DO vs PA ?

[nwmedapplicant]

Classic case of "grass is always greener". PAs and DNPs will always say go MD/DO because of autonomy, income, etc etc while physicians will always say how you should go PA/DNP because of less schooling, job security, good hours vs income, less risks etc etc.

This is my experience with some friends that are family practice docs as well: advise that if someone is interested in family medicine - if they had to do it over again - they'd go the PA route for reasons cited above + more patient contact time during the day.

GL with your decision.

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[IH8ColdWeath3r]

How is that?

My understanding is that they are there when stuff is done, but they don't do things like techs or CNAs do. Do they draw labs or start IVs, hang or give meds, write their own notes (instead of transcribing verbal dictation), have one on one time with the patient fulfilling any orders, apply splints/casts/bandages/dressings etc?

I would define clinical as anything that involves direct patient care and responsibility like RNs, paramedics, RTs, CNAs, ED techs, etc, etc.

Perhaps this is just my own misconception but I thought that scribes were just that, scribes; they only helped the doc with completing the chart. I'm definitely not saying they don't see and experience a lot. All that one on one time with a physician would be fantastic! But if they aren't seeing patients alone, I don't see how that's clinical?

Maybe it's different from hospital to hospital and scribes are more like techs? If that's the case then I'm 100% wrong and I take back what I said. Otherwise, not clinical

Being an ER scribe is invaluable. And, it IS in fact clinical experience. Again, there should be a distinction between clinical experience and clinical care provider.

Actually, I was talking to one of the attendings the other day at UTSW and he conducted a study of all of the EM residents who had been scribes prior to the onset of medical school. The study showed (according to him) that the ones who were scribes outperformed their non scribe counterparts. More of them had gone on to become chief residents in a residency class of 19 residents.

I have been a scribe for nearly 2 years. I see ~25 patients per shift. I usually work 4 shifts a week (sometimes more). So I see roughly 100 patients a week, 400 a month. 400 x 24. That is 9,600 patients that I have seen.

I always type my own notes. The note is not dictated to me by the physician. I just ask him for the physical exam. At some hospitals, I even put in the orders. I put in the differential diagnosis myself. If someone has new onset leg swelling and risk factors for DVT (recent immobility/bed bound status, recent surgery, long car/plane trip, blood clotting disorder, previous history of DVT/PE), I will put DVT, superficial thrombophlebitis. If it is a patient with RUQ and MEG pain that worsened after eating greasy food and their pain is associated with nausea, vomiting. I will put cholelithiasis with/without evidence of acute cholecystitis. Patient can also be concerning for pancreatitis. Their work up will include basic blood work, lipase, and RUQ US. Pain control PRN, anti emetic. The patient will be rehydrated with IV fluids and reassessed after labs, gallbladder sono.

Some of the things to look for on the sono include a dilated common bile duct, pericholecystitic fluid, or a sonographic murphy's sign.

Your telling me that this isn't going to be helpful when I start medical school?

 

[angldrps]

Being an ER scribe is invaluable. And, it IS in fact clinical experience. Again, there should be a distinction between clinical experience and clinical care provider.

Actually, I was talking to one of the attendings the other day at UTSW and he conducted a study of all of the EM residents who had been scribes prior to the onset of medical school. The study showed (according to him) that the ones who were scribes outperformed their non scribe counterparts. More of them had gone on to become chief residents in a residency class of 19 residents.

I have been a scribe for nearly 2 years. I see ~25 patients per shift. I usually work 4 shifts a week (sometimes more). So I see roughly 100 patients a week, 400 a month. 400 x 24. That is 9,600 patients that I have seen.

I always type my own notes. The note is not dictated to me by the physician. I just ask him for the physical exam. At some hospitals, I even put in the orders. I put in the differential diagnosis myself. If someone has new onset leg swelling and risk factors for DVT (recent immobility/bed bound status, recent surgery, long car/plane trip, blood clotting disorder, previous history of DVT/PE), I will put DVT, superficial thrombophlebitis. If it is a patient with RUQ and MEG pain that worsened after eating greasy food and their pain is associated with nausea, vomiting. I will put cholelithiasis with/without evidence of acute cholecystitis. Patient can also be concerning for pancreatitis. Their work up will include basic blood work, lipase, and RUQ US. Pain control PRN, anti emetic. The patient will be rehydrated with IV fluids and reassessed after labs, gallbladder sono.

Some of the things to look for on the sono include a dilated common bile duct, pericholecystitic fluid, or a sonographic murphy's sign.

Your telling me that this isn't going to be helpful when I start medical school?

I completely agree with everything you posted. I just recently started working as a scribe and the experience is absolutely invaluable. I am putting up with driving in ridiculous amount of traffic 2-hours one way to the hospital I am working at all because of just how much I learn in every shift.

 

[MedPR]

I completely agree with everything you posted. I just recently started working as a scribe and the experience is absolutely invaluable. I am putting up with driving in ridiculous amount of traffic 2-hours one way to the hospital I am working at all because of just how much I learn in every shift.

That's crazy

Sent from my SGH-T999 using SDN Mobile

 

[angldrps]

That's crazy

Sent from my SGH-T999 using SDN Mobile

haha thats pretty much what my folks have been telling me since I started. The Cali traffic has been driving me insane. We'll see how long until my patience runs out, if it ever does.

 

[SpecterGT260]

I'm in a bit of a pickle.

I'm 23, graduated college spring 2011, and have been applying to PA schools since May. I have gotten into three and have a deposit on one. Naturally, I have now decided to go into all out crisis mode about whether or not I will regret not at least attempting to get into medical school. SO, I am faced with the decision of either declining these PA schools and giving it a go with DO schools in the upcoming cycle OR going to PA school and hope that I will be content with my choice.

Here are my reservations about PA school:
1. frustration of not being in full control of my patient's care all of the time and not have their full faith or trust all of the time.
2. not having a large enough scope of practice or education to quench my thirst for the rest of my career.
3. making a half or a third of the money and having a capped salary.

