I'm with jwk.
NPs and PAs Fight For Your Rights Now!!
- Thread starter guetzow
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I'm with jwk.
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Sure,
Academic degree's at the graduate level within the sciences and arts aren't usually available to the masses....You are usually a graduate assistant or fellow, have your own research interests and motivations and your curriculum tailored and supervised by a mentor/faculty advisor who you assist by teaching courses/labs and perform various tasks in their research efforts. This isn't a class of 25-50 whom have a common goal of practicing within the provisions of a certain vocation. Its 1-5 folks consisting of MA/Ms and PhD students whose job are to stimulate each other, produce scholarly work and encourage scholarly criticism. The goal of the academic degree is to foster the growth and development of scholars within a narrowly defined field and within the researcher's interests... not to create practitioners.
Just some random links of programs that is more academic in nature,
http://coursecat.sdsu.edu/bulletin/KINE.pdf
http://biochem.uvm.edu/graduate_program.php
All the health science and medical degrees in the USA are merely a result of inflation.....in both degree and market.
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I have to say, I've seen some pretty ridiculous claims from the PA's posting on this thread.
First off, I'm a dentist, and I'd put my background in the medical sciences up against any PA at any stage in their career, any day. There are just some things that doctors (physicians-M.D. and D.O., dentists, podiatrists, optometrists) get in their education that non-doctors don't. Why? Because we spend four years in hell earning our degrees. Our education is more thorough (especially a physician's, when it comes to the practice of medicine). All 50 state health boards recognize this fact, and as such grant us unfettered and undisputed authority over non-doctorate health care providers. The reason it seems to me that so many PA's think they are educationally and clinically on-par with physicians is because they don't realize the importance of a thorough doctorate-level education. Of course, how could they? They don't haven't been through one. To them, they think that practicing medicine involves taking a two-year crash-course in clinical medicine, then learning about a specific specialty while on-the-job.
Yes, a PA having worked in orthopedics for three years is going to know a hell of a lot more about clinical orthopedic practice than I will, and they'll know more about it than an ophthalmologist would as well. This has nothing to do with a PA's formal education, rather, it is indicative of on-the-job training. Precisely the same thing would occur should any bumb off the street spend three years working hands-on in an orthopedic practice.
It is specifically a PA's lack of in-depth education that allows them to go from specialty to specialty and perform the more basic tasks--a feature of their profession in which they seem to take such pride. Having graduated from a PA program, they have just enough education to work in a medical specialty and 1. not be completely clueless and 2. learn to do what PA's do, i.e. provide health care with A. ultimately no responsibility of their own (as it's the doctors license that makes any treatment "official") and B. a safety net (i.e. a doctor near by). Simultaneously, it's a PA's lack of in-depth education that renders them ineligible to "officially" specialize (i.e. obtain board certification) in any particular health care discipline the way a physician does.
A physician has an incredible knowledge base on which he/she can build a vastly more thorough education in any medical discipline than a PA can. This is a fact. Want proof? There isn't a residency program in the world that will take a PA.
First off, I'm a dentist, and I'd put my background in the medical sciences up against any PA at any stage in their career, any day. There are just some things that doctors (physicians-M.D. and D.O., dentists, podiatrists, optometrists) get in their education that non-doctors don't. Why? Because we spend four years in hell earning our degrees. Our education is more thorough (especially a physician's, when it comes to the practice of medicine). All 50 state health boards recognize this fact, and as such grant us unfettered and undisputed authority over non-doctorate health care providers. The reason it seems to me that so many PA's think they are educationally and clinically on-par with physicians is because they don't realize the importance of a thorough doctorate-level education. Of course, how could they? They don't haven't been through one. To them, they think that practicing medicine involves taking a two-year crash-course in clinical medicine, then learning about a specific specialty while on-the-job.
Yes, a PA having worked in orthopedics for three years is going to know a hell of a lot more about clinical orthopedic practice than I will, and they'll know more about it than an ophthalmologist would as well. This has nothing to do with a PA's formal education, rather, it is indicative of on-the-job training. Precisely the same thing would occur should any bumb off the street spend three years working hands-on in an orthopedic practice.
It is specifically a PA's lack of in-depth education that allows them to go from specialty to specialty and perform the more basic tasks--a feature of their profession in which they seem to take such pride. Having graduated from a PA program, they have just enough education to work in a medical specialty and 1. not be completely clueless and 2. learn to do what PA's do, i.e. provide health care with A. ultimately no responsibility of their own (as it's the doctors license that makes any treatment "official") and B. a safety net (i.e. a doctor near by). Simultaneously, it's a PA's lack of in-depth education that renders them ineligible to "officially" specialize (i.e. obtain board certification) in any particular health care discipline the way a physician does.
