs tell me that they haven't done an I+D on a baseball sized abscess(for example) in 20 years and no longer feel comfortable doing it. many docs in the community do not know the capacities of their local e.d. and believe many things require specialty consult which do not. I see pts all the time who say" my doctor sent me in to see an orthopedist to reduce my boxers fx," etc when that is something we do every day and almost never call ortho for. ditto "this cut will require a plastic surgeon because it involves the lip" uh, no it won't.

 

[deleted6669]

With regards to your study... What are you saying? That fellows (who are by definition NOT cardiologists but physicians in TRAINING) can do it as good as a PA who has completed the training (whatever that entails)....

fellows are docs who have already completed a residency and are getting additional training beyond residency. I wasn't making any specific point with posting this other than it is an interesting piece of data for the "what pa's can do in some places" discussion.

 

[scotchtapetest]

we do see a lot of patients that community docs are not comfortable with for procedural issues. I know they were not sent in specifically to see a pa but that is the end result. I have talked to many on the phone who state they don't feel comfortable with xyz because it is not something they deal with frequently. granted some of these come in because the community doc doesn't have a slit lamp or capacity to do procedural sedation, etc but I have had some community docs tell me that they haven't done an I+D on a baseball sized abscess(for example) in 20 years and no longer feel comfortable doing it. many docs in the community do not know the capacities of their local e.d. and believe many things require specialty consult which do not. I see pts all the time who say" my doctor sent me in to see an orthopedist to reduce my boxers fx," etc when that is something we do every day and almost never call ortho for. ditto "this cut will require a plastic surgeon because it involves the lip" uh, no it won't.

You don't expect the physician to actually tell the private patient that they have to leave their office, drive to the ED, sit in the waiting room for god knows how long and be treated like s*** by the staff to see a PA just because they are not going to get adequately reimbursed for a procedure; Do you? Of course they are going to tell them go and you'll be seen by ortho or plastics or at least that's what the patients think their doctor said, but the physicians know very well that the plastic surgeon is not coming for an abscess/minor laceration and ortho will laugh at you for a boxer's fracture consult.... You're not giving doctors enough credit, my friend.... They trained in those same hospitals.... They know the deal 😉

Also, could you explain the difference between "treating" a baseball size abscess and a golf ball size abscess? Last time I checked they are both treated the same (i.e. I&D) and requires very little confidence or training....

 

[scotchtapetest]

fellows are docs who have already completed a residency and are getting additional training beyond residency. I wasn't making any specific point with posting this other than it is an interesting piece of data for the "what pa's can do in some places" discussion.

No, for the purposes of cardiac catheterization, fellows are physicians in TRAINING.... During their residency training, they performed 0-5 cardiac catheterizations....

 

[deleted6669]

No, for the purposes of cardiac catheterization, fellows are physicians in TRAINING.... During their residency training, they performed 0-5 cardiac catheterizations....

an interventional cardiology fellow is already a cardiologist. yes, they are getting additional training but I find it interesting that a pa with a total of 3 years of medical training does as well as a fellow with 7-8 years of training for some cases. I do understand the selection bias involved in the study.
once again my "point" was "look pa's can do some cool stuff in some places and don't just treat runny noses".

 

[deleted6669]

Also, could you explain the difference between "treating" a baseball size abscess and a golf ball size abscess? Last time I checked they are both treated the same (i.e. I&D) and requires very little confidence or training....

having done thousands of these I can tell you the larger they get the more difficult it is to get the pt comfortable BEFORE making the incision, exploring, etc
for really large abscesses or with particularly anxious patients I often use procedural sedation to make it go more smoothly all around. also the larger they are, the older the pt, the more comorbidities they have, etc the greater the chance of it having systemic repercussions. the 55 yr old poorly controlled diabetic with a baseball sized abscess can actually get pretty sick and require iv abx, +/- admission, etc if it precipitates dka, etc.
you would be surprised how many folks get admitted to the icu from fast track or by pa's working in the main dept. at my rural job that # approaches 30% of all the pts I see( it's a retirement community, avg age presenting to the dept is > 70)

 

[scotchtapetest]

an interventional cardiology fellow is already a cardiologist. yes, they are getting additional training but I find it interesting that a pa with a total of 3 years of medical training does as well as a fellow with 7-8 years of training for some cases. I do understand the selection bias involved in the study.
once again my "point" was "look pa's can do some cool stuff in some places and don't just treat runny noses".

No, they were not "interventional cardiology fellows", they were cardiology fellows which means that they were not cardiologist and the only required prior post graduate training for that position is completion of an Internal Medicine residency....

