As a nontrad who quit his job to go back to school and earn another degree in bio, and take the mcat in order to get accepted to med school, it really annoys me that these nurse think they can get a pass at the whole process I went through just because they have some clinical experience. At least PA's take the same prereqs as med students except for physics. The basic science courses that nurses take is a joke.
New idea for NP/PA to MD
- Thread starter FNPinKS
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From some of the previous posts I believe you may be better off just being an art major and simply taking the required pre-reqs. That way you can have a high GPA. As opposed to being a "biology major".
As a fall back you could apply to PA school. Send out multiple applications to several schools with a poor probability of getting into one of them.
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deleted6669
you obviously know NOTHING about pa's.
we can already do this today. unlike np's, pa's get a well rounded generalist medical education, both didactic and clinical, which is adaptable to any specialty. any new pa grad can apply for any position out there in which a doc is willing to teach them the specialty.
there is nothing stopping me from applying to work in peds, surgery, obgyn, endocrinology, interventional radiology, etc RIGHT NOW.
the pa degree is a generalist degree and allows us to work in any field we can find a physician willing to hire us into. I know lots of folks who go family medicine to surgery or peds or nephrology, or whatever. a residency trained doctorate level education standard would change nothing except give you a smarter pa right out of residency, as it does today for those pa's who choose to attend one. a doctorate doesn't give us more political power. we would still work for physicians and be under the medical board. if anything mandatory specialty training for pa's would decrease our options as you would have to do a second residency to switch specialties.
the only way that pa's would gain independence is if physicians decided in every state to give it to us which for them would make no sense. right now they make a lot of money from their association with pa's. since hiring pa's into their group 20 yrs ago my physician colleagues have made 48 million dollars in pure profit off the work of myself and my pa partners. why would they vote that away and want us to be able to bill independently? IT WON'T HAPPEN AND ANYONE WHO THINKS IT WILL IS DELUSIONAL. docs have too much($$$) to lose by letting pa's practice independently of physician collaboration. even pa's who own their own practices( 4% of all pa's by the way, the same % interestingly enough as np's who own their own practices) have to hire docs to work for the practice in a supervisory role.
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Actually smart ass, I have been recently accepted to a medical school. I purposely became a bio major so I can take extra science classes to get a stronger science foundation such as molecular bio, biochemistry, embryology, histology, etc... And I did graduated with a "high" GPA with a bio major. I don't need to fall back on anything!
Do I think that NP's or PA's having to skip a large portion of medical school based on prior experience, no I don't, but I don't see how there is any harm in an individual school allowing midlevels to test out of certain portions of basic clinical skills if they are able to meet or exceed the minimal requirements that the other medical students are required to meet.
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That's just more crap. Really, PAs are dependent practitioners and will never have more power than MDs. That said, any additional training no matter what the degree awarded (certificate, etc) received via PA residency is only going to help the MD that hires them (less work for that MD to train the PA locally) and the patients we serve.
This is what confuses me. If PAs like so much to be supervised by physicians why do 4% of them start a private practice, only to turn around and hire a physician to sign off on charts for them, after seeing patients all day when the supervisiong MD is not even in the building?
Then PAs turn around and talk about how much money they make for their "supervising" physicians and that they want to get doctorate level degrees. They even want to complete residencies and give up the right to jump from specialty to specialty.
This all just seems quite confusing and doesn't make much sense. It seems quite clear that PAs want to practice independently.
I don't see how the doctorate trained PA could benefit the MDs who supervise them. These PAs would ask for higher wages from MDs since they have a doctorate degree. Some of them would even go around calling themselves doctor. The patient's of the MDs would be confused.
Furthermore, they would begin to open up clinics and private practices and hire real doctors.
You don't see nurse's assistants, physical therapy assistants, COTAs, or SLPAs pursuing doctorate level clinical degrees. The doctorate in physician assisting is ludicrous.
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More false assumptions and crap.
There is only one clinical doctorate for PAs in the US granted by Baylor to US Army PAs that graduate from their emergency medicine program. There are plenty of PAs that have doctorates in other fields, yet when they practice the do not use the term doctor.
There is no need to have a doctorate to open up a clinic as a PA. That can be done by any PA, some of whom hold associates degrees.
You don't see nursing assistants pursuing clinical doctorates, but you cannot compare these paraprofessionals to a PA. A much better comparison is the nurse practitioner, pharmacist, and physical therapist who do hold clinical doctorates. Considering that the degree you are arguing about is not available to 99.9% of all the PAs that are out there, what is ludicrous is your baseless argument.
