New idea for NP/PA to MD

[Starpower]

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4)"PAs in surgery are referred to as "Surgical Physician Assistants." I have heard some use the term "Surgeon Physician Assistant/PA Surgeon." The point is, the "PA" is still part of their name." ARAI

I guess you misunderstood my point. I corrected someone by saying that PAs are never considered to be surgeons. I never said that they weren't surgical physician assistants. And being a surgical physician assistant does not make one a surgeon!

You seem to have grossly misread my words. I said, "That being said, if I do end up going into surgery, I will never, ever, be a surgeon." I'm not sure how you got anything out of that which needed to be "corrected", but please re-read.

 

[Footpain]

You grossly misread my words. I'm the one who said that if I were to be a Surgical PA, that I would never, ever be a surgeon. Please re-read.

Sorry. I misread that portion of your post.

 

[deleted6669]

I'm not sure what to think about this. Why do you have to go back and learn basic sciences to the same depth that we do and then skip the year when we learn to put all of that into practice? I don't doubt that your clinical year that you equate to our 3rd year is very intense, but I think its worthwhile to do it again with the new foundation of knowledge that you get with the first 2 years of medical school.

I can understand why that would be frustrating, but I honestly don't see why you'd take the first two years without taking 3 AND 4 to apply the extra knowledge you picked up.

take a look at the curriculum if interested:
http://www.lecom.edu/pros_pathways.php/apap-curriculum/76/0/1955/17901
those in this program will do a "clinical core block" during the first summer instead of having it off then do a yr that is a hybrid of ms3 and ms4(with fewer breaks than a typical ms 4 yr). it's a well thought out curriculum.

 

[Starpower]

PA schools don't require 1 yr of biology with labs, 1 yr of physics with labs, 1 yr of gen chem with lab and one yr of ochem with labs. And some med schools like mine also required biochem and cell and molec. In fact, each PA program varies with their own prerequisite courses. In applying to med school, the prereq courses don't vary that much between programs.

.Most PA programs require prior coursework in the sciences which are equal in many respects to pre-med students, more or less. For example, PA students for many programs must have already completed a Biology series with labs, General Chemistry series with labs, Organic Chemistry with Labs, Biochemistry (which some programs will take as substitute for Ochem II), Microbiology with Lab, Anatomy with Lab, and Physiology. Pre-meds are not required to take Anatomy or Microbiology in undergrad, but PA students are. This is so they can jump you straight into deeper study of medicine from day one (we started our PA curriculum with Advanced Antomy). The other main difference with undergrad requirements is that pre-meds are required to take Physics in preparation for the MCAT, but most PA schools don't require Physics..

I do agree that it's not as across the board, compared to the required coursework before you can sit for the MCAT, but most PA programs do require the basic sciences for admission.

.In addition to the brutal first year of didactic coursework, the second year consists of training rotations in Surgery, Emergency Medicine, Psychiatry, Pediatrics, Obstetrics/Gynecology, and Adult Medicine. The student is taught and graded by a preceptor during each rotation, usually a MD or DO. I have had one rotation (Emed) where I was primarily taught and graded by PAs. In addition to the preceptor's grade, each rotation ends with an exam (roughly half of the final rotation grade).

For our Adult Medicine rotation exam, here were our learning objectives:

..Cardiovascular..

..Category I:.. Coronary artery disease; AMI, angina, hyperlipidemia, valvular heart disease, dysrhythmias, congestive heart failure; hypertension (essential, secondary, malignant), orthostatic/postural hypotension, arterial/venous insufficiency, deep vein thrombosis, thrombophlebitis, peripheral vascular disease (venous and arterial).

.Category II:. . Pericardial diseases / cardiomyopathies (dilated, hypertrophic, restrictive) rheumatic heart disease, infectious endocarditis, mesenteric ischemia.

.Pulmonary. .

..Category I:.. Acute bronchitis, pneumonias (community & nosocomial, bacterial, viral, fungal, ..HIV-related), pleural effusion, pulmonary edema, asthma, chronic bronchitis/ emphysema, pulmonary embolus, tuberculosis, influenza..

.Category II:. . Abscesses, empyema, restrictive lung diseases related to environmental/occupational and connective tissue etiologies, carcinomas, sarcoidosis, pulmonary hypertension, cystic fibrosis, primary pulmonary hypertension, pulmonary fibrosis.

.Gastrointestinal.

.Category I:. . Peptic ulcer disease: H. pylori, gastric, duodenal; gastroesophageal reflux, esophageal spasm, esophagitis, gastritis/gastreoenteritis; hepatitis, pancreatitis, inflammatory bowel disease, irritable bowel syndrome, diarrhea (infectious, parasitic), constipation, diverticular disease, pseudomembranous colitis, cholelithiasis, cholecystitis, lactose intolerance, constipation, Nutritional Deficiencies (Niacin, Thiamine, Riboflavin, Vitamins A, C, D, K)., Metabolic Disorders (Lactose intolerance).

.Category II:. . Esophageal/gastric/colorectal carcinoma; achalasia, esophageal varices, malabsorption syndromes, biliary obstruction, cirrhosis, parasitic diseases, large or small bowel obstruction.
.
..Musculoskeletal.

.Category I:. . Rheumatoid arthritis, osteoarthritis, low back pain, gout, pseudogout, septic arthritis, osteoporosis, carpal tunnel syndrome.

.Category II:. . Systemic lupus erythematosus, progressive systemic sclerosis, psoriasis, vasculitis, Reiter's syndrome, aseptic necrosis, polymyositis, polymyalgia rheumatica, fibromyalgia, osteomyelitis.

.EENT.

.Category I:. . Glaucoma, otitis media/externa, labyrinthitis, Meniere's disease, acute/chronic sinusitis, allergic rhinitis, pharyngitis, conjunctivitis.

.Category II:. . Oral leukoplakia, orbital/periorbital cellulitis, retinal detachment, ocular herpes, oral carcinoma, cataracts, diabetic/hypertensive retinopathy.

.Endocrine.

.Category I:. . Diabetes Mellitus (types I and II), hypo/hyperthyroidism, Graves' disease, Hashimoto's thyroiditis, thyroid storm, Cushing's syndrome, hypercholesterolemia, hypertriglyceridemia..

.Category II:. . Hyper/hypoparathyroidism, acromegaly/gigantism, corticoadrenal insufficiency, pituitary adenoma, thyroid cancer, diabetes insipidus, SIADH.
.
..Neurologic.

.Category I:. . Alzheimer's disease, CVA / TIA, tension/cluster/migraine headache, trigeminal neuralgia, giant cell arteritis, meningitis, diabetic peripheral and autonomic neuropathies.

.Category II:. . Multiple sclerosis, cerebral aneurysm, seizure disorders, encephalitis, Bell's palsy, subarachnoid hemorrhage, epidural bleed, Parkinson's disease, dementia, Guillian Barre, myasthenia gravis, SAH.

.Genitourinary.

.Category I:. . Acute and chronic renal failure, nephrotic syndrome, renal calculi, pyelonephritis, benign prostatic hyperplasia, acute and chronic prostatitis, cystitis, urethritis, incontinence, epididymitis, cystitis.

.Category II:. . Glomerulonephritis, Goodpasture's syndrome, polycystic kidney disease, renovascular hypertension, tubulointerstitial disease, bladder/prostate carcinoma, renal cell carcinoma, testicular carcinoma.

.Dermatologic.

.Category I:. . Stasis dermatitis, venous stasis ulcers, tinea corporis/pedis/cruris, rosacea, onycomycosis, herpes simplex, cellulitis, decubitus ulcers, urticaria, herpes zoster, psoriasis, seborrheic/actinic keratoses, contact dermatitis, viral exanthum, gram positive and gram negative skin infections.

.Category II:. . Basal cell carcinoma, squamous cell carcinoma, melanoma..

..Hematologic.

.Category I:. . Anemias: iron deficiency, vitamin B12, folate, anemia of chronic disease, sickle cell anemia, anticoagulant use (warfarin, heparin, Lovonox, aspirin, clopidogrel).

.Category II:. . Coagulation disorders, thrombocytopenia, VonWillebrand's disease, acute and chronic lymphocytic leukemia, acute and chronic myelogenous leukemia, lymphoma, multiple myeloma, ITP, aplastic anemia, myeloproliferative disease, G6PD-deficiency.
.
..Infectious Disease..

..Category I:.. Candidiasis, gonococcal infections, salmonellosis, shigellosis, Lyme disease, HIV, streptococcal infections, staph infections, sepsis, Epstein Barr, cytomegalovirus.

.Category II:. . Pneumocystis, atypical mycobacterial disease, syphilis, histoplasmosis, cryptococcus, malaria.
.
..Miscellaneous..

..Dehydration, edema..
.
.Procedures.

.Given an adult patient, the PA student will observe and perform, where permitted, the following procedures: using proper technique and precautions; will identify the indications, contraindications and hazards for such procedures, and will appropriately educate the patient or legal guardian about such procedures and the meaning of the results. Including, obtaining the appropriate releases. The student will identify the age/gender appropriate "normal" values..

.As indicated, with preceptor permission. .: ..

