Graduating medical students should be allowed to challenge the PA exam

[sylvanthus]

I was thinking about thus during my pre-residency freakout. I think graduating medical students should be allowed to challenge the PA exam and be licensed PAs. We have completed all the core PA courses and rotations and then some. I think this would help several people.

1) Those who cannot get a residency spot, could challenge the exam and work as a PA. This helps not only them, but also the looming "provider shortage."

2) Those who decide for whatever reason they do not want to complete a residency have some kind of escape route from doing a long residency that doesn't leave them completely screwed and in debt forever.

Thoughts, flames, rants?

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[notbobtrustme]

good idea, but it'll never happen.

Also, not sure how many graduates will feel about taking a major demotion instead.

 

[sylvanthus]

I think tose FMGs/IMgs unable to land a residency would accept working as a PA over nothing. Also the AMGs who cant land a residency spot wouls probable be cool with being a PA over endless debt. Also, they all could continue to apply for residency spots and in the meantime work as a PA.

I know it would never happen, partially because these people havent paid tuition to PA schools and god knows those schools would throw a hissy fit.

 

[sylvanthus]

Excuse typos, on my phone.

 

[deleted307836]

I think tose FMGs/IMgs unable to land a residency would accept working as a PA over nothing. Also the AMGs who cant land a residency spot wouls probable be cool with being a PA over endless debt. Also, they all could continue to apply for residency spots and in the meantime work as a PA.

I know it would never happen, partially because these people havent paid tuition to PA schools and god knows those schools would throw a hissy fit.

For these reasons, PA's would be smart to block any attempt like this. It would probably do their collective future harm if swarms of IMG's willing to accept any working conditions and pay for a chance to get US clinical experience to eventually match clouded the job market.

I think it would make more sense if only US grads were allowed to do this... but even that could turn into a dangerous precedent where some may be "encouraged" to work as a PA in competitive fields before matching (though financially that probably wouldn't make too much sense from a program's perspective now that I think about it...)

 

[maybemed2013]

IMGs and FMGs were once able to work as PAs but that stop for reasons I do not know.

 

[witzelsucht]

I've heard that in some practice settings PAs can let their "C" lapse without negative consequences. I think this is if they are not writing Rxs, orders, etc. Would an unlicensed MD be able to do the same job?

 

[Textbookversion]

I've heard that in some practice settings PAs can let their "C" lapse without negative consequences. I think this is if they are not writing Rxs, orders, etc. Would an unlicensed MD be able to do the same job?

no, and no.

 

[alpinism]

Not sure how many physicians would be willing to walk into a patient's room and introduce themselves as a physician assistant, then not try to practice medicine.

They could also just do an internship to get their medical licence, then work in urgent care or at rural clinic.

 

[Textbookversion]

Not sure how many physicians would be willing to walk into a patient's room and introduce themselves as a physician assistant, then not try to practice medicine.

They could also just do an internship to get their medical licence, then work in urgent care or at rural clinic.

Well, all the unemployed IMG's would love to do that. As well as many third world doctors. As for "not practicing medicine" wtf do you think PA's do draw pictures of the patients and then do interpretive dance? They play doctor all day aka practice medicine.

As for the last sentence, not accurate for an IMG/FMG they have to do 2-3 years of residency in most states internship alone is not enough. Not to mention "just get an internship" is a non trivial proposition. Even for an AMG there weren't that many unfilled internships floating around to scramble for this year.

 

[Kaustikos]

Yeah,
And let's also include an RN or DNP. While we're at it...include CNA's.

 

[tco]

Well, all the unemployed IMG's would love to do that. As well as many third world doctors. As for "not practicing medicine" wtf do you think PA's do draw pictures of the patients and then do interpretive dance? They play doctor all day aka practice medicine.

As for the last sentence, not accurate for an IMG/FMG they have to do 2-3 years of residency in most states internship alone is not enough. Not to mention "just get an internship" is a non trivial proposition. Even for an AMG there weren't that many unfilled internships floating around to scramble for this year.