Here are my reservations about Med school:
1. I will devolve into a miserable lifeless zombie for 8 years and wish I had time to enjoy my 20's as I would as a PA
2. that doctor salaries will go down and PA scope of practice will go way up thus further blurring the line btw doc and PA and further increasing my regret of bearing the long med school journey
***3. will not get into med school and will have completely wasted another year or two of my life......


Just to give you a feel for my relative competitiveness, or lack thereof.....

-Biology major
-3.26 GPA (3.58 in last 60 credits)
-3.19 sGPA
-A and B in Bio 1 and 2, A's in both physics, A's in both orgos, B's in both chems
-MCAT- plan to take it in the spring. what score would give me a decent chance at DO schools?

-650 hours as volunteer EMT-aid
-400 or 500 hours as Emergency room scribe by the spring
-Decent amount of random volunteering over the years
-Licensed USCG Captain Since age 18
-Captain of high school volleyball and college club basketball


So,

do I put off PA school to give DO a shot?

do I even have a shot at DO school?

What are your thoughts on the career outlook of PA vs Doc?

looking back, did you think med school was worth it while you were going through it?

can you have a life through med school and residency?


ANY thoughts on these matters are GREATLY appreciated!

Someone mentioned this already but (or alluded to it) - changes in salary and scope do not happen independently of each other. Salary is highly tied to work volume. If PA scope increases salaries will also likely increase (this is, after all, why some of them are pushing for increased scope) and if that line blurs too much either PA schooling will start to look more like med school (more time in training, the most likely outcome given our current views on healthcare) or people will start to choose the more highly trained option if all else is equal and PA workflow will suffer except in rural areas (where they currently enjoy the most autonomy anyways).
Absolute worst case from the physician perspective is PAs will get full rights to primary care, but PAs will not be encroaching on specialties any time soon.

 

[SpecterGT260]

HA!

Please, you should know that clinical experience implies providing care. Otherwise, why wouldn't we (as pre-meds) just stuck with volunteering and shadowing? "Direct observation" means nothing. Why should we bother doing stuff as 3rd and 4th year medical students? Wouldn't just directly observing be good enough to develop our clinical judgement skills?

Anyhow, I'm willing to accept that I may be wrong about the scope of practice that scribes have in various EDs. But, I don't think that any doc (or anyone else with legit "clinical experience") would say that simply observing a patient, however directly, counts as clinical experience.

"Clinical experience" has different meaning depending on where you are in the game.

For VOLUNTEER experience, any observational situation is "clinical experience" from the adcom's point of view. But (to everyone else) let's be clear - you don't learn jack squat doing it, at least in terms of clinical knowledge. You will learn much about what a doctor does and what the day is like, but really nothing useful about HOW the doctor does it. I did a ton of shadowing and scribing before med school. Worked full shifts twice a month (usually overnights) 1on1 with an ER doc. "learned" a few neat things, but came out still not in any way capable of providing care. When a med student or above uses the phrase "clinical experience" it implies experience in providing care which simply cannot be gained through observation like shadowing/scribing. If you think it can, you are only demonstrating how vast the knowledge gap is such that you can't even identify it (think "Flatland", if you are familiar with the story).

If pre-med volunteer stuff actually taught anything useful we would have a drastically different medical school model. It is just important to understand the implied meaning of the phrase based on who uses it. AdComs are not interested in any way in recruiting people who already "know" patient care.

 

[racerwad]

Being an ER scribe is invaluable. And, it IS in fact clinical experience. Again, there should be a distinction between clinical experience and clinical care provider.

Actually, I was talking to one of the attendings the other day at UTSW and he conducted a study of all of the EM residents who had been scribes prior to the onset of medical school. The study showed (according to him) that the ones who were scribes outperformed their non scribe counterparts. More of them had gone on to become chief residents in a residency class of 19 residents.

I have been a scribe for nearly 2 years. I see ~25 patients per shift. I usually work 4 shifts a week (sometimes more). So I see roughly 100 patients a week, 400 a month. 400 x 24. That is 9,600 patients that I have seen.

I always type my own notes. The note is not dictated to me by the physician. I just ask him for the physical exam. At some hospitals, I even put in the orders. I put in the differential diagnosis myself. If someone has new onset leg swelling and risk factors for DVT (recent immobility/bed bound status, recent surgery, long car/plane trip, blood clotting disorder, previous history of DVT/PE), I will put DVT, superficial thrombophlebitis. If it is a patient with RUQ and MEG pain that worsened after eating greasy food and their pain is associated with nausea, vomiting. I will put cholelithiasis with/without evidence of acute cholecystitis. Patient can also be concerning for pancreatitis. Their work up will include basic blood work, lipase, and RUQ US. Pain control PRN, anti emetic. The patient will be rehydrated with IV fluids and reassessed after labs, gallbladder sono.

Some of the things to look for on the sono include a dilated common bile duct, pericholecystitic fluid, or a sonographic murphy's sign.

Your telling me that this isn't going to be helpful when I start medical school?

It would be helpful if you knew those things and could do them.

Just saying...

 

[racerwad]

"Clinical experience" has different meaning depending on where you are in the game.

For VOLUNTEER experience, any observational situation is "clinical experience" from the adcom's point of view. But (to everyone else) let's be clear - you don't learn jack squat doing it, at least in terms of clinical knowledge. You will learn much about what a doctor does and what the day is like, but really nothing useful about HOW the doctor does it. I did a ton of shadowing and scribing before med school. Worked full shifts twice a month (usually overnights) 1on1 with an ER doc. "learned" a few neat things, but came out still not in any way capable of providing care. When a med student or above uses the phrase "clinical experience" it implies experience in providing care which simply cannot be gained through observation like shadowing/scribing. If you think it can, you are only demonstrating how vast the knowledge gap is such that you can't even identify it (think "Flatland", if you are familiar with the story).

If pre-med volunteer stuff actually taught anything useful we would have a drastically different medical school model. It is just important to understand the implied meaning of the phrase based on who uses it. AdComs are not interested in any way in recruiting people who already "know" patient care.

 

[felix2929]

It would be helpful if you knew those things and could do them.

Just saying...

i think that is asking a lot of a pre-med. like he said, it depends on where you are in your education.

 

[racerwad]

i think that is asking a lot of a pre-med. like he said, it depends on where you are in your education.