Agree with the bolded part.... If your posts or claims were limited to that, I would've continued to stay out of this discussion.

 

[scotchtapetest]

for really large abscesses or with particularly anxious patients I often use procedural sedation to make it go more smoothly all around. also the larger they are, the older the pt, the more comorbidities they have, etc the greater the chance of it having systemic repercussions. the 55 yr old poorly controlled diabetic with a baseball sized abscess can actually get pretty sick and require iv abx, +/- admission, etc if it precipitates dka, etc.

None of what you've described is outside of a physician's training or comfort level, no matter how crappy the physician is.... This is basic stuff that even a medical student knows.... Also besides the "comfort" issue there is no real difference in how you would/should handle an abscess in a patient with given comorbidities based on the size (baseball vs. golf ball)...

you would be surprised how many folks get admitted to the icu from fast track or by pa's working in the main dept. at my rural job that # approaches 30% of all the pts I see( it's a retirement community, avg age presenting to the dept is > 70)

That only tells me that you work at a hospital with very, very, very poor triage capabilities/systems...

Listen, I'm not saying being a PA is bad or dumb or anything negative... In fact, if you ask me, it's the smart way to go (3yrs and you make bank with almost no liability).... If you want to be a PA and that's what makes you happy then be a PA... Who am I to judge?.... But don't come here and say that PAs get consulted by physicians because somehow they know more or do a better job or any other reason that you might post next!

 

[deleted6669]

Listen, I'm not saying being a PA is bad or dumb or anything negative... In fact, if you ask me, it's the smart way to go (3yrs and you make bank with almost no liability)....!

why do folks think pa's have "almost no liability". I hear that here all the time.
the outcomes are the same:
physician loses malpractice claim, malpractice policy pays off, doc may lose job or be sanctioned by hospital or medical board. doc may have difficulty finding next job.
pa loses malpractice claim. malpractice policy pays off. pa may lose job or be sanctioned by hospital or medical board. pa may have difficulty finding next job.

I know pa's who have been sued and lost. it made their lives significantly more difficult in terms of getting licensed in other states or getting new jobs.
if you look to my first post in this thread as well as my post #47 you will see I recommend to most folks that they become docs and not pa's. I know what the limitations to being a pa are. it seems many others here do not. they are not what you think they are. they mostly involve respect, scope of practice and financial compensation. I could care less about the money. I do very well. it's the lack of respect and inappropriate limitations(as opposed to those that have merit) on my scope of practice that really piss me off and have caused me to change jobs several times for places with better autonomy and scope of practice(often, interestingly enough, for less money).

 

[deleted6669]

But don't come here and say that PAs get consulted by physicians because somehow they know more or do a better job or any other reason that you might post next!

just a point of clarification. specialty PA's often know more about a specialty than docs who do not practice that specialty. often when a doc sends a pt to see a specialist they end up seeing a pa who works for that specialty group even if they have made arrangements specifically with the specialist. the specialty pa then consults the md specialist as needed for the cases beyond their level of expertise and this varies by individual.
an ortho pa with 5 years of full time ortho experience whose prior experience before pa school was as an ortho tech knows a lot more ortho than a community fp doc.

 

[scotchtapetest]

why do folks think pa's have "almost no liability". I hear that here all the time.
the outcomes are the same:
physician loses malpractice claim, malpractice policy pays off, doc may lose job or be sanctioned by hospital or medical board. doc may have difficulty finding next job.
pa loses malpractice claim. malpractice policy pays off. pa may lose job or be sanctioned by hospital or medical board. pa may have difficulty finding next job.

I know pa's who have been sued and lost. it made their lives significantly more difficult in terms of getting licensed in other states or getting new jobs.
if you look to my first post in this thread you will see I recommend to most folks that they become docs and not pa's. I know what the limitations to being a pa are. it seems many others here do not. they are not what you think they are.

Yes and that's why there was the phrase "almost" right before "no liability"...

Anyone can get sued.... Even medical students can get sued.... But it's all about likelihood... The likelihood of a PA getting sued is a lot less than the attending getting sued and liability for the attending is lot higher than for the PA even if both get sued and both lose.... This is evident by lower malpractice insurance rates in any given specialty for PA vs MD/DO... If their liabilities/likelihood to get sued was the same, the insurance companies would've charged them equally...

Anyways, I think decisions on what professions to choose are up to the individual and all we can do is to provide facts not life decisions....