There's some ridiculous number of unfilled prelim surgery positions last year. They should suck it up and match into those.

This is not a good idea, IMO.

 

[DrBowtie]

There's some ridiculous number of unfilled prelim surgery positions last year. They should suck it up and match into those.

This is not a good idea, IMO.

~460 prelim surgery after the match. ~10 after the SOAP. I think most did suck it up and take those spots.

 

[tco]

~460 prelim surgery after the match. ~10 after the SOAP. I think most did suck it up and take those spots.

I think a significant amount of those were AMGs who didn't get into the residency they wanted. I know of at least 3 from the class ahead of me that SOAPed into prelim surgery.

Regardless, I still think the above idea is a bad one. No offense, OP.

 

[alpinism]

Well, all the unemployed IMG's would love to do that. As well as many third world doctors. As for "not practicing medicine" wtf do you think PA's do draw pictures of the patients and then do interpretive dance? They play doctor all day aka practice medicine.

As for the last sentence, not accurate for an IMG/FMG they have to do 2-3 years of residency in most states internship alone is not enough. Not to mention "just get an internship" is a non trivial proposition. Even for an AMG there weren't that many unfilled internships floating around to scramble for this year.

FM had 66 unfilled programs in 2012. Path had 33. IM had 21. IM and GS prelim combined had 188 unfilled. http://www.nrmp.org/data/resultsanddata2012.pdf

It's really not that hard at all as long as you have decent board scores, graduated med school on time w/ no red flags, apply broadly, and are willing to live in BFE. However, in 10yrs it might be a different story.

If you're not competitive enough to land a middle of nowhere FM internship/residency at a small community hospital (even as a IMG), IMO you prob shouldn't be seeing patients at all (even as a PA/NP/whatever).

The majority of PAs and NPs are still supervised by an attending who has to review and sign off on their charts. Treatment/management plans are ultimately decided upon by the attending. They don't just "play doctor all day." Most spend their day seeing low acuity and f/u pts without any major problems. PAs are only trained to handle normal, average cases. It's the physicians that handle the complex and weird stuff b/c that's what we're trained to do in med school. Why do you think they are always pushing for more autonomy and greater practice rights?

 

[hrandani]

Does anybody know what the deal is with "house staff" in some of these East Coast hospitals?

Someone was explaining to me that it means they are licensed physicians in another country, but have not completed a residency in the United States.

It was kind of bizarre, in retrospect, to watch a 27 year old intern sign off on a 45 year old veteran doctor's routine post-surgical med orders.

Anyways, nothing short of actually expanding residency slots is going to fix this debacle. It'll never happen, though. I don't know who had the great idea of funding residency slots out of Medicare.

 

[PrideNeverDie]

Does anybody know what the deal is with "house staff" in some of these East Coast hospitals?

Someone was explaining to me that it means they are licensed physicians in another country, but have not completed a residency in the United States.

It was kind of bizarre, in retrospect, to watch a 27 year old intern sign off on a 45 year old veteran doctor's routine post-surgical med orders.

Anyways, nothing short of actually expanding residency slots is going to fix this debacle. It'll never happen, though. I don't know who had the great idea of funding residency slots out of Medicare.

i'll take an attending from the 3rd world with 10+ years experience over a fresh PA anyday

 

[MSTPlease]

Does anybody know what the deal is with "house staff" in some of these East Coast hospitals?

Someone was explaining to me that it means they are licensed physicians in another country, but have not completed a residency in the United States.

It was kind of bizarre, in retrospect, to watch a 27 year old intern sign off on a 45 year old veteran doctor's routine post-surgical med orders.

Anyways, nothing short of actually expanding residency slots is going to fix this debacle. It'll never happen, though. I don't know who had the great idea of funding residency slots out of Medicare.

At my school's hospital, house staff just refers to any intern/resident.

 

[Dral]

For these reasons, PA's would be smart to block any attempt like this. It would probably do their collective future harm if swarms of IMG's willing to accept any working conditions and pay for a chance to get US clinical experience to eventually match clouded the job market.