..arterial blood gases urinalysis..
..electrocardiogram
urine pregnancy tests..
..foley catheterization
venipuncture / fingerstick..
..gram stain wet mounts ..
..IV catheter placement ..
..nasogastric tube placement ..
..occult blood in stool ..
..rapid strep tests ..
..injections:.. intradermal, intravenous, subcutaneous..
..specimen collection..: ..
..culture/sensitivity of blood, ..
..cervical, nasopharyngeal, ..
..sputum, stool, urethral, ..
..urine, wound ..

..As indicated, under direct supervision and with assistance as needed..: ..

..thoracentesis ..
..paracentesis ..
..joint aspiration ..
..proctoscopy ..
..arterial puncture, other than radial artery ..
..Removal of non-penetrating ocular foreign bodies ..

..Principles of Monitoring/Therapeutics ..

..The student will identify the indications, contraindications, hazards and management of the following:..

..intravenous fluid therapy ..
..total parenteral nutrition ..
..blood transfusions ..
..arterial cannulation and catheterization ..
..central pressure monitoring ..
..pulmonary artery pressure monitoring ..

..Diagnostic Studies

. .The student will demonstrate knowledge of normal values, and list common diseases, which may account for abnormal values, for the following laboratory tests:.
.
..complete blood count with white cell differential / anemia profiles ..
..urinalysis ..
..blood urea nitrogen, creatinine, electrolytes – Na+, K+, CL -, CO2 ..
..biochemical profiles: liver function, renal function, cardiac function, ..
..calcium metabolism tests, glucose, lipid levels ..
..hepatitis profiles ..
..arterial blood gases ..
..thyroid profiles ..
..lipid profiles..
..rheumatologic disease profiles..
..pulmonary function testing ..
..HIV/AIDS profiles ..
..cardiovascular testing (cardiac enzyme profiles, echocardiography,..
..stress testing, cardiac catheterization, BNP, C-reactive protein)..
..spinal fluid analysis ..
..microbiology: tests for infectious diseases .

.Radiographic Studies.

.The student will describe the indications for ordering radiologic studies such as radiographs; CT scans, MRI, nuclear medicine studies and ultrasound techniques, as diagnostic procedures, and will describe the health risks associated with radiologic procedures. .

.The student will: .

.Interpret PA and lateral chest x-rays for pneumonia, pneumothorax, pleural.. effusion, CHF, cardiomegaly, solid tumors, fractures, hyperinflation.
..Interpret x-rays of the extremities for fractures, dislocations and degenerative ..joint/disc disease..
.Interpret x-rays of the spine for scoliosis, kyphosis, and DJD. .
.Interpret the descriptive reports of radiologists concerning flat plates of the ..abdomen, upper GI series, barium enema, IVP's, skull and sinus films..

 

[Footpain]

.Most PA programs require prior coursework in the sciences which are equal in many respects to pre-med students, more or less. For example, PA students for many programs must have already completed a Biology series with labs, General Chemistry series with labs, Organic Chemistry with Labs, Biochemistry (which some programs will take as substitute for Ochem II), Microbiology with Lab, Anatomy with Lab, and Physiology. Pre-meds are not required to take Anatomy or Microbiology in undergrad, but PA students are. This is so they can jump you straight into deeper study of medicine from day one (we started our PA curriculum with Advanced Antomy). The other main difference with undergrad requirements is that pre-meds are required to take Physics in preparation for the MCAT, but most PA schools don't require Physics..

I do agree that it's not as across the board, compared to the required coursework before you can sit for the MCAT, but most PA programs do require the basic sciences for admission.

.In addition to the brutal first year of didactic coursework, the second year consists of training rotations in Surgery, Emergency Medicine, Psychiatry, Pediatrics, Obstetrics/Gynecology, and Adult Medicine. The student is taught and graded by a preceptor during each rotation, usually a MD or DO. I have had one rotation (Emed) where I was primarily taught and graded by PAs. In addition to the preceptor's grade, each rotation ends with an exam (roughly half of the final rotation grade).

For our Adult Medicine rotation exam, here were our learning objectives:

..Cardiovascular..

..Category I:.. Coronary artery disease; AMI, angina, hyperlipidemia, valvular heart disease, dysrhythmias, congestive heart failure; hypertension (essential, secondary, malignant), orthostatic/postural hypotension, arterial/venous insufficiency, deep vein thrombosis, thrombophlebitis, peripheral vascular disease (venous and arterial).

.Category II:. . Pericardial diseases / cardiomyopathies (dilated, hypertrophic, restrictive) rheumatic heart disease, infectious endocarditis, mesenteric ischemia.

.Pulmonary. .

..Category I:.. Acute bronchitis, pneumonias (community & nosocomial, bacterial, viral, fungal, ..HIV-related), pleural effusion, pulmonary edema, asthma, chronic bronchitis/ emphysema, pulmonary embolus, tuberculosis, influenza..

.Category II:. . Abscesses, empyema, restrictive lung diseases related to environmental/occupational and connective tissue etiologies, carcinomas, sarcoidosis, pulmonary hypertension, cystic fibrosis, primary pulmonary hypertension, pulmonary fibrosis.

.Gastrointestinal.

.Category I:. . Peptic ulcer disease: H. pylori, gastric, duodenal; gastroesophageal reflux, esophageal spasm, esophagitis, gastritis/gastreoenteritis; hepatitis, pancreatitis, inflammatory bowel disease, irritable bowel syndrome, diarrhea (infectious, parasitic), constipation, diverticular disease, pseudomembranous colitis, cholelithiasis, cholecystitis, lactose intolerance, constipation, Nutritional Deficiencies (Niacin, Thiamine, Riboflavin, Vitamins A, C, D, K)., Metabolic Disorders (Lactose intolerance).

.Category II:. . Esophageal/gastric/colorectal carcinoma; achalasia, esophageal varices, malabsorption syndromes, biliary obstruction, cirrhosis, parasitic diseases, large or small bowel obstruction.
.
..Musculoskeletal.

.Category I:. . Rheumatoid arthritis, osteoarthritis, low back pain, gout, pseudogout, septic arthritis, osteoporosis, carpal tunnel syndrome.

.Category II:. . Systemic lupus erythematosus, progressive systemic sclerosis, psoriasis, vasculitis, Reiter's syndrome, aseptic necrosis, polymyositis, polymyalgia rheumatica, fibromyalgia, osteomyelitis.

.EENT.

.Category I:. . Glaucoma, otitis media/externa, labyrinthitis, Meniere's disease, acute/chronic sinusitis, allergic rhinitis, pharyngitis, conjunctivitis.

.Category II:. . Oral leukoplakia, orbital/periorbital cellulitis, retinal detachment, ocular herpes, oral carcinoma, cataracts, diabetic/hypertensive retinopathy.

.Endocrine.

.Category I:. . Diabetes Mellitus (types I and II), hypo/hyperthyroidism, Graves' disease, Hashimoto's thyroiditis, thyroid storm, Cushing's syndrome, hypercholesterolemia, hypertriglyceridemia..

.Category II:. . Hyper/hypoparathyroidism, acromegaly/gigantism, corticoadrenal insufficiency, pituitary adenoma, thyroid cancer, diabetes insipidus, SIADH.
.
..Neurologic.

.Category I:. . Alzheimer's disease, CVA / TIA, tension/cluster/migraine headache, trigeminal neuralgia, giant cell arteritis, meningitis, diabetic peripheral and autonomic neuropathies.

.Category II:. . Multiple sclerosis, cerebral aneurysm, seizure disorders, encephalitis, Bell's palsy, subarachnoid hemorrhage, epidural bleed, Parkinson's disease, dementia, Guillian Barre, myasthenia gravis, SAH.

.Genitourinary.

.Category I:. . Acute and chronic renal failure, nephrotic syndrome, renal calculi, pyelonephritis, benign prostatic hyperplasia, acute and chronic prostatitis, cystitis, urethritis, incontinence, epididymitis, cystitis.

.Category II:. . Glomerulonephritis, Goodpasture's syndrome, polycystic kidney disease, renovascular hypertension, tubulointerstitial disease, bladder/prostate carcinoma, renal cell carcinoma, testicular carcinoma.

.Dermatologic.

.Category I:. . Stasis dermatitis, venous stasis ulcers, tinea corporis/pedis/cruris, rosacea, onycomycosis, herpes simplex, cellulitis, decubitus ulcers, urticaria, herpes zoster, psoriasis, seborrheic/actinic keratoses, contact dermatitis, viral exanthum, gram positive and gram negative skin infections.

.Category II:. . Basal cell carcinoma, squamous cell carcinoma, melanoma..

..Hematologic.

.Category I:. . Anemias: iron deficiency, vitamin B12, folate, anemia of chronic disease, sickle cell anemia, anticoagulant use (warfarin, heparin, Lovonox, aspirin, clopidogrel).

.Category II:. . Coagulation disorders, thrombocytopenia, VonWillebrand's disease, acute and chronic lymphocytic leukemia, acute and chronic myelogenous leukemia, lymphoma, multiple myeloma, ITP, aplastic anemia, myeloproliferative disease, G6PD-deficiency.
.
..Infectious Disease..

..Category I:.. Candidiasis, gonococcal infections, salmonellosis, shigellosis, Lyme disease, HIV, streptococcal infections, staph infections, sepsis, Epstein Barr, cytomegalovirus.

