How do we get our PAs more job satisfaction?

[debvz]

It's a little easier in your environment. You presumably don't have interns. The major issue where midlevels become a problem on an academic surgical service is that "midlevel appropriate procedures" are also by definition "intern appropriate procedures". I highly doubt there are any chiefs out there disgruntled that PAs are taking their Whipples or maxillectomies.

It is a problem, especially with the new intern hours. The only useful solution I've found is if there's time when the residents are unavailable due to didactics the midlevels can cover those cases and get OR time. Otherwise you've got to give the residents the cases, try to work the midlevels into the procedure rotation (in a fair way) and hope everyone gets along.

We have rotators as PGY 1-3's. There are no PGY 4-5's unless they are taking paid weekend or night call. On any given 12 hr shift, we place on average 2-4 lines. If I have my intern placing every line and doing every procedure, they'd never finish, and the service would grind to a halt. Between my PA and I one shift last week, we placed 7 lines, 2 chest tubes, did multiple lac repairs, rounded in the ICU and admitted multiple new patients, including emergency general surgery and traumas.

The residents get more than their fair share of bedside procedures, if they're not already in the OR with the scheduled/emergent operative cases. I don't think i've heard any of the residents complain about lack of procedures with the current setup.

I remember during residency (at a different place) getting overwhelmed being the sole person on-call doing 6 line consults while trying to cross-cover 60 patients and handle new admissions. At least I was a PGY-2 and not a shell-shocked intern at that point. Makes me wish there was a PA back then to help share the workload.

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[cpants]

We have rotators as PGY 1-3's. There are no PGY 4-5's unless they are taking paid weekend or night call. On any given 12 hr shift, we place on average 2-4 lines. If I have my intern placing every line and doing every procedure, they'd never finish, and the service would grind to a halt. Between my PA and I one shift last week, we placed 7 lines, 2 chest tubes, did multiple lac repairs, rounded in the ICU and admitted multiple new patients, including emergency general surgery and traumas.

The residents get more than their fair share of bedside procedures, if they're not already in the OR with the scheduled/emergent operative cases. I don't think i've heard any of the residents complain about lack of procedures with the current setup.

I remember during residency (at a different place) getting overwhelmed being the sole person on-call doing 6 line consults while trying to cross-cover 60 patients and handle new admissions. At least I was a PGY-2 and not a shell-shocked intern at that point. Makes me wish there was a PA back then to help share the workload.

Sounds like your program needs to man up and tell medicine to do their own lines. It's not a procedure that requires a surgeon. How we handle it is if they call and ask for a line, and we aren't busy, the intern will do it. Otherwise they are on their own, and we won't get involved until after their attending has attempted. Most of the time they just get a picc put in.

How long does a non-emergent line take? At least 30-60 minutes with getting consent, getting set up, and putting it in, writing a note. We would have serious work shortage problems too if our only on-call resident had to do 6 every night. Not a good use of resources.

 

[debvz]

Sounds like your program needs to man up and tell medicine to do their own lines. It's not a procedure that requires a surgeon. How we handle it is if they call and ask for a line, and we aren't busy, the intern will do it. Otherwise they are on their own, and we won't get involved until after their attending has attempted. Most of the time they just get a picc put in.

How long does a non-emergent line take? At least 30-60 minutes with getting consent, getting set up, and putting it in, writing a note. We would have serious work shortage problems too if our only on-call resident had to do 6 every night. Not a good use of resources.

I'll never understand why the hospitalists, who cover the medical ICUs, are unwilling or unable to place their own lines. During the day, they usually order PICC lines. We try to accomodate them at night for emergent lines/HD caths, but certainly not every line request is granted. Problem is that they treat every line request like it's life or death. It's an abuse of our good graces.

 

[deleted6669]

if a PA is not satisfied because they are not getting OR time in general surgery, then they chose the wrong career IMO.

I would say they chose the wrong job. plenty of non-academic gen. surg jobs have pa's in the o.r. 50% and clinic 50%.
for those pa's who want to work at the big name academic medical center they should understand that time in the o.r. is not part of the job if that was made clear up front.

