Granting medical students PA degree as well

[Coastie]

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no one is against them working, just not as pa's. as david says call them" supervised physicians" and let them work with a doc for a yr or 2 until they land a residency slot. they are physicians. there is no reason to call them pa's or license them as such..

Gotcha. I agree with that...

 

[TheEarDoc]

so you have never worked with a pa and yet you make lots of statements here about our abilities and what we should call ourselves? WTF IS THAT? that is insincere AT BEST.....I've reviewed your post hx here and the vast majority of your posts are about undercutting pa's/np's who apparently you have no personal experience with.

guess what? not all pa's "get simple cases". many of us staff icu's and emergency depts without a physician present and work with a high degree of autonomy(with physician phone back up as needed)....my last shift several of my "simple cases" ended up getting admitted to the icu and the first physician to be involved in their care in any way was the admitting intensivist....
(are you perhaps one of those fmg's who couldn't match and think you should be able to do my job? does "post doc" perhaps actually mean "pre-intern"? )
I've worked with MANY fmg's from all over the world over the last 24 years. many are truly cream of the crop, top notch physicians. at my first job I precepted an fp intern who used to be an ent doc in south africa. incredible doc. I have also worked with many fmg's who either couldn't pass boards or passed boards and couldn't match who were frankly unsafe and dangerous. core0 brought up an excellent point elsewhere. for these folks to practice they don't need to be pa's. a category of "supervised physician" could be created. these folks are physicians and if they are going to work they should work in that capacity either with supervision if that's the best they can do or as fully licensed docs if they can match and finish a residency.

I can't help but feel a sense of familiarity to my situation in my field to the current discussion at hand.

I am a doctor of clinical Audiology. I work with hearing and balance, 50 hours a week, 365 days a year. Three years just on studying all aspects of hearing and balance with clinical rotations and then a 12 month full practice rotation before receiving my degree. We have a lot of battles over autonomy between MD's and ENT's. I've always loved when an MD can look at my hearing test results (most of them can't even read an audiogram) and then tell a patient that they do not need hearing aids. I've also worked with some pediatricians who view me as the end all be all for hearing disorders. I've worked with some awesome ENT's and some downright awful ENT's who think they are the end all be all for hearing aids and balance and feel as though an Audiologist is simply a technician to do their testing.

I've studied under lecturers who are ENT's in their prospective countries and the majority of them I wouldn't let lance a boil on my face let alone work on my auditory or balance system. There is a reason our country has a huge educational and experience requirement to be a medical doctor; it's because it's a lot to know and a lot is at stake. That same education requirement is not always held in other countries. I will agree that some foreign docs are just as good if not better than our current MD's, but the majority of them are not.

As for Socrates and his obvious down nose look at anyone without MD after their name, please do us all a favor and go find a school that offers some classes on teamwork, integrity, and humility. I think any local kindergarten can teach you the skills you somehow didn't acquire or lost somewhere on the way to becoming a physician. We can all work together to provide the best patient care possible. The only people who lose in a pissing contest over this is our patients. You remember our patients right? Those people you went into school to help treat and care for? If you didn't go into medicine to help people and simply wanted the title of doctor then you could have received a PhD and been completely full of yourself and only made your students miserable and not harmed any patients.

 

[Instatewaiter]

guess what? not all pa's "get simple cases". many of us staff icu's and emergency depts without a physician present and work with a high degree of autonomy(with physician phone back up as needed)....my last shift several of my "simple cases" ended up getting admitted to the icu and the first physician to be involved in their care in any way was the admitting intensivist....
(are you perhaps one of those fmg's who couldn't match and think you should be able to do my job? does "post doc" perhaps actually mean "pre-intern"? )
I've worked with MANY fmg's from all over the world over the last 24 years. many are truly cream of the crop, top notch physicians. at my first job I precepted an fp intern who used to be an ent doc in south africa. incredible doc. I have also worked with many fmg's who either couldn't pass boards or passed boards and couldn't match who were frankly unsafe and dangerous. core0 brought up an excellent point elsewhere. for these folks to practice they don't need to be pa's. a category of "supervised physician" could be created. these folks are physicians and if they are going to work they should work in that capacity either with supervision if that's the best they can do or as fully licensed docs if they can match and finish a residency.

Generally, I use sending my patient to the ICU as a sign that I wasn't doing a great job.

 

[deleted6669]

Generally, I use sending my patient to the ICU as a sign that I wasn't doing a great job.

more likely it's a sign that they are really sick....some folks are bound for the icu the minute they hit the door. you should know that.