I think it would make more sense if only US grads were allowed to do this... but even that could turn into a dangerous precedent where some may be "encouraged" to work as a PA in competitive fields before matching (though financially that probably wouldn't make too much sense from a program's perspective now that I think about it...)

This. Spot on.

 

[CDI]

Not sure how many physicians would be willing to walk into a patient's room and introduce themselves as a physician assistant, then not try to practice medicine.

They could also just do an internship to get their medical licence, then work in urgent care or at rural clinic.

Why would the introduce themselves as PAs? You haven't heard of DNPs introducing themselves as "Doctors"?

 

[PrideNeverDie]

For these reasons, PA's would be smart to block any attempt like this. It would probably do their collective future harm if swarms of IMG's willing to accept any working conditions and pay for a chance to get US clinical experience to eventually match clouded the job market.

I think it would make more sense if only US grads were allowed to do this... but even that could turn into a dangerous precedent where some may be "encouraged" to work as a PA in competitive fields before matching (though financially that probably wouldn't make too much sense from a program's perspective now that I think about it...)

NP/PAs encroach on our turf under the guise of improved patient care, why not use the same reasoning back to them

some FMG attendings would be 10x better than any US NP/PA

 

[CDI]

NP/PAs encroach on our turf under the guise of improved patient care, why not use the same reasoning back to them

some FMG attendings would be 10x better than any US NP/PA

True, just let the patient decide in the end.

 

[GoSpursGo]

FMGs have NOT satisfied the requirements of the PA curriculum. The lack of US-based clinical experience is pretty big--it doesn't matter how much experience you have in your home country if you're not able to integrate with the US healthcare system effectively.

I don't really have a problem with the idea of unmatched AMGs trying to go that route, but I think that in general: 1) most AMGs who fail to match once, maybe twice would be more likely to first try and improve their application and re-enter the match; 2) once these MDs are a few years out of clinical medicine, they may not be as attractive as strong PA applicants who have recent clinical exposure; 3) it seems like there would be a problem with this working legally anyways, so I think the point is likely moot.

 

[CDI]

FMGs have NOT satisfied the requirements of the PA curriculum. The lack of US-based clinical experience is pretty big--it doesn't matter how much experience you have in your home country if you're not able to integrate with the US healthcare system effectively.

I don't really have a problem with the idea of unmatched AMGs trying to go that route, but I think that in general: 1) most AMGs who fail to match once, maybe twice would be more likely to first try and improve their application and re-enter the match; 2) once these MDs are a few years out of clinical medicine, they may not be as attractive as strong PA applicants who have recent clinical exposure; 3) it seems like there would be a problem with this working legally anyways, so I think the point is likely moot.

FMG, does that not include IMGs who do 2 years of rotations within the US?

 

[evilbooyaa]

np/pas encroach on our turf under the guise of improved patient care, why not use the same reasoning back to them

some fmg attendings would be 10x better than any us np/pa

+1

 

[DrBowtie]

FMG, does that not include IMGs who do 2 years of rotations within the US?

Medical school rotations do not count. They must be done as part of GME training.

 

[GoSpursGo]

FMG, does that not include IMGs who do 2 years of rotations within the US?

I can never keep the terms straight in my head, and I think different people take them as meaning different things. I meant FMG as in a foreign national who had gone to school and possibly even completed residency in their home country.

Regardless, it still seems like this is generally a hypothetical scenario that wouldn't work legally.

 

[CDI]

Medical school rotations do not count. They must be done as part of GME training.

No, I know that. I'm just talking about GoSpurs saying you need clinical experience. I would think IMGs who've done a couple years of rotations (US clinical experience) here are similar to AMGs in that regard, and would be good enough for the PA track.

Either way this is all hypothetical and probably a waste of time.

 

[sylvanthus]

No, I know that. I'm just talking about GoSpurs saying you need clinical experience. I would think IMGs who've done a couple years of rotations (US clinical experience) here are similar to AMGs in that regard, and would be good enough for the PA track.

Either way this is all hypothetical and probably a waste of time.