Why do folks have to resort to profanity and insults when they are confronted with the truth?
Somehow I am getting used to this. All I wanted to do was engage in intellectual dialogue.
Please take this up with EMED, a PA leader. He brought up that future of the PA profession is with doctorate level preparation.
This is a quote by EMED:
"bs( 4 yrs) + pa @ 3 yrs + mandatory 1 yr residency= 8 yrs.
practice any specialty, switch whenever you want. minimal debt.
md 11 yrs min
1 specialty
major debt
see the difference?
you may not like it but this is probably where the field is heading. when the pa concept began all the applicants had significant prior medical experience along the lines of medic, rn, rt. this is less true every yr now so as a result they will need to lengthen the training"
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Maybe we are heading towards requiring residencies, and maybe we are not. But that still shows the fallacy of your argument, because all a residency grants is a certificate, not a doctorate.
See the difference?
See the difference?
Here is the entire quote from EMED (2010), a respected PA leader. Note that he says that the PA would soon need doctorate level education:
"bs( 4 yrs) + pa @ 3 yrs + mandatory 1 yr residency= 8 yrs.
practice any specialty, switch whenever you want. minimal debt.
md 11 yrs min
1 specialty
major debt
see the difference?
you may not like it but this is probably where the field is heading. when the pa concept began all the applicants had significant prior medical experience along the lines of medic, rn, rt. this is less true every yr now so as a result they will need to lengthen the training. it's been creeping up a month or so every few yrs as it is with most programs now 27-28 months or so instead of the traditional 2 yrs.
also consider that education is a business. if a school can charge for 3 yrs of tuition instead of 2 they will. the np's forced us to go to a masters degree ( for the most part- a few non-ms programs remain but they are under serious pressure to transition to the ms level) to remain competitive and when they fully embrace the dnp we will probably need to come up with a mechanism for having a doctorate as well, although I think ours will not be entry level but granted at the completion of residency like the current baylor em, ortho, and surgical residencies. hospitals and organizations like the joint commission have been cracking down on all types of medical providers moreso every yr to demonstrate ability and training to perform many procedures and the best way to show that ability is through formal training and procedure logs generated in a residency. I've been following trends in pa education for the better part of 3 decades and I think the writing is on the wall for all of this to happen.
and there is a path for "more training" now with the 3 yr pa to physician bridge program for those who want to be docs. I think once this takes off many more programs like this will open up, first at DO schools and then at MD programs as well."
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The other fallacy is the assumption that EmedPA is a PA leader. Smart guy, and I respect his opinions and would be glad to buy him a beer anytime, but posting on SDN and the PA forums does not make him a PA leader, participation in the leadership of his state PA organization and the AAPA setting policy does. He may be good at predicting the future of the profession, but he is not out there setting the guidelines for it.
See the difference? Are you tired of looking stupid yet?
See the difference? Are you tired of looking stupid yet?
I understand your point. May I ask you what the names of your PA organizations are?
Also, are any of them independent of any oversight by the AMA/BOM?
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I am a member of the AAPA www.aapa.org and the NCAPA www.ncapa.org. I am regulated by the NC medical board www.ncmedboard.org, which includes a PA representative and state law.
This is exactly what the MDs fear. Look at the thought process of EMED's previous posts. They want residencies, name changes, a few years off from MD/DO schools, doctorate level education, and yes independent practice.
PAs are even beginning to organize as evidenced by these organizatons. Read some of the posts the PAs have made.
A. I am not a PA.
B. Despite PAs being seen as competition by the naked eye, at the federal/political level they are a huge tool towards the nursing resistance. One truth (unfortunate or not) is that mid-levels are necessary for the US healthcare system. If NPs become the preferred mid-level in the future, it will put a major strain on the system, both financially and more importantly patient safety will go down that drain. PAs are 'controllable' to a certain extend that is unseen with NPs. Despite concerns that PAs may want to go independent 30 years from now or so for example, but pushing them down, the NPs are gaining ground. PAs allow employers a choice from employing an NP right now and despite what these PAs want to do (loosen requirements, so forth), they are regulated too heavily by organized medicine to gain any ground.
Despite what people may think, if it wasn't for PAs, NPs would be 100% independent now. Not saying PAs are perfect, but supporting PAs is a MUCH better alternative then supporting NPs at this time.
I don't agree my friend. The agenda of these PAs (i.e. residencies ect.) seems far more ambitious than that of NPs. I believe many of them truly think that what they learn in 2 years is comparable to what an MD learns in 4-5. At least NPs know their limitations and are able to admit that they are not medical doctors. PAs have been arguing with MDs for weeks now about how great their education is.