 

[cpants]

I'll never understand why the hospitalists, who cover the medical ICUs, are unwilling or unable to place their own lines. During the day, they usually order PICC lines. We try to accomodate them at night for emergent lines/HD caths, but certainly not every line request is granted. Problem is that they treat every line request like it's life or death. It's an abuse of our good graces.

Now that status quo is surgery does the lines, it will be hard to reverse the trend. I think you really need to sit down with the medicine leadership and tell them they will now be expected to do their own lines. You could offer training to them during the transition. Medicine doctors, especially covering the ICU, should be able to do lines.

If your staff wants to continue to do the lines so they can bill for them, that's fine, but the attending staff should be expected to place the lines themselves or hire PA coverage to place some of the lines. It is not appropriate for a lone surgical resident to be placing 5-10 lines per night for other services. If there are 3-4 residents in house and they are spreading it around, maybe.

In the old days it didn't matter, but these days you gotta maximize every minute in the hospital or the residents aren't going to be adequately trained.

 

[susruta]

Makes me think of CRNA' s ROLE in anesthesia few decades ago.

Galaxy Note @ mobile

 

[debvz]

Now that status quo is surgery does the lines, it will be hard to reverse the trend. I think you really need to sit down with the medicine leadership and tell them they will now be expected to do their own lines. You could offer training to them during the transition. Medicine doctors, especially covering the ICU, should be able to do lines.

If your staff wants to continue to do the lines so they can bill for them, that's fine, but the attending staff should be expected to place the lines themselves or hire PA coverage to place some of the lines. It is not appropriate for a lone surgical resident to be placing 5-10 lines per night for other services. If there are 3-4 residents in house and they are spreading it around, maybe.

In the old days it didn't matter, but these days you gotta maximize every minute in the hospital or the residents aren't going to be adequately trained.

I agree with the statements above. That's why I stated that I support my PA/NP's placing lines, where others were arguing that the residents should have that experience. The PA's like to do them, and they bill for them independently. Note that I mentioned that the PA and I placed the lines. The resident was actually in the OR doing cases with my partner during that time.

During my own residency, we did get abused for lines, and there's nothing I can do to change the culture of that program, as I am no longer there. I clearly remember one of my fellow residents placing 9 lines on an overnight shift.

 

[Nooblet]

someone cross posted this in the anesthesia forum. look what happened to us in anesthesia. we have a plague of CRNAs who are militant and consider themselves equals to the MD. Their political groups and powers far outweigh our lousy ASA and they are gaining grounds to work solo as many states have opted out of requiring an MD to be present for all cases.

The generation of anesthesiologists above us basically were where you all are at today with your PAs - training CRNAs to do cases, blocks, lines, etc and used them as cash cows to bill for multiple things at once. It may all seem innocent now, but years down the line it will come back to bite you. Look where anesthesiologists are now with every MS4 applicant and resident fretting about the future of the field.

We as MDs have to stand together (i know surgeons and anesthesiologists may not always see eye to eye) but this is happening all across the lines of medicine...its just that surgery is being touched last. Do not yield to the PAs and do not train them to do a physicians work.

 

[Mman]

I'm SURE one experienced PA could handle BOTH our floor AND ER consults if we had a tech or something we could have do our real scut (transport patients, draw emergency labs, maybe even place ngts) which would free up a PA to actually practice medicine.

Just FYI but the PA isn't licensed to "actually practice medicine". Nor are they trained to do it. They are trained to assist physicians in taking care of patients. The only people trained to "practice medicine" are MDs and DOs.

 

[cpants]

someone cross posted this in the anesthesia forum. look what happened to us in anesthesia. we have a plague of CRNAs who are militant and consider themselves equals to the MD. Their political groups and powers far outweigh our lousy ASA and they are gaining grounds to work solo as many states have opted out of requiring an MD to be present for all cases.

The generation of anesthesiologists above us basically were where you all are at today with your PAs - training CRNAs to do cases, blocks, lines, etc and used them as cash cows to bill for multiple things at once. It may all seem innocent now, but years down the line it will come back to bite you. Look where anesthesiologists are now with every MS4 applicant and resident fretting about the future of the field.