So lowest common denominator is good enough?

I agree, it is a lot. It is also why I always suggest pre-meds to pursue being an ED tech versus ED scribe, all things being equal. It's a more efficient form of experience (IMHO).

 

[CannonballComin]

OP, I am a PA who will be starting at an MD school in 2013. From my experience, I would say that you should not blow off your hesitation to attend PA school. My roommate and I were both struggling with this problem when we were seniors in college (we are 26 now). I jumped into PA school while he took a year off, taught chemistry, and shadowed physicians and PA's like it was a part time job. In retrospect, I admire his maturity in that decision as he went on to choose medical school and is now applying to residencies. While I would never call my last 4 years a waste considering the experience and relationships that have I have developed during that time, it would be nice to be applying to resdencies instead of medical schools. If you have any specific questions please feel free to message me.

Also: After reading through a good portion of this thread, I would warn readers to take all of the perspectives/advice with a grain of salt (including mine). The VAST majority of midlevel providers do not wish they were physicians and the VAST majority of primary care physicians do not wish they were midlevels. As for the "at my facility" type perspectives, know that every facility is different in the way they utilize midlevel providers. I work in two hospitals; in one we are perpetual residents and in the other we don't discuss any patients with the physicians unless we have a question or are seeking help and I see sicker patients at the one where we have more autonomy.

 

[felix2929]

I dont think lowest common denominator is good enough but I don't think you need to be a CNA, paramedic or nurse to go to med school and become a doctor. I think having those experiences is valuable and adcoms seem to agree. I think adcoms also know that ER scribes follow doctors around and don't touch patients vs. direct caregivers who do. I dont remember exactly what started the discussion but it seems that for applying to med school, if you saw patients with your eyes vs. worked at the bench in the lab it is OK to call it a clinical experience.

 

[IH8ColdWeath3r]

It would be helpful if you knew those things and could do them.

Just saying...

Could do them? What, you mean like hang a bag of normal saline? Give someone some Zofran ODT or a Phenergan suppository? Start a line and draw blood? Do some splinting? and take patients up to the telemetry/med surg floor?

These are the thing that you do as a paramedic/ER tech/nurse. At some point, there is a point of diminishing return. And I am not trying to sound condescending to nurses or ER technicians because they are valuable members of the healthcare team. The ER would not function without them.

However, I think scribing differs though. Some people scribe and just go through the motions and learn nothing. They don't take the time to look things up that they see clinically on uptodate.com They don't think about the patient's clinical presentation and put in "dummy" differential diagnoses on the chart based on what is ordered as opposed to thinking about the clinical presentation (for example, they put pneumothorax on anyone receiving a chest xray even though the patient did not sustain any blunt trauma or is not a tall, thin, frail male). They don't ask questions (when it is appropriate).

I was fortunate because the group of doctors that my scribing company works for love to teach. I work full time and usually more than half my shifts are during nights, which can get slow. The doctors love to teach (obviously you don't want to bombard them with questions). If you use the opportunity to its full potential, there is ALOT that you can learn, CLINICALLY. Your are with a doctor ~9 hours! You can learn about different clinical presentations, symptoms, treatment options, dosage of the medications, how to read certain imaging.

For example, the doctors taught me about someone concerning for a kidney stone

symptoms: include flank pain, usually radiating to back/front abdomen, dysuria, hematuria
exam: CVA tenderness on exam
lab results: moderate to large amount of blood in the UA

For imaging, these patient will have a noncontrasted CT of the abdomen/pelvis so that the stone "lights" up in the kidney/ureter. A contrasted CT would make it difficult to visualize the stone because the iodine also lights up. They even showed me where the ureter is anatomically and how to follow the ureter down to the pelvis to look for a ureteral stone and evidence of hydronephrosis.

and this is just an example of one type of patient. This happens daily with patients whose complaints range from fever/cough, dizziness, abdominal pain, chest pain ...etc. etc.

Techs/nurses rarely/never get to sit next to a doctor who is willing to go through this stuff with them and explain why certain things are the way that they are (they are just to busy doing other stuff). They don't get to look at imaging with them and show them where things are anatomically and what to look for. So, to the person who said that being a paramedic is a better learning experience than scribing for medical school, I would very politely disagree.

 

[racerwad]

Techs/nurses rarely/never get to sit next to a doctor who is willing to go through this stuff with them and explain why certain things are the way that they are (they are just to busy doing other stuff). They don't get to look at imaging with them and show them where things are anatomically and what to look for. So, to the person who said that being a paramedic is a better learning experience than scribing for medical school, I would very politely disagree.

I didn't actually say being a paramedic is a better learning experience than being a scribe. I said being an EMT-B/MA is a better experience than a scribe's.

I've worked in the ED and my experience is/was better than a scribe, but I definitely do not think people need to invest the amount of time that I did.

The same doctors that are so generous with their time for you also happen to work with nurses, medics, and techs and are willing to do the exact same teaching. All those nurses/techs et al need to do is ask, and I assure you, those of us in those positions who were thinking of a similar career path as yourself have indeed asked all of those questions. They're not dumb automatons that just go through motions. Pre-meds aren't the only intellectually curious people in the world.

There is something fundamentally different to doing the orders you're transcribing. Apart from an error in what you've written, there are no repercussions. When a nurse fulfills an order, even though they're "just doing the doctor's orders," I assure you they approach that situation with a level of critical thinking that is nothing close to what a scribe is doing. The same holds true for even a tech-level position where the most technical thing we might do is place a splint.

As someone who has done both (note taking and being a care provider), I can assure you that this is the case. I'm not saying this to undermine your experience. It's more for those pre-meds out there that are making a decision between one preparatory experience and another. Again, I'm not saying that one needs to go to nursing school to be ready for medical school. I'm saying that just writing things down isn't as valuable as someone who is able to interact with the physicians in the same way that you do and performs some basic skills. It gives you a chance to act one on one with the patient, ask questions, inflict pain, make mistakes and through those experiences, develop a style towards how you approach people.