And again, I hope my posts weren't interpreted as insulting PAs, because some of them (if not most of them) are really down to earth and cool to work with and have lot of great experiences/attitudes... I have also learned a lot (especially procedures) from PAs.... (Note how, NPs were not included in this last paragraph).... I just wanted to set the record straight regarding some claims made earlier....

 

[TriagePreMed]

And again, I hope my posts weren't interpreted as insulting PAs, because some of them (if not most of them) are really down to earth and cool to work with and have lot of great experiences/attitudes... I have also learned a lot (especially procedures) from PAs.... (Note how, NPs were not included in this last paragraph).... I just wanted to set the record straight regarding some claims made earlier....

As a side note to this, one of the coolest guys at the ED I volunteer is a PA. He's much more approachable than the doc himself.

 

[scotchtapetest]

just a point of clarification. specialty PA's often know more about a specialty than docs who do not practice that specialty. often when a doc sends a pt to see a specialist they end up seeing a pa who works for that specialty group even if they have made arrangements specifically with the specialist. the specialty pa then consults the md specialist as needed for the cases beyond their level of expertise and this varies by individual.
an ortho pa with 5 years of full time ortho experience whose prior experience before pa school was as an ortho tech knows a lot more ortho than a community fp doc.

Again, you are going in circles..... Who sees the patient is irrelevant... The patient could've been seen by a PA, NP, medical student, resident, fellow or the janitor or anyone else... The final report back to the primary doctor has to come from (signed by) the attending physician... Therefore, the family physicians or other physicians consult physicians who at their discretion may relegate the task to whomever they see fit...

 

[beethousand]

Maybe you can expound on this emedpa but isn't it a bit of a misnomer that pa's are afforded a much easier lifestyle in terms of call, hours worked, etc than physicians? I would guess it's much more contingent on where you practice. Please correct me of im wrong.

 

[deleted6669]

Maybe you can expound on this emedpa but isn't it a bit of a misnomer that pa's are afforded a much easier lifestyle in terms of call, hours worked, etc than physicians? I would guess it's much more contingent on where you practice. Please correct me of im wrong.

Most of the pa's I know work more hrs than the docs they work with. for example pa's in my group work 180 hrs/mo while docs max out at 140 with most working 120.
I have several friends who are critical care pa's for different groups and they work more hrs and take more call than the docs they work with.
surgeons are probably the only docs who work more than the pa's in their groups but the pa's still often take 1st call and do night h+p's and hospital d/c's , etc
docs training is longer and harder and for this they are well compensated and most have great lifestyles.
pa's have a shorter training but work long hrs for most of their careers. some primary care pa's get the m-f 9-5 job but this is becoming rare and most pa's(like most docs) in 2012 work in specialties, not primary care.
docs hire pa's to do the work they don't want to do(poorly compensated populations) at the times they don't want to do it(nights,weekends, holidays, early am) and in the places they don't want to go(rural, inner city).

 

[gators21]

just a point of clarification. specialty PA's often know more about a specialty than docs who do not practice that specialty. often when a doc sends a pt to see a specialist they end up seeing a pa who works for that specialty group even if they have made arrangements specifically with the specialist. the specialty pa then consults the md specialist as needed for the cases beyond their level of expertise and this varies by individual.
an ortho pa with 5 years of full time ortho experience whose prior experience before pa school was as an ortho tech knows a lot more ortho than a community fp doc.

Thats your argument? Really, no crap. Your talking about someone in a very specific field with a minimum of 10 yrs experience vs a FP doc? terrible comparison dude.

Your entire argument of most of the time a PA can do the work of an md. Thats fine for a lot of the general public. But to try to convince people that are trying to decide a career in heathcare and claim PA knowledge is somehow superior is not right and deserves to be called out. Dont try and pee on someone and call it rain.
Like bala I have upmost respect for PAs. Everyone has a role in heathcare and there is such a need. If a PA is knowledgable, experienced, and friendly I would gladly take any advice from them.

 

[deleted6669]

Thats your argument? Really, no crap. .

MANY here on sdn believe EVERY DOC knows more than EVERY PA about EVERYTHING.
seriously.I have been here over ten years and that is the prevailing attitude here. you can't blame me for being a bit defensive.
generally the DO folks have more common sense and less attitude than the MD folks and I certainly appreciate that.

 

[swamprat]

emedpa - idk why this bothers me and this was posted by u a little back but a coroner is not a medical examiner theres a difference. coroners are voted into office and do not necessarily have to have any degree or knowledge of anything (although they then would prob not get voted in, but theres no rules for it). that is what your fellow PA is..a coroner. a medical examiner is a physician that performs autopsies etc. they are appointed not voted in. the coroner is usually the one that goes into the field takes crime scene pics and reports back to the medical examiner and the police etc.

