"Mid-Level Provider"

[Nasrudin]

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Would the residents like to fund their own residencies as part of their education costs?

I can't some up with a scenario to where your comment makes any sense. Perhaps you could elaborate. Or allow me to:

I realized during bow pose of my yoga class, as the echo of my comment bounced through my thoughts, that the comment I hastily put together before it, was uncharacteristically un-spidey like in my instincts for Red Army Nursing propaganda and that certain minds would immediately feel anger towards the fact that I had not acknowledged nurses as the backbone of the health care delivery system. So. Without further ado. Nurses are the backbone of the health care delivery system. What I meant....was the system that produces clinicians.

Now. Perhaps it's entirely unnecessary. And they just provide normal banker's hours for academic attendings. But the point is I'll be costing myself 2000 dollars a month just in interest on my debt overhead while working like a dog this time next year. Which is the point I'm making. I represent the near future average. Albeit at a later age.

So. Back to your point...which is elusive of any sense I can make.

I suggest you take up your case with the nearest post call resident you can find. And say to them....doesn't the public deserve to be compensated for your efforts sir/madam?

 

[pamac]

I can't some up with a scenario to where your comment makes any sense. Perhaps you could elaborate. Or allow me to:

I realized during bow pose of my yoga class, as the echo of my comment bounced through my thoughts, that the comment I hastily put together before it, was uncharacteristically un-spidey like in my instincts for Red Army Nursing propaganda and that certain minds would immediately feel anger towards the fact that I had not acknowledged nurses as the backbone of the health care delivery system. So. Without further ado. Nurses are the backbone of the health care delivery system. What I meant....was the system that produces clinicians.

Now. Perhaps it's entirely unnecessary. And they just provide normal banker's hours for academic attendings. But the point is I'll be costing myself 2000 dollars a month just in interest on my debt overhead while working like a dog this time next year. Which is the point I'm making. I represent the near future average. Albeit at a later age.

So. Back to your point...which is elusive of any sense I can make.

I suggest you take up your case with the nearest post call resident you can find. And say to them....doesn't the public deserve to be compensated for your efforts sir/madam?

I don't think you owe the public anything. I'm just asking if you guys funding your own residencies would give you more claim over the situation where you currently feel screwed. I fail to see how PAs and NPs contribute to the screwedness you feel, but I see how hospitals take funding from the government for residencies, and also bill for your services, and then you get a stipend of sorts that accounts to less than what I make working half your hours as a nurse. So is there a scenario where it would be better for you guys just to get he whole sum diverted to you somehow?

 

[NYEMMED]

Would the residents like to fund their own residencies as part of their education costs?

This actually does happen at some programs believe it or not.

 

[Nasrudin]

I don't think you owe the public anything. I'm just asking if you guys funding your own residencies would give you more claim over the situation where you currently feel screwed. I fail to see how PAs and NPs contribute to the screwedness you feel, but I see how hospitals take funding from the government for residencies, and also bill for your services, and then you get a stipend of sorts that accounts to less than what I make working half your hours as a nurse. So is there a scenario where it would be better for you guys just to get he whole sum diverted to you somehow?

NP's, PA's, and docs are beginning to compete in the labor market. We're in the infantile stages of that progression. But it is inevitable. As it intensifies in the future it will put huge pressure on the sustainability of our system of training. Opinions on this vary. I'm an amateur student of labor history. And from my sense of it, the guild system that a physician meanders through with a huge chunk of his/her life, cannot survive in its current form or size. It's not the fault of NP/PA's for being cheaper labor. But that is what they are.

What I find bitterly amusing--probably what you're interpreting as "feeling screwed"--is that nobody seems to want to work as hard as residents but everybody wants the job of being a doctor or a clinician. This is a large pink elephant smoking cigars in the room that is conveniently ignored by all. What happens to this elephant is acutely interesting to me. Aside from my own stakes in the game. There isn't even a consensus in our own circle if this elephant is a burden to the system or a source of cheap labor for it. Although, if you ask me, all we would have to do to determine the worth of residents to the economic bottom line of hospitals is for them to walk off the job tomorrow and strike. Oh yeah...that's right. We're ethically and legality barred from that. One of the reasons why the public has no awareness of what we go through as they myopically focus on the rewards we obtain from huge effort. It'll be fascinating to see how it plays out.

