Mid Level Providers

[Big_Bee]

I feel I should just start a thread to ask some questions.

I'm a third year medical student, I'm looking at four more years of medical education including residency, USMLE steps II, III, and a final board test (from what I can gather) in order to at the core, diagnose and treat patients for their problems.

With the influx of PA's, NP's, CRNA's, DPT's, etc... going through much less training/education while still diagnosing and treating patients. Will I be overtrained?

I would like to think that I wouldn't. I would like to think that to be Qualified to diagnose and treat patients one would require a Core of College Prerequesites, Bachelor's degree, Four year medical school education, three or more years of residency and multiple tests along the way would be the minimum to diagnose and treat.

Why can Anyone with less, diagnose and treat patients? I can only conclude that I'm overtrained.

BUZZZ

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[Bandit]

Big bee, are you sure you are a third year? You know, it is tough enough explaining the role of mid-level providers to the community, but to see the ignorance of those in the field is astounding.
Speaking for the PA profession -- you need to do some research. I have an ms in chem and math -- working on a PhD in computational chem. I taught physics and chem at a local college for years. I wanted to help out in the medical community so I then recieved a PA degree. 9 years as a paramedic, 37 years old -- family demands and lifestyle convinced me this was the way to go -- and I have never been happier.

PA schools are indeed "less training" than medical school -- of this there is no doubt. But the clinical med/phys diag/pharm/patho/anatomy/micro/and biochem are the same. PA programs replace some of the other tough courses like cytology/histology/virology with bullsh** classes like death, dying and berievment, and behav. counsle classes. The program is 6 straight semester (summers too) grad level material, that require many of the same prereq`s that med school does. No residency is required, but there are many PA residencys out there. PA`s can also change their area of specialty without extra training. Kinda nice if ya get bored.
I also teach medical students every day. I take them on rounds and they are for the most part - thankful for the help.
There is a heavy price for all this though---much less money (although you will be OUT of residency before you come close to my salary), and disrespect from the medical STUDENT community (not the attendings).

Mid level is not for everyone. Hell if I were younger -- I would have gone to med school too. Ask your self how much more training you need to dx allergic rhinitis. You will not be over trained -- you will be a medical doctor. You will never stop learning, and you will need it!

What really hurts the profession is the lack of consistancy in programs around the country. Like any other profession, there are good and bad programs and PA`s.

Hope this elightens you a bit on mid-levels I certainly did not mean to sound mean spirited or insulting to you! Good luck.

PS, I hope this does not turn into a mid-level bashing thread.

 

[md03]

Several of the clinics I have worked in have midlevel providers, and there are several midlevel providers in every class at my medical school.

While there are many cases where a midlevel provider and a physican can manage the same problem. However, the physician generally has much more in depth training and exprerinece, and thus can handle more complex problems than the midlevel can. (having said that, I realize there are some practicing physicans who are idiots and some super sharp midlevels). As an example, both the midlevel and the physician could manage HTN in the office. However, the midlevel probably can't manage a HTN emergency in the ER.

 

[Bandit]

mdo3 is very close here. Your example is off, I worked the ER for years and my friend, a PA for 25 years is in charge of the ICU, but you are pretty close on the point. Esp in the primary care setting, after many years of experience on both parts (MD and PA) there is really not allot the PA is not gonna handle.

Do you need to take linear algabra and functional analysis to be a good calculus teacher?
Can you say that one knows calc better than the other?

 

[Big_Bee]

I can assure you that I am a third year medical student and I also don't want this thread to become a midlevel provider bashing thread.

During this year I've been in the hospital give or take 80 hours a week not including call nights and I've also seen some allergic rhinitis, HTN, etc... and I don't think that it would take six semesters of grad level training including summers to diagnose and treat them.

My main curiosity in the overtraining thing is that although there are many easy to treat diseases there are some very complicated diseases to treat as well. With all the confusion in medical care why do we need a complication in who you can go to for what? I mean by this, if you are sick, do you then determine how sick you are then determine what level of care you require, etc...? Should doctors become specialty care only; allowing midlevel providers to distribute all of the primary care needs?

I personally grew up with the notion that if you were sick, you went to a doctor who had a nurse help him in the running of the office.

It is my understanding that PA's and other midlevel providers were created to help in underserved areas where doctor's couldn't keep up with the demands of their patient population and the cost of attracting another doctor was too great.

I could be mistaken but It seems to me as though you chose to become a midlevel provider because you wanted to provide health services but didn't want to give the time/family/etc.. commitment that going through MD training would require.

My problem with that is this. I'm considering an Internal Medicine/Primary Care residency. I would like to provide primary care services. If midlevel providers are Diagnosing and Treating patients with Primary Care problems then what is the need for my increased amount of training?

I personally think that there is a need for my increased amount of training because a zebra might look like a horse from a distance, I will have to have malpractice insurance, and I will ultimately be the one responsible for the care provided. I've asked my senior residents if they feel prepared to practice and they have all responded with a "well we'll see?" type answer. Not a single resident has felt confidently without a doubt prepared and I think it is because ultimately the care of the patient is the MD's responsibilty. Legally and Morally.

That being said, I acknowledge the services that PA's provide can be valuable, But I also believe that those same services could be rendered by someone a lot less trained and without a title. If I as an MD ultimatly bear the responsibility of the care provided to a patient is it not up to my descretion as to whom provides my assistance, could it not be my nurse?

my original post asked if I was overtrained. I feel I'm undertrained secondary to my experiences in medical school have been eye-opening. I think that it is a humbling thought that after giving up seven years of my life to medical training I will still not feel "without a doubt" confident in my skills to diagnose and treat patients. Why should someone who agrees that they recieve less training be allowed to do the same?

BANDIT my questions to you are as follows:
-What role do you see PA's having in medical care?
-Would you like to operate independently without the oversight of an MD, (Legally responsible)?
-Do you operate in an underserved area?

BUZZZZ

 

[med student]

I would not worry about being overtrained because in every clinic I have worked in the mid level providers did a good job of patient care but they would frequently have to ask the DRs questions about cases. I would also see the Dr correct the PA every once in a while. This is not saying they are bad it just shows there is a difference between Dr and PA/NP. It is not fair to either to try and compare the two because they have a different purpose and a different role.

Bandit you got to be kidding when you say "But the clinical med/phys diag/pharm/patho/anatomy/micro/and biochem are the same." Unless PA have figured out how to learn the same material in less time there is no way the classes are the same.

 

[Bandit]

Son, I am not kidding you. PA school it notoriously faster paced than med school. They pound you for 8 hours of lecture every day for 3 straight semesters. Harrisons was the main text (with sup texts) and were constantly told we need to know 80% of what physicians know by the time we grad. Not the residents--attendings. Now I will also grant you that all that material cannot be tested every time, but you are responsible for it. And not all PA`s are created equal and the lack of standardized programs and testing (aside from boards) lends to those not willing to put in the extra time to learn what we are responsible for and not what was on the exams.
Pay attention and you will see MD`s correcting other MD`s and going to others for advice every day. Nurses too. Its called team work. I get physicians/residents and med student asking me for my opinion and help all the time. It is what we do. No one practices medicine as an island. It is all about helping one another. Not simply professionals helping each other out, but helping the people we walk among. I know your young and in the infancy of your career/education--but always keep this in the back of your mind.

Ever hear that song from Tommy Shane Shieder -- what if shes an angel? Just a thought.