PAs have had residencies for over 20 years now. It hasn't changed their scope of practice at all. It's old news.
On the other hand, NPs are basically independent in 20-or-so states and growing. With about half the clinical knowledge of these PAs you are looking down on.
To dare say that NPs know "their limits" and PAs don't is asinine
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deleted6669
none of this is new. pa's have been going to residencies for over 20 yrs. pa's have been members of specialty societies for over 40yrs. pa's have even been presidents of state medical societies.
brad is right. I am not currently in any leadership position (but I will still take that beer.)
my opinions are mine alone but I think many of them have merit and will come to pass, specifically lengthening of programs(happening already), the need for more pa residencies and the likely granting of a DHSc by those residencies, after all if you have an ms and do 2 more yrs of intensive training what is the next step up the ladder? what does the competition(np's) have?
brad is right. I am not currently in any leadership position (but I will still take that beer.)
my opinions are mine alone but I think many of them have merit and will come to pass, specifically lengthening of programs(happening already), the need for more pa residencies and the likely granting of a DHSc by those residencies, after all if you have an ms and do 2 more yrs of intensive training what is the next step up the ladder? what does the competition(np's) have?
With all of his training why don't PAs just go to medical school? It seems like you are proposing medical school and disguising it as a doctorate in physician assisting. You are proposing and I quote from you EMEDPA (2010):
"bs( 4 yrs) + pa @ 3 yrs + mandatory 1 yr residency= 8 yrs.
practice any specialty, switch whenever you want. minimal debt."
First of all, the student might as well just go to medical school because it would cost just about as much to take all of these classes. With the level of training you are proposing doctorate level PAs would be the direct competition of the MD.
With all of this training how would MDs be able to pay PAs? With 4 years post baccalaureate training is seems like you are planning to displace MDs or become independent practitioners EMED.
The doctorate in physician assisting is unrealistic. Furthermore, what would be the purpose of a residency (to specialize and become an expert at something) just to turn around and be able to switch subspecialties?
As I said earlier, if PAs were granted a doctorate degree they would have more powers than the physicians who created them.
They have been going to residencies but that has been the exception rather than the norm. EMED wants all PAs to have doctorates which include a residency component. With all of that training what would be the purpose of having a supervising MD? PAs will become the direct competition of MDs and no longer assistants.
EMED you are by far the most astute PA on this site. Please come clean and let all of us on the SDN know your true agenda?
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deleted6669
world domination bwah ha ha(said like dr evil with pinky in mouth)...
seriously though
I'm just calling it like I see it. consider the history if you will:
1.when I started pa school there were only 50 pa programs, 2 granted a masters. now there are 150 programs, most grant an ms to keep up with the np's degree creep.
2. when I started pa school there were maybe 12 residencies, mostly in surgery with a few in em and peds. a few granted an ms. now there are probably 30 pa residency programs in almost every specialty with the programs at baylor granting a DHSc after 18 mo of residency.
3. pa programs used to be 2 yrs(24 mo). now most are 27-28 mo or so. USC went to a 3 yr entry level program to compensate for decreased experience of applicants compared to historical applicants who had years of prior experience.
so follow the trends...longer programs, more(and longer) residencies, higher level degrees.
note I didn't say independence.
I don't have an agenda here. I don't "want pa's to have doctorates", I just think it will happen. it would have been easier for me if we stayed at the bs level, I wouldn't have had to get a postgrad ms. I'm fairly established in my career now. any new requirement won't apply to me or other older pa's as we will be grandfathered. I admit that most of these changes are driven by market forces. we have to keep up with the competition(np's). but we will do it by adding SUBSTANCE to our entry level programs and residencies, not more fluff like the np's did to create the dnp. a certificate level pa still gets a better educational experience than a dnp but what matters to some employers is the alphabet soup after the name so we will likely get DHSc's to keep up with the dnp's.
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You are aware that MDs are satisfied with the status quo? They are not requiring you all to have doctorate level degrees. PTs are now facing similar problems as the MDs. PTAs now want to be granted a BS degree and be called associates.
In the long run students and physicians will be paying the price and I mean this literally.
I have yet to see an assistant pursue an entry level clinical doctorate.