 

[deleted6669]

emedpa - idk why this bothers me and this was posted by u a little back but a coroner is not a medical examiner theres a difference. coroners are voted into office and do not necessarily have to have any degree or knowledge of anything (although they then would prob not get voted in, but theres no rules for it). that is what your fellow PA is..a coroner. a medical examiner is a physician that performs autopsies etc. they are appointed not voted in. the coroner is usually the one that goes into the field takes crime scene pics and reports back to the medical examiner and the police etc.

I know the difference. I never said he was a medical examiner.

 

[swamprat]

I know the difference. I never said he was a medical examiner.

Didn't seem like u did since like i said anyone can be a coroner..so rlly not a big deal if a PA is one. Anyway its just annoying when people who chose the easier route for whatever reason like to equate themselves to doctors when thats not the case. Not that theres not a need for mid-levels but I think some of them should keep their egos in check.

 

[nico vazquez]

Didn't seem like u did since like i said anyone can be a coroner..so rlly not a big deal if a PA is one. Anyway its just annoying when people who chose the easier route for whatever reason like to equate themselves to doctors when thats not the case. Not that theres not a need for mid-levels but I think some of them should keep their egos in check.

I dont think this guy has an ego problem he is stating facts.

 

[scotchtapetest]

Didn't seem like u did since like i said anyone can be a coroner..so rlly not a big deal if a PA is one. Anyway its just annoying when people who chose the easier route for whatever reason like to equate themselves to doctors when thats not the case. Not that theres not a need for mid-levels but I think some of them should keep their egos in check.

Let's keep emotional statements out of this conversation and just stick with facts.... 👍

I dont think this guy has an ego problem he is stating facts.

S/He was stating facts at the beginning and then there was a divergence.....

I think the mis-statements have been addressed (Unless I missed something)... Let's resume with the original topic (whatever that was).....

 

[swamprat]

I dont think this guy has an ego problem he is stating facts.

He is and the ego comment wasn't really directed at him/her but others I've encountered sorry for the confusion. And not all of them by any means I have a friend whos a rlly cool gal and a PA and shes taught me different suturing techniques and even provided me with a magazine article to a PA newsletter type of deal with more information.

Let's keep emotional statements out of this conversation and just stick with facts.... 👍

Why? I'm not using it as an argument like its not fair therefore it shouldn't be allowed, I'm just saying for the sake of saying it..venting if you would.

 

[scotchtapetest]

Why? I'm not using it as an argument like its not fair therefore it shouldn't be allowed, I'm just saying for the sake of saying it..venting if you would.

I know, but I think we have proved our point and don't need to

 

[SpecterGT260]

No, they were not "interventional cardiology fellows", they were cardiology fellows which means that they were not cardiologist and the only required prior post graduate training for that position is completion of an Internal Medicine residency....

Agree with the bolded part.... If your posts or claims were limited to that, I would've continued to stay out of this discussion.

Yep

 

[SpecterGT260]

MANY here on sdn believe EVERY DOC knows more than EVERY PA about EVERYTHING.
seriously.I have been here over ten years and that is the prevailing attitude here. you can't blame me for being a bit defensive.
generally the DO folks have more common sense and less attitude than the MD folks and I certainly appreciate that.

And therefore your argument is that EVERY DO has less attitude than EVERY MD in ALL situations... its interesting how you can apply generalizations when they suit you but have a generalization applied to you and suddenly identifying one specific exception invalidates the overall observation....

 

[flyhi]

And therefore your argument is that EVERY DO has less attitude than EVERY MD in ALL situations... its interesting how you can apply generalizations when they suit you but have a generalization applied to you and suddenly identifying one specific exception invalidates the overall observation....

Dude, he said 'GENERALLY', not 'EVERY'. You even quoted him, for crying out loud

 

[deleted6669]

Dude, he said 'GENERALLY', not 'EVERY'. You even quoted him, for crying out loud

It's nice to see some of today's medstudents can read....maybe there is hope for the future....🙂

 

[SpecterGT260]

Dude, he said 'GENERALLY', not 'EVERY'. You even quoted him, for crying out loud

The point is that he applies generalizations in one context and denies the usefulness in another. To get hung up on 1 word really just means u missed the irony

 

[SpecterGT260]

It's nice to see some of today's medstudents can read....maybe there is hope for the future....🙂

Reading is one thing. understanding is another. It doesn't matter that you used qualifiers like generally or many. One of 2 things have to be true, either you believe in a value to generalized facts or you had a massive brain infarct which prompted your post about attitudes.

