Hi there. I am interested in one day applying to a PA program. I am worried, however, about how much material they are able to cover as the program seems rather short. How often does an average PA typically need to ask for help from their supervising doctor? Overall, how prepared are typical PAs? Thank you for your time.
How much do you really learn in PA school?
- Thread starter salley
- Start date
D
deleted6669
PA school is often compared to the 2nd and 3rd yrs of medschool. Most PA schools and Medschools require a prior BS with similar prereqs.
The quick path to PA (not including prior hce and training/certs) is 4 yrs(BS) + 2 yrs= 6 years. for medschool it is 4 yrs + 4 yrs + 3 yrs(min)= 11 years
we do a bit of ms1, most of ms2, and all of ms3. it is essentially 100 weeks of training in 2 years while medschool is often quoted as 150 weeks in 4 yrs(as much of 4th yr is vacation and interviewing). in fact several medschools have gone to 3 yrs without losing any content.
as a new grad any pa(or md) grad will have lots of questions. this is normal. mds ask those questions in residency, pas ask them at their first job. the real difference between md and pa at graduation is basic medical sciences in the ms1 year. ask any doc, they will tell you much of this is not needed for the day to day practice of medicine. As a new grad I worked at a place with an fp residency. my sp(the residency director) treated me like an intern for 1 year. after that he treated me like a pgy-2 and I precepted md pgy-1's and wrote their evals. my last year there he treated me like a chief resident. I moved on to a job with a broader scope of practice after that.
today I don't ever see or work with my sponsoring physician of record at 2 of the 3 places I work at as I work solo nights. at the other job I alternate charts with a doc regardless of acuity.he could be suturing while I am running a code or a trauma or vis versa. I still get specialty consults(everyone does) but typically if I don't know the answer to a question neither does my SP so I end up talking to a specialist. hope that helps.
as far as the clinical rotations, as a PA everyone does a full year of rotations and typically has a few electives or selectives(this or that). I ended up with quite a bit of em and trauma due to the way I set up my electives and selectives. I also did a peds em rotation.
There are also optional postgrad programs for PAs see www.appap.org for links to most.
Last edited by a moderator:
- Joined
- Mar 3, 2010
- Messages
- 858
- Reaction score
- 630
Got a job as single coverage in rural ER right out of school. Doc on the phone. I do pretty much everything (no LPs).
Succeeding so far. PA school is only 26 months, but they cram in the learning, and if you pay close attention and study hard you can learn what you need to.
D
deleted6669
LP's are easy. take a cert course or do some with your sp. working solo it's nice to be able to do the lp before staring IV abx for meningitis or for r/o sah after a neg head ct. do them with the pt sitting and leaning forward, not on their side. much easier. also use whitacre needles. I carry 2 around in the pocket of my lab coat.
- Joined
- Mar 3, 2010
- Messages
- 858
- Reaction score
- 630
It's on my list to do, but down there a ways. Right now I just wake up the CRNA and have them come in. And I don't feel bad about it at all considering they make twice what I do!
😱😱😱
My personal feeling is you can be the smartest, best student that ever walked into PA/DO/MD school, but after 26 months you are NOT prepared for single coverage in an ED (even rural).
Also for emedpa- agree with your post except I'm not sure precepting interns should be delegated to a PA with 2 years experience. Did you feel comfortable with that role 😕
D
deleted6669
- Joined
- Mar 3, 2010
- Messages
- 858
- Reaction score
- 630
I tend to agree with you.
D
deleted6669
I met boatswain a month ago. seems like a solid fellow(and not just because he is a foot taller than I am...). I think he will rise to the challenge and fill in the gaps in his knowledge asap.
- Joined
- Mar 3, 2010
- Messages
- 858
- Reaction score
- 630
Thanks E. It is certainly a steep learning curve.
But steepest for the patients.
- Joined
- Mar 3, 2010
- Messages
- 858
- Reaction score
- 630
Everyone is entitled to their opinion Pamac. Of course, how much one's opinion matters to others is usually tied to your experience and expertise. There is a group of 9 "old school" physicians who were adequately impressed with my former career, with my academic performance, and with my performance as a student with them, that they thought I could give good care to their patients.
Good luck in your endeavors in nursing school.
Good luck in your endeavors in nursing school.
- Joined
- Oct 11, 2012
- Messages
- 839
- Reaction score
- 28
This is why the whole midlevel thing is getting out of control. After 4 years in school with way more schooling and clinical time (rightfully) no one is nuts enough to let me practice on my own without another 3 years of working 60-80 hours a week supervised. Recipe for disaster in something like EM imo. I can just see the deposition now. That lawyer is going to grill you...