Anyhow, I know that this will come across as an attack and I'm sorry. It definitely isn't that way. It's more a cautionary note to not overestimate your experience as I myself have done. If I've learned anything, it's that I don't know or understand even a small portion of what I thought I did about being a doctor prior to coming to med school.
.

 

[pattr]

The same doctors that are so generous with their time for you also happen to work with nurses, medics, and techs and are willing to do the exact same teaching. All those nurses/techs et al need to do is ask, and I assure you, those of us in those positions who were thinking of a similar career path as yourself have indeed asked all of those questions. They're not dumb automatons that just go through motions. Pre-meds aren't the only intellectually curious people in the world.

I'm saying that just writing things down isn't as valuable as someone who is able to interact with the physicians in the same way that you do and performs some basic skills. It gives you a chance to act one on one with the patient, ask questions, inflict pain, make mistakes and through those experiences, develop a style towards how you approach people..

I agree mostly with the above. I was an EMT before going to medical school... didn't really hear about scribe until I had already been accepted. But I think they're both worthwhile clinical experiences in their own ways. As a scribe you can easily develop a mentoring relationship with a physician and through shadowing, writing their notes and discussing with them, as other posters have noted, you can learn about differentials, workup, pharmacology...

I think the difference is that as an EMT, paramedic, nurse, etc. you have your own patients. You are responsible for what happens to them. And you get experience directly interacting with the patient, as racerwad said, on a 1 to 1 basis, taking a history, doing an exam, counseling, developing your own plan of care. It's definitely more "hands-on."

Whether one is more valuable than the other I really can't say. I think they prepare you for medical school in different ways. I was more prepared than some of my classmates for all my doctoring, patient interviewing/interaction labs and for the clinical years in school. However someone who learned a bunch as a scribe might have benefited more when it came time for retaining some clinical pearls, having remembered them from before.

 

[Buckeye(OH)]

In my fairly extensive experience in the medical community, PA's are permanent residents. You don't want that. There are plenty of PAs that go back to medical school. There are plenty of DOs that don't go back to PA school...

 

[OCDEMS]

I think it's worth making a big distinction between being a paramedic or nurse and a scribe:

I think many paramedics and nurses, who typically have a associate's degree or bachelor's in their field ALONG with respective professional organizations, scopes of practices, and some autonomy would probably balk at being compared to a scribe. We have scribes in the local ED. I took pre-medical classes with one of them. There isn't a comparison in clinical exposure. You can dismiss giving Zofran or hanging NS as menial work, but frankly you're a scribe. You watch people do these things and then write about it. When the patient is crashing in the code room, the paramedic and nurse can jump and be useful. Likewise, being an EMT is not the same as being a paramedic. Both are prehospital and both work together, but there is a vast difference in education. One is a 180 hour course and the other two years of study. Likewise, a CNA is not a nurse.

I'm not trying to diminish being a scribe, although I'm sure that's exactly what it sounds like I'm doing. As someone who writes patient care reports on a regular basis, I wish I had someone to dictate my thoughts to or simply do it for me. I spend almost as much time on the documentation as the actual patient care. Trust me, you're valuable. My understanding is that Scribe America and other organizations were created specifically to impart clinical experience to scribes while paying a competitive salary in the context of the student's capability, education, and experience. You're paid to do something because other people dislike doing it AND because it increases efficiency. I asked a physician recently why their particular ED didn't use scribes and he said, "Meh. I'd rather type my own charts." You'd never hear me ask, "Why doesn't your ED use RNs?" It would sound ridiculous.

I did a lot of precepting with physicians in undergrad. No, I didn't work with them for months on end, but I did put in considerable hours at their side. There is a point where shadowing or watching physicians leads to the mistaken belief that medicine is algorithmic. That if only I knew a bit more about microbes, and a bit more pharmacology, and how to read an X-Ray or CT that I could be a doctor. You have to eventually shake your head and realize that you're kidding yourself. Being any sort of clinician demands a healthy amount of didactic education and experience. There is a substantial amount of intuition and knowledge that comes from applying concepts with clinical experience. IVs probably look easy, but being proficient at it takes time. You may watch the ED tech do it effortlessly, but that's because they do it all of the time. Sure, pushing atropine may look easy, but would you know the implications of doing so in a second or third degree block? This is one among many examples. I think many people see nurses and paramedics as entirely protocol driven. "If this, then do that." That may have been true 15 years ago (and in some regressive EMS systems this is still true), but most modern, educated practitioners in both professions can look at basic labs and recognize the consequences. Most have a fundamental working knowledge of the body, pathogenesis, etc, with the exception that paramedics are highly specialized to prehospital emergency care and nurses are educated as generalist.

SDN is full of paramedic and nurse misconceptions. People forget that "EMT School" is not the same as being a paramedic. People forget that nurses actually go to school and, depending on their field, have a fairly decent scope. Talk to a seasoned ICU nurse sometime and see what he/she says about this discussion.

The difference is that being a paramedic, nurse, or respiratory therapist is a profession and being a scribe is a preparatory job to purposefully expose you to medicine. Sure, plenty of paramedics and nurses go on to medical school, but that doesn't mean it's not a fulfilling and rewarding career in its own right. Basically, being any sort of clinician is a career of serious consequence, both to society and each patient you see and care for.

 

[PAorMDhopeful]

OP, have you made any headway in your decision?

I can directly relate to your situation. I have been accepted to a few PA programs this cycle (my top choices, too), but I have been worrying whether or not I am making a mistake. I am concerned about all of the reservations you listed (for both med school and PA school), but my biggest concern is delaying family life if I choose medical school.

Have you done any more shadowing of DOs or PAs? I think I am going to try and get a few more experiences under my belt in the coming weeks, shadowing a couple PAs and a couple docs. Hopefully it'll give me an idea of which direction I should pursue.

Good luck with your decision, keep us posted!

 

[CjOz]

How is that?

My understanding is that they are there when stuff is done, but they don't do things like techs or CNAs do. Do they draw labs or start IVs, hang or give meds, write their own notes (instead of transcribing verbal dictation), have one on one time with the patient fulfilling any orders, apply splints/casts/bandages/dressings etc?

I would define clinical as anything that involves direct patient care and responsibility like RNs, paramedics, RTs, CNAs, ED techs, etc, etc.