But it is not changeable internally any more than we could become a different species from a desire to be one. Which is exactly why cheaper labor is an existential challenge. This system took a 100 year to establish itself. And it's push has always been increased complexity and length of training. That is the animal it is. Evolution is always at play with violent change and mass extinctions. Ask a union autoworker of he 50's what Detroit would like now and see how accurate that would be. Like that for us.

 

[pianoman511]

But it is not changeable internally any more than we could become a different species from a desire to be one. Which is exactly why cheaper labor is an existential challenge. This system took a 100 year to establish itself. And it's push has always been increased complexity and length of training. That is the animal it is. Evolution is always at play with violent change and mass extinctions. Ask a union autoworker of he 50's what Detroit would like now and see how accurate that would be. Like that for us.

Along those same lines there has been an expansion of medical knowledge and pathology. If you talk to some of the more experienced physicians they will tell you how much harder it is to practice medicine today than it used to be for a myriad of reasons. The current push is to have providers that train for less time yet are expected to perform the same job. This is among concern that many residencies are not producing quality physicians due to work hour restrictions and a push for longer residency training. It would (and does) seem counter intuitive.

I have no problems referring to NPs, PAs, even DNPs as my colleagues in health care, and some of them who have been practicing longer than I have been alive certainly receive my respect, but to imply equality of training and education just does not make sense to me. I will do my best to keep up with the nomenclature by which I should be referring to my fellow providers, but I will be doing my best to care for my patients at the same time.

 

[fab4fan]

I'd prefer to be called a Nurse Practitioner. I have colleagues that don't care. Generally speaking, I think it is falling out of favor.

I don't dislike it for the reasons described above; I dislike it because I think it is disrespectful to RNs. I was a RN for 18 years, eventually rising to the level of expert in my field (critical care). It bugged me then to hear the NPs in our units called "mid-levels" because that made me feel that I was considered "low-level." Now that I am a NP, I don't want to cheapen the contribution of my RN peers, so I discourage use of the term.

My Mom always taught me that it is polite to call people what they want to be called, lol. If an anesthesiologist did not like the term MDA, I would respect his or her feelings and refrain from using it. I'd expect the same respect in return and would ask not to be referred to as a mid-level. Just call me a NP, I'm quite pleased to be one.

Well said. Congratulations on your accomplishment, Chilly. 👍

 

[sarjasy]

My Mom always taught me that it is polite to call people what they want to be called, lol.

I prefer to be called "Your Excellency." I'm not having much luck with that for some reason.

 

[associate]

"More than a nurse, but not quite a Doctor". Sounds like mid-level to me.

👍

 

[EMDO2018]

So hopefully I don't start another typical SDN thread here but I was just curious what you all thought about the term "mid-level provider". I've been using this term to describe NP/PA but I recently discovered some consider it almost a derogatory term now. I'm not sure when that happened since it was just a few years ago when I heard people self-describe themselves as mid-levels and seemed proud of it. I had been using it because I had no idea it was offensive. I guess I will stop using it now? Is this term off limits now?

Everybody want to be called doctor, but nobody wants to do all the darn studying.

 

[Makati2008]

Everybody want to be called doctor, but nobody wants to do all the darn studying.

Honestly the great majority of MLP dislike being called doctor. There are rogues(both PA and NP) that enjoy it though.

 

[Instatewaiter]

Regardless of your qualms the DNP is a clinical doctorate and it is appropriate to use it in a hospital.

Sounds like someone drank the Kool Aid

 

[Instatewaiter]

]
The reality is this: nurses are respected by the healthcare establishment when they "stay in their place" at the bedside taking orders. Once they break away and become independent, all hell breaks loose. Physicians aren't used to seeing nurses function on the same level as them and it scares them. They combat this fear by belittling nursing education much in the same way that you have, boatswain. Fortunately, neither of our opinions matters and NPs, both in supporting and leadership roles in healthcare, are here to stay.