 

[IMDoc607]

As an upper level resident I have authority over both med students and PA students who rotate thru -- I make sure that the PA dudes dont come anywhere near our patients and that they spend the greater part of the day in the team room doing stupid logistical work like setting up f/u appts.

I like teaching students regardless if they are PA or MD/DO students. However, I let them know if they are overstepping their boundaries. In fact, many of them agree with me (at least to my face). I find it offensive that someone with 4 years of training can think that my 4 years of undergrad, 4 years of med school, & 3 years of residency is equivalent to their training.

 

[guetzow]

The problem seems to be that midlevels think that they're equivalent to graduating med students. This became more apparent with the recent PA thread....

I don't know ANY PAs that think that. I think your confusing us with "D"NPs.....

 

[guetzow]

"As an upper level resident I have authority over both med students and PA students who rotate thru -- I make sure that the PA dudes dont come anywhere near our patients and that they spend the greater part of the day in the team room doing stupid logistical work like setting up f/u appts."

Not only is this a waste of the PAs training and abilities, it's just plain stupid from a business perspective. I bring in 50% of the revenue into my docs practice. That's a ton of profit FOR THE DOC, for utilizing me properly. If you want your graduates and their Docs to live in the poorhouse, keep giving them cr@ppy advice...

 

[Makati2008]

I don't know ANY PAs that think that. I think your confusing us with "D"NPs.....

I agree. He is only a premed at this point. He will figure it out soon enough

 

[Starpower]

Generally, I use sending my patient to the ICU as a sign that I wasn't doing a great job.

What a bizarre statement. It's actually a bit frightening that someone would actually even say such a thing.

 

[Charles_Carmichael]

I don't know ANY PAs that think that. I think your confusing us with "D"NPs.....

I agree. He is only a premed at this point. He will figure it out soon enough

Did either of you read this thread and/or the other PA thread where a couple of PA students were arguing that PA school graduates are equivalent to medical school graduates? I even pointed that out in the statement of mine that you quoted guetzow; I don't know how you missed that when you were directly quoting it. I assure you I wasn't confusing you with DNPs.

Before you accuse me anything else, I'll repeat again (for the umpteenth time) that I'm fully in support of PAs and the only midlevel I'm against is the NP/DNP/CRNA (ie. basically the nursing midlevels).

 

[silas2642]

What a bizarre statement. It's actually a bit frightening that someone would actually even say such a thing.

Why is this a bizarre statement? If I admit a patient to the floor and then that pt crumps, I am absolutely going to take a step back to re-evaluate the situation-- was the patient mis-triaged and should have been admitted directly to the ICU? Did I miss something which if I had intervened on, it would have prevented the pt's transfer to a higher level of care?

If you're not asking your questions to yourself and looking for mistakes, then I'd be concerned.

 

[Starpower]

Why is this a bizarre statement? If I admit a patient to the floor and then that pt crumps, I am absolutely going to take a step back to re-evaluate the situation-- was the patient mis-triaged and should have been admitted directly to the ICU? Did I miss something which if I had intervened on, it would have prevented the pt's transfer to a higher level of care?

If you're not asking your questions to yourself and looking for mistakes, then I'd be concerned.

EMEDPA works in the ER. So no, he doesn't 'mis-triage' in such situations; his triage is accurate, i.e. he makes correct decisions and does what's necessary.

While you and Instatewaiter are humming and hahing over your egos and checklists, let's let true medical professionals do the work. To use EMED's statement as some type of petty leverage comes across as completely irrational.

Good points tho, if it were a floor admit.

 

[silas2642]

EMEDPA works in the ER. So no, he doesn't 'mis-triage' in such situations; his triage is accurate, i.e. he makes correct decisions and does what's necessary.

While you and Instatewaiter are humming and hahing over your egos and checklists, let's let true medical professionals do the work. To use EMED's statement as some type of leverage shows a complete lack of insight, and frankly, capability.

Good points tho, if it were a floor admit.

Okay, so I'm going to take a step back and remember that you do not represent the majority of the PA profession.

First of all, have you ever worked with EMEDPA? How do you know he/she is a good clinician, particularly based on your limited experience? For all you know EMEDPA is a complete and total ***** who has no idea how to practice medicine (not saying that this is so, all I'm saying is that there is no way to tell from an anonymous forum whether or not someone is clinically competent). I don't care how many years someone has been in the field; they're still going to make mistakes because they're human. You get tired, you get busy, you miss things.

If there's one thing I've learned these past four years, it's that you can always be better. If you're satisfied where you are in medicine, if you think that you're not making mistakes and not constantly thinking, "what could I have done differently," then you need to get the hell out of medicine.