Perhaps this is just my own misconception but I thought that scribes were just that, scribes; they only helped the doc with completing the chart. I'm definitely not saying they don't see and experience a lot. All that one on one time with a physician would be fantastic! But if they aren't seeing patients alone, I don't see how that's clinical?

Maybe it's different from hospital to hospital and scribes are more like techs? If that's the case then I'm 100% wrong and I take back what I said. Otherwise, not clinical

I am an ED scribe, have been for over a year. I firmly believe that I would not have gotten into medical school this cycle if I hadn't been. No, we are not involved in direct patient care as my company forbids my involvement with direct patient care. However, don't let this diminish the clinical experience you gain while scribing. While I may not know how to start an IV on a patient, I have gained substantial knowledge on recognizing key symptoms from patient testimony and what labs/rads to order as well as how to diagnose/treat the patient based upon their lab results. While you may define clinical experience as direct patient care, I guarantee you I have gained more clinical knowledge through scribing than a tech has by doing his job. As a scribe, you follow a doctor around all day, and as time progresses you begin to think like a doctor.

But I'd have to say the best part of being a scribe is building relationships with the doctors you work with. I essentially am shadowing a doctor and getting paid to do it.
All these relationships result is some pretty awesome LORs.

I'd highly recommend scribing to anybody who is pre-med.

 

[racerwad]

I guarantee you I have gained more clinical knowledge through scribing than a tech has by doing his job. As a scribe, you follow a doctor around all day, and as time progresses you begin to think like a doctor.

But I'd have to say the best part of being a scribe is building relationships with the doctors you work with. I essentially am shadowing a doctor and getting paid to do it.
All these relationships result is some pretty awesome LORs.

I'd highly recommend scribing to anybody who is pre-med.

I absolutely disagree with what I bolded, but 100% agree with what I underlined.

 

[MiracleforMD]

I haven't done both but let's not forget that 1/4 of a tech's time in a shift involves wheeling people to CT/US/MRI.

 

[sylvanthus]

I am an ED scribe, have been for over a year. I firmly believe that I would not have gotten into medical school this cycle if I hadn't been. No, we are not involved in direct patient care as my company forbids my involvement with direct patient care. However, don't let this diminish the clinical experience you gain while scribing. While I may not know how to start an IV on a patient, I have gained substantial knowledge on recognizing key symptoms from patient testimony and what labs/rads to order as well as how to diagnose/treat the patient based upon their lab results. While you may define clinical experience as direct patient care, I guarantee you I have gained more clinical knowledge through scribing than a tech has by doing his job. As a scribe, you follow a doctor around all day, and as time progresses you begin to think like a doctor.

But I'd have to say the best part of being a scribe is building relationships with the doctors you work with. I essentially am shadowing a doctor and getting paid to do it.
All these relationships result is some pretty awesome LORs.

I'd highly recommend scribing to anybody who is pre-med.

Ok dude, whatever you say. You don't think you gain clinical knowledge by directly working on patients? You don't think the techs talk to the physicians about patients and that physicians don't realize that alot of techs are pre-meds and teach them things?

I would have put my measley tech clinical knowledge against your scribe clinical knowledge any day of the week before med school.

 

[SpecterGT260]

Ok dude, whatever you say. You don't think you gain clinical knowledge by directly working on patients? You don't think the techs talk to the physicians about patients and that physicians don't realize that alot of techs are pre-meds and teach them things?

I would have put my measley tech clinical knowledge against your scribe clinical knowledge any day of the week before med school.

I think the correct response here is that the clinical knowledge for both is essentially bill and not in any way beneficial to a medical student. Do the volunteering to get an idea of what you are getting into, not for some sort of "leg up" in terms of clinical knowledge. Id suspect adcoms want people with a good idea of what it is and as clinically green as possible. Nothing worse than a student who already thinks he knows something.

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[MiracleforMD]

Ok dude, whatever you say. You don't think you gain clinical knowledge by directly working on patients? You don't think the techs talk to the physicians about patients and that physicians don't realize that alot of techs are pre-meds and teach them things?

I would have put my measley tech clinical knowledge against your scribe clinical knowledge any day of the week before med school.

I don't think anyone is doubting that tech's gain valuable knowledge while working with physicians. It is simply a numbers thing. If you got 20 good minutes per shift of one on one with the physician solely about clinical impression, workup, whatever, that would be a good learning day. A full time scribe is working 4-5 9 hour shifts alongside the doctor for practically every minute (within reason) doing the same thing you do in those 20 minutes. In this case it is quantity with equal quality.

That being said, I do still feel physicians will go into more depth than with scribes, but this is just my personal experience. Could vary with department.

 

[sylvanthus]

I don't think anyone is doubting that tech's gain valuable knowledge while working with physicians. It is simply a numbers thing. If you got 20 good minutes per shift of one on one with the physician solely about clinical impression, workup, whatever, that would be a good learning day. A full time scribe is working 4-5 9 hour shifts alongside the doctor for practically every minute (within reason) doing the same thing you do in those 20 minutes. In this case it is quantity with equal quality.

That being said, I do still feel physicians will go into more depth than with scribes, but this is just my personal experience. Could vary with department.

You will learn when you enter medical school that the patients themselves are your best teachers.

 

[MiracleforMD]

You will learn when you enter medical school that the patients themselves are your best teachers.

Wut.

 

[sylvanthus]

Wut.

Exactly.

 

[MiracleforMD]

Exactly.

Wow. You must be a blast.

 

[MedPR]

You will learn when you enter medical school that the patients themselves are your best teachers.

Philosophy mindf*ck dude.

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[racerwad]

I don't think anyone is doubting that tech's gain valuable knowledge while working with physicians. It is simply a numbers thing. If you got 20 good minutes per shift of one on one with the physician solely about clinical impression, workup, whatever, that would be a good learning day. A full time scribe is working 4-5 9 hour shifts alongside the doctor for practically every minute (within reason) doing the same thing you do in those 20 minutes. In this case it is quantity with equal quality.

That being said, I do still feel physicians will go into more depth than with scribes, but this is just my personal experience. Could vary with department.