People would be less worried about NP independent practice if their education was similar to physician education. Instead it is essentially a shortcut and the clinical education is a joke. Period. I will have completed about 30,000 clinical hours when done (no joke, did the math). An independent NP can practice with what, 500? That is attrocious.

And it is evidenced by what gets sent to us (cardiology) from FNPs/NPs. Don't get me wrong, some NPs are excellent but these people are smart and would thrive in any educational setting. They would make great doctors, great NPs, great PAs, probably great underwater basket weavers. They pick ups stuff quickly.

However, the lack of structured clinical education leads those who arent as strong to be dangerous clinicans because they lack the length of training needed to be competent.

 

[Zenman1]

Texas is really concerned because they are a very restricted state for NP's. I've had Texans come into NM to see me when I worked there because it took a yr to get in to see a physician. Patient care problem? Won't be too long before I head back to NM.

http://newsok.com/new-mexico-governor-wants-to-recruit-oklahomas-nurse-practitioners/article/3909794
http://www.businessweek.com/ap/2013-11-13/governor-seeks-money-to-recruit-more-nurses-to-nm
http://hscnews.unm.edu/news/nurse-practitioners-celebrate-20-years-of-independence

 

[Makati2008]

Texas is really concerned because they are a very restricted state for NP's. I've had Texans come into NM to see me when I worked there because it took a yr to get in to see a physician. Patient care problem? Won't be too long before I head back to NM.

http://newsok.com/new-mexico-governor-wants-to-recruit-oklahomas-nurse-practitioners/article/3909794
http://www.businessweek.com/ap/2013-11-13/governor-seeks-money-to-recruit-more-nurses-to-nm
http://hscnews.unm.edu/news/nurse-practitioners-celebrate-20-years-of-independence

Honestly I read one of the stories and the main thing that is concerning is that some believe (the posters at the end) total independence is the way to go.

Midlevels have their place but with some programs only having 700hrs of training that is not enough for independence. I would personally say triple the hours for clinical training and add at least phone support with monthly chart reviews(random and not cherry picked) as well as reviews of all M&M via a Physician/medical board would be a safer alternative.

If a PA/NP wants an unrestricted license then maybe add the basic sciences(abbreviated) and pass a version of the usmle or Comlex and let them complete a stringent 1yr residency in primary care , pass step 3 and get the GP designation and not the FM, IM, or peds ones.

I predict in a few decades NPs will be autonomous in more states than not unfortunately.

 

[Instatewaiter]

Texas is really concerned because they are a very restricted state for NP's. I've had Texans come into NM to see me when I worked there because it took a yr to get in to see a physician. Patient care problem? Won't be too long before I head back to NM.

http://newsok.com/new-mexico-governor-wants-to-recruit-oklahomas-nurse-practitioners/article/3909794
http://www.businessweek.com/ap/2013-11-13/governor-seeks-money-to-recruit-more-nurses-to-nm
http://hscnews.unm.edu/news/nurse-practitioners-celebrate-20-years-of-independence

Didn't read these but I know what you're getting at.

The answer to not enough of something is not to drop your standards; it is to increase your supply of what you're lacking.

A shortage of doctors is not a reason to allow poorly trained people to practice. Why not just make medical school 2 years and cut out residency and fellowship all together?
Answer: Because it's a bad idea.

 

[deleted6669]

The answer to not enough of something is not to drop your standards; it is to increase your supply of what you're lacking.

A shortage of doctors is not a reason to allow poorly trained people to practice. Why not just make medical school 2 years and cut out residency and fellowship all together?
Answer: Because it's a bad idea.

OR concentrate on what is really important. consider the following:
1.MANY physicians trained during WW2 attended shortened programs to quickly increase the number of docs out there. many of these docs went on to make great discoveries, be founders of new specialties, lead physician organizations, etc.
2. There is a newly developing trend of shorter medschools(3 yrs). these folks will be fully licensed physicians.
the difference between a 3 yr medschool and a 28 month pa program is not clinical. it's a year of basic medical sciences. we can argue endlessly here how valuable those are and good arguments can be made both ways. at what point does it make sense to offer a program allowing for continuity between the 2 professions when the difference at graduation(before residency) is only 1 yr of classes?