A physician has an incredible knowledge base on which he/she can build a vastly more thorough education in any medical discipline than a PA can. This is a fact. Want proof? There isn't a residency program in the world that will take a PA.
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I agree, but just wait. I guarantee you emedpa will find some backwater residency program that accepted a PA once.
Countdown 5, 4, 3, 2, 1....
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I seriously doubt that.
This whole discussion from the PA's side reeks of insecurity and lack of touch with reality.
Claims like "we almost never have to consult with physicians" and "we perform the same exact job" are ludicrous. There are two expressions to which the PA-proponents seem to be oblivious: "in practice" and "by law".
Yes, a physician may think that a problem is straightfoward enough for a PA to handle and not want to take time out of his/her schedule to watch what the PA's doing. And yes, in some cases or perhaps even many cases, PA's and physicians see the same types of patients. That's where the "in practice" expression comes in.
But here's where the similarity beteen the two ends: when there's a disagreement over how to handle a case. In such situations, the PA has to do what the doctor (or another doctor) says, period, no questions asked. The doctor can overrule a PA. Not vice-versa. That's what characterizes the "by law" expression.
That is the inescapable difference between PA's and doctors (i.e. MD's, DO's, DDS's, DPM's, etc.) The doctor has the final say. The doctor is the authority. And that's the whole enchilada right there.
Besides that, any work a PA performs requires a doctor's stamp of approval in some form. So by law, a PA does require a doctor's supervision--contrary to their repeated claims.
It is clear to me that PA's want to be not only de-facto but de-jure doctors, which they are neither.
This whole discussion from the PA's side reeks of insecurity and lack of touch with reality.
Claims like "we almost never have to consult with physicians" and "we perform the same exact job" are ludicrous. There are two expressions to which the PA-proponents seem to be oblivious: "in practice" and "by law".
Yes, a physician may think that a problem is straightfoward enough for a PA to handle and not want to take time out of his/her schedule to watch what the PA's doing. And yes, in some cases or perhaps even many cases, PA's and physicians see the same types of patients. That's where the "in practice" expression comes in.
But here's where the similarity beteen the two ends: when there's a disagreement over how to handle a case. In such situations, the PA has to do what the doctor (or another doctor) says, period, no questions asked. The doctor can overrule a PA. Not vice-versa. That's what characterizes the "by law" expression.
That is the inescapable difference between PA's and doctors (i.e. MD's, DO's, DDS's, DPM's, etc.) The doctor has the final say. The doctor is the authority. And that's the whole enchilada right there.
Besides that, any work a PA performs requires a doctor's stamp of approval in some form. So by law, a PA does require a doctor's supervision--contrary to their repeated claims.
It is clear to me that PA's want to be not only de-facto but de-jure doctors, which they are neither.
D
deleted6669
"But here's where the similarity beteen the two ends: when there's a disagreement over how to handle a case. In such situations, the PA has to do what the doctor (or another doctor) says, period, no questions asked. The doctor can overrule a PA. Not vice-versa. That's what characterizes the "by law" expression.
That is the inescapable difference between PA's and doctors (i.e. MD's, DO's, DDS's, DPM's, etc.) The doctor has the final say. The doctor is the authority. And that's the whole enchilada right there.
Besides that, any work a PA performs requires a doctor's stamp of approval in some form. So by law, a PA does require a doctor's supervision--contrary to their repeated claims."
first, way to go dredging up a month old post to spout off nonsense.
you just don't get it do you. if a pa thinks a doc will disagree with them over a pt they simply don't present that pt. end of problem. pa sees pt, handles it their way. discharges pt. I know docs who work up every cough with chest pain as a p.e.- I never present pts to them with this complaint. if I have a question I call a consultant but never talk to them about it. they are completely outside the loop.