Whenever a physician asks any delegate (nurse, tech, medic, whomever) do perform a task, they are investing a lot more into that person and that relationship than just someone who is taking notes. I promise. If a scribe transcribes something wrong, the physician *should* catch that when they review the chart and finalize it; it could become a big deal, but it's unlikely. If someone fulfills the orders wrong, someone could be hurt.

The point in all of this is that regardless of how much experience we enter medical school with, none of us really know what it's like to be a doctor. Of course, I understand that we only know what we know, so if someone's experience as a scribe was beneficial to them, of course they're going to defend that. I respect and acknowledge that. But, as SpecterGT260 said, no one wants a student that thinks they know it all already. I know I had a ton of experience and my lack of understanding is exactly why I wanted to go to medical school.

And, as cliche as it sounds, patients really are the best teachers, if only because they're the reason you royally F something up or put your foot in your mouth. Or, as was my specialty, do both.

 

[Ost3oclast]

Just my experience on the interview trail, I had one interviewer at an M.D school praise the fact that I DIDNT work as a scribe. He ranted for like 10 minutes about how pre meds think it is some great experience, when in his opinion, it shouldn't constitute clinical experience at all. He said that if working as a scribe is your only clinical experience, in his eyes, you have no clinical experience. I found that quite odd but....to each his own.

 

[SpecterGT260]

Just my experience on the interview trail, I had one interviewer at an M.D school praise the fact that I DIDNT work as a scribe. He ranted for like 10 minutes about how pre meds think it is some great experience, when in his opinion, it shouldn't constitute clinical experience at all. He said that if working as a scribe is your only clinical experience, in his eyes, you have no clinical experience. I found that quite odd but....to each his own.

It has variable meaning. I went in each exam room with the doc, was introduced to the patient, took notes, and talked to the doc after each patient while scribing. I still think the clinical experience is great for apps, minimal in terms of knowledge gained (other than "a day in the life of"). Clinical experience in the sense of what an M3 gains is only gained in M3. Everything pre meds do is more likely to miss the mark than approach it. Everything (even non trads). Emt is cool, scribing is cool, tech jobs are cool, cna is cool. None of it is "clinical experience" from the standpoint of medicine. It's only clinical exposure.

 

[Ost3oclast]

It's only clinical exposure.

Yeah good call there.

 

[MedPR]

It has variable meaning. I went in each exam room with the doc, was introduced to the patient, took notes, and talked to the doc after each patient while scribing. I still think the clinical experience is great for apps, minimal in terms of knowledge gained (other than "a day in the life of"). Clinical experience in the sense of what an M3 gains is only gained in M3. Everything pre meds do is more likely to miss the mark than approach it. Everything (even non trads). Emt is cool, scribing is cool, tech jobs are cool, cna is cool. None of it is "clinical experience" from the standpoint of medicine. It's only clinical exposure.

Yea, my scribing experience involved listening to dictation (tape recorded) and typing it into charts. Booooooooooooooooooooooring.

 

[SpecterGT260]

Yea, my scribing experience involved listening to dictation (tape recorded) and typing it into charts. Booooooooooooooooooooooring.

Lame. I had a doc who loved to teach but was at the private hospital near the university. He let me do overnights with him. Saw cool stuff and did proof reading on his charting (basically just corrected voice to text errors and got them ready for him to hit ok) when hints got slow. Also kept a record of his exams for each patient to help him out and started the charting file for him. Way better than real scribing haha


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[MiracleforMD]

Whenever a physician asks any delegate (nurse, tech, medic, whomever) do perform a task, they are investing a lot more into that person and that relationship than just someone who is taking notes. I promise. If a scribe transcribes something wrong, the physician *should* catch that when they review the chart and finalize it; it could become a big deal, but it's unlikely. If someone fulfills the orders wrong, someone could be hurt.

The point in all of this is that regardless of how much experience we enter medical school with, none of us really know what it's like to be a doctor. Of course, I understand that we only know what we know, so if someone's experience as a scribe was beneficial to them, of course they're going to defend that. I respect and acknowledge that. But, as SpecterGT260 said, no one wants a student that thinks they know it all already. I know I had a ton of experience and my lack of understanding is exactly why I wanted to go to medical school.

And, as cliche as it sounds, patients really are the best teachers, if only because they're the reason you royally F something up or put your foot in your mouth. Or, as was my specialty, do both.

I dunno why you're equating degree of consequence of error of said worker to clinical knowledge gained, but I have nowhere near the inclination to get into this with another poster.

 

[bajastapler]

If quality of life is the most important thing to you: go PA.

If you got hoop dreams: go DO.

Either way, stick to your guns, smile, and don't look back. Every year that goes by is a year of $XXX,XXX salary you give up. GL!

 

[racerwad]

I dunno why you're equating degree of consequence of error of said worker to clinical knowledge gained, but I have nowhere near the inclination to get into this with another poster.

I thought you were making a value judgement that as a scribe, because you followed a doc around all day, you believed you were learning and experiencing more, thereby making it valuable. I'm saying that part of clinical experience is having some level of responsibility to a patient. This is where the value of being a tech (or other physician delegate) comes from. The responsibility and being alone with another person who is looking to you for help and reassurance is when you should have your first chance at learning if this is indeed something you want to do.

I haven't done both but let's not forget that 1/4 of a tech's time in a shift involves wheeling people to CT/US/MRI.

I think this is a perfect example of how the two positions vary and where the I think that the techs have a leg up. What happens when the patient decompensates (let alone codes) in CT? How do you know that a patient is even appropriate for a tech to take to CT and not a nurse or doc (that is, recognize sick vs. not-sick and not just do as you're told)? This type of planning and decision making is a part of every tech/nurse's daily routine and it's the type of independent decision making that isn't the scope of a scribe.

As someone who has done both, they are different. From the perspective of a medical student, nothing is really effective "preparation" for medical school expect maybe patience and an open mind. Basically, the best prep is whatever gets you into a program.