.Category II:. . Pneumocystis, atypical mycobacterial disease, syphilis, histoplasmosis, cryptococcus, malaria.
.
..Miscellaneous..

..Dehydration, edema..
.
.Procedures.

.Given an adult patient, the PA student will observe and perform, where permitted, the following procedures: using proper technique and precautions; will identify the indications, contraindications and hazards for such procedures, and will appropriately educate the patient or legal guardian about such procedures and the meaning of the results. Including, obtaining the appropriate releases. The student will identify the age/gender appropriate "normal" values..

.As indicated, with preceptor permission. .: ..

..arterial blood gases urinalysis..
..electrocardiogram
urine pregnancy tests..
..foley catheterization
venipuncture / fingerstick..
..gram stain wet mounts ..
..IV catheter placement ..
..nasogastric tube placement ..
..occult blood in stool ..
..rapid strep tests ..
..injections:.. intradermal, intravenous, subcutaneous..
..specimen collection..: ..
..culture/sensitivity of blood, ..
..cervical, nasopharyngeal, ..
..sputum, stool, urethral, ..
..urine, wound ..

..As indicated, under direct supervision and with assistance as needed..: ..

..thoracentesis ..
..paracentesis ..
..joint aspiration ..
..proctoscopy ..
..arterial puncture, other than radial artery ..
..Removal of non-penetrating ocular foreign bodies ..

..Principles of Monitoring/Therapeutics ..

..The student will identify the indications, contraindications, hazards and management of the following:..

..intravenous fluid therapy ..
..total parenteral nutrition ..
..blood transfusions ..
..arterial cannulation and catheterization ..
..central pressure monitoring ..
..pulmonary artery pressure monitoring ..

..Diagnostic Studies

. .The student will demonstrate knowledge of normal values, and list common diseases, which may account for abnormal values, for the following laboratory tests:.
.
..complete blood count with white cell differential / anemia profiles ..
..urinalysis ..
..blood urea nitrogen, creatinine, electrolytes – Na+, K+, CL -, CO2 ..
..biochemical profiles: liver function, renal function, cardiac function, ..
..calcium metabolism tests, glucose, lipid levels ..
..hepatitis profiles ..
..arterial blood gases ..
..thyroid profiles ..
..lipid profiles..
..rheumatologic disease profiles..
..pulmonary function testing ..
..HIV/AIDS profiles ..
..cardiovascular testing (cardiac enzyme profiles, echocardiography,..
..stress testing, cardiac catheterization, BNP, C-reactive protein)..
..spinal fluid analysis ..
..microbiology: tests for infectious diseases .

.Radiographic Studies.

.The student will describe the indications for ordering radiologic studies such as radiographs; CT scans, MRI, nuclear medicine studies and ultrasound techniques, as diagnostic procedures, and will describe the health risks associated with radiologic procedures. .

.The student will: .

.Interpret PA and lateral chest x-rays for pneumonia, pneumothorax, pleural.. effusion, CHF, cardiomegaly, solid tumors, fractures, hyperinflation.
..Interpret x-rays of the extremities for fractures, dislocations and degenerative ..joint/disc disease..
.Interpret x-rays of the spine for scoliosis, kyphosis, and DJD. .
.Interpret the descriptive reports of radiologists concerning flat plates of the ..abdomen, upper GI series, barium enema, IVP's, skull and sinus films..

I don't have the time to read or even glance through this long post as my vacation has ended.

 

[Coastie]

both pa and md/do are intense( # hrs/week) and rigorous(volume of material responsible for). that being said the docs have to go into more DETAIL both in basic medical sciences AND in clinical medicine courses. they learn a lot of esoteric info about the biochemistry of disease(for example) that we only touch on.
the best comparison is pa-2 vs ms-3 clinical yrs.
at some institutions( mine for example) pa 2 and ms 3 students were scheduled interchangeably for rotation slots and held to the same standards. I know this is not the case everywhere.
the 3 YR bridge program from pa to do at lecom requires the students to complete all of ms1 and ms 2 to get the full science background and then gives credit for 1 clinical yr.( as it should).

I disagree. I think the LECOM "bridge" is a real joke, and given that this school has a history of expanding, uh, "interesting" programs for money, I'm not too impressed...at all.

 

[Coastie]

You have a good midlevel curriculum there.

It's not as intense or in-depth as med school. In any shape or form. Period. 🙂

.Most PA programs require prior coursework in the sciences which are equal in many respects to pre-med students, more or less. For example, PA students for many programs must have already completed a Biology series with labs, General Chemistry series with labs, Organic Chemistry with Labs, Biochemistry (which some programs will take as substitute for Ochem II), Microbiology with Lab, Anatomy with Lab, and Physiology. Pre-meds are not required to take Anatomy or Microbiology in undergrad, but PA students are. This is so they can jump you straight into deeper study of medicine from day one (we started our PA curriculum with Advanced Antomy). The other main difference with undergrad requirements is that pre-meds are required to take Physics in preparation for the MCAT, but most PA schools don't require Physics..

I do agree that it's not as across the board, compared to the required coursework before you can sit for the MCAT, but most PA programs do require the basic sciences for admission.

.In addition to the brutal first year of didactic coursework, the second year consists of training rotations in Surgery, Emergency Medicine, Psychiatry, Pediatrics, Obstetrics/Gynecology, and Adult Medicine. The student is taught and graded by a preceptor during each rotation, usually a MD or DO. I have had one rotation (Emed) where I was primarily taught and graded by PAs. In addition to the preceptor's grade, each rotation ends with an exam (roughly half of the final rotation grade).

For our Adult Medicine rotation exam, here were our learning objectives:

..Cardiovascular..

..Category I:.. Coronary artery disease; AMI, angina, hyperlipidemia, valvular heart disease, dysrhythmias, congestive heart failure; hypertension (essential, secondary, malignant), orthostatic/postural hypotension, arterial/venous insufficiency, deep vein thrombosis, thrombophlebitis, peripheral vascular disease (venous and arterial).

.Category II:. . Pericardial diseases / cardiomyopathies (dilated, hypertrophic, restrictive) rheumatic heart disease, infectious endocarditis, mesenteric ischemia.

.Pulmonary. .

..Category I:.. Acute bronchitis, pneumonias (community & nosocomial, bacterial, viral, fungal, ..HIV-related), pleural effusion, pulmonary edema, asthma, chronic bronchitis/ emphysema, pulmonary embolus, tuberculosis, influenza..

.Category II:. . Abscesses, empyema, restrictive lung diseases related to environmental/occupational and connective tissue etiologies, carcinomas, sarcoidosis, pulmonary hypertension, cystic fibrosis, primary pulmonary hypertension, pulmonary fibrosis.

.Gastrointestinal.

.Category I:. . Peptic ulcer disease: H. pylori, gastric, duodenal; gastroesophageal reflux, esophageal spasm, esophagitis, gastritis/gastreoenteritis; hepatitis, pancreatitis, inflammatory bowel disease, irritable bowel syndrome, diarrhea (infectious, parasitic), constipation, diverticular disease, pseudomembranous colitis, cholelithiasis, cholecystitis, lactose intolerance, constipation, Nutritional Deficiencies (Niacin, Thiamine, Riboflavin, Vitamins A, C, D, K)., Metabolic Disorders (Lactose intolerance).

.Category II:. . Esophageal/gastric/colorectal carcinoma; achalasia, esophageal varices, malabsorption syndromes, biliary obstruction, cirrhosis, parasitic diseases, large or small bowel obstruction.
.
..Musculoskeletal.

.Category I:. . Rheumatoid arthritis, osteoarthritis, low back pain, gout, pseudogout, septic arthritis, osteoporosis, carpal tunnel syndrome.

.Category II:. . Systemic lupus erythematosus, progressive systemic sclerosis, psoriasis, vasculitis, Reiter’s syndrome, aseptic necrosis, polymyositis, polymyalgia rheumatica, fibromyalgia, osteomyelitis.

.EENT.

.Category I:. . Glaucoma, otitis media/externa, labyrinthitis, Meniere’s disease, acute/chronic sinusitis, allergic rhinitis, pharyngitis, conjunctivitis.

.Category II:. . Oral leukoplakia, orbital/periorbital cellulitis, retinal detachment, ocular herpes, oral carcinoma, cataracts, diabetic/hypertensive retinopathy.

.Endocrine.

.Category I:. . Diabetes Mellitus (types I and II), hypo/hyperthyroidism, Graves’ disease, Hashimoto’s thyroiditis, thyroid storm, Cushing’s syndrome, hypercholesterolemia, hypertriglyceridemia..

.Category II:. . Hyper/hypoparathyroidism, acromegaly/gigantism, corticoadrenal insufficiency, pituitary adenoma, thyroid cancer, diabetes insipidus, SIADH.
.
..Neurologic.

.Category I:. . Alzheimer’s disease, CVA / TIA, tension/cluster/migraine headache, trigeminal neuralgia, giant cell arteritis, meningitis, diabetic peripheral and autonomic neuropathies.

.Category II:. . Multiple sclerosis, cerebral aneurysm, seizure disorders, encephalitis, Bell’s palsy, subarachnoid hemorrhage, epidural bleed, Parkinson’s disease, dementia, Guillian Barre, myasthenia gravis, SAH.

.Genitourinary.