We as MDs have to stand together (i know surgeons and anesthesiologists may not always see eye to eye) but this is happening all across the lines of medicine...its just that surgery is being touched last. Do not yield to the PAs and do not train them to do a physicians work.

I see where you're going on the slippery slope argument, but I think training a PA to do central lines is a lot different then training them to do your whole job, which is basically what anesthesia did. Honestly you don't need a surgeon, or even an MD for that matter, to put in a line. Midlevels are already doing this procedure independently all over the country, and there is no special certification or training required. It's a glorified IV. Honestly, I don't think PA's would even want to do surgery independently, but maybe I'm naive.

 

[deleted6669]

just fyi but the pa isn't licensed to "actually practice medicine". Nor are they trained to do it. They are trained to assist physicians in taking care of patients. The only people trained to "practice medicine" are mds and dos.

Wrong. Totally and completely wrong. I have a state issued license to practice medicine and my own dea #. I have to work in association with a physician but I and all other pa's practice medicine by definition and with the blessing of state medical boards in all 50 states..
read the first sentence: http://en.wikipedia.org/wiki/Physician_assistant
let me help you with that: A Physician Assistant (PA) is a healthcare professional who is authorized by the state/province to practice medicine as part of a team with physicians.
My license says:
"Emedpa" has satisfactorily complied with and completed the statutory requirements to engage in the practice of MEDICINE.
I would be happy to send a copy of my license to practice medicine to any senior moderator here by pm for verification.

 

[Nooblet]

I see where you're going on the slippery slope argument, but I think training a PA to do central lines is a lot different then training them to do your whole job, which is basically what anesthesia did. Honestly you don't need a surgeon, or even an MD for that matter, to put in a line. Midlevels are already doing this procedure independently all over the country, and there is no special certification or training required. It's a glorified IV. Honestly, I don't think PA's would even want to do surgery independently, but maybe I'm naive.

Many won't want to, but thats the older generation of PAs who have been in the system for decades. There is a new breed of PAs that are militant and will push for boundaries to be expanded. See emedpa for example

Wrong. Totally and completely wrong. I have a state issued license to practice medicine and my own dea #. I have to work in association with a physician but I and all other pa's practice medicine by definition and with the blessing of state medical boards in all 50 states..
read the first sentence: http://en.wikipedia.org/wiki/Physician_assistant
let me help you with that: A Physician Assistant (PA) is a healthcare professional who is authorized by the state/province to practice medicine as part of a team with physicians.
My license says:
"Emedpa" has satisfactorily complied with and completed the statutory requirements to engage in the practice of MEDICINE.
I would be happy to send a copy of my license to practice medicine to any senior moderator here by pm for verification.

 

[deleted6669]

Many won't want to, but thats the older generation of PAs who have been in the system for decades. There is a new breed of PAs that are militant and will push for boundaries to be expanded. See emedpa for example

I am just speaking the truth. I am not militant. and I am not " a new pa". I do not want independence from physicians like the np's do. I am currently in an academic doctoral program in global health. when I am done I will not be introducing myself to pts as "Dr. Emedpa".
by definition pa's practice medicine. we must do so in conjunction with physicians but we are practicing medicine.
what do you call it if I see a pt, do a h+p, order and interpret diagnostic studies, develop a plan, write an rx and write referrals all without input from anyone else? is that the practice of knitting?
my sponsoring physician reviews my all charts within 30 days( or 10% of them in another state in which I practice) and occasionally comments on them but has no input into what happens with the pt in real time. this is a relationship built up over years based on trust and feedback. I have been at my current job(solo coverage of an 11 bed dept) for 10 years. new grads are monitored much more closely than this and should be.

 

[Mman]

Wrong. Totally and completely wrong. I have a state issued license to practice medicine and my own dea #. I have to work in association with a physician but I and all other pa's practice medicine by definition and with the blessing of state medical boards in all 50 states..
read the first sentence: http://en.wikipedia.org/wiki/Physician_assistant
let me help you with that: A Physician Assistant (PA) is a healthcare professional who is authorized by the state/province to practice medicine as part of a team with physicians.
My license says:
"Emedpa" has satisfactorily complied with and completed the statutory requirements to engage in the practice of MEDICINE.
I would be happy to send a copy of my license to practice medicine to any senior moderator here by pm for verification.