 

[IH8ColdWeath3r]

Just my experience on the interview trail, I had one interviewer at an M.D school praise the fact that I DIDNT work as a scribe. He ranted for like 10 minutes about how pre meds think it is some great experience, when in his opinion, it shouldn't constitute clinical experience at all. He said that if working as a scribe is your only clinical experience, in his eyes, you have no clinical experience. I found that quite odd but....to each his own.

That's funny, because 2 of the 5 chief residents in EM right now were scribes. The residency director at UTSW thought that their previous exposure was beneficial and played a role in not only getting those candidates into the EM residency, but also helped with the chief resident selection process.

And sorry, but where I work there is zero interaction between the physicians and techs (I know this varies from facility to facility). At our hospital, if there is an order for an EKG, it pops up on the techs computer and he does it. The blood is drawn immediately by the nurse/tech. If the patient needs blood cultures, the nurse gets it. If a patient needs to be transported, the tech takes them. The only time really when a doctor verbalizes anything to a tech is in regard to different types of splinting or during a code.

And to the people who think that a scribe is some kind of courtroom stenographer, I can assure that it's not. You learn things ALL the time. It's clinical. And yes, the patients are the best teachers. When I put in physical exams, I learn clinically. When I put moon facies, buffalo hump, truncal obesity, and abdominal striae on someone's physical exam and have a brief discussion with the doc that I'm with for 9 hours, I quickly find out that these are the CLINICAL manifestations of someone with Cushing's Symdrome. I find out that cushings is from prolonged exposure to steroids, both exogenous and endogenous. And the most common form of Cushings is iatrogenic (an inadvertent consequence of medical treatment; like patients with RA, SLE who are on chronic steroids). These are the things that the physician that I was working with TAUGHT me during my shift a few days ago. Again, where I work, techs do not learn these things. These kinds of lengthy conversations never go on between the physicians and techs because the techs are just too busy doing other things (starting lines, transporting, doing EKGs, putting on a splint).

Im sure I came of ass an ass in this post, which I didnt mean too. I have much respect for techs and I am friends with all the techs at our hospital. They keep the ED running. But, its just my two cents on the difference in the kind of learning experience based on facilities that I have worked at (both private and academic teaching hospital).

And Racerwad, my lack of understanding is exactly what made me also want to pursue medicine. I acknowledge that these experiences in no way prepare you the the volume and depth of info that's presented in medical school.

 

[Ost3oclast]

That's funny, because 2 of the 5 chief residents in EM right now were scribes. The residency director at UTSW thought that their previous exposure was beneficial and played a role in not only getting those candidates into the EM residency, but also helped with the chief resident selection process.

And sorry, but where I work there is zero interaction between the physicians and techs (I know this varies from facility to facility). At our hospital, if there is an order for an EKG, it pops up on the techs computer and he does it. The blood is drawn immediately by the nurse/tech. If the patient needs blood cultures, the nurse gets it. If a patient needs to be transported, the tech takes them. The only time really when a doctor verbalizes anything to a tech is in regard to different types of splinting or during a code.

And to the people who think that a scribe is some kind of courtroom stenographer, I can assure that it's not. You learn things ALL the time. It's clinical. And yes, the patients are the best teachers. When I put in physical exams, I learn clinically. When I put moon facies, buffalo hump, truncal obesity, and abdominal striae on someone's physical exam and have a brief discussion with the doc that I'm with for 9 hours, I quickly find out that these are the CLINICAL manifestations of someone with Cushing's Symdrome. I find out that cushings is from prolonged exposure to steroids, both exogenous and endogenous. And the most common form of Cushings is iatrogenic (an inadvertent consequence of medical treatment; like patients with RA, SLE who are on chronic steroids). These are the things that the physician that I was working with TAUGHT me during my shift a few days ago. Again, where I work, techs do not learn these things. These kinds of lengthy conversations never go on between the physicians and techs because the techs are just too busy doing other things (starting lines, transporting, doing EKGs, putting on a splint).

Im sure I came of ass an ass in this post, which I didnt mean too. I have much respect for techs and I am friends with all the techs at our hospital. They keep the ED running. But, its just my two cents on the difference in the kind of learning experience based on facilities that I have worked at (both private and academic teaching hospital).

And Racerwad, my lack of understanding is exactly what made me also want to pursue medicine. I acknowledge that these experiences in no way prepare you the the volume and depth of info that's presented in medical school.

I wasnt knocking scribes, just to be clear. Just thought I would share what somebody involved in the admissions process told me.....

 

[felix2929]

That's funny, because 2 of the 5 chief residents in EM right now were scribes. The residency director at UTSW thought that their previous exposure was beneficial and played a role in not only getting those candidates into the EM residency, but also helped with the chief resident selection process.

And sorry, but where I work there is zero interaction between the physicians and techs (I know this varies from facility to facility). At our hospital, if there is an order for an EKG, it pops up on the techs computer and he does it. The blood is drawn immediately by the nurse/tech. If the patient needs blood cultures, the nurse gets it. If a patient needs to be transported, the tech takes them. The only time really when a doctor verbalizes anything to a tech is in regard to different types of splinting or during a code.

And to the people who think that a scribe is some kind of courtroom stenographer, I can assure that it's not. You learn things ALL the time. It's clinical. And yes, the patients are the best teachers. When I put in physical exams, I learn clinically. When I put moon facies, buffalo hump, truncal obesity, and abdominal striae on someone's physical exam and have a brief discussion with the doc that I'm with for 9 hours, I quickly find out that these are the CLINICAL manifestations of someone with Cushing's Symdrome. I find out that cushings is from prolonged exposure to steroids, both exogenous and endogenous. And the most common form of Cushings is iatrogenic (an inadvertent consequence of medical treatment; like patients with RA, SLE who are on chronic steroids). These are the things that the physician that I was working with TAUGHT me during my shift a few days ago. Again, where I work, techs do not learn these things. These kinds of lengthy conversations never go on between the physicians and techs because the techs are just too busy doing other things (starting lines, transporting, doing EKGs, putting on a splint).

Im sure I came of ass an ass in this post, which I didnt mean too. I have much respect for techs and I am friends with all the techs at our hospital. They keep the ED running. But, its just my two cents on the difference in the kind of learning experience based on facilities that I have worked at (both private and academic teaching hospital).