If people honestly think it is a good idea ill create a resolution for the resident fellow section of the AMA. If people think it blows than so be it. Interesting to see your input.

 

[CDI]

If people honestly think it is a good idea ill create a resolution for the resident fellow section of the AMA. If people think it blows than so be it. Interesting to see your input.

If my state got SOP for PAs with equal pay, I'd skip residency and go straight to being a private practice "PA".

 

[survivordo]

I don't think it is a bad idea to at least have the option, if a med school graduate wanted to do it then it is completely up to them. However, I think they would be smarter to complete a one year internship in ANYTHING that way they can be licensed. Not to mention... I don't see PAs ever letting this go through... although I'm not sure how they could argue that we aren't just as if not more qualified.

Survivor DO

 

[CDI]

I don't think it is a bad idea to at least have the option, if a med school graduate wanted to do it then it is completely up to them. However, I think they would be smarter to complete a one year internship in ANYTHING that way they can be licensed. Not to mention... I don't see PAs ever letting this go through... although I'm not sure how they could argue that we aren't just as if not more qualified.

Survivor DO

We're not more qualified, we're all "equals". Kumbaya.

 

[primadonna22274]

I think it's an interesting idea (and you know I'm a PA and MS3 now).
A big problem would be reopening every state's PA practice law to change the eligibility wording that currently states "must have graduated from an accredited Physician Assistant program" and a bunch of other stuff. Nobody ever wants to touch the sacred practice act.
I actually think NCCPA (those guys who write and administer the national PA certification exam, aka the "C") might be in favor of the idea cuz it would make them more money. I'm sure you would have pushback from all the state PA societies, the AAPA and its constituent organizations, and MOST PA programs for the many reasons listed above.
Personally I like the stem cell model of overhauling medical education: we all start on the same trajectory; we take the same classes and fulfill the same accreditation requirements; at various points one can "jump off" the train and become a PA or become a GP or go on to a residency, fellowship, etc...
But man oh man, how the American medical establishment reveres its Tradition, and PA-Dom is not immune to that. We were, after all, conceived by and brought up by Momma and Daddy Medicine.

 

[wonderdog]

Why would the introduce themselves as PAs? You haven't heard of DNPs introducing themselves as "Doctors"?

Uhh...I've heard a few DNP's call themselves doctors

 

[CDI]

Uhh...I've heard a few DNP's call themselves doctors

Exactly.

So why would a PA who's got a doctorate in medicine or is a doctor in osteopathic medicine, not introduce themselves as Doctor?

 

[deleted6669]

IMGs and FMGs were once able to work as PAs but that stop for reasons I do not know.

florida had a practice pathway for FMG's to practice as PAs for a while in the 80's. they had to take written and practical exams which most of them(95%) failed.
seriously.
don't believe me? look it up.
PS: this PA 1/2 way through an academic doctorate will not be introducing himself as Dr. to pts when done in 2 more years...

 

[PrideNeverDie]

FMGs have NOT satisfied the requirements of the PA curriculum. The lack of US-based clinical experience is pretty big--it doesn't matter how much experience you have in your home country if you're not able to integrate with the US healthcare system effectively.

I don't really have a problem with the idea of unmatched AMGs trying to go that route, but I think that in general: 1) most AMGs who fail to match once, maybe twice would be more likely to first try and improve their application and re-enter the match; 2) once these MDs are a few years out of clinical medicine, they may not be as attractive as strong PA applicants who have recent clinical exposure; 3) it seems like there would be a problem with this working legally anyways, so I think the point is likely moot.

you bring up good points

though i would think a FMG who can be an attending in another country could adapt better than some failed AMG

i have no problems with strong PA applicants being taken first

 

[PrideNeverDie]

florida had a practice pathway for FMG's to practice as PAs for a while in the 80's. they had to take written and practical exams which most of them(95%) failed.
seriously.
don't believe me? look it up.
PS: this PA 1/2 way through an academic doctorate will not be introducing himself as Dr. to pts when done in 2 more years...

then you got nothing to worry about

i bet the only med school graduates applying to be PAs would be weak FMG/AMG applicants

i'm sure any decent PA applicant would easily be selected over them

 

[deleted6669]

OR we could help fmg's become licensed here as physicians.
..:http://fm.mednet.ucla.edu/IMG/img_program.asp
http://welcomebackinitiative.org/sf/about/
http://welcomebackcenter.org/

 

[deleted6669]

florida had a practice pathway for FMG's to practice as PAs for a while in the 80's. they had to take written and practical exams which most of them(95%) failed.
seriously.