It isn't practicing medicine when you have to be supervised by a physician to do it. And quoting Wikipedia isn't exactly a source. What does the state board of medicine where you work have to say about what you are doing? And DEA #s have nothing to do with practicing medicine.

 

[leaverus]

hehehe, you referenced wikipedia as a source. dude you realize ANYONE can write/edit a wikipedia article, right?

 

[Nooblet]

Why does your surname read "Global Doctor"? Honest question

 

[Poetic Silence]

Why does your surname read "Global Doctor"? Honest question

Emedpa is completing his doctorate degree in global health.

 

[deleted6669]

. What does the state board of medicine where you work have to say about what you are doing? .

They are the ones who issued me a license to practice medicine and approved my practice plan.

 

[deleted6669]

Emedpa is completing his doctorate degree in global health.

yup, doing a doctorate in global health science. 1 yr down, 3 to go. FWIW when I am done I will not be introducing myself to pts as Dr. Emedpa and my ID will not say Dr. Emedpa.....I'm not an np....

 

[deleted6669]

hehehe, you referenced wikipedia as a source. dude you realize ANYONE can write/edit a wikipedia article, right?

fair enough. how about this from a us govt agency:
http://www.bls.gov/ooh/Healthcare/Physician-assistants.htm:
Physician assistants, also known as PAs, practice medicine under the direction of physicians and surgeons. They are formally trained to examine patients, diagnose injuries and illnesses, and provide treatment.

"under the direction" does not mean they are looking over my shoulder and seeing my pts. it means they have some general idea of what I am doing. they need not be present for me to practice nor do they need to know about each and every pt I see. I have about as much freedom as a third yr resident in most fields. I have not worked a shift alongside my sponsoring physician in probably 6 months and even when he is there we each see our own pts.
their salary figures are a bit low by the way, current avg pa salary is around 95k with many in specialties making considerably more.
http://nurse-practitioners-and-phys...res/Articles/National-Salary-Report-2011.aspx

 

[deleted6669]

It isn't practicing medicine when you have to be supervised by a physician to do it.

so md residents don't practice medicine? same argument . most 2nd yr residents have passed step 3 and have their own licenses yet they are in a chain of command below third yr residents and attendings. are they practicing medicine?
I would agree that I don't have an unrestricted license to practice medicine but I still have a license to practice medicine.
I have a world of respect for the training all of you go through and respect your expertise. please extend to me the same courtesy.

 

[cpants]

Guys this argument is getting pretty stupid. What PA's do looks a whole lot like practicing medicine, whatever the semantics. The question is what the scope of that practice should be in the context of a surgical residency program. In a residency setting residents should operate over PA's every time. Keeping junior level residents on the floor while PA's are operating is shameful, and there is no excuse for it. Residents are training to do procedures on their own in a few short years, while PA's will always have an assistant's role in the OR. This can lead to hard feelings, but should not as long as the PA's know what their role is and it is well defined. There might be times where it's of more educational value for the resident to be outside of the OR (taking care of a sick patient in the ICU vs. an I and D, for example). From what I understand the job market for PA's is pretty strong right now. So if you don't want to be in a residency setting, then start looking.

 

[deleted6669]

guys this argument is getting pretty stupid. What pa's do looks a whole lot like practicing medicine, whatever the semantics. The question is what the scope of that practice should be in the context of a surgical residency program. In a residency setting residents should operate over pa's every time. Keeping junior level residents on the floor while pa's are operating is shameful, and there is no excuse for it. Residents are training to do procedures on their own in a few short years, while pa's will always have an assistant's role in the or. This can lead to hard feelings, but should not as long as the pa's know what their role is and it is well defined. There might be times where it's of more educational value for the resident to be outside of the or (taking care of a sick patient in the icu vs. An i and d, for example). From what i understand the job market for pa's is pretty strong right now. So if you don't want to be in a residency setting, then start looking.

well stated. I agree with all of this.

 

[thedrjojo]

PA's also have a 3 year training, and do many of their clerkships along side medical students, getting nearly the same experience they do. There classes are also medical based, compared to DNP's which have a nursing background. So, yes, PA's certainly practice medicine.