.Category I:. . Acute and chronic renal failure, nephrotic syndrome, renal calculi, pyelonephritis, benign prostatic hyperplasia, acute and chronic prostatitis, cystitis, urethritis, incontinence, epididymitis, cystitis.

.Category II:. . Glomerulonephritis, Goodpasture’s syndrome, polycystic kidney disease, renovascular hypertension, tubulointerstitial disease, bladder/prostate carcinoma, renal cell carcinoma, testicular carcinoma.

.Dermatologic.

.Category I:. . Stasis dermatitis, venous stasis ulcers, tinea corporis/pedis/cruris, rosacea, onycomycosis, herpes simplex, cellulitis, decubitus ulcers, urticaria, herpes zoster, psoriasis, seborrheic/actinic keratoses, contact dermatitis, viral exanthum, gram positive and gram negative skin infections.

.Category II:. . Basal cell carcinoma, squamous cell carcinoma, melanoma..

..Hematologic.

.Category I:. . Anemias: iron deficiency, vitamin B12, folate, anemia of chronic disease, sickle cell anemia, anticoagulant use (warfarin, heparin, Lovonox, aspirin, clopidogrel).

.Category II:. . Coagulation disorders, thrombocytopenia, VonWillebrand’s disease, acute and chronic lymphocytic leukemia, acute and chronic myelogenous leukemia, lymphoma, multiple myeloma, ITP, aplastic anemia, myeloproliferative disease, G6PD-deficiency.
.
..Infectious Disease..

..Category I:.. Candidiasis, gonococcal infections, salmonellosis, shigellosis, Lyme disease, HIV, streptococcal infections, staph infections, sepsis, Epstein Barr, cytomegalovirus.

.Category II:. . Pneumocystis, atypical mycobacterial disease, syphilis, histoplasmosis, cryptococcus, malaria.
.
..Miscellaneous..

..Dehydration, edema..
.
.Procedures.

.Given an adult patient, the PA student will observe and perform, where permitted, the following procedures: using proper technique and precautions; will identify the indications, contraindications and hazards for such procedures, and will appropriately educate the patient or legal guardian about such procedures and the meaning of the results. Including, obtaining the appropriate releases. The student will identify the age/gender appropriate “normal” values..

.As indicated, with preceptor permission. .: ..

..arterial blood gases urinalysis..
..electrocardiogram
urine pregnancy tests..
..foley catheterization
venipuncture / fingerstick..
..gram stain wet mounts ..
..IV catheter placement ..
..nasogastric tube placement ..
..occult blood in stool ..
..rapid strep tests ..
..injections:.. intradermal, intravenous, subcutaneous..
..specimen collection..: ..
..culture/sensitivity of blood, ..
..cervical, nasopharyngeal, ..
..sputum, stool, urethral, ..
..urine, wound ..

..As indicated, under direct supervision and with assistance as needed..: ..

..thoracentesis ..
..paracentesis ..
..joint aspiration ..
..proctoscopy ..
..arterial puncture, other than radial artery ..
..Removal of non-penetrating ocular foreign bodies ..

..Principles of Monitoring/Therapeutics ..

..The student will identify the indications, contraindications, hazards and management of the following:..

..intravenous fluid therapy ..
..total parenteral nutrition ..
..blood transfusions ..
..arterial cannulation and catheterization ..
..central pressure monitoring ..
..pulmonary artery pressure monitoring ..

..Diagnostic Studies

. .The student will demonstrate knowledge of normal values, and list common diseases, which may account for abnormal values, for the following laboratory tests:.
.
..complete blood count with white cell differential / anemia profiles ..
..urinalysis ..
..blood urea nitrogen, creatinine, electrolytes – Na+, K+, CL -, CO2 ..
..biochemical profiles: liver function, renal function, cardiac function, ..
..calcium metabolism tests, glucose, lipid levels ..
..hepatitis profiles ..
..arterial blood gases ..
..thyroid profiles ..
..lipid profiles..
..rheumatologic disease profiles..
..pulmonary function testing ..
..HIV/AIDS profiles ..
..cardiovascular testing (cardiac enzyme profiles, echocardiography,..
..stress testing, cardiac catheterization, BNP, C-reactive protein)..
..spinal fluid analysis ..
..microbiology: tests for infectious diseases .

.Radiographic Studies.

.The student will describe the indications for ordering radiologic studies such as radiographs; CT scans, MRI, nuclear medicine studies and ultrasound techniques, as diagnostic procedures, and will describe the health risks associated with radiologic procedures. .

.The student will: .

.Interpret PA and lateral chest x-rays for pneumonia, pneumothorax, pleural.. effusion, CHF, cardiomegaly, solid tumors, fractures, hyperinflation.
..Interpret x-rays of the extremities for fractures, dislocations and degenerative ..joint/disc disease..
.Interpret x-rays of the spine for scoliosis, kyphosis, and DJD. .
.Interpret the descriptive reports of radiologists concerning flat plates of the ..abdomen, upper GI series, barium enema, IVP’s, skull and sinus films..

 

[Coastie]

at "epidural anesthesia" surgery joke.

Nice one!

I don't know any anesthesiologist who would provide any type of anesthesia for any "surgeon" that is a noctor or PA. What a huge joke.

Hi all. Been busy with school and hadn't found the time to address all your comments until now.



More in-depth only in terms of basic medical sciences. It's equal in terms of clinical medical sciences.

I'm not going to argue with you about intensity. Yes, the first 16-months of PA school is more intense than the first 16 months of medical school, but it doesn't really matter. Why be this petty?



Many MD/DO students don't understand PA training. When you try to teach them, they disagree with you.

You tell them: "PAs are studying the same subjects you are."
They respond: "No they're not. They're PA students. They can't possibly be learning what we are learning. That's ludicrous."

Face it: after teaching medicine over a 4-year curriculum for 80 years in the US, educators have figured a more efficient way to teach the material needed to practice safe medicine.



I appreciate Pado's perspective, but it's just one perspective. I've heard plenty of PA-turned-MDs say of MD school "it's a cake-walk after PA school." Their words, not mine. Everyone will have a different perspective.



Let's be more specific: in terms of clinical medical science, it IS AS IN-DEPTH. It is not as in-depth in terms of basic medical science.



We will never claim equivalency or independence. However, we may continue to push for a greater scope of practice and more autonomy.

And these PA students are going to become leaders of PA orgs.



Each Surgeon has their own protocol. There are surgeons who will let their PA do the entire surgery. There are some who only let PAs do minor surgery.

In most states, a PA can perform any surgery that does not require general anesthesia without the direct supervision of a surgeon. While it may not be common practice now, as time goes by and PAs become more specialized, you may see more PAs performing routine surgery under an epidural anesthesia (i.e., hernia repair).


PAs in surgery are referred to as "Surgical Physician Assistants." I have heard some use the term "Surgeon Physician Assistant/PA Surgeon." The point is, the "PA" is still part of their name.



I'm glad that you agree that at least 3 years will suffice. Nevertheless, one of the reasons I believe 2 years is enough comes from having looked at the USMLE Step 1 Q-book and review materials; nothing terrribly surprising to me about the questions. And that's considering it's all basic medical science in which we do not receive as in-depth of instruction as MD/DO students.

 

[deleted6669]

I disagree. I think the LECOM "bridge" is a real joke

How do you feel about the new 3 yr primary care track medschool ( MD) program starting next yr in texas( texas tech )?

 

[ARAI]

I have to disagree a bit. After sitting in on lunch conferences during my IM rotation on a Nephro service, there was much I had never been taught in regards to clinical medicine. Much of it was more obscure than more common clinical issues, but still. That's but one reason why the world needs Doctors.

Ok, but who was disseminating the information regarding the clinical issues? A MD/DO student?

There were a lot of responses to my last post. I will touch on a few individual comments below, but here is a blanket response to the issues of education of PAs in terms of clinical sciences:

Now while it seems evident that some are taking offense at the high-level of medical education PAs receive, in short, there's not a single disorder or disease that MD students are exposed to in class to which PA students aren't also exposed--in terms of pathology, clinical presentation and treatment. At least that's how it is at my school.

But what really makes a difference is doing a year of clinical work prior to PA school. I've seen more than most MD students can imagine. In fact, working in foreign hospitals, I've seen some diseases that some attending physicians have only read about in textbooks. And trust me, if I see these disorders again, I'll probably pick them up faster than my supervising physician.

Many medical schools also give out PhDs. Can those scientists also claim that they went to "medical school" since their degree was granted by a school/college of medicine?

I don't see why not, although they should make it clear that they are not physicians.

Oh wow, my lab coat says "Kaushik, Radiation Oncology" ... I did not realize that I'm now a radiation oncologist!

Nice try. That's your affiliation; not your title. Perhaps you can say that you work in radiation oncology though.

Don't hold your breathe waiting for anesthesiologists to change their anesthetic plans (ie. NOT under General anesthesia) so that we can accomodate PA's doing the surgery rather than surgeons. How many "routine surgeries" do you see done under epidural anesthesia.

Most of the hernia repairs I've seen were done under spinal anesthesia. I'm surprised you haven't seen this. Regardless, I'm sure that an anesthesiologist wouldn't risk their license and expose a patient to unnecessary anesthesia risks or refuse to provide anesthesia just to spite a PA.