...

(yes, the first summary below is from a pa/np journal. the second, however is not.)

"To address the issue of unlicensed IMGs, some states enacted legislation that funded so-called "fast-track" educational programs to recruit and matriculate IMGs into PA programs. In such instances, IMGs' clinical skills were assessed and compared with those of second-year PA students and found to be nonequivalent. While these experimental tracks in PA programs never became well established, it is upon that basis that many in the PA profession hold that IMGs are inferior in their skills and medical knowledge compared with PA students. "
source:
http://nurse-practitioners-and-phys.../International-Medical-Graduates-and-PAs.aspx

"Of the 50 IMGs accepted into California's PA programs in recent years, 62% had academic or personal difficulties. Only 34 IMGs became certified, and all accepted jobs in primary care specialties. Two preparatory programs in California have assessed the readiness of unlicensed IMGs to enter PA programs, and they have shown that the participants did not demonstrate knowledge or clinical skills equivalent to those expected of licensed PAs. Therefore, policymakers should not consider that IMGs are or can easily become the equivalent of PAs without additional professional training in accredited PA programs. Preparatory programs appear to lessen the barriers to PA training for a few IMGs. In times of scarce resources for training, however, these programs may not be the best use of public funds to increase the primary care workforce:
Source:
http://www.ncbi.nlm.nih.gov/pubmed/9125965

 

[CDI]

(yes, the first summary below is from a pa/np journal. the second, however is not.)

"To address the issue of unlicensed IMGs, some states enacted legislation that funded so-called "fast-track" educational programs to recruit and matriculate IMGs into PA programs. In such instances, IMGs' clinical skills were assessed and compared with those of second-year PA students and found to be nonequivalent. While these experimental tracks in PA programs never became well established, it is upon that basis that many in the PA profession hold that IMGs are inferior in their skills and medical knowledge compared with PA students. "
source:
http://nurse-practitioners-and-phys.../International-Medical-Graduates-and-PAs.aspx

"Of the 50 IMGs accepted into California's PA programs in recent years, 62% had academic or personal difficulties. Only 34 IMGs became certified, and all accepted jobs in primary care specialties. Two preparatory programs in California have assessed the readiness of unlicensed IMGs to enter PA programs, and they have shown that the participants did not demonstrate knowledge or clinical skills equivalent to those expected of licensed PAs. Therefore, policymakers should not consider that IMGs are or can easily become the equivalent of PAs without additional professional training in accredited PA programs. Preparatory programs appear to lessen the barriers to PA training for a few IMGs. In times of scarce resources for training, however, these programs may not be the best use of public funds to increase the primary care workforce:
Source:
http://www.ncbi.nlm.nih.gov/pubmed/9125965

This is like the NPs who did "studies" to show how they're equal to MDs.

This is something called bias. We learn about it in med school.

 

[deleted6669]

This is like the NPs who did "studies" to show how they're equal to MDs.

This is something called bias. We learn about it in med school.

actually most of us learned about bias as undergrads....it's not bias that fmg's failed out of PA programs, it's poor students...
the 2nd study was done by PHYSICIANS at the stanford school of medicine.
I don't doubt that AMG'S could do the work of PAs. the issue with the fmg/img folks is the variable quality of their programs. many are not as good as a typical pa student. many(say from australia/england/etc) are as good as amg's.
once again, see my post #39. we should try to get IMG's up to snuff as docs, not try to make them into something they aren't.