 

[swamprat]

OR concentrate on what is really important. consider the following:
1.MANY physicians trained during WW2 attended shortened programs to quickly increase the number of docs out there. many of these docs went on to make great discoveries, be founders of new specialties, lead physician organizations, etc.
2. There is a newly developing trend of shorter medschools(3 yrs). these folks will be fully licensed physicians.
the difference between a 3 yr medschool and a 28 month pa program is not clinical. it's a year of basic medical sciences. we can argue endlessly here how valuable those are and good arguments can be made both ways. at what point does it make sense to offer a program allowing for continuity between the 2 professions when the difference at graduation(before residency) is only 1 yr of classes?

Yeah but its really not, the difference between PA and MD pre-clinical years is more than just MS1. PA programs vary amongst how much detail they go into as far as their 1 year "MS2" classroom work with some being more detailed, others less. Also, the USMLE step 1 is on a whole other level of understanding outside of the classroom work. I learned a ton more in the 4-5 weeks from the end of the first 2 years of med school to taking Step 1. Not just reinforcing facts, but learning completely new ones as well. With that said I am skeptical when PAs or PA students try to equate their pre-clinical education to our second year of medical school. As far as clinicals is concerned, it also varies but I think for the most part the PA students and MS3s share similar roles and responsibilities although from my experience the PA students seemed to be delegated tasks by the MS3s (I'm sure its not like this everywhere). With all this being said, how does this affect the end game of being a clinician? I couldn't comment fully, I'm not an attending yet but it just seems strange..I feel PAs should have a required 1 year residency or something because me being almost done with medical school I feel no way comfortable being thrown out to start practicing independently and I have a ton more knowledge and clinical experience than a graduating PA student.

 

[Makati2008]

Yeah but its really not, the difference between PA and MD pre-clinical years is more than just MS1. PA programs vary amongst how much detail they go into as far as their 1 year "MS2" classroom work with some being more detailed, others less. Also, the USMLE step 1 is on a whole other level of understanding outside of the classroom work. I learned a ton more in the 4-5 weeks from the end of the first 2 years of med school to taking Step 1. Not just reinforcing facts, but learning completely new ones as well. With that said I am skeptical when PAs or PA students try to equate their pre-clinical education to our second year of medical school. As far as clinicals is concerned, it also varies but I think for the most part the PA students and MS3s share similar roles and responsibilities although from my experience the PA students seemed to be delegated tasks by the MS3s (I'm sure its not like this everywhere). With all this being said, how does this affect the end game of being a clinician? I couldn't comment fully, I'm not an attending yet but it just seems strange..I feel PAs should have a required 1 year residency or something because me being almost done with medical school I feel no way comfortable being thrown out to start practicing independently and I have a ton more knowledge and clinical experience than a graduating PA student.

Well as someone who has done both (PA and medical school) I can say year two would have been the biggest waste of my life minus the integrated pathology/histology as well as a few parts of physio.

Also I would hate it for the PA-S delegated task by a 3rd year. I would question the program being a strong one OR I would consider those students outliers because I would be getting that fixed ASAP.

Also PAs are never independent so they can be watched closely to make sure they know their stuff, no so much for NP... I foresee PA fellowships becoming the norm.

Also I agree with you as far as more knowledge but clinical experience is dependent on the PA because some have prior hce while others set up brutal rotations to get experience while others skate by. Also 4th year seems to be the biggest joke at some schools? Saying they show up one day and then come back at the end of the month to get a grade.

 

[deleted6669]

Agree Makati- any program in which pa and md students are not interchangeable on rotation would be atypical. I took direction from residents and attendings only on rotations and was treated exactly the same as the medstudents on every rotation with the same requirements for rounding, patient loads, call, etc. My surgery rotation was over 100 hrs/week for example. I lived at the facility in the residents quarters.
I think 3 yr pa programs with required postgrad training and specialty boards are coming. I see lateral monbility going away for PAs. I don't think that is a bad thing.