If I were a pre-medical student I wouldn't be able to see what is so great about becoming a PA for several reasons besides independence. These include:
1) having to have a 3.6 or above (how would this work in my favor when this would force me to become an art major, put me under unecessary stress, or force me to go to a school which inflates grades)
2) I may have to go to whatever school that does accept me
3) I would have to get all of this expensive training (EMED proposes a doctorate) just to have the same scope of practice as my predecessors
4) With so many pre-med students out there with 3.6 GPAs why would a PA program pick me which leaves me in a compromising position/able to be failed easily, waitlisted, or mistreated
5) Why not just study podiatry (who are independent and earn $187,000)
6) Why not just become a pharmacist (" " " $125,000)
7) Why not just become a CRNA (" " " $160,000 easily)
Your plans are unrealistic EMED.
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deleted6669
What do you mean? dnp's are getting them. they are still "midlevels" even with the doctorate. most np's "assist" physicians. only 4% own their own practices.
so dnp's for all their talk are still just as much "assistants" as the pa's you have yet to respect or understand.
this will be my last response to you . please take a loooooooooooooooong hiatus.
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Do you make a point to do drugs before you post? None of this makes any sense. . .
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Just a reminder to keep the discussion in this thread civil.
If this thread continues to deteriorate, it will be closed.
If this thread continues to deteriorate, it will be closed.
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If PsychNP is going to keep posting then I say close it, please, before we all become dumber from reading psychnp's posts.
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whoa whoa whoa emed...you've always told us that the doctorate was only gonna be in the military, for the PAs who need to advance in rank...
Now civi guys need doctorates to remain competitive?
Now civi guys need doctorates to remain competitive?
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I think that may be what PA's want-- more power and autonomy. However, the fact that their existence is overseen by the board of medicine makes this more unlikely than the the DNP's gaining even more independence, as they fall under "nursing" (which continues to amaze me that you can practice medicine under the guise of nursing).
I think if there is one thing to learn from the CRNA's, it's that they're a force to be reckoned with and we should not underestimate the mid-levels. On the other hand, they're a cost-effective way to practice medicine as they're basically eternal interns/residents who can free up the attending's time for more complicated work/cases.
I consider myself to be relatively intelligent and educated, but I can honestly say that I don't understand your point at all.
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deleted6669
I didn't say it was what I want or that it is a good thing but I think that degree creep is a force to be reckoned with so sooner or later(not now but in 10 yrs when most nps' are dnp's...probably) I think it's coming. baylor has a dhsc residency program-several actually as they do em, ortho, and surgery. there are now 2 well known postgrad dhsc's for pa's(nova and atsu) and a pa/phd medical scientist program(wake forest).
in a perfect world pa's and np's would have stayed at the bs level but anytime someone ups the degree ante the other side needs to do the same to remain competitive in the overall job market. there are folks out there(including docs and administrators who don't know the difference between an np and a pa) who assume that any doctorate>any ms>any bs>any as>any certificate when that is not the case. some of the best pa's I know have a certificate + a postgrad em residency(done in the early 80's without any other degree given).
regardless of the degree issue I think residencies for pa's just make sense. what's wrong with a more educated pa? they don't make more money, they can't replace docs, they can't work independently, they are just more efficient and make fewer mistakes. how is that a bad thing? I would still do an em or critical care/trauma residency if there was one in my home town. there are some things that I just don't do often enough to get the #s to get credentialed to do them which a residency would train me to do.
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The PA was brought about to work under direct supervision of the MD thus the title physician assistant.
With that being said, there is such a thing as being an overqualified PA (one with a clinical doctorate in physician assisting). In much the same way as I would consider a PTA, COTA, or CNA with a PhD to be overqualified to work in the capacity of a direct care assistant.
MDs should never have allowed the entry level of the PA profession to go beyond the A.S. or B.S. degree.
Better yet, it should be a 2-3 year hospital based training/diploma program (like the old RN diploma programs). That way MDs could better monitor the situation.
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deleted6669
yup.
I know you're a troll and all but wow.
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It's obvious they have no clue on PA education. My program director was-family medicine MD. My medical director was an internal medicine MD. 65% of my didactic instructors were MDs teaching their specialty, the rest were PAs. My clinical rotations were done at a teaching hospital along with the PGY1-3s from their family medicine residency program. Doctors had a hand in everything I learned from day one.
Quote:
Originally Posted by Socrates25
As an upper level resident I have authority over both med students and PA students who rotate thru -- I make sure that the PA dudes dont come anywhere near our patients and that they spend the greater part of the day in the team room doing stupid logistical work like setting up f/u appts.
Yeah.
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Funny, I seem to recall emedpa suggesting that BC ED physicians knew more than him and, if memory serves, even upper level EM residents. He made the very fair point that he knows more about EM than non-EM physicians (as a resident in FM I can agree with this assessment.