the pa supervisory laws are no where close to as stringent as you think. in my state for example a doc has to be present in clinic 4 hrs/week with no specific chart review requirement. they have to have a general idea of how things are going. that's it. the way this usually works for me is that I finish a solo overnight shift in the er and the doc comes in for day shift as I'm leaving and says" any problems last night?" and I either say "nope, c'ya" or "yeah, I would like to discuss this case". notice, it's all on me. if I think a pt needs to be admitted, I admit them. if I think a pt can go home, I send them home. if I want a specialty consult I get one. I work with a large group of docs( 40 ish) and over time I have learned who to ask about what conditions and who not to ask. if I think I will get a reasonable answer I ask the question. if I know they go over the top with every complaint of xyz because of 1 bad outcome they had with that complaint 20 yrs ago I don't talk to them. that's the beauty of emergency medicine. I have a whole list of consultants I can call anytime I want. if I know that the surgeon on until 5 is unreasonable I wait until 5 after 5 and talk to the next guy who I know will admit the obvious appy without a ct, etc
some states require a doc be in clinic whenever a pa is working. I would never work in one of these states( and they are becoming fewer every year...there are maybe 5 or so left now.....)
That is the inescapable difference between PA's and doctors (i.e. MD's, DO's, DDS's, DPM's, etc.) The doctor has the final say. The doctor is the authority. And that's the whole enchilada right there.
Besides that, any work a PA performs requires a doctor's stamp of approval in some form. So by law, a PA does require a doctor's supervision--contrary to their repeated claims."
first, way to go dredging up a month old post to spout off nonsense.
you just don't get it do you. if a pa thinks a doc will disagree with them over a pt they simply don't present that pt. end of problem. pa sees pt, handles it their way. discharges pt. I know docs who work up every cough with chest pain as a p.e.- I never present pts to them with this complaint. if I have a question I call a consultant but never talk to them about it. they are completely outside the loop.
the pa supervisory laws are no where close to as stringent as you think. in my state for example a doc has to be present in clinic 4 hrs/week with no specific chart review requirement. they have to have a general idea of how things are going. that's it. the way this usually works for me is that I finish a solo overnight shift in the er and the doc comes in for day shift as I'm leaving and says" any problems last night?" and I either say "nope, c'ya" or "yeah, I would like to discuss this case". notice, it's all on me. if I think a pt needs to be admitted, I admit them. if I think a pt can go home, I send them home. if I want a specialty consult I get one. I work with a large group of docs( 40 ish) and over time I have learned who to ask about what conditions and who not to ask. if I think I will get a reasonable answer I ask the question. if I know they go over the top with every complaint of xyz because of 1 bad outcome they had with that complaint 20 yrs ago I don't talk to them. that's the beauty of emergency medicine. I have a whole list of consultants I can call anytime I want. if I know that the surgeon on until 5 is unreasonable I wait until 5 after 5 and talk to the next guy who I know will admit the obvious appy without a ct, etc
some states require a doc be in clinic whenever a pa is working. I would never work in one of these states( and they are becoming fewer every year...there are maybe 5 or so left now.....)
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If I will be held liable for the actions done by the midlevel I am supervising, you can sure bet I'll keep them on a short leash. If midlevels want independence, let them carry their own insurance. Of course, they'll claim it's unfair when their premiums are so much higher than physician's because some consider themselves equivalent to physicians. Some midlevels just want the same salary and recognition, but not the responsibilities and liabilities. 
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Cmon emedpa I know you want to accept my challenge. Whats wrong, you looked up every podunk residency in the state and couldnt find one who took a PA?
D
deleted6669
you don't think the 1st post by the dental wanna be was inflamatory? it basically says "pa's suck, that's all there is to it!"
if I posted something in the dental forum about idiot dentists treating mi's as dental infections I would be banned by the end of the day yet folks can come into THE CLINICIANS FORUM and spout bs about a field they know nothing about? where is the fairness there?
there is a reason sdn is considered one of the most unfriendly places on the internet for anyone but docs......
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Emedpa, obviously, you're dumb enough to think that the fact that your supervising doctor not asking you about every last occurrence amounts to you having the authority to function in a health care setting autonomously.
And obviously, you're dumb enough to think that being secretive and hiding potential disagreements from your supervising doctor amounts to autonomy.
It doesn't.
The fact of the matter is that, should the two of you ever have a disagreement, the doctor's orders are carried out. Period. End of discussion.
But let me ask you this: Can you prescribe medications without a doctor's DEA and/or license number on or associated with the prescription? No. You can't.
Can you admit a patient into a hospital without a doctor's authorization? No. You can't.
Even some dentists (who are not oral surgeons) have such privileges.
Can you start up your own PA practice and see patients without a doctor who is willing to allow you to work under his/her license? No. You can't.
All of these things, and many more, are representative of the fact that you are not a doctor, not a "doctor equivalent". You are essentially a representative for the doctor, whose license you work under.