 

[d2305]

1961
An address to the House of Delegates of the AMA by newly elected Trustee, Charles Hudson, MD, is published in theJournal of the American Medical Association. Entitled, "Expansion of Medical Professional Services with Nonprofessional Personnel," it calls for a "mid-level" provider from the ranks of former military corpsmen. Movement toward the concept of the physician assistant is set in motion.

The World Health Organization (WHO) begins introducing and promoting new categories of health care workers in developing countries (e.g., Me'decin Africain, Dresser, Assistant Medical Officer, and Rural Health Technician).

 

[deleted6669]

OTHER NAMING OPTIONS:
South Africa http://www.clinicalassociate.co.za/
In saudi arabia PAs are "assistant physicians".

 

[NYEMMED]

OR concentrate on what is really important. consider the following:
1.MANY physicians trained during WW2 attended shortened programs to quickly increase the number of docs out there. many of these docs went on to make great discoveries, be founders of new specialties, lead physician organizations, etc.
2. There is a newly developing trend of shorter medschools(3 yrs). these folks will be fully licensed physicians.
the difference between a 3 yr medschool and a 28 month pa program is not clinical. it's a year of basic medical sciences. we can argue endlessly here how valuable those are and good arguments can be made both ways. at what point does it make sense to offer a program allowing for continuity between the 2 professions when the difference at graduation(before residency) is only 1 yr of classes?

Are they really fully licensed? I thought many/ Most of the 3 yr tracks are limited only to Family Medicine. For instance even at my alma mater there is a 3 yr track but their diploma says in large letters "LIMITED TO FAMILY PRACTICE ONLY".

 

[NYEMMED]

OTHER NAMING OPTIONS:
South Africa http://www.clinicalassociate.co.za/
In saudi arabia PAs are "assistant physicians".

Is the difference between physician assistant and assistant physician even substantial enough to consider? I also oppose "physician associate" as the associate of a physician is a physician, the wording just dosent work. In the end people need to not be concerned what their title is and they need to do their job.

I do see however many people at my shop saying "well im here to see a doctor, not a PA, so go get the doctor" And these are mostly level 5 urgent track patients (where we staff PAs for lacerations/ spasms/ minor MVAs etc.) So I understand the frustration sometimes.

 

[deleted6669]

Are they really fully licensed? I thought many/ Most of the 3 yr tracks are limited only to Family Medicine. For instance even at my alma mater there is a 3 yr track but their diploma says in large letters "LIMITED TO FAMILY PRACTICE ONLY".

The 3 yr PA to DO bridge program at Lecom allows grads to match to any specialty. they reserve 1/2 the class spots for folks who "express an interest in primary care" but they can apply to any residency they choose.

 

[deleted6669]

I do see however many people at my shop saying "well im here to see a doctor, not a PA, so go get the doctor" And these are mostly level 5 urgent track patients (where we staff PAs for lacerations/ spasms/ minor MVAs etc.) So I understand the frustration sometimes.

any place where pas have to staff level 5 pts either has crappy pas or docs who are not utilizing them to the level of their training. sounds like a malignant work environment.
most of the docs I work with are honest enough to tell patients, including their own family members, that the pas in our group(avg em experience > 10 yrs) do the vast majority of the minor procedures with the most frequency and do them better than the docs. a doc in my group recently told me he had not sutured or done an I+D in over a decade. I'm guessing most of the docs don't even know where the slit lamp is kept. I have sutured multiple complex facial lacs on my physician partners kids, etc over the years. our ent and plastics guys won't even come in unless the pas refuse a case. I call them for pit pull vs kids face type of things but that is about it. I can count on 1 hand the number of plastics repairs I have needed to call for in 12 years at my current job. The pas at my facility teach the minor procedures rotation for the residents.it's amazing how many pgy-1s didn't learn how to suture or do a digital block, etc as med students.
at my current jobs I only need to present pts who will be admitted. I do present others on occasion for input and the answer I almost always get is " I don't know either, call the xyz specialist". the requirement is only real time staffing for admits and critical care. they review and sign all charts after the fact and get 50% of the production for each chart they sign, 75% if they actually see the pt themselves.
Makati(asst mod @sdn and both former pa and current med student) can corroborate my statement that pas do this type of work. he had a similar job before returning to medschool.