Maybe you PA's can buddy up with the CRNA's and open your own discount "physician free" surgical center. Good luck recruiting patients.

I don't know why you dragged CRNA's into this conversation. It seems you are revealing an irrelevant bias at this point. I'm not going to comment on NPs or CRNAs.

PA's can't really do what you've suggested, but you make a good point. There are areas of poor economic means which have a difficult time recruiting and paying for the services of physicians and surgeons. Some states are exploring options to allow PAs to work in these areas with more independence.

PA school applicants don't apply to the same application service....PA schools don't require 1 yr of biology with labs, etc.

I feel it's best not to even go into this topic. This point is mute. Most PAs completed the pre-med admissions series. And a lot of PA programs require courses like o-chem, microbiology, genetics, human anatomy and physiology. You need to take a full year of bio with labs just to take some of the above courses.

Some PA programs are not even graduate programs. Even if this changes, it is still a fact.

This will change; not over-night, but w/in the next 10 years all programs will be at the graduate level.

Since there is a big difference in the didactic portion of the training, a PA cannot state that he/she went to med school.

This obviously seems to be a sensitive subject given the response. So here's what I'll do: I'll stop using the term "medical school" in reference to PA education.

I will continue to explain to patients that "PA's study medicine and practice medicine under their own medical license."

guess you misunderstood my point. I corrected someone by saying that PAs are never considered to be surgeons. I never said that they weren't surgical physician assistants. And being a surgical physician assistant does not make one a surgeon!

Fair enough.

Some of you PAs (Oh wait you're not even a PA yet) are close to claiming to be equivalent, but when you get called on it, you deny it. You want more autonomy go to medical school. You can't have your cake and eat it too.

Well, let's set the record straight then. In general, practicing PAs aren't equivalent to practicing Physicians. However, in school, we challenge each others knowledge at the same level, all the time--in a good way.

You are a Physician's ASSISTANT. Your job is to do what the physician needs, not to assert your independence. KNOW YOUR ROLE.

PAs are not doctor's secretaries. You want a secretary, hire one. However, if you have too many patients and need a health care professional to take on some of your patient load, you can consider a PA, NP or another Physician.

Here's the deal: PA's practice medicine under their own license, carry their own insurance and make their own decisions. PA's work autonomously under the direction of a physician-leader, AND IF ANY private-practice doc talks down to a PA like you are doing, the PA will walk right off the job with a fat severance payment in hand. You lose out on a bunch of costs and a lot of time.

Seriously, are you smoking something. We're going to let a PA who couldn't get into medical school, who did 2-3 years of sub-M.D/DO standard education without formal residency operate.

Excuse me? Who couldn't get into med school? Where are you from, the 1970's? Most PAs these days would have no problem getting into a MD/DO program. I sure wouldn't. PAs go to PA programs by choice, not by default.

Secondly, PAs do surgery. When you go in for your quadruple bypass, look to see who is doing your vein harvesting.

The lesson: PA's are good at being physician assistants, KNOW YOUR ROLE.

PA's know their role. Apparently you don't.

 

[Starpower]

You have a good midlevel curriculum there.

It's not as intense or in-depth as med school. In any shape or form. Period. 🙂

Oh, those are just the learning objectives for one rotation. Five weeks. Test. Of course we're taught much of that during our didactic year as well, but those are specifically just for our Adult Med weeks. I'd definitely be interested in seeing the learning objectives for a med student, for their same/similar rotation, to compare.

Ok, but who was disseminating the information regarding the clinical issues? A MD/DO student?

No, the lecturers were the Attendings, and comments came from the Residents. Wow, there were some brilliant people in that room. The PA students and 3rd/4th years sat together in the back.

 

[deleted87716]

How do you feel about the new 3 yr primary care track medschool ( MD) program starting next yr in texas( texas tech )?

All it really does is eliminate most subspecialty electives. Kinda makes sense, if you're committed to primary care.

A three-year med school curriculum isn't anything new. My alma mater was founded as a three-year school in the 1970's. They later changed to a conventional four-year curriculum.

 

[ARAI]

No, the lecturers were the Attendings, and comments came from the Residents. Wow, there were some brilliant people in that room. The PA students and 3rd/4th years sat together in the back.

Of course! The residents and attendings I've come across (one of them being a PA resident) are amazing!

 

[Coastie]

How do you feel about the new 3 yr primary care track medschool ( MD) program starting next yr in texas( texas tech )?

Same thing. Joke.

Why should primary care be 3 years? It should be the full 4, it's among the broadest of specialties.

 

[Coastie]

Arai,

I will never provide anesthesia for a PA "surgeon" or Noctor "surgeon". Why should I be liable for the midlevel?

I have an unrestricted license to practice medicine and surgery, the midlevel would not. Who do you think the lawyers would come after when the hernia goes wrong?

I will never change my anesthetic plan to meet some stupid state requirements for a wannabe to cut (assault) a patient.

 

[Coastie]

Oh, those are just the learning objectives for one rotation. Five weeks. Test. Of course we're taught much of that during our didactic year as well, but those are specifically just for our Adult Med weeks. I'd definitely be interested in seeing the learning objectives for a med student, for their same/similar rotation, to compare.



No, the lecturers were the Attendings, and comments came from the Residents. Wow, there were some brilliant people in that room. The PA students and 3rd/4th years sat together in the back.

The learning objectives are usually not as clear cut because we don't have a limited focus, like the midlevel curriculum you posted. 5 weeks of internal medicine? I thought PAs had the same clinical science as MDs?

 

[Starpower]

The learning objectives are usually not as clear cut because we don't have a limited focus, like the midlevel curriculum you posted. 5 weeks of internal medicine? I thought PAs had the same clinical science as MDs?

A "limited focus", interesting. You're not able to expand, or post any examples? So far in my travels, my MD preceptors have been intent on one thing and one thing only, finding out what level of medical knowledge I'm at and expanding on it from there. And btw, I'm currently on my 9th week of an IM preceptorship, so my total IM rotation time will be around 15 weeks.

Secondly, you might want to educate yourself on PAs and liability.

Finally, you state that the learning objectives I posted are "midlevel curriculum". Are you saying that our IM rotation objectives are the same as NPs, and if so, can you state how you know this to be the case?

 

[ARAI]

Arai,
I will never change my anesthetic plan to meet some stupid state requirements for a wannabe to cut (assault) a patient.

When you call a PA "a wannabe," you look down on their education and training--which ultimately means you look down on your own education and training. Lest you forget, PAs are made by putting students through the most useful and best components of MD programs.

The learning objectives are usually not as clear cut because we don't have a limited focus, like the midlevel curriculum you posted. 5 weeks of internal medicine? I thought PAs had the same clinical science as MDs?

You should know that the potential for learning a during clinical clerkship in PA/MD/DO programs is anything but limited. Objectives only serve as guidelines.

 

[Coastie]

When you call a PA "a wannabe," you look down on their education and training--which ultimately means you look down on your own education and training. Lest you forget, PAs are made by putting students through the most useful and best components of MD programs.




You should know that the potential for learning a during clinical clerkship in PA/MD/DO programs is anything but limited. Objectives only serve as guidelines.

Any midlevel expecting to be "the surgeon" is definitely a wannabe.

 

[Coastie]

A "limited focus", interesting. You're not able to expand, or post any examples? So far in my travels, my MD preceptors have been intent on one thing and one thing only, finding out what level of medical knowledge I'm at and expanding on it from there. And btw, I'm currently on my 9th week of an IM preceptorship, so my total IM rotation time will be around 15 weeks.

Secondly, you might want to educate yourself on PAs and liability.

Finally, you state that the learning objectives I posted are "midlevel curriculum". Are you saying that our IM rotation objectives are the same as NPs, and if so, can you state how you know this to be the case?

1) I thought you said 5 weeks. My bad. 15 weeks sounds like a good rotation in medicine. How many weeks total clinical do you have?

2) If a PA is "the surgeon", then the only physician in the room with a full, unrestricted license will be the anesthesiologist. Who do you think the lawyers will come after when the wannabe screws up the surgery?

3) It is midlevel curriculum. Physicians Assistants are midlevels. I've always stated that PA training is >>>>>>>>>>>>> NP training. On the same level, MD training is >>>>>>>>>>>>>PA training.

Docs love PAs because they understand their roles as midlevels. Patients do well under their care because it's a physician-led care approach. NPs should be eliminated from the healthcare equation as far as I'm concerned...The limited training and full scope of practice they are given makes them pretty expensive healthcare assassins when placed near sick patients.

 

[Charles_Carmichael]

When you call a PA "a wannabe," you look down on their education and training--which ultimately means you look down on your own education and training. Lest you forget, PAs are made by putting students through the most useful and best components of MD programs.

Wait, what? There is no way that this is a true statement. If educators had an idea of what the "most useful and best components" of medical programs are, you really think training would still be 7 years minimum?

Follow your own advice. When you equate yourself to those who have far greater training than you do, it "ultimately means you look down on your own education and training." Are you really that dissatisfied with your PA education that you have the need to tell people that you're attending medical school instead, like you have earlier in the thread?

Just because I've done part-time research for the past couple of years doesn't mean I tell people that I'm a graduate student or that I attend graduate school. Or that I get the "most useful and best components" of grad school.