 

[DrNick Riviera]

I think the real issue that gets residents ruffled here is that not all PAs are created equal. We have two PA on the thoracic service here, and they are great. They cover clinic, handle floor bs, take consults, and do chest tube consults, etc. this frees the pgy2 and the fellows to basically be in the OR all day. The PAs will cover OR cases, but pretty much only if no one else is available. Now, contrast that with some of the younger PAs or NPs that I have seen who really think that they are a doctor. I could care less about semantics, but it is simply wrong to introduce yourself to a patient or let them think that you are a doctor.

As has been stated before, it is important to have a clear definition of mid level expectation, and that is often driven by the administration or attendings. Furthermore, I think there is more insecurity as a junior resident. I am perfectly happy having the PAs on our thoracic service take care of floor issues, clinic, and consults (but mind you, if I discharge someone on the weekend, I do the summary, I will see consults if I am free, and they are happy to let me do chest tube consults if I am not scrubbed). I think that if I was an intern though, I may feel like they were doing what I was supposed to be doing.

As a resident, if you have a PA or NP on your service, no matter how militant they are or are not, just remember that you CHOSE to be a resident, go through med school, etc. A good mid level is priceless. And you will be his/her boss someday...

 

[ESU_MD]

I work with PAs who can independently open and close a chest, harvest conduit- both vein, radial and mammary, control bleeding by placing sutures in the ascending aorta independently and take care of ICU patients sicker than any trauma/general surgeon can dream about- all without calling me.

None of them want to open up their own practice or care about being called "Dr"

With the right experience and training, Well trained PAs can take care of almost any primary care issue. In fact, maybe we should free them up to do this and relieve some of the strain on the system.

 

[Socrates25]

I work with PAs who can independently open and close a chest, harvest conduit- both vein, radial and mammary, control bleeding by placing sutures in the ascending aorta independently and take care of ICU patients sicker than any trauma/general surgeon can dream about- all without calling me.

None of them want to open up their own practice or care about being called "Dr"

With the right experience and training, Well trained PAs can take care of almost any primary care issue. In fact, maybe we should free them up to do this and relieve some of the strain on the system.

Actually you've made a great argument that they can effectively replace YOU. Why should we pay you 400k per year when a PA can do the same job for 150k?

Also, why would a PA want to do primary care and get paid 80k when they can work for you and get paid 150k with no extra training?

 

[anonperson]

I work with PAs who can independently open and close a chest, harvest conduit- both vein, radial and mammary, control bleeding by placing sutures in the ascending aorta independently and take care of ICU patients sicker than any trauma/general surgeon can dream about- all without calling me.

None of them want to open up their own practice or care about being called "Dr"

With the right experience and training, Well trained PAs can take care of almost any primary care issue. In fact, maybe we should free them up to do this and relieve some of the strain on the system.

I find this description a bit unsettling to be honest. These specific PAs may not want to open their own practice but you can bet there are some out there who use this type of a situation to increase their practice scope.

 

[deleted6669]

The only way a pa can open their own practice legally is by hiring a physician to work with them. you will not see independent pa's acting like np's and working completely apart from md oversight.

 

[DoctwoB]

With the right experience and training, Well trained PAs can take care of almost any primary care issue. In fact, maybe we should free them up to do this and relieve some of the strain on the system.

Here's the problem though. PAs generally do not have formal training beyond their two years in school, so there is no way to really regulate their qualifications which largely come through experience.

Could a PA with 20 years experience in outpatient medicine clinics practice essentially unsupervised? Of course. Could a PA student fresh out of school with less training then a 3rd year med student do the same? Definitely not. There is no way to formally assess post-grad education for PAs like there is for physicians. Right now there is no legal distinction between the two, and granting practice rights to one does the same as the other.

 

[joeDO2]

Here's the problem though. PAs generally do not have formal training beyond their two years in school, so there is no way to really regulate their qualifications which largely come through experience.

Could a PA with 20 years experience in outpatient medicine clinics practice essentially unsupervised? Of course. Could a PA student fresh out of school with less training then a 3rd year med student do the same? Definitely not. There is no way to formally assess post-grad education for PAs like there is for physicians. Right now there is no legal distinction between the two, and granting practice rights to one does the same as the other.