 

[PrideNeverDie]

actually most of us learned about bias as undergrads....it's not bias that fmg's failed out of PA programs, it's poor students...
the 2nd study was done by PHYSICIANS at the stanford school of medicine.
I don't doubt that AMG'S could do the work of PAs. the issue with the fmg/img folks is the variable quality of their programs. many are not as good as a typical pa student. many(say from australia/england/etc) are as good as amg's.
once again, see my post #39. we should try to get IMG's up to snuff as docs, not try to make them into something they aren't.

well if they can't match then they aren't AMG material

why not give them a second chance to see if they are PA material?

 

[CDI]

actually most of us learned about bias as undergrads....it's not bias that fmg's failed out of PA programs, it's poor students...
the 2nd study was done by PHYSICIANS at the stanford school of medicine.
I don't doubt that AMG'S could do the work of PAs. the issue with the fmg/img folks is the variable quality of their programs. many are not as good as a typical pa student. many(say from australia/england/etc) are as good as amg's.
once again, see my post #39. we should try to get IMG's up to snuff as docs, not try to make them into something they aren't.

"program quality" in primary care...

 

[deleted6669]

well if they can't match then they aren't AMG material

why not give them a second chance to see if they are PA material?

you realize how insulting that sounds, right?
that would be like " well, he didn't make it in his Phd program in neuroscience at harvard, I guess he will have to settle for being just an md neurologist since he isn't PhD material" .

 

[CDI]

you realize how insulting that sounds, right?
that would be like " well, he didn't make it in his Phd program in neuroscience at harvard, I guess he will have to settle for being just an md neurologist since he isn't PhD material" .

So, you finally realize how insulting it is to claim PAs and DNPs are equivalent to MDs?

Brb, while I become a neurosurgeon.

 

[deleted6669]

So, you finally realize how insulting it is to claim PAs and DNPs are equivalent to MDs?
.

I have never made that claim.
a residency trained and boarded physician in a given specialty is the gold standard. no argument from me.
In settings in which a residency trained and boarded physician is not available or at facilities which can not financially support an em physician at 150 dollars/hr+, a specialty PA may be preferable to a generalist physician, for example staffing a rural emergency department which sees 20-30 pts in 24 hrs.. staffing a dept with an emergency medicine PA is preferable to using locums fp physicians without extensive emergency medicine experience or specialists from other non-emergency fields because a pa who has devoted 100% of their training and practice to that specialty develops a level of competence higher than all but em boarded or experienced docs.. for example, I have worked at facilities where the "em doc" of the day was a locums nephrologist with no em experience aside from what he did in residency(major cluster). while I will be the first to admit I am not at the level of an em doc, I offer a quality of em service higher than the vast majority of physicians who lack specific em training or work experience having worked in emergency medicine for over 25 years in every type of em setting and having seen over 100,000 em patients with the full spectrum of presenting complaints.

 

[PrideNeverDie]

you realize how insulting that sounds, right?
that would be like " well, he didn't make it in his Phd program in neuroscience at harvard, I guess he will have to settle for being just an md neurologist since he isn't PhD material" .

lol that isn't how i meant it

so you have FMGs who can't get into the specialties of their choice

instead of redoing residency in a specialty they dont like, they now have the option to be a PA

i'd rather be a PA in the specialty i love than a FM MD

 

[deleted6669]

lol that isn't how i meant it

so you have FMGs who can't get into the specialties of their choice

instead of redoing residency in a specialty they dont like, they now have the option to be a PA

i'd rather be a PA in the specialty i love than a FM MD

fair enough. thanks for restating what you meant.

 

[CDI]

lol that isn't how i meant it

so you have FMGs who can't get into the specialties of their choice

instead of redoing residency in a specialty they dont like, they now have the option to be a PA

i'd rather be a PA in the specialty i love than a FM MD

Most FMGs settle for primary care anyways. Its well known that thats all they'll ever get, no matter the scores.

Also, they wouldn't even know what a PA is. Hell, I'm from here and up past undergrad I'd never even heard of PA, DNP or even DO.