 

[Makati2008]

any place where pas have to staff level 5 pts either has crappy pas or docs who are not utilizing them to the level of their training. sounds like a malignant work environment.
most of the docs I work with are honest enough to tell patients, including their own family members, that the pas in our group(avg em experience > 10 yrs) do the vast majority of the minor procedures with the most frequency and do them better than the docs. a doc in my group recently told me he had not sutured or done an I+D in over a decade. I'm guessing most of the docs don't even know where the slit lamp is kept. I have sutured multiple complex facial lacs on my physician partners kids, etc over the years. our ent and plastics guys won't even come in unless the pas refuse a case. I call them for pit pull vs kids face type of things but that is about it. I can count on 1 hand the number of plastics repairs I have needed to call for in 12 years at my current job. The pas at my facility teach the minor procedures rotation for the residents.it's amazing how many pgy-1s didn't learn how to suture or do a digital block, etc as med students.
at my current jobs I only need to present pts who will be admitted. I do present others on occasion for input and the answer I almost always get is " I don't know either, call the xyz specialist". the requirement is only real time staffing for admits and critical care. they review and sign all charts after the fact and get 50% of the production for each chart they sign, 75% if they actually see the pt themselves.
Makati(asst mod @sdn and both former pa and current med student) can corroborate my statement that pas do this type of work. he had a similar job before returning to medschool.

Yep I can confirm EMED statement. It does get frustrating at times when you do the entire work up , call to admit or transfer and the doc says I don't speak to PA/NP and slams the phone down. Your doc comes in, doesn't touch the patient, reads your note and transfer done.

Also a PA that only sees that mild complexity stuff will lose their skills. I did see one setup where the PAs saw all the 5s but that was in a residency program and even those PAs could float and see the higher level stuff based on dept needs.

 

[swamprat]

Yep I can confirm EMED statement. It does get frustrating at times when you do the entire work up , call to admit or transfer and the doc says I don't speak to PA/NP and slams the phone down. Your doc comes in, doesn't touch the patient, reads your note and transfer done.

Also a PA that only sees that mild complexity stuff will lose their skills. I did see one setup where the PAs saw all the 5s but that was in a residency program and even those PAs could float and see the higher level stuff based on dept needs.

Makati, what made you switch and go back to med school?

 

[Makati2008]

Makati, what made you switch and go back to med school?

Hey doxy,
1.) respect- I don't want to be 50 and have a 30yo brand new attending running my life or fire me for a younger pa
2.)autonomy
3.)more chances to become an expert in my field ( if I match EM I'll try to do something in tox or ems)
4.)did I mention respect lol.
5.)my family

Least important was/is money. I just need enough for my kid to go to college and pay off debts

 

[sarjasy]

I have sutured multiple complex facial lacs on my physician partners kids

Your physicians partner's kids have had MULTIPLE complex facial lacs? Sounds suspicious. 🙂

 

[primadonna22274]

The 3 yr PA to DO bridge program at Lecom allows grads to match to any specialty. they reserve 1/2 the class spots for folks who "express an interest in primary care" but they can apply to any residency they choose.

Not quite true E.
Half of the APAP (Accelerated Physician Assistant Pathway) are undeclared and may apply to any osteopathic residency (new since the first class of 2014 matriculated; we argued out of this and I only applied to allopathic residencies, mostly for geographic reasons as I live and want to remain in SC). The other half are committed to primary care BY CONTRACT (FM, IM, Peds--OB isn't allowed) and if they violate the terms of this contract (do a primary care osteopathic residency, practice for 5 years in PC immediately after residency completion) they can be sued for that 4th year of tuition as "breach of contract".
Not sure how well that would hold up in court but since my interests are varied, I didn't want to be restricted and chose the undeclared pathway.

 

[deleted6669]

OK, my point was any of the undeclared folks could apply to neurosurgery, derm, etc and not be limited to primary care.
I think it would be hard for anyone to enforce a "primary care mandate" on someone holding an unrestricted medical license in a state. for example someone who does a 3 yr program and does IM("primary care") could probably then match to a fellowship in interventional cards or something I imagine. I don't think any states have options to issue primary care physician limited licenses. if they did would this prevent an fp doc from working rural em, etc? would be hard to enforce.