And Racerwad, my lack of understanding is exactly what made me also want to pursue medicine. I acknowledge that these experiences in no way prepare you the the volume and depth of info that's presented in medical school.

I was in the PICU the other day and noticed this kids huge swollen face and the nurse I was with said, yea, cushingoid, nicu grad with BPD and long term steroid use. Later in the day I put cushingoid into google and learned all the same stuff you just spit out. Probably won't help me much in med school...thought the word was cool though.

 

[deleted6669]

If quality of life is the most important thing to you: go PA.

this is only true for the duration of training...after graduation who is working most of the nights/weekends/holidays/rural/inner city/prison jobs so the other group doesn't have to.....docs hire pa's to do things they don't want to do at the times and places they don't want to do them so they can be home with their families.
docs in my group 120 hrs/mo, 360k/yr. 1 night/mo.
pa's in my group 180+ hrs/mo, 120-130k/yr, 4-5 nights/mo

who has more free time? who drives a porsche and who drives a honda? who goes to barbados for vacation for a month while the other goes to arizona for a week?
who can make most of their kids ball games and plays because they have someone else they can tell that they have to work?
md lifestyle after training(with the possible exception of surgeons who decide to take a lot of call)>>>>>avg pa lifestyle

 

[Temperature101]

this is only true for the duration of training...after graduation who is working most of the nights/weekends/holidays/rural/inner city/prison jobs so the other group doesn't have to.....docs hire pa's to do things they don't want to do at the times and places they don't want to do them so they can be home with their families.
docs in my group 120 hrs/mo, 360k/yr. 1 night/mo.
pa's in my group 180+ hrs/mo, 120-130k/yr, 4-5 nights/mo

who has more free time? who drives a porsche and who drives a honda? who goes to barbados for vacation for a month while the other goes to arizona for a week?
who can make most of their kids ball games and plays because they have someone else they can tell that they have to work?
md lifestyle after training(with the possible exception of surgeons who decide to take a lot of call)>>>>>avg pa lifestyle

That's 30hrs/wk average. What kind of specialty doc working 30 hrs/wk making 360k/year? Are these docs spinal surgeons?

 

[SpecterGT260]

this is only true for the duration of training...after graduation who is working most of the nights/weekends/holidays/rural/inner city/prison jobs so the other group doesn't have to.....docs hire pa's to do things they don't want to do at the times and places they don't want to do them so they can be home with their families.
docs in my group 120 hrs/mo, 360k/yr. 1 night/mo.
pa's in my group 180+ hrs/mo, 120-130k/yr, 4-5 nights/mo

who has more free time? who drives a porsche and who drives a honda? who goes to barbados for vacation for a month while the other goes to arizona for a week?
who can make most of their kids ball games and plays because they have someone else they can tell that they have to work?
md lifestyle after training(with the possible exception of surgeons who decide to take a lot of call)>>>>>avg pa lifestyle

I have a honda and am in AZ on vaca right now

I will also be 35 before I get my first real job after training.



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[Temperature101]

I have a honda and am in AZ on vaca right now



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You are not a doc yet...Lol

 

[SpecterGT260]

I know

I was mostly joking and partially implying it is a trade off in both directions.

Also I don't really have a Honda

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[Temperature101]

I know

I was mostly joking and partially implying it is a trade off in both directions.

Also I don't really have a Honda

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I know...My answer was a sarcasm.

 

[SpecterGT260]

I know...My answer was a sarcasm.

A sarcasm

Kinda like "the wal mart"

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[Textbookversion]

Could do them? What, you mean like hang a bag of normal saline? Give someone some Zofran ODT or a Phenergan suppository? Start a line and draw blood? Do some splinting? and take patients up to the telemetry/med surg floor?

These are the thing that you do as a paramedic/ER tech/nurse. At some point, there is a point of diminishing return. And I am not trying to sound condescending to nurses or ER technicians because they are valuable members of the healthcare team. The ER would not function without them.

However, I think scribing differs though. Some people scribe and just go through the motions and learn nothing. They don't take the time to look things up that they see clinically on uptodate.com They don't think about the patient's clinical presentation and put in "dummy" differential diagnoses on the chart based on what is ordered as opposed to thinking about the clinical presentation (for example, they put pneumothorax on anyone receiving a chest xray even though the patient did not sustain any blunt trauma or is not a tall, thin, frail male). They don't ask questions (when it is appropriate).

I was fortunate because the group of doctors that my scribing company works for love to teach. I work full time and usually more than half my shifts are during nights, which can get slow. The doctors love to teach (obviously you don't want to bombard them with questions). If you use the opportunity to its full potential, there is ALOT that you can learn, CLINICALLY. Your are with a doctor ~9 hours! You can learn about different clinical presentations, symptoms, treatment options, dosage of the medications, how to read certain imaging.

For example, the doctors taught me about someone concerning for a kidney stone

symptoms: include flank pain, usually radiating to back/front abdomen, dysuria, hematuria
exam: CVA tenderness on exam
lab results: moderate to large amount of blood in the UA

For imaging, these patient will have a noncontrasted CT of the abdomen/pelvis so that the stone "lights" up in the kidney/ureter. A contrasted CT would make it difficult to visualize the stone because the iodine also lights up. They even showed me where the ureter is anatomically and how to follow the ureter down to the pelvis to look for a ureteral stone and evidence of hydronephrosis.

and this is just an example of one type of patient. This happens daily with patients whose complaints range from fever/cough, dizziness, abdominal pain, chest pain ...etc. etc.

Techs/nurses rarely/never get to sit next to a doctor who is willing to go through this stuff with them and explain why certain things are the way that they are (they are just to busy doing other stuff). They don't get to look at imaging with them and show them where things are anatomically and what to look for. So, to the person who said that being a paramedic is a better learning experience than scribing for medical school, I would very politely disagree.

YOU ARE GOING TO BE A SUPER GOOD DOCTOR THE VERY BEST DOCTOR EVER THE BEST INTERN THE BEST RESIDENT ALL BECAUSE OF YOUR SCRIBING HOW SMART.

Is that what you wanted to hear? Nobody cares btw.