I think that this hit on the problem. While PAs like emedpa might have the experience and developed into a competent practitioner, there is nothing regulating which PAs are allowed this amount of autonomy. Allowing a PA to run an 11 bed ED completely unsupervised as emedpa does? I would suspect that only the top 1-2% of PAs can do this with any degree of competency. Also years in practice is not something that necessarily translates to competency. I've spoken with a PA who worked unsupervised in solo coverage ED who had 15 years experience...problem was that he worked in surgery for most of those years. We certainly don't expect a dermatologist to one day start working in the ED, why should we expect that PAs can switch like this with only "on the job" training.

 

[deleted6669]

Here's the problem though. so there is no way to really regulate their qualifications which largely come through experience.

.

actually there is now(since 2011).
our national accrediting body(NCCPA) introduced a series of specialty exams designed by physicians practicing in specialties. they are called "certificates of added qualifications" and are taken in addition to our regular primary care recert exam. I was one of the first pa's to pass the CAQ in emergency medicine.
to qualify to take a caq one must meet several requirements including time in practice, passage of several cme courses(for em it was acls, atls, pals, difficult airway) and have a physician attestation signed by a doc in your specialty which says you are competent and can perform a list of procedures.
they are currently offered in em, psych, ct surg, ortho, and nephrology. new specialties will be added every year.
basic info on the caq's:http://www.nccpa.net/specialtycaqs.aspx
I think we will start to see these listed as requirements for the more autonomous pa jobs. I have already seen one job posted in em asking for someone who holds a caq in em. there are a few em pa postgrad programs which require their grads to pass this exam. I think over time it will become the defacto requirement to get a job in certain specialties.

 

[Poetic Silence]

I'd love to see one of those for oncology PA's. Some of the most intelligent professionals I've ever met.

 

[Consigliere]

Wrong. Totally and completely wrong. I have a state issued license to practice medicine and my own dea #. I have to work in association with a physician but I and all other pa's practice medicine by definition and with the blessing of state medical boards in all 50 states..
read the first sentence: http://en.wikipedia.org/wiki/Physician_assistant
let me help you with that: A Physician Assistant (PA) is a healthcare professional who is authorized by the state/province to practice medicine as part of a team with physicians.
My license says:
"Emedpa" has satisfactorily complied with and completed the statutory requirements to engage in the practice of MEDICINE.
I would be happy to send a copy of my license to practice medicine to any senior moderator here by pm for verification. (AS PART OF A TEAM OF PHYSYCIANS)

Big part of that you left out there, assistant.

 

[Consigliere]

I am just speaking the truth. I am not militant. and I am not " a new pa". I do not want independence from physicians like the np's do. I am currently in an academic doctoral program in global health. when I am done I will not be introducing myself to pts as "Dr. Emedpa".
by definition pa's practice medicine. we must do so in conjunction with physicians but we are practicing medicine.
what do you call it if I see a pt, do a h+p, order and interpret diagnostic studies, develop a plan, write an rx and write referrals all without input from anyone else? is that the practice of knitting? (No, it's the practice of following algorithms and protocols that you've memorized over the years through rote repetition. It is certainly NOT the practice of medicine, ace.)
my sponsoring physician reviews my all charts within 30 days( or 10% of them in another state in which I practice) and occasionally comments on them but has no input into what happens with the pt in real time. this is a relationship built up over years based on trust and feedback. I have been at my current job(solo coverage of an 11 bed dept) for 10 years. new grads are monitored much more closely than this and should be.

Note the bolded section, assistant.

 

[deleted6669]

Note the bolded section, assistant.

so if a doc works up chf it's practicing medicine and if a pa does exactly the same things based on the clinical picture it isn't? party on in your delusions.
pa's practice medicine. our licenses say "license to practice medicine". you are deluded if you think otherwise troll.