You should know that the potential for learning a during clinical clerkship in PA/MD/DO programs is anything but limited. Objectives only serve as guidelines.

Look, no one's downplaying the education PAs get. What people are saying is that it is not equivalent to what physicians get. And that physician training is longer and more comprehensive than PA training is. I don't see why you guys are getting all worked up about this when it's a pretty accurate statement.

 

[Charles_Carmichael]

Finally, you state that the learning objectives I posted are "midlevel curriculum". Are you saying that our IM rotation objectives are the same as NPs, and if so, can you state how you know this to be the case?

I feel like you're really misreading what people are writing. No one equated you to NPs. I don't even know how you came to that conclusion. Just because PAs and NPs/DNPs are considered in the "midlevel" category doesn't mean that they're equal. Surely you understand this basic concept...In my personal opinion, after looking at a ridiculous amount of NP/DNP curricula, PAs receive far superior basic science and clinical training compared to NPs/DNPs.

 

[ARAI]

Any midlevel expecting to be "the surgeon" is definitely a wannabe.

A patient sent to general surgery for a tissue biopsy to be performed under local anesthesia may find that "the surgeon" is a surgical PA. There's no "wannabe" about it.

Wait, what? There is no way that this is a true statement. If educators had an idea of what the "most useful and best components" of medical programs are, you really think training would still be 7 years minimum?

The short answer is "no." MD students will always have to take all of the Basic Medical Science courses and be forced to memorize every little detail regardless of clinical utility. That's not going to change.

By the way, the MD program is a 4-year program, not a 7-year program. Were you including the residency? When PAs speak of PA training in terms of MD training, they are only referring to school, not residencies.

Look, no one's downplaying the education PAs get.

If forum members weren't downplaying the education of PAs, this conversation thread would have been very short. When a DO program starts a 3-year PA-to-DO bridge program and forum members start calling it "ludicrous," that is severely downplaying PA education.

 

[Starpower]

1) I thought you said 5 weeks. My bad. 15 weeks sounds like a good rotation in medicine. How many weeks total clinical do you have?

I did say 5 weeks. Our IM rotation is 5 weeks. In my program, we also complete two 10 week preceptorships, one of mine happened to be in IM (we have to do one in Primary, and the other can be Primary, Emed, or Peds. I did one in Peds, and my last primary site happens to be in IM). You still haven't stated any examples, or explained about how long you consider med school rotations to be. My experience when rotating with med students is that their rotations are anywhere from 5-10 weeks, usually depending on the hospital/rotation situations. If I remember correctly, they do have additional rotations in areas such as Neurology, Orthopedics, and there are probably others that I don't know about (Pulmonology, maybe?), but I was unaware that they are longer time-wise.

2) If a PA is "the surgeon", then the only physician in the room with a full, unrestricted license will be the anesthesiologist. Who do you think the lawyers will come after when the wannabe screws up the surgery?

To tell you the truth, I don't know a lot about anesthesiologists and liability. I will definitely do some research, it's something I'd like to know about. I do know that there are suits which have involved only PAs, and not their SP(s).

3)It is midlevel curriculum. Physicians Assistants are midlevels. I've always stated that PA training is >>>>>>>>>>>>> NP training. On the same level, MD training is >>>>>>>>>>>>>PA training.

You stated that it is "midlevel curriculum", not 'PA curriculum'. Since both PAs and NPs are considered to be midlevel practitioners, your words inferred that the curriculum is the same. Thus why I asked for more detail.

Docs love PAs because they understand their roles as midlevels. Patients do well under their care because it's a physician-led care approach. NPs should be eliminated from the healthcare equation as far as I'm concerned...The limited training and full scope of practice they are given makes them pretty expensive healthcare assassins when placed near sick patients.

I understand what you're saying, and I agree to a large extent. However, I have more of a problem with the independent NPs and DNPs, than I do NPs in general.

 

[Starpower]

I feel like you're really misreading what people are writing. No one equated you to NPs. I don't even know how you came to that conclusion. Just because PAs and NPs/DNPs are considered in the "midlevel" category doesn't mean that they're equal. Surely you understand this basic concept...In my personal opinion, after looking at a ridiculous amount of NP/DNP curricula, PAs receive far superior basic science and clinical training compared to NPs/DNPs.

I find your observation to be bizarre. When someone looks at our LOs and states that they are a good "midlevel curriculum", and not a good 'PA curriculum', they are saying just that, "midlevel curriculum", which would include all midlevels. Sheesh, you don't have to be a rocket scientist! If you can't understand my point, give it some time to sink in. What would be optimum would be if a NP or med student would actually post their IM LOs as well, so that we could all compare.

 

[Charles_Carmichael]

The short answer is "no." MD students will always have to take all of the Basic Medical Science courses and be forced to memorize every little detail regardless of clinical utility. That's not going to change.

By the way, the MD program is a 4-year program, not a 7-year program. Were you including the residency? When PAs speak of PA training in terms of MD training, they are only referring to school, not residencies.

Physicians need to know all that minutia of basic sciences and clinical sciences because the buck stops with them. They need to be able to include zebras in their differential, not just the common stuff. That's where the clinical utility comes in: when they're able to figure out whether something presenting as a common ailment is actually a zebra.

Why wouldn't you include residency as part of medical training? Correct me if I'm wrong but, after PA school (barring attending a 1-year PA residency), aren't you a full-fledged PA? After graduating medical school, MDs/DOs can't practice independently until they do at least 1 year of residency (and my understanding is that it's incredibly hard to establish yourself as a physician after only 1 year of residency). The vast, vast majority do a minimum of 3 years of residency.

If forum members weren't downplaying the education of PAs, this conversation thread would have been very short. When a DO program starts a 3-year PA-to-DO bridge program and forum members start calling it "ludicrous," that is severely downplaying PA education.

I understand that people saying a 3-year-PA-to-DO bridge is "ludicrous" is annoying to hear. But I don't think the people who mentioned it meant it as an insult to PAs or their education. To me, it seems like that's an automatic response to people saying they're "streamlining" medical education based on all the stuff that's going on with NPs/DNPs claiming equivalency to physicians and demanding equal reimbursement rates, autonomy, etc.

I mean, NPs/DNPs have also said the same thing you have, that they've taken the most useful and best parts of medical training and streamlined it. So, it's understandable that when PAs, such as yourself, start making similar comments and saying that you attend medical school, that the knee-jerk reaction would be to call it ludicrous. Does that make sense?

I also want to point out that people on these forums, including myself, have repeatedly pointed out that PA training is far superior to that of NPs/DNPs. And several residents and med students have also mentioned that they will preferentially hire PAs over nursing midlevels. That alone should tell you that physicians-in-training and physicians hold your education in high regard.

 

[Charles_Carmichael]

I find your observation to be bizarre. When someone looks at our LOs and states that they are a good "midlevel curriculum", and not a good 'PA curriculum', they are saying just that, "midlevel curriculum", which would include all midlevels. Sheesh, you don't have to be a rocket scientist! If you can't understand my point, give it some time to sink in. What would be optimum would be if a NP or med student would actually post their IM LOs as well, so that we could all compare.

You're being very nit-picky here. Just because someone called the PA curriculum a midlevel curriculum doesn't mean that PA curricula = NP/DNP curricula. You really jumped to a conclusion there. I understand your point, but I feel like you're being really nit-picky. It would also be nice if you relaxed a bit on the snide comments (ie. "you don't have to be a rocket scientist," etc).

Not only that, but the poster mentioned that it was a good midlevel curriculum. That alone knocks the NP/DNP curricula out of the picture.

 

[bradt9881]

1) I thought you said 5 weeks. My bad. 15 weeks sounds like a good rotation in medicine. How many weeks total clinical do you have?

Rotation length will have some variation from program to program. Most programs only have 12-15 months of rotations, so time is valuable when you are trying to fit it all in. My program focused on primary care, so we did eight weeks of IM, 12 weeks of family medicine, and the other rotations were four weeks long (peds, general surgery, ob, emergency, pysch, ortho, and a four week elective). At the end of it all was a three month preceptorship in a specialty of your choice, which I did in family medicine at Fort Bragg's Clark Clinic.

 

[ARAI]

Physicians need to know all that minutia of basic sciences and clinical sciences because the buck stops with them. They need to be able to include zebras in their differential, not just the common stuff. That's where the clinical utility comes in: when they're able to figure out whether something presenting as a common ailment is actually a zebra.

I'm not going to contradict anything you've said. I agree with it. However, I'm compelled to inform you that PA's know their zebras. If someone comes into the office with neurological symptoms mimicking Alzheimer's, a good PA should have a prion-based infection listed somewhere way down in their differential.

Despite MD students' more in-depth education, PAs do not depend on physicians for what they learned in school; rather they depend on physicians for what they learned and experienced in their residency. Let's face it:

"Medical school doesn't even begin to teach you what you need to know to practice medicine; you learn it in residency." - Mary Raynard, MD

Why wouldn't you include residency as part of medical training? Correct me if I'm wrong but, after PA school (barring attending a 1-year PA residency), aren't you a full-fledged PA? After graduating medical school, MDs/DOs can't practice independently until they do at least 1 year of residency (and my understanding is that it's incredibly hard to establish yourself as a physician after only 1 year of residency). The vast, vast majority do a minimum of 3 years of residency.

Yes, it is part of MD training, but this whole discussion is based on schooling, not residencies. This all goes back to my first post in this thread (post number 71 on pg 2 of this thread) which addressed an individual who raised the question as to why, after graduating an MD program, a physician couldn't go straight to work as a midlevel without attending a residency. My response to him was that there are certain aspects of PA education and that better prepare PAs to go straight into the midlevel practice of medicine. MD-graduates need to complete their residencies. Again:

"Medical school doesn't even begin to teach you what you need to know to practice medicine; you learn it in residency." - Mary Raynard, MD

While PA's don't spend as much time going over the minutia of basic medical sciences, they have just about the same amount of classroom hours in their didactic curriculum as MD students. That time away from the "minutia" of basic sciences is re-focused on clinical sciences and the practice of medicine.

So, unfortunately, if physicians want to practice medicine without attending at least an intern year, they'll probably have to find another country.

I mean, NPs/DNPs have also said the same thing you have, that they've taken the most useful and best parts of medical training and streamlined it. So, it's understandable that when PAs, such as yourself, start making similar comments and saying that you attend medical school, that the knee-jerk reaction would be to call it ludicrous. Does that make sense?

NPs aren't trained in the medical model; PAs and MD/DOs are.

Knee-jerk reaction or not, whenever a physician makes negative remarks about PA training, they are putting down the majority of their own education.

 

[FutureDoc4]

I'm not going to contradict anything you've said. I agree with it. However, I'm compelled to inform you that PA's know their zebras. If someone comes into the office with neurological symptoms mimicking Alzheimer's, a good PA should have a prion-based infection listed somewhere way down in their differential.

Despite MD students' more in-depth education, PAs do not depend on physicians for what they learned in school; rather they depend on physicians for what they learned and experienced in their residency. Let's face it:

"Medical school doesn't even begin to teach you what you need to know to practice medicine; you learn it in residency." - Mary Raynard, MD




Yes, it is part of MD training, but this whole discussion is based on schooling, not residencies. This all goes back to my first post in this thread (post number 71 on pg 2 of this thread) which addressed an individual who raised the question as to why, after graduating an MD program, a physician couldn't go straight to work as a midlevel without attending a residency. My response to him was that there are certain aspects of PA education and that better prepare PAs to go straight into the midlevel practice of medicine. MD-graduates need to complete their residencies. Again:

"Medical school doesn't even begin to teach you what you need to know to practice medicine; you learn it in residency." - Mary Raynard, MD

While PA's don't spend as much time going over the minutia of basic medical sciences, they have just about the same amount of classroom hours in their didactic curriculum as MD students. That time away from the "minutia" of basic sciences is re-focused on clinical sciences and the practice of medicine.

So, unfortunately, if physicians want to practice medicine without attending at least an intern year, they'll probably have to find another country.



NPs aren't trained in the medical model; PAs and MD/DOs are.

Knee-jerk reaction or not, whenever a physician makes negative remarks about PA training, they are putting down the majority of their own education.

Honestly, I feel as though many have tried to point out their respect for PA education (as do I ), but you seem to really have a lack of respect for MD education.

This seems to be a real contradiction---you want others to respect your education but have no respect for us and the minutia us MD/DO students have to memorize to come up with our 10 differentials in addition to understanding the pathophysiology of each condition.

Please remember that respect is a two-way street


Of course, lots of education (as you quoted twice) comes in residency. But, that specialized education is ONLY possible with a very-well established based knowledge in general medicine and medical science (including basic, FP, surgery, and internal medicine) it is that broad exposure and then refocusing in residency that allows our knowledge to span so much.

If this wasn't true, than we would have people just do one year of basic science and jump right into their "speciality" with a lack of exposure to other fields of medicine/thought.

But, when that patient comes in with cheilitis, you better be thinking of trauma, C1 esterase deficiency, and crohn's disease along with a host of other issues.

 

[Starpower]

But, when that patient comes in with cheilitis, you better be thinking of trauma, C1 esterase deficiency, and crohn's disease along with a host of other issues.

Our discussion case this week was acute prostatitis, so I looked a little further past Current and Harrison's and the acute/chronic/non-bacterial (which Harrison's now refers to as 'Chronic Pelvic Pain Syndrome'), into Smith's General Urology, and lo and behold I discover:

Granulomatous Prostatis, which "can result from bacterial, viral, or fungal infection, the use of bacillus Calmette-Guérin therapy, malacoplakia, or systemic granulomatous diseases affecting the prostate."

"Patients with granulomatous prostatitis often present acutely, with fever, chills, and obstructive/irritative voiding symptoms. Some may present with urinary retention. Patients with eosinophilic granulomatous prostatitis are severely ill and have high fevers. Digital rectal examination in patients with granulomatous prostatitis demonstrates a hard, indurated, and fixed prostate, which is difficult to distinguish from prostate carcinoma. Urinalysis and culture do not show any evidence of bacterial infection. Serum blood analysis typically demonstrates leukocytosis; marked eosinophilia is often seen in patients with eosinophilic granulomatous prostatitis. The diagnosis is made after biopsy of the prostate."

And for management,

"Some patients respond to antibiotic therapy, corticosteroids, and temporary bladder drainage. Those with eosinophilic granulomatous prostatitis dramatically response to corticosteroids. Transurethral resection of the prostate may be required in patients who do not respond to treatment and have significant outlet obstruction."

Isn't that interesting stuff? Anyhow, very interesting about the chelitis, thank you for sharing that; see:

http://www.ncbi.nlm.nih.gov/pubmed/14980194

http://dermatology.cdlib.org/103/NYU/case_presentations/111803n6.html

 

[bradt9881]

Similarly, not all mouth ulcers are herpes. Always keep in the back of your mind that Behcets disease needs ruling out through at least a thorough history and physical....

 

[altap]

IMHO, the notion that PAs don't aspire to practice independently is just baloney. They (and the NPs) are out to replace physicians. That is just human instinct: If NPs (purportedly with lesser education and training) are able to practice independently, why could not we? So instead of utilizing NPs or PAs as midlevels, physicians should hire med school grads who don't match as midlevels. The encroachment of NPs is on going and do you think cozying up with another midlevel will solve this? Think again. For the sake of patients and medicine, all physicians (US grads and FMGs with residency or not) and med students should band together to defeat this encroachment.

 

[drift]

IMHO, the notion that PAs don't aspire to practice independently is just baloney. They (and the NPs) are out to replace physicians. That is just human instinct: If NPs (purportedly with lesser education and training) are able to practice independently, why could not we? So instead of utilizing NPs or PAs as midlevels, physicians should hire med school grads who don't match as midlevels. The encroachment of NPs is on going and do you think cozying up with another midlevel will solve this? Think again. For the sake of patients and medicine, all physicians (US grads and FMGs with residency or not) and med students should band together to defeat this encroachment.

u do realize that PAs are governed by the Board of Medicine right? You do realize that the BOM can revoke accreditation if PAs go out to replace MDs right? You do realize that every public statement from the AAPA emphasizes the Physician-PA team and not independent practice right?

oh wait, ofcourse you don't.

Taking one's frustrations from NPs and turning them on PAs is not the answer. They were never the enemy. Ofcourse it's human nature to want more, but there are checks out there in the medical community to keep a balance to the division of power. If NPs claim 100% equivalency, the AMA can do nothing other than lobby against it (since NPs claim to practice 'advanced nursing', not medicine). On the other hand, since PAs practice 'medicine' and thus are governed by the same organization that governs MD/DO's, they will never replace doctors. You wouldn't make that statement if you knew more about the inside-workings of the Physician-PA organizations involved in the production/accreditation of PAs.

As a complete gross oversimplification, the real issue here is not Physician Vs. Midlevel, but it is Medicine Vs. Nursing.

 

[bradt9881]

IMHO, the notion that PAs don't aspire to practice independently is just baloney. They (and the NPs) are out to replace physicians. That is just human instinct: If NPs (purportedly with lesser education and training) are able to practice independently, why could not we? So instead of utilizing NPs or PAs as midlevels, physicians should hire med school grads who don't match as midlevels. The encroachment of NPs is on going and do you think cozying up with another midlevel will solve this? Think again. For the sake of patients and medicine, all physicians (US grads and FMGs with residency or not) and med students should band together to defeat this encroachment.

Righttt. I am secretly looking to fire all doctors and send them to Guantanamo Bay as a danger to national security. This is about the biggest pile of trash I have seen posted on SDN since the OP of this thread looked to create a study at home NP to MD bridge....

 

[Charles_Carmichael]

Righttt. I am secretly looking to fire all doctors and send them to Guantanamo Bay as a danger to national security. This is about the biggest pile of trash I have seen posted on SDN since the OP of this thread looked to create a study at home NP to MD bridge....

🤣

Best post of the thread.

 

[ARAI]

Honestly, I feel as though many have tried to point out their respect for PA education (as do I ), but you seem to really have a lack of respect for MD education. This seems to be a real contradiction---you want others to respect your education but have no respect for us and the minutia us MD/DO students have to memorize to come up with our 10 differentials in addition to understanding the pathophysiology of each condition.

Thanks for your response. If I did not respect MD education, it would also mean I didn't respect PA education since PA programs are based on MD programs. My saying that PA programs are great does not mean I do not think the same of MD programs.

By the way, I also noticed that you had bolded my statement about PAs having as many classroom hours as MD students. During the 16 continuous months of the PA didactic curriculum, PA students accumulate as many classroom/lab hours as the MD students in their 20 non-continuous months didactic curriculum. But maybe it's just my school that does this. Do any other PA programs go to class from 8-5 everyday and have an association with a MD/DO program that is in class from 8-3 everyday?

But, when that patient comes in with cheilitis, you better be thinking of trauma, C1 esterase deficiency, and crohn's disease along with a host of other issues.

You mean other issues such as drugs (isotretinoin), infections, immune-responses, sun-exposure, dehydration, B12 deficiency and iron deficiency.

PA students are also expected to come up with a DDx laundry list for each case.

So instead of utilizing NPs or PAs as midlevels, physicians should hire med school grads who don't match as midlevels.

MD/DO program graduates who do not enter a residency likely won't have a license to practice medicine. Thus, they are not permitted to work as a mid-levels. You'll either have to hire a PA, NP or a licensed physician.

The encroachment of NPs is on going and do you think cozying up with another midlevel will solve this?

Yes, if you're referring to cozying-up with PAs. Whenever NP organizations lobby for a bill giving them greater practice rights, PA organizations are right there to lobby against it. PA organizations spend a large amount of time and effort blocking NPs from expending their scope of practice.

 

[altap]

To drift and arai thank you for enlightening me. If there are checks and balances in the practice of PAs and that the BOM can rein in on any PA org anytime PAs deviate from their role (want equivalency and independence) and if the PA org. is in consonance with the med. orgs' stance against independent practice of NPs then it is well and good. But there is always the nagging question at the back of my mind: 50 years ago who would have thought that nurses would be practicing medicine independently? Would the propagation of midlevels eventually "destroy" medicine in this country? I do not know and nobody knows. Although PAs and NPs play important roles in healthcare, IMHO the utilization of midlevels (instead of physicians) in healthcare is not to the best interest of patients.

 

[altap]

If I may add, a med student or IMG who passed all of the USMLEs (1 to 3) cannot work as a midlevel but someone who passed the PANCE and NCLEX can do the job of a physician. IMHO, I think this is putting down medicine and leaders of med org should do something to correct this.

 

[VA Hopeful Dr]

To drift and arai thank you for enlightening me. If there are checks and balances in the practice of PAs and that the BOM can rein in on any PA org anytime PAs deviate from their role (want equivalency and independence) and if the PA org. is in consonance with the med. orgs' stance against independent practice of NPs then it is well and good. But there is always the nagging question at the back of my mind: 50 years ago who would have thought that nurses would be practicing medicine independently? Would the propagation of midlevels eventually "destroy" medicine in this country? I do not know and nobody knows. Although PAs and NPs play important roles in healthcare, IMHO the utilization of midlevels (instead of physicians) in healthcare is not to the best interest of patients.

Except when they are. Surgeons work faster in the OR with a good PA's help. Do you really need a cardiologist for lipid control/HTN office visit, or can a PA do that while the cardiologist is in the cath lab stenting and putting in pacemakers? In my state, midlevels are the ones who staff health departments (with assigned protocols mind you) because a) no doctor would do it and b) they are much cheaper.

Maybe that's just me though.

 

[VA Hopeful Dr]

If I may add, a med student or IMG who passed all of the USMLEs (1 to 3) cannot work as a midlevel but someone who passed the PANCE and NCLEX can do everything a physician does. IMHO, I think this is putting down medicine and leaders of med org should do something to correct this. Just my 2 cents.

Why would I want to practice as a midlevel?

 

[drift]

Why would I want to practice as a midlevel?

Exactly. Why would a Physician want to be a Mid-Level? People need to realize that while sure we all practice medicine, we do so at different levels. Just because someone made it through "most" of the process of being an MD/DO doesn't mean they have any right to automatically become a Mid-Level. Just like I wouldn't consider a NP with 25 years of experience to ever be a physician, I wouldn't consider an MD with no years of experience to be a NP. There are no shortcuts in medicine.

 

[altap]

Not specifically you, but people who cannot get into residency. Since healthcare is in need of midlevels and there are not enough residency spots, why not utilize those who cannot secure a residency as midlevels.

 

[altap]

There are board certified attendings (IM, Surgery, TCVS, FM, Ortho, Peds, Anes, etc) from different countries who come here and do not even attempt the MLEs bec. passing the mles does not guarantee anyone a residency or a job (even as a midlevel). All I'm saying is that, why not give these highly skilled and highly educated individuals ( and by virtue of them passing the mles) some sort of training then there should be a way for them to work as midlevels.

 

[altap]

This is a resource of this country that should be tapped. I bet that a board certified attending in Ortho or Anes from a foreign country who passed the mles would do a good job as a midlevel in ortho or anes.

 

[core0]

This is a resource of this country that should be tapped. I bet that a board certified attending in Ortho or Anes from a foreign country who passed the mles would do a good job as a midlevel in ortho or anes.

The evidence says no. There have been three attempts to use FMGs as PAs. The best documented was in Florida. None of the FMGs could pass a modified PA test administered by the state. They continue to practice under temporary licenses due to a flaw in the way the law was written. even though they account for less than 7% of the PAs in Florida, they are responsible for more than 20% of the board complaints and National Practitioner Data Bank submissions. Similar attempts in California and Oklahoma have ended in a similar manner.

There is a reason that physicians in the United States are generally required to receive medical training in the United States. In a similar manner there are reasons that all PAs must be a graduate of an ARC-PA accredited program.

 

[ARAI]

If I may add, a med student or IMG who passed all of the USMLEs (1 to 3) cannot work as a midlevel, but someone who passed the PANCE and NCLEX can do the job of a physician. IMHO, I think this is putting down medicine and leaders of med org should do something to correct this.

PAs could go through all the Kaplan prep courses and pass the USMLE series just the same. I'm confident of that. But PAs don't take the USMLE and MD/DOs don't take the PANCE.

PAs are trained to go straight to work as mid-levels. MD/DOs are trained to go on to a residency program.

Although PAs and NPs play important roles in healthcare, IMHO the utilization of midlevels (instead of physicians) in healthcare is not to the best interest of patients.

I believe that PAs, working within their individual capacity, are serving the best interest of both patients and hospitals.

This is a resource of this country that should be tapped. I bet that a board certified attending in Ortho or Anes from a foreign country who passed the mles would do a good job as a midlevel in ortho or anes.

Well, an ortho from a foreign country isn't exactly a resource of this country, is it? Bringing over aliens to work in medicine isn't exactly a positive move for our country's economy. There are plenty of resources right here at home.

If there's one take-home message, it's this: mid-level medicine is not a fallback career for FMG/IMG/AMGs. No offense, but if they aren't picked-up by a residency program, why should PAs or other mid-levels be forced to accept them? Talk about "not in the best interest of patients."

 

[princekc]

Except when they are. Surgeons work faster in the OR with a good PA's help. Do you really need a cardiologist for lipid control/HTN office visit, or can a PA do that while the cardiologist is in the cath lab stenting and putting in pacemakers? In my state, midlevels are the ones who staff health departments (with assigned protocols mind you) because a) no doctor would do it and b) they are much cheaper.

Maybe that's just me though.

You're absolutely right! mid-level providers = cost effective.

 

[pado13]

PAs could go through all the Kaplan prep courses and pass the USMLE series just the same. I'm confident of that. But PAs don't take the USMLE and MD/DOs don't take the PANCE.

There is a huge difference from giving a PA Kaplan review materials in order to pass USMLE Step I and giving a Physician a Pance Review and asking him/her to pass it.

Sorry, but that comment solidifies your ignorance on medical education.

 

[ARAI]

There is a huge difference from giving a PA Kaplan review materials in order to pass USMLE Step I and giving a Physician a Pance Review and asking him/her to pass it.

Sorry, but that comment solidifies your ignorance on medical education.

Whoa! This isn't about giving MD students a PANCE review. Where did I say that? I didn't. So I don't know where you pulled that statement from. Here's what I said...

PAs could go through all the Kaplan prep courses and pass the USMLE series just the same. I'm confident of that. But PAs don't take the USMLE and MD/DOs don't take the PANCE.

First of all, most PAs don't want to take the USMLE. They don't want to do a residency, and they don't want to be physicians. PAs want to be PAs. And the ONLY way to be a PA is to go to PA school. That's why they go to PA school. So there's really no reason to be hostile and defensive towards PAs.

Secondly, regarding this little gem...

Sorry, but that comment solidifies your ignorance on medical education.

Maybe you didn't pay attention to my previous posts. I'm in a school with both MD and PA programs. PAs are in some of the very same classes with the MD students. So yes, I do know a few things about the education of both professionals. And despite being in different programs, PA students do occasionally study with MD students and compare knowledge--it suffices to say that PAs know their medicine.

I review the USMLE books (Step 1 and Step 2). All the PAs at my school do. And nothing in those books have caught us off-guard. So you can sit at your computer and tell me how much I'm making a fool of myself and the PA profession by claiming to be learning things such as "medicine" (*gasp*), but that doesn't change the fact that PAs are medical professionals and they are expected to practice medicine at the same level of safety and quality as physicians. Therefore, they are taught at the same level.