- Joined
- Mar 3, 2010
- Messages
- 858
- Reaction score
- 630
Text - you bring up some good points. I'm sure this physician group would rather have brought in a physician instead....but there aren't any who wants the job. So who then covers the little ER?
I work FOR the physicians. They hired me, they set the level of supervision. That's how the PA thing works.
- Joined
- Oct 11, 2012
- Messages
- 839
- Reaction score
- 28
That is sort of my whole point, economic pressure is leading to unsafe practices. The ideal setup is something where you have direct supervision for your first few years like emedpa's work environment when he graduated.
Nursing school is over, and as flattered as I was that the physicians and nursing managers have been impressed at my own performance and previous health care experience, there's a learning curve (just like you said). You bring up a good point by asking what they do about treating patients when no physician will show up. Since I'm not privy to what's going on there, I can't say if the docs exhausted every option available before they hired a brand new physician assistant for solo coverage of an ER. That's a dicey situation even for an experienced physician assistant. I can't imagine how scary it is not only for you, but the other staff at that facility. You have to admit that the whole arrangement simply sounds like a nail biter.
Yeah, I suppose that's the problem. They should have some sort of course in medical school dealing with how to responsibly supervise midlevels. I bet half the physician grads can't even tell you the education of a PA or what the difference is between DNP NP RN LPN LNA
D
deleted6669
folks who attend a residency program at a place that uses PAs and NPs tend to understand them better than folks who attend a place without. many docs who graduate from the latter type of program have zero understanding of what a pa/np is/does and thinks they have to physically examine each pt seen by the pa/np at every visit and ok every lab/diagnostic study/script. there is always a huge learning curve for these new docs when the older docs sit them down and tell them what reality is and that this group of folks they are putting down is responsible for buying them a new car every year and over 20 years buying their house through the profits they generate for the group above and beyond their expenses. (this is based on my em group- each em doc gets 30k profit/yr for work done by the PAs in our group. in a typical 20 year career each one of them will realize 600k profit for work they did not do themselves.).
I don't think most of them are doing it to put down the PAs. I think they genuinely don't know the capabilities and are probably just trying to do the right thing. I'd rather that than someone who is lazy and never even looks at a chart or offers help and advice.
D
deleted6669
some don't know and that's ok. some just think they are the best thing since sliced bread and everyone who is not a doctor must therefore suck(really). it gets a little old having someone who was in residency last week try to tell me how to do a job I have done since they were in diapers. That generally doesn't go on for too long because the senior docs notice they are not behaving appropriately, take them aside and read them the riot act.
So, what are you going to do once you attain your goal and become a NP. Full independent practice....cha ching. No need for those pesky Docs. You roll solo...unless you aren't into the whole independent thing.
The guys knows he is in a challenging position and admits he is somewhat apprehensive. To me, that means they picked the right guy. Leave the ego at the door.
The whole "scary for the staff" line is nursing to the bone. You have fully converted.
D
deleted6669
Chances are "the staff" at a tiny rural er is the pa, one nurse, one tech, one lab tech and one xray tech who also does ct. that is the setup at my smallest rural gig...and the xray tech goes home at midnight and carries a pager until 7 am....u/s and crna on call only.
So, what are you going to do once you attain your goal and become a NP. Full independent practice....cha ching. No need for those pesky Docs. You roll solo...unless you aren't into the whole independent thing.
The guys knows he is in a challenging position and admits he is somewhat apprehensive. To me, that means they picked the right guy. Leave the ego at the door.
The whole "scary for the staff" line is nursing to the bone. You have fully converted.
What I'm not going to do once Im a new NP is get flattered thinking solo ER is a place for a new grad. The right guy can leave the ego at the door and say he is in over his head for a solo ER gig as a brand new, freshly graduated provider. Still apprehensive, but eager to tout the bonifides of being awesome enough from a previous career to roll solo? Can't have it both ways.
Look, the cop out "what will they do without me" argument is just the sort of thing that gets people into trouble for the benefit of someone higher up who doesn't want to stretch themselves out to meet a need (whether its the group coughing up more cash to lure in a doctor, or the doctors adjusting shifts and vacation to handle coverage). Just like emed said, a doc in a situation like that makes money with every day off that they are taking....while the new guy is out there serving the rural folks the best he can with what he's got. Maybe this is an ER that gets nothing serious rolling through and is basically urgent care with the tough stuff knowing to bypass it. Or maybe there is 100% chart review and spot checks on top of it being slow. As long as brand new providers (NP or PA) are willing to step in and are comfortable with that kind of role, more old school doctors might find the risk worth it to the bottom line. This isn't a PA or NP issue.