I was pointing out that you do seem to understand the concepts of applied averages and how an exception to a rule doesn't necessarily invalidate its usefulness. And how you seem to reject such logic based on context i.e. this thread. That = irony

 

[Dharma]

Dude, he said 'GENERALLY', not 'EVERY'. You even quoted him, for crying out loud

👍

 

[deleted6669]

👍

another reader!
wow, that's two....

 

[SpecterGT260]

another reader!
wow, that's two....

Do u intend to split hairs or actually respond to my posts? U seemed to miss the part where you contest generalizations about PAs and NPs using ~5% minority cases and n=1 anecdotes. As if these things things can completely invalidate the points and concerns brought up by other posters.

Then you employ your own generalization about MDs and DOs which, is either entirely false because I can identify 1 exception ans therefore you are babbling to the wind, or has value and you just seem to pick and choose where generalizations can have meaning based on what suits you.

Regardless of your use of the word generally, if any if your past counterpoints have any validity at all, then that comment has no validity and you might as well have said "I like the flavor purple because it tickles my feet" for all the usefulness it has. Regardless of any qualifiers your position was previously that generalizations cannot have meaning while an exception exists.

It hurts to have to spell these things out... it would be much nicer if you would do some actual reading rather than split hairs over one word.

 

[deleted6669]

Do u intend to split hairs or actually respond to my posts? U seemed to miss the part where you contest generalizations about PAs and NPs using ~5% minority cases and n=1 anecdotes. As if these things things can completely invalidate the points and concerns brought up by other posters.

Then you employ your own generalization about MDs and DOs which, is either entirely false because I can identify 1 exception ans therefore you are babbling to the wind, or has value and you just seem to pick and choose where generalizations can have meaning based on what suits you.

Regardless of your use of the word generally, if any if your past counterpoints have any validity at all, then that comment has no validity and you might as well have said "I like the flavor purple because it tickles my feet" for all the usefulness it has. Regardless of any qualifiers your position was previously that generalizations cannot have meaning while an exception exists.

It hurts to have to spell these things out... it would be much nicer if you would do some actual reading rather than split hairs over one word.

fine- you couldn't just let the thread die.
you guys have nit picked my posts in the past here to try to discredit them.
my points once again.
pa's can work as coroners. I didn't say medical examiners, I said coroners. I know the difference. my point was a pa is working in a job normally done by a physician and that is nifty.
regarding cardiac caths. I don't care if the docs in the comparison are fellows or not, it doesn't matter. the point was pa's are doing work normally done by docs who have already completed a residency. that is nifty.
regarding pts sent to the e.d. by community docs who are then seen by pa's. this happens for a variety of reasons. sometimes it's political, sometimes it's financial, and yes, sometimes it's because an er doc or pa can do something a community fp can't do or isn't comfortable doing because they haven't done it in years or never learned how. yes, I know the docs wasn't thinking " I will send them to see a pa at the er" they were thinking " I can't do this so I will send it to someone who can". same thing. I teach fp residents from 3 well known programs and med students from many programs and have for over 15 years. it's surprising the things some residents don't know. these residents then become attendings. I taught a 3rd yr resident recently how to do a digital block. not a difficult procedure and presumably something they should already know but they didn't. I teach them all the time how to use a slit lamp, do abg's, reduce fxs, remove fb's, etc
our facility won't even credential fp docs for sedation. they aren't felt to have the airway skills needed if a case goes south. yes, I can and do intubate and run codes. how often does your typical fp doc do that? yup, many can, however some airways/codes are tougher than others and as an er provider and former medic who does all their cme in emergent pt management is better at it than someone who does all their cme in management of the abnl pap smear. I can do many things that they can't. that's just how it is. the basic concept here is providers of whatever type are good at what they do every day, regardless of the initials after their names. many premeds just can't accept that a pa who does em every day all day is better at it than anyone except a residency trained and boarded er doc. I run circles around the community docs and residents who moonlight in the dept. and yes, they ask my opinion about cases. it hurts to have to spell these things out to you. do a little research here and you will find many posts from residents appreciative of the training they receive from pa's.
and yes, many DO's are really cool people and many md's aren't. there are exceptions but in my 25 years working in em I can count on one hand the # of DO's who I know who are jerks but it would take me days to recite the # of md's who are. yes, I know a lot of cool md's too but the avg jerk is an md, not a do.