I agree i think primary care docs are getting screwed in our system. if anything the success of PAs should show them that such a long and ardous training process doesn't make sense for primary care... it is unfair that one group only has 2 years of mandatory training to practice, while the other has to do 7.
PA limitation compared to MD
- Thread starter titanz7
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I agree i think primary care docs are getting screwed in our system. if anything the success of PAs should show them that such a long and ardous training process doesn't make sense for primary care... it is unfair that one group only has 2 years of mandatory training to practice, while the other has to do 7.
So the physician supervising determines what the PA's scope of practice is? I did not know that.
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deleted6669
yup. we have to file documents with the state and the hospital. my current one is a 3 page document (single spaced) listing tasks I can perform. the docs also have a similar list for each specialty that the hospital agrees they can do. an er doc for example can't just decide to do a cardiac cath or a hysterectomy.
the difference between mine and an er docs is very little, probably 3-4 procedures.
also remember "supervision" or "sponsorship" is a loose term. my sp "sponsors" me from home while he is sound asleep or even outside the country. he has no idea what I am seeing until days to weeks later when he reviews the charts.
a good delegation of services agreement basically says a pa can do anything within the confines of their experience and training. a bad one limits pa's to a handful of tasks and makes them inefficient and not cost effective.
The ****ty way of doing primary care where you refer out for anything out of the ordinary and you are essentially a gatekeeper can certainly be done by a midlevel. Primary care that is full scope, especially in many rural areas requires a lot more training and a much broader and deeper knowledge base.
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deleted6669
yup, they are doing exactly what their sp's do.....ever seen an fp doc at an hmo?
rash? derm referral
joint pain? rheum referal
back pain? pain clinic referal, etc
that's what happens when you have 15 min appts all day long and have to see 32 pts in 8 hrs.
I agree rural fp docs are studs. no doubt about it. I work with some great ones at one of my rural per diem jobs. they do ob, see pts in the icu, do treadmills, vasectomies, etc
if that's truly the case, the ER docs are getting a raw deal... everyone should just do the PA path if they want to do ER.. why do so much more just to get 3 or 4 more procedures?
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deleted6669
1. respect.
2. 3x the salary for 2/3 the hrs
3. the ability to work internationally
also consider I am not a new grad pa. I have worked in em for 26 yrs and clawed ny way up from the bottom. the difference between a new grad pa and an em doc is probably 20+ procedures-including most of the fun ones-(not to mention a HUGE knowledge difference).
True. Also if there were no primary care physicians who would train PAs in primary care? A person right out of PA school cannot do primary care. That's saying a 3rd year med student can do primary care... Neither can and it's ludicrous to think otherwise. Most every resident going into primary care will tell you it requires more than 3 years of training in residency to be good at primary care...
PAs and NPs are not taking over primary care or any setting in medicine for that matter (though I'll give you that both alone are far better than nothing in the most rural settings).
ON CARDIOLOGY PAs that emedpa discusses...
Here's the intro from 2003 paper:
"A greater emphasis on cost containment and a generalized shortage of qualified physicians [1] have resulted in the expanded use of physician extenders—physician assistants (PAs) and nurse practitioners—in the provision of medical services [2, 3]. In some academic and proprietary medical centers, physician extenders now assist with invasive procedures, including cardiac catheterization. The American College of Cardiology (ACC) and the Society for Cardiac Angiography and Intervention recently addressed this issue and recommended that physician extenders be allowed to participate in cardiac catheterization procedures, though not as primary operators [4]. This recommendation was based on data from two small series and on the minimal requirements established for acceptable training. Although some institutions utilize physician extenders only for the work-up and follow-up of cardiac catheterization patients, other institutions have expanded their role to include assistance with the cardiac catheterization procedure itself.
Physician assistants at our institution began to participate in invasive catheterization procedures in July 1986 and were granted institutional privileges to inject coronary arteries under the supervision of an attending physician in July 1998. We report here the initial experience with performance of cardiac catheterization procedures by supervised PAs. These PAs are employed full time in the catheterization laboratory and are not assigned other duties in the hospital. Physician assistants undergo extensive training in diagnostic cardiac catheterization, including patient work-up and obtaining consent before the procedure, assisting with vascular access, manipulation of intravascular catheters, ventriculography, and coronary angiography during the procedure, and handling data compilation and report generation following the procedure."
Of note:
those PAs are no different than surgical PAs. They work exclusively in the cath lab and have no other responsibilities (as is the same with most surgical PAs/NPs). None. They do not perform the role of an interventional cardiologist. They ASSIST in the caths (if you have ever seen one that means they stand there and watch the attending do the procedure for the most part and maybe inject) and are not primary operators, are not advocated as being a primary operator, and nor are they trained to become a primary operator as a fellow is. They are therefore EXTENDERS of the cardiologist's skill set. Fellows are trained to be primary operators and will function at a higher level over time than a PA who works in the cath lab.
Also you can train anyone to do any one procedure if that is the only thing that person will ever do. If starting tomorrow all I did was help remove and then start to remove gallbladders day in day out for 10 years you can bet I would be really good at that. But no one would argue I was on par with a surgeon...
This website discusses the responsibilities of a Duke PA/NP who can work in the cardiology department (likely on the floor patients it seems):
http://www.nurse.com/jobs/1075495-c...at-duke-university-health-system-in-durham-nc
They only require 1 year of experience (not specified as being in any field in particular) to perform all the listed functions.
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deleted87716
This is actually more mythological than factual. Kaiser Permanente, the largest HMO in the nation, recognizes the cost of over-referrals and expects their primary care physicians to treat problems within their scope, not just refer everything to specialists. Their specialists don't want to see crap that could be taken care of in a primary care practice, either. And patients sure as heck don't want to be sent to a new doctor every time they have a new complaint.
As for volume, that's part of the over-referral problem, but not all of it. An efficient practice and an experienced physician can see a lot more patients in the same amount of time than an inefficient or inexperienced clinician. There's a reason the typical mid-level sees a fraction of the number of patients in a day as the typical physician. They spend more time with their patients because they have to.
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deleted6669
um, no. they were doing the procedure with a cardiologist in the room watching them. they were doing the same thing as the cards fellows for diagnostic caths(the fellows also did interventional). did you even read the studies? they weren't helping, they were doing. if they were just handing instruments over and being a drs little helper why compare their role to that of residents and compare outcomes?
see, even in the face of documented evidence we still get no respect.
look at the em pa study in england I posted and try to explain it away as the pa's really just handing out bandaids....look at the conclusion:
Physician Assistants saw more patients and required less supervision than Senior House Officers. Physician Assistants proved to be a cost effective method of supporting Accident and Emergency doctors at City Hospital, Birmingham.
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deleted6669
I worked at kp for > 10 years and know all about their referal patterns. also the docs and pa's get the same schedule. the pa's don't get "more time" they also see 15 min appts./32 per day just like the docs.
Just curious, when PAs are doing procedures like caths... how does the malpractice work? If the PA makes a mistake while the supervising physician isnt there, what happens (since you mentioned that your own supervising physician is rarely there) is the PA held responsible at all?
If not PAs are the best gig in town. Not only do you get to avoid a huge amount of mandatory training, you also get to do procedures and not take on the risk!!
i would trade respect for not being sued any day...
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deleted6669
pa's get sued if they mess up. in theory the sp's are also named but often later removed. a recent case in maine found an sp not responsible for an error made by a pa in his absence. only the pa faced financial penalties and hospital