 

[Chirurg]

so if a doc works up chf it's practicing medicine and if a pa does exactly the same things based on the clinical picture it isn't? party on in your delusions.
pa's practice medicine. our licenses say "license to practice medicine". you are deluded if you think otherwise troll.

to me, the difference is that at the same time, the doc can use all his expertise (being educated in all basic sciences to bachelor/master/phd level, u choose) to ponder what else is going on while following protocol.
in my humble opinion a PA can NOT do that.

 

[deleted6669]

to me, the difference is that at the same time, the doc can use all his expertise (being educated in all basic sciences to bachelor/master/phd level, u choose) to ponder what else is going on while following protocol.
in my humble opinion a PA can NOT do that.

let me start by thanking you for your tone in this discussion.
to some extent I would agree with your conclusions but it depends on the pa. most pa's today have similar undergrads to docs(bio degrees or biochem degrees). some pa's have masters/phd's in basic medical sciences. some pa's have done postgrad specialty residencies or fellowships alongside physicians and been trained to think the same way at a high level. for example I have done a lot of tropical medicine training and overseas missions. I will catch stuff (and have) that most fp or em docs would not in this arena.
I would agree that in general an md/do would have a broader ddx for any given complaint. that doesn't mean the outcome will be different the vast majority of the time, just that the physician considered some zebras that show up once in a career and the pa did not. if pa's missed stuff on a regular basis our educational system would be overhauled. physicians design and oversee our training. I trained alongside 3rd/4th yr med students and residents. they didn't send me away to have secret doctors only training sessions. I took the same call, had the same pt load, worked 100+ hrs/week on surgery, etc. At my school the second yr of pa school was interchangeable with the ms3 year at the same med school.
granted docs have the advantage of a residency which most pa's do not do at the present time(although I think this will change within the next 20 years).

 

[Consigliere]

so if a doc works up chf it's practicing medicine and if a pa does exactly the same things based on the clinical picture it isn't? party on in your delusions.
pa's practice medicine. our licenses say "license to practice medicine". you are deluded if you think otherwise troll.

I don't care what your license says, assistant. If for one nanosecond you think what PA's do is "practicing medicine" then it is you who is delusional. I have already spent WAY too much time dealing with a mid-level and will now bid you adieu. Keep telling yourself you're a real doctor and keep getting your myriad number of degrees (doctorate in global health?! WTF?) to make yourself feel better.

 

[Poetic Silence]

Wow. . . That was completely uncalled for, Consigliere.

 

[Ace007]

I don't care what your license says, assistant. If for one nanosecond you think what PA's do is "practicing medicine" then it is you who is delusional. I have already spent WAY too much time dealing with a mid-level and will now bid you adieu. Keep telling yourself you're a real doctor and keep getting your myriad number of degrees (doctorate in global health?! WTF?) to make yourself feel better.

Everyone is entitled to their opinion, and here is mine- you, sir, are an idiot. Posting rhetoric you wouldn't dare say otherwise under the guise of anonymity is all the proof I need to make such a statement. Of course, you could prove me wrong and provide your real name and credentials, but you wouldn't dare because you know what you are saying is nonsense and you would be lampooned and ostracized from whatever medical community is unfortunate enough to have to suffer you on a daily basis.

Your statements are tantamount to a middle school student talking behind somebody's back during recess. Congratulations, all that time and effort spent on your education, and you have the emotional maturity of a 6th grader.

Despite your clearly biased PERSONAL opinion, a physician assistant ABSOLUTELY practices medicine. Get over it.

On a more constructive note:

The physician assistant profession is still young and going through growing pains. In time there will hopefully be a more standardized method of determining PA training and competence (CAQs or something like it) which will in turn dictate scope of practice parameters. Until then, be kind to your PAs and help them grow- the majority of them come to work everyday with the intention of trying to make YOUR day a little easier.

 

[Winged Scapula]

I don't care what your license says, assistant. If for one nanosecond you think what PA's do is "practicing medicine" then it is you who is delusional. I have already spent WAY too much time dealing with a mid-level and will now bid you adieu. Keep telling yourself you're a real doctor and keep getting your myriad number of degrees (doctorate in global health?! WTF?) to make yourself feel better.

A reminder that while such insults may be tolerated in the Anesthesiology forums, they are not in the rest of the Residency forums and most certainly not here. Insulting another user is an SDN Terms of Service violation. Please keep interactions civil.