 

[deleted6669]

Hey doxy,
1.) respect- I don't want to be 50 and have a 30yo brand new attending running my life or fire me for a younger pa
2.)autonomy
3.)more chances to become an expert in my field ( if I match EM I'll try to do something in tox or ems)
4.)did I mention respect lol.
5.)my family

Least important was/is money. I just need enough for my kid to go to college and pay off debts

agree. and my list would also include 6) respect and 7) respect and also 8) better ability to work internationally and 9) option to work much less for similar or slightly higher income.
I too could care less about the money. as a pa I already make more than many primary care docs. I would not expect much more as a doc. ( I would however expect to work less than I currently do for that income).

 

[primadonna22274]

My reasons are all of the above--very little about money--and the desire to know more and be INDEPENDENT.

 

[d2305]

When I was working in ER an ENT attending pulled the "I want to speak to the doctor" He never got a referral from me while working in FM.

 

[deleted6669]

When I was working in ER an ENT attending pulled the "I want to speak to the doctor" He never got a referral from me while working in FM.

I do the same thing; disrespect me on the phone or in person and I will steer business anywhere but to you. I will recommend specialists straight out of residency over a prick with 20 yrs of experience.

 

[joeDO2]

I do the same thing; disrespect me on the phone or in person and I will steer business anywhere but to you. I will recommend specialists straight out of residency over a prick with 20 yrs of experience.

lets remember what we're doing here and try to keep things to the patient's best interest. I have seen attending physicians refer to docs they personally hate because they were the best guy for the job and it was best for the patient. don't let your own feelings interfere with the care you give....even if the guy is a disrespectful jerk.

 

[deleted6669]

lets remember what we're doing here and try to keep things to the patient's best interest. I have seen attending physicians refer to docs they personally hate because they were the best guy for the job and it was best for the patient. don't let your own feelings interfere with the care you give....even if the guy is a disrespectful jerk.

All else being equal if the guy is a jerk to me he will probably disrespect the family and the pt as well. these dinosaurs need to retire. it used to be that many surgeons were like this but many of the new guys trained with pas and recognize our value. today it is mostly hospitalists who do this. I am happy to wait 20 min to call the next guy coming on or admit to a different service if another consultant isn't a jerk rather than present to some assclown who will say no even to a totally reasonable request.

 

[altap]

You get disrespected when a physician says I would like to speak to the doctor? IMHO, if you feel that you don't get the respect you deserve bec. you are not a physician then take up the challenge and try to become one.

 

[Makati2008]

You get disrespected when a physician says I would like to speak to the doctor? IMHO, if you feel that you don't get the respect you deserve bec. you are not a physician then take up the challenge and try to become one.

You miss the point. They do this without even listening to what we have to say. Now if they are listening to us and want to speak to the doc because of mismanagement of the patient that is understandable.

 

[altap]

You miss the point. They do this without even listening to what we have to say. Now if they are listening to us and want to speak to the doc because of mismanagement of the patient that is understandable.

I see this as a non-issue. A physician who wants to speak to a fellow dr regarding a patient is just that a physician ...

 

[primadonna22274]

I see this as a non-issue. A physician who wants to speak to a fellow dr regarding a patient is just that a physician ...

You think it's a non-issue because you have not been repeatedly rebuffed by a consultant when you need that consultant's help to take care of a patient. Several times a day. Perhaps you are the consultant doing the rebuffing.
We PAs who practice in high-autonomy, high-responsibility roles do so without our supervising physicians looking over our shoulders. They have worked with us far longer than you have and they know the quality of our work and trust our assessments. So when you ask to speak to them, rather than listening to the PA who actually saw and treated the patient, you are likely going to hear "I don't know, I haven't seen the patient--why aren't you talking to the PA who knows all about this patient?!"
I for one got tired of this attitude among other things and went on to med school, but it's not a feasible option for most. Or do you think PAs only treat runny noses and sprained ankles?