I may just be a med student, but you're just a PA student (or recent grad at most). So forgive me when I say I don't need to be lectured on how I'm "humming and haha-ing over my ego and checklist," thank you very much.

 

[deleted6669]

agree that no one is above making mistakes.(thanks for the props though star...but I do F things up sometimes just like anyone....)
my point was that sending a pt to the icu is not a failure on the part of a clinician( as instantwaiter implied) but an indication that they need a higher level of care than can be provided elsewhere in the hospital.
Silas- I actually know star outside of sdn. we attended the same program(years apart obviously) but have been in contact throughout his educational process to discuss a variety of topics and know many of the same folks in academia. ( and no, I wasn't offended by your post).

 

[silas2642]

agree that no one is above making mistakes.(thanks for the props though star...but I do F things up sometimes just like anyone....)
my point was that sending a pt to the icu is not a failure on the part of a clinician( as instantwaiter implied) but an indication that they need a higher level of care than can be provided elsewhere in the hospital.
Silas- I actually know star outside of sdn. we attended the same program(years apart obviously) but have been in contact throughout his educational process to discuss a variety of topics and know many of the same folks in academia. ( and no, I wasn't offended by your post).

Ah, well then my apologies to starpa, then-- I had no idea that he knew you outside of anonymous forums.

 

[Starpower]

Ah, well then my apologies to starpa, then-- I had no idea that he knew you outside of anonymous forums.

Knowing him outside of this forum truthfully has little to do with it, I've read enough of his posts to recognize.

I don't care who or what you are, but hopefully if you or I plan on going into emergency medicine you'll/we'll have (or gain) the know-how for when to admit a case to the ICU. Certainly after 20 years.

No one who is a "complete and total *****" is allowed to fly the ER solo (which EMED does). I would certainly hope not, anyways. It seems you and Instatewaiter just didn't know EMED's position, which is why I acknowledged your comments as being good if applicable to floor admits.

Apologies if I came on too strong, I just have a beef with people jumping on someone who works in that capacity.

 

[VA Hopeful Dr]

Knowing him outside of this forum truthfully has little to do with it, I've read enough of his posts to recognize.

I don't care who or what you are, but hopefully if you or I plan on going into emergency medicine you'll/we'll have (or gain) the know-how for when to admit a case to the ICU. Certainly after 20 years.

No one who is a "complete and total *****" is allowed to fly the ER solo (which EMED does). I would certainly hope not, anyways. It seems you and Instatewaiter just didn't know EMED's position, which is why I acknowledged your comments as being good if applicable to floor admits.

Apologies if I came on too strong, I just have a beef with people jumping on someone who works in that capacity.

That's just flat wrong. Its rare, thankfully, but it does happen.

 

[Colonel Kurtz]

Emed is a PA and he's angry that he doesnt get to have the MD title, independence, or respect that comes with being a physician. Its eating away at him and you can tell that by the fact that he literally seethes with anger that state law requires him to be "supervised" by a physician.

Socrates25 is correct. I am a second year PA student who has disagreed sharply but professionally with EMED on the PA forum. Sadly, EMED, as moderator of the forum, has banned me from the forum for my remarks that are critical of both the PA profession and PA Education. If in fact any forum is a open exchange of ideas, then one should be free to dissent. When EMED chooses to ban (ie block) posters who are critical, it is clear that he seeks to puff up the PA profession.

Finally, EMED has been quoted as equating "pre-pa training as a medic or EMT to medical school residency" and he cites that alleged equivalence as the basis for PAs being able to perform like doctors. I don't understand how starting IVs and drawing blood for a couple years is the same as supervised clinical experience caring for patients after medical school. I'm baffled by his comparison.

 

[deleted6669]

Socrates25 is correct. I am a second year PA student who has disagreed sharply but professionally with EMED on the PA forum. Sadly, EMED, as moderator of the forum, has banned me from the forum for my remarks that are critical of both the PA profession and PA Education. If in fact any forum is a open exchange of ideas, then one should be free to dissent. When EMED chooses to ban (ie block) posters who are critical, it is clear that he seeks to puff up the PA profession.

Finally, EMED has been quoted as equating "pre-pa training as a medic or EMT to medical school residency" and he cites that alleged equivalence as the basis for PAs being able to perform like doctors. I don't understand how starting IVs and drawing blood for a couple years is the same as supervised clinical experience caring for patients after medical school. I'm baffled by his comparison.