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Quote:
Originally Posted by Socrates25
As an upper level resident I have authority over both med students and PA students who rotate thru -- I make sure that the PA dudes dont come anywhere near our patients and that they spend the greater part of the day in the team room doing stupid logistical work like setting up f/u appts.
Yeah.
And if a PGY-3 acted like that at Womack Army Medical Center where i trained, the attending would have had him at attention reading him the riot act. Like it or not, the PAs I trained with need to be trained well, because within a month of graduation they end up in a war zone saving lives.....
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Originally Posted by Starpower
For 20 years years prior to PA school, I worked in making and delivering meals to people dying of AIDS, in caring for Alzheimer's patients, hospice patients, patients in AIDS hospice, Peds ICU, Alzheimer's care, two EDs, and did live-in care of a bedbound woman with MS for two years. How dare you accuse me of avoiding menial tasks. My point was that the FMGs had no idea what a PA is, they thought I was akin to a MA.
This is a perfect example of what can happen when assistants are not kept in their role. The FMG gave his assistant, the PA, a direct order and she failed to carry it out. Then displayed an attitude. I am sorry, but this borders upon insubordination. The PA should have done the urine dip and H&P without question. She had no idea what the supervising MD wanted these assessments for.
Do you think a CNA could question a direct order given by an RN? The PA in this case example should have been reprimanded.
Originally Posted by Starpower
For 20 years years prior to PA school, I worked in making and delivering meals to people dying of AIDS, in caring for Alzheimer's patients, hospice patients, patients in AIDS hospice, Peds ICU, Alzheimer's care, two EDs, and did live-in care of a bedbound woman with MS for two years. How dare you accuse me of avoiding menial tasks. My point was that the FMGs had no idea what a PA is, they thought I was akin to a MA.
You were clearly never in the military.
"Now that you're here, you're all equal now".
You're a PA student just like every other. If you're the lowest on the totem pole in rounds, you may get the privilege of disimpacting the 90 yo gomer. Maybe. Get it?
Urine dip and h&p sounds like a PA student task, not MA. What MA does an h&p anyway?
This is a perfect example of what can happen when assistants are not kept in their role. The FMG gave his assistant, the PA, a direct order and she failed to carry it out. Then displayed an attitude. I am sorry, but this borders upon insubordination. The PA should have done the urine dip and H&P without question. She had no idea what the supervising MD wanted these assessments for.
Do you think a CNA could question a direct order given by an RN? The PA in this case example should have been reprimanded.
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Quote:
Originally Posted by Starpower
For 20 years years prior to PA school, I worked in making and delivering meals to people dying of AIDS, in caring for Alzheimer's patients, hospice patients, patients in AIDS hospice, Peds ICU, Alzheimer's care, two EDs, and did live-in care of a bedbound woman with MS for two years. How dare you accuse me of avoiding menial tasks. My point was that the FMGs had no idea what a PA is, they thought I was akin to a MA.
This is a perfect example of what can happen when assistants are not kept in their role. The FMG gave his assistant, the PA, a drect order and she failed to carry it out. Then displayed an attitude. I am sorry, but this borders upon insubordination. The PA should have done the urine dip and H&P without question. She had no idea what the supervising MD wanted these assessments for.
Do you think a CNA could question a direct order given by an RN? The PA in this case example should have been reprimanded.
You do realize that according to your definition of the PA assistant, an NP (like a Psych-NP), is an "assistant" as well. Just a lesser trained assistant right?
i cant believe they let trolls like you loose on here
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Who cares what noctors do?
PAs don't have to degree creep. Folks in healthcare know the difference in training and abilities..
PAs don't have to degree creep. Folks in healthcare know the difference in training and abilities..
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PA stud vs Med stud, med stud gets the goodies all the time, first. I'm sure that's what socrates meant...
I'm sorry, but @ womack, given it's lack of clinical stuff compared to other residencies, the pgy-3 and below should basically be doing everything medical, with the PA student doing scut, following 1 patient..there isn't much learning @ that place compared to any average civi residency.
On any medical service with residents, the PA's role is solely scut....let the residents focus on learning..med studs focus on learning.
Maybe socrates can jump back in to clarify things, but what's the problem with PA's doing only scut while the residents do all the learning?
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There is a difference in productive scut versus non-productive scut. Having the PA student do the h&p on your new admit is useful for both parties. Having the PA student do nothing but arrange f/u appointments and other such mundane work on purpose because you think PAs are a threat to your profession as Socrates states is another.
All students are there to get their hands dirty, and not allowing your PA students to participate only produces a poorly trained PA.