So, what are you going to do once you attain your goal and become a NP. Full independent practice....cha ching. No need for those pesky Docs. You roll solo...unless you aren't into the whole independent thing.
The guys knows he is in a challenging position and admits he is somewhat apprehensive. To me, that means they picked the right guy. Leave the ego at the door.
The whole "scary for the staff" line is nursing to the bone. You have fully converted.
" New PAs need to be adequately precepted during their first couple of years, while working on the lower end of the pay scale. Whether someone has or hasn't had HCE shouldn't really be a deciding factor. The only way to know how someone will be as a PA is to evaluate them as a PA.
BTW, I have almost 20 years HCE, I don't think it will matter much when I look for my first job after graduation. If it does good, if not...I will pay my dues"
-Will352nd
Last edited:
- Joined
- Dec 18, 2008
- Messages
- 1,640
- Reaction score
- 423
The same can definitely be said about NPs and I am currently on a service with CNRAs/SNRAs and it has been a very steep learning curve for a few folks that they have touched to say the least...and unlike PAs those guys are/will be independent which makes it scary.
Which goes along with what I said earlier of it not being a PA or NP issue. Its not even a nonphysician provider issue. I never said the solution was to put a new grad NP in a situation like that, just someone with experience or direct oversight. I've had my share of frustration at certain NPs myself, not to mention nurses with attitude.
- Joined
- Mar 3, 2010
- Messages
- 858
- Reaction score
- 630
I agree that is not "ideal" for a new grad. Just like the "ideal" provider in an ER is a board certified Emergency Physician. But we rarely get the "ideal" situation.
It is an absolutely nail biter for me. But I've been in that situation before, and I know how to use that to motivate me to my benefit. I am studying harder now than I was in school. No problems with "fear" from the other staff, although a couple of bent attitudes because they hired me right from school.
Naaaa…you can't teach that. The military has spent hundreds of millions of dollars trying to develop "classes" or "schools" to teach leadership, but it never works. Leadership/supervision/responsibility is learned in the school of hard knocks. The nine docs I work for probably average 55 years old, they have been through the school of hard knocks and I believe they know what they are doing.
Maybe "half the physician grads" can't tell you the educational differences between their staff, but once they move beyond the "medicine" they quickly learn the business aspect.
I wonder….do YOU know the difference in education of a PA vs DNP/NP??
I must be lucky. I have TWO nurses until midnight! And xray in house!! Actually, I am incredibly lucky because I have awesome nurses who pull my ***** out of the fire on a regular basis.
Certainly wasn't trying to say I am "awesome" due to my previous career, but it certainly helps me manage the ER.
You have some really good points here, but don't make the mistake of thinking I am "comfortable" in that role. I expect that will take 2-3 more years. In my case, however, the doc's are not making much money off of me. They hired me for other reasons.
To the OP: PA school is pretty well standardized with the goal of spitting out a medical provider trained in general medicine. How much do you really learn? The analogy of "it's like drinking from a firehose for two years" is appropriate.
You stalking me?
I didn't say it was a good position for him to be in, but it seems like he has the right mindset and his previous experience is helping him out.
You are mis-quoting the meaning of that post. The point was the only way to evaluate how someone will be as a provider is to evaluated them as a provider. He is being evaluated as a provider....quickly, but he is. You may have also noticed on that thread that E countered what I said and stated that previous experience would count.....guess he was right. If my first job gives me credit for previous experience....great. If not....I will pay my dues. That said, I don't think I would want Boatswains job right after school.
Don't get angry....it's ok.
You stalking me?
I didn't say it was a good position for him to be in, but it seems like he has the right mindset and his previous experience is helping him out.
You are mis-quoting the meaning of that post. The point was the only way to evaluate how someone will be as a provider is to evaluated them as a provider. He is being evaluated as a provider....quickly, but he is. You may have also noticed on that thread that E countered what I said and stated that previous experience would count.....guess he was right. If my first job gives me credit for previous experience....great. If not....I will pay my dues. That said, I don't think I would want Boatswains job right after school.
Don't get angry....it's ok.
Nobody is stalking you.... I read the posts on here.
A PA in that position is trying to fill a needed niche in an underserved locality. But most of the risks fall to the patients that are paving the way for this awesome new grad opportunity. Everyone seems to understand its far from ideal, so there's not much else to say... Its happening no matter what.
Interesting enough, boatswain does give props to his support staff who travel this road with him, so maybe knocking attitudes as being "nursing to the bone" is misplaced. Many of us respect providers and are impressed by what they do. I'm inclined to give them the benefit if the doubt that they know what they are doing rather than be a backseat driver without the benefit of their training.