 

[Apollyon]

Actually, insults aren't tolerated in the anesthesiology forum anymore, either. Even though you can use the and smilies on SDN, you can't SAY "what the ****" or "bull ****", and, if you go around the filter one way or another, some mod of whom you have never heard and never seen do anything will ding you.

 

[Winged Scapula]

Actually, insults aren't tolerated in the anesthesiology forum anymore, either. Even though you can use the and smilies on SDN, you can't SAY "what the ****" or "bull ****", and, if you go around the filter one way or another, some mod of whom you have never heard and never seen do anything will ding you.

You are correct in that SDN policy is that the Gas forums will be moderated in similar fashion to other forums in terms of user of profanity; however, I still assert that the culture of users there tolerates insults (as long as they come from a long term user whom other users like) much more than users in other forums. There is plenty of "tone" that still exists in the Gas forums although it has improved.

 

[Apollyon]

As the sole derail I shall put in this thread, the culture of SDN in toto tolerates insults better that virtually all on the mod staff. Many of even the insulted are not aware that the mod staff has ruled that that person has been aggrieved. Does that even sound logical? That I am not offended, but that a third person has decreed that I have been insulted? "Insults" have to insult someone; they're not victimless crimes. Then, add on "whom other users like", and it is no better than a (pre)pubescent schoolyard.

"Hate us 'cause we're beautiful/Well we don't like you either!/We're cheerleaders, we..are...cheerleaders!"

[YOUTUBE]uMO2rDPMJmI[/YOUTUBE]

(and, yes, I quoted "Bring It On")

 

[Winged Scapula]

As the sole derail I shall put in this thread, the culture of SDN in toto tolerates insults better that virtually all on the mod staff. Many of even the insulted are not aware that the mod staff has ruled that that person has been aggrieved. Does that even sound logical? That I am not offended, but that a third person has decreed that I have been insulted? "Insults" have to insult someone; they're not victimless crimes. Then, add on "whom other users like", and it is no better than a (pre)pubescent schoolyard.

Yes, it does sound logical and that is why we consider whether the "insultee" has reported the post before taking any action.

If they have not and there are no other complaints, action is *usually* not taken by Mod staff (*usually* since I cannot comment on all actions in all forums by all staff members).

However, I would disagree that the culture of SDN tolerates insults more than the moderators. There are many many reported posts from users crying about some perceived mistreatment which are felt to be not worthy of any administrative action.

But let's not derail this thread any further, shall we?

 

[deleted6669]

Everyone is entitled to their opinion, and here is mine- you, sir, are an idiot. Posting rhetoric you wouldn't dare say otherwise under the guise of anonymity is all the proof I need to make such a statement. Of course, you could prove me wrong and provide your real name and credentials, but you wouldn't dare because you know what you are saying is nonsense and you would be lampooned and ostracized from whatever medical community is unfortunate enough to have to suffer you on a daily basis.

Your statements are tantamount to a middle school student talking behind somebody's back during recess. Congratulations, all that time and effort spent on your education, and you have the emotional maturity of a 6th grader.

Despite your clearly biased PERSONAL opinion, a physician assistant ABSOLUTELY practices medicine. Get over it.

On a more constructive note:

The physician assistant profession is still young and going through growing pains. In time there will hopefully be a more standardized method of determining PA training and competence (CAQs or something like it) which will in turn dictate scope of practice parameters. Until then, be kind to your PAs and help them grow- the majority of them come to work everyday with the intention of trying to make YOUR day a little easier.

Thank you. seeing rational physicians in training here at sdn gives me hope for the future.....

 

[Denatured]

If you feel that you're PAs are underutilized and the administration won't let you hire more transporters for payroll purposes, the solution may be that when one quits you hire two transporters/lpn/MAs. This may stretch your resources more, but now you will all be too busy for scut and they are more techs to handle what there is to do.

If you get stretched to thin, then the administration will see that PAs are necessary for smooth flow and coverage. You get back the PA positions you gave up and now how more techs because you demonstrated the PAs value doesn't lie in transport.

Just a thought.

And this thread has given me much hope as well for the future treatment of PAs.