Without a doctor's acknowledged involvment, your job is non-existent.
Case closed.
D
deleted6669
don't want to give you the satisfaction....and yes, there is one....and no, you can dredge it up yourself if you really care.....
D
deleted6669
But let me ask you this: Can you prescribe medications without a doctor's DEA and/or license number on or associated with the prescription? No. You can't.....YES, I CAN...PA'S HAVE THEIR OWN DEA#S ....
Can you admit a patient into a hospital without a doctor's authorization? No. You can't. YES, I CAN...I ADMIT TO THE PA HOSPITALIST who works for the hospital
Can you start up your own PA practice and see patients without a doctor who is willing to allow you to work under his/her license? No. You can't.
I CAN HIRE A FEW RETIRED DOCS TO SIGN a few CHARTS WITHOUT EVER SEEING PTS. THERE ARE PLENTY OF DOC ****** LINING UP FOR THE PRIVILEDGE
Case closed.
YOU STILL DON'T GET IT. if a doc and I have a disagreement it doesn't matter. the pt is already gone and already treated my way. it's just academic.
why do you even care?
you are a dentist. you take care of teeth. you can't do anything else....ever hear is there a dentist in the house/on the plane/etc?...no one cares....go clean some dirty meth teeth
Can you admit a patient into a hospital without a doctor's authorization? No. You can't. YES, I CAN...I ADMIT TO THE PA HOSPITALIST who works for the hospital
Can you start up your own PA practice and see patients without a doctor who is willing to allow you to work under his/her license? No. You can't.
I CAN HIRE A FEW RETIRED DOCS TO SIGN a few CHARTS WITHOUT EVER SEEING PTS. THERE ARE PLENTY OF DOC ****** LINING UP FOR THE PRIVILEDGE
Case closed.
YOU STILL DON'T GET IT. if a doc and I have a disagreement it doesn't matter. the pt is already gone and already treated my way. it's just academic.
why do you even care?
you are a dentist. you take care of teeth. you can't do anything else....ever hear is there a dentist in the house/on the plane/etc?...no one cares....go clean some dirty meth teeth
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I love it! A physician-assistant berating a doctor because he's not a physician! Sounds like someone's head has swelled, yet, from what has this swelling occurred? That dubious 2-year PA degree?
The bottom line is that 1. I have hospital privileges on my own, without a physician's involvment at any stage, 2. I can take a patient to the OR based on my own diagnosis and treatment plan, 3. I can prescribe medications without having to have the DEA and/or license number of a physician on my prescription pad, 4. I can start my own practice with no one but myself involved, and 5. I get called "doctor" wherever I go.
Your "hospitalist PA" I can guarantee you, has an M.D. or D.O. who ultimately has to approve the admission. No P.A. can autonomously admit a patient any hospital in the united states without a physician's approval somewhere along the line. That's a fact.
And just FYI, Ms. bed-pan cleaner, we dentists do a hell of a lot more than treat teeth. I don't blame you for your ignorance, however, because I understand that your PA program was too short to cover that fact.
D
deleted6669
why do you think I have a docs name on my script pad?
it has my name and my dea# on it. period.
I like dentists, I have no problem with dentists. they perform an important service. I'm just wondering why you need to come into a pa forum to bash pa's when you know about as much about pa's as I do about dentists?(that would be very little).
do you have any idea what attending a pa program entails? is your wife a pa?
I won't pretend to know anything about dental training if you will stop insulting my profession, a profession it took me 9 yrs of post high school education to enter into.......I apologize about the meth teeth comment, it was out of line.
"Your "hospitalist PA" I can guarantee you, has an M.D. or D.O. who ultimately has to approve the admission. No P.A. can autonomously admit a patient any hospital in the united states without a physician's approval somewhere along the line. That's a fact"
were you aware that there are hospitals where the entire surgical housestaff is pa residents? they admit pts and discuss them the next day on morning rounds, they cover all calls to the icu, er,etc
they decide when to call an attending surgeon for going to the o.r. and when to send the pt home. they staff all the surgical clinics, etc
see the norwalk hospital/yale surgical residency in ct for an example...no md residents at all....a good friend of mine( a pa) used to be the chief of the icu there after he completed his residency there.
http://www.appap.org/ct.html#one
lots of places are going to a model of using pa's as stand alone icu and critical care coverage with docs available at home as needed but not required......
it has my name and my dea# on it. period.