 

[Makati2008]

You think it's a non-issue because you have not been repeatedly rebuffed by a consultant when you need that consultant's help to take care of a patient. Several times a day. Perhaps you are the consultant doing the rebuffing.
We PAs who practice in high-autonomy, high-responsibility roles do so without our supervising physicians looking over our shoulders. They have worked with us far longer than you have and they know the quality of our work and trust our assessments. So when you ask to speak to them, rather than listening to the PA who actually saw and treated the patient, you are likely going to hear "I don't know, I haven't seen the patient--why aren't you talking to the PA who knows all about this patient?!"
I for one got tired of this attitude among other things and went on to med school, but it's not a feasible option for most. Or do you think PAs only treat runny noses and sprained ankles?

Agreed. If memory serves me correctly he is a FMG that can't land a residency.... also that attitude puts patients in danger and guess what-> if that delay in care leads to a bad outcome no jury will take- I wanted to talk to a Physician not a midlevel as a suitable defense when an acceptable surrogate is delivering patient care.

 

[altap]

It is your attitude that would get a pt in trouble. Why don't you accept the fact that the leader and the most knowledgable in your grp is the physician. I hear a lot of hubris here about midlevels being as good as a dr about having taken the same subjects about doing this and that. Why don't you ask a FMG if ever he or she did those things while he or she was in MED SCHOOL? Ask him or her what he or she had to go through to finish med school. It is just ignorantand *****ic to say yeah there was a number of FMGs who practiced as PAs in Florida but they were incompetent therefore all FMGs are incompetent.

 

[Makati2008]

It is your attitude that would get a pt in trouble. Why don't you accept the fact that the leader and the most knowledgable in your grp is the physician. I hear a lot of hubris here about midlevels being as good as a dr about having taken the same subjects about doing this and that. Why don't you ask a FMG if ever he or she did those things while he or she was in MED SCHOOL? Ask him or her what he or she had to go through to finish med school. It is just ignorantand *****ic to say yeah there was a number of FMGs who practiced as PAs in Florida but they were incompetent therefore all FMGs are incompetent.

Your post confuses me. No one claims that PA/NP is smarter than the Physician. No one brought up the Florida debacle? Also there are PLENTY of good FMG/IMGs that are in practice. MLPs only ask to be listened to when it involves patient care and it's honestly a very fair request and what is best for the patient. All egos aside.

As far as my attitude, I will be a Physician in 5 months so the MLP debate is a moot one for me. I just disagree with someone who comes into the forum and attack MLPs for no apparent reason but to stir up trouble/strife.

I will ask nicely and you are free to decline or answer. Are you a residency trained Physician(residency in the USA) or someone that is currently a resident/medical student?

 

[deleted6669]

You get disrespected when a physician says I would like to speak to the doctor? IMHO, if you feel that you don't get the respect you deserve bec. you are not a physician then take up the challenge and try to become one.

this from a nurse? have you matched yet? didn't think so... if I present a totally reasonable admission I shouldn't need to have a doc read MY NOTE to a consultant to get them to admit and that is only if I happen to be working with a doc which is about 20% of the time now...the rest of the time there is no doc on the premises. I run the dept, I do codes on the floor, icu, etc
Makati how about banning this guy once and for all? check his post history. all he does is come here and bash PAs and NPs because he is jealous that we can work autonomously in medicine and he can not.

 

[Makati2008]

Let's all calm down. Let's try to go back to the original topic of this thread. We got a tad off track and I will take the blame on that.

Makati

 

[altap]

Spare me super emedpa. I have never seen any PA come close to the clinical skills or medical knowledge of a physician. It is what it is. You are a PA, I'm a dr so dream on lol

 

[primadonna22274]

Spare me super emedpa. I have never seen any PA come close to the clinical skills or medical knowledge of a physician. It is what it is. You are a PA, I'm a dr so...

Ban time. Nothing educational or useful has come out of this dude's mouth...and I am a ridiculously patient person.
And btw, add me to the list of longtime PAs, near-graduate physicians too. We know what we're talking about. And p.s. I've had nothing but rave reviews from the 9 residency programs with which I've interviewed and not a bit worried about the match.

 

[altap]

There are FMGs here in the US who were heads of their respective departments but bec of politics have no chance of ever practicing in the US.

 

[altap]

With PAs like these...