B.S. to all of the above. I have never equated being a medic to residency. being a medic/etc gives you a leg up in pa school and helps you hit the ground running but is not a substitute for a pa residency or md training of any kind. those with more prior hce just make better pa's. this is based on almost 25 yrs of interactions with hundreds of pa's. if you are a pa student at all(which I doubt) it sounds like you both had no prior experience and went to a crappy program. you probably should have gone to med school. the better pa programs have pa students do clinicals alongside md students with the same requirements. my program based at a medical school scheduled pa-2 and ms-3 students interchangeably.
you were banned for trolling.

 

[Makati2008]

B.S. to all of the above. I have never equated being a medic to residency. being a medic/etc gives you a leg up in pa school and helps you hit the ground running but is not a substitute for a pa residency or md training of any kind. those with more prior hce just make better pa's. this is based on almost 25 yrs of interactions with hundreds of pa's. if you are a pa student at all(which I doubt) it sounds like you both had no prior experience and went to a crappy program. you probably should have gone to med school. the better pa programs have pa students do clinicals alongside md students with the same requirements. my program based at a medical school scheduled pa-2 and ms-3 students interchangeably.
you were banned for trolling.

EMED-Bro I call troll on Col. K. It appears like he has a thing against Physician Assistants. I personally think he is one of the members on this board that is anti-pa and I will be emailing one of the mods. to compare IP addresses....I have my guesses on who it is.

Furthermore, if this was really happening then I wouldn't/couldn't fathom this happening due to them either: 1.)Failing accredation 2.)Failing to keep it after being rechecked. Also as angry as he is, if he is a PA I would bet he is in the small minority that is failing out.....just a guess.

If your not a troll Col. K-you should just drop out of the profession now and save yourself and the profession a career worth of unhappiness. Also why not tell us what school you are in PA wise so we can contact AAPA/NCCPA/etc to correct these problems at your school.

PS-Are you a member of AMSA? If so that would make you a med. student and not a PA student wouldn't it? Just wondering....

 

[deleted6669]

looks like the mods agree with us.
scratch 1 more troll.
1 down, many more to go...

 

[Maybeknot]

no one is against them working, just not as pa's. as david says call them" supervised physicians" and let them work with a doc for a yr or 2 until they land a residency slot. they are physicians. there is no reason to call them pa's or license them as such..

Agreed. This is a "solution" searching for a problem. If you can't match into a categorical residency, being licensed as a PA would be silly. It would make much more sense to do a prelim, get licensed, and moonlight while you're doing research (or something else to improve your chances of matching categorical.) You could work less hours while moonlighting, make more money, and actually do something productive to further your career.

Emed:

You know I'm pro-PA, but "authority over md students and residents"? I smell an ACGME violation....and that must be one awful residency program.

Sorry dude, but no program worth it's salt has midlevels anywhere near an "authority" over med studs or residents..

In my surgery program, PA's regularly supervise interns in "lumps and bumps" type cases. For me, it was pretty helpful in the first month or two of residency, since I actually got to operate a bit rather than retract for the chiefs. It got really tiring after that.... partially because of the monotony of the cases, mostly because it stopped being educational quite quickly. But certainly, PA's can have some semblance of "authority" over residents... if it's a chronic and persistent thing, I would agree that the quality of the residency program would be called into question.

 

[prism74]

deleted

 

[MasterThespian]

Whatever you want to call them- "supervised physicians" or "physician assistants", there should most certainly be some sort of option for MDs who either do not match residency or choose to leave residency for whatever reason to put their valuable training to use in the U.S. I am a U.S. medical grad from a top program who was AOA-nominated with 99's on all 3 USMLEs and because I chose (yes, chose) to leave residency in my first year after having children, my options for employment in medicine are severely limited. It makes no sense that I cannot work part-time as a PA or "supervised physician" like many PA friends I have who choose to limit their working hours while they have young children. And I really can't imagine when in my childrens' lives I will want to go back to residency (I am an older nontrad so by the time they are older I will be very old for residency, not to mention my knowedge/skills fade every day I'm out). Of course, you can argue that I should have gone to PA school in the first place, but I didn't know how having children would change my priorities and anyway, there are other reasons, say for health or family difficulties, that people might leave residency. Why should the U.S. waste all the talent and training of people who have made it through medical school? Sure, have them take the PA board exams or pass all USMLEs or whatever to prove they have a competent grasp of medical knowledge, but then let them work! It's just BS to argue otherwise.

 

[deleted6669]

if you finished internship can't you be licensed in some states as an md?

 

[Big Bad Byron]

yea most of the physicians that are disdainful or disgruntled over PAs are just not happy people in general. They have it all, yet still something is lacking, and its very likely a sense of self worth besides all the money they earned.