I like dentists, I have no problem with dentists. they perform an important service. I'm just wondering why you need to come into a pa forum to bash pa's when you know about as much about pa's as I do about dentists?(that would be very little).
do you have any idea what attending a pa program entails? is your wife a pa?
I won't pretend to know anything about dental training if you will stop insulting my profession, a profession it took me 9 yrs of post high school education to enter into.......I apologize about the meth teeth comment, it was out of line.
"Your "hospitalist PA" I can guarantee you, has an M.D. or D.O. who ultimately has to approve the admission. No P.A. can autonomously admit a patient any hospital in the united states without a physician's approval somewhere along the line. That's a fact"
were you aware that there are hospitals where the entire surgical housestaff is pa residents? they admit pts and discuss them the next day on morning rounds, they cover all calls to the icu, er,etc
they decide when to call an attending surgeon for going to the o.r. and when to send the pt home. they staff all the surgical clinics, etc
see the norwalk hospital/yale surgical residency in ct for an example...no md residents at all....a good friend of mine( a pa) used to be the chief of the icu there after he completed his residency there.
http://www.appap.org/ct.html#one
lots of places are going to a model of using pa's as stand alone icu and critical care coverage with docs available at home as needed but not required......
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Emed, either you know even less about your profession than you do mine, or you're deliberately skirting the crux of the matter. I'm not disputing these claims of yours (althoug in my hospital experience, I've never seen such scenarios. Usually the PA-C rounded with the residents and stayed behind to write up the charts.). Nonetheless, just because you may not encounter a doctor once during the day, week, or even month doesn't mean that a doctor's involvment isn't required at some level--a level above yours, and at a level that is required by law in order for you to do your job. PA's are not physician replacements. They are physician surrogates. But ultimately, everything gets traced back to a doctor. If a PA screws up and kills someone, somewhere there is a doctor who is going to have to answer for it because he/she was ultimately the responsible party. Again, I'm stating fact.
Furthermore, your DEA license is not the same as mine or any other doctor's. You cannot apply for a DEA license without a doctor who allows you to write prescriptions on his/her behalf.
As for your education, I looked into it a little further. Here's a typical PA program:
http://medinfo.ufl.edu/pa/program/curric.htmhttp://philau.edu/paprogram/PACurriculum.htm
One year of didactic training followed by one year of clinical training. Then you're unleashed on the public. In fact, looking at the PA curriculum above, I'd venture to say that (with the exception of a few areas such as OBGYN, ophthalmology and urology), PA programs cover pretty-much what we got in dental school. Yet, there's one big difference: in dental school we were being trained to practice dentistry, not medicine. All that medical science we learned in dental school was there to support us in our practice of dentistry. A medical school curriculum, where students are being trained to practice medicine, is going to be nothing less than a bombardment of information.
I'm glad you compelled me to examine a PA curriculum. I've learned that the difference between PAs and physicians is more pronounced than I previously thought.
So you like dentists and think we dentists perform an important service, do you? Well, I'm just tickled pink that my profession has the approval of a physician assistant.
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This is what EMEDPA thinks of physicians. Case closed.
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In our facility, a DDS or DPM must have H&P's performed by or reviewed and signed off by an MD or DO prior to surgery.
And megboo - just because someone wants to drag up an old thread (five months dead, not one) doesn't mean they've got something earth-shattering to say. All of these types of arguments have been harangued to death on numerous threads in different sections of SDN. DocHolliday added absolutely nothing new to the discussion. And although SDN is open to all across a variety of areas, this IS the CLINICIAN's forum. When I go to MD threads and CRNA forums on other boards, I'm fully aware I'm in the minority and try not to be too abrasive and at the same time defend my views. DocHolliday on the other hand is a brand-new member and his first post is not in the dental forums where you would expect, but in the clinician's forum bashing PA's. Why? He obviously knows little about PA's.
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D
deleted6669
nope, just folks like you and those who see us as means to an end.
no pa/md debate would be complete without anonymous and macgyver, co-trolls in all things anti-midlevel
D
deleted6669
your right. I'm done with this thread.
mods-if you had any sense you would close this now since the actual moderator of this forum has been basically absent for 2 yrs and not replaced yet......shows the value sdn places on non-physician clinicians....did you guys even catch the fact that this area has been unmoderated forever.....
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What? I would never "*****" my medical license to any midlevel, so your argument is irrelevant and is only applicable to any physician (in your eyes) willing to allow you to use their hard-earned medical license for your "practice".
D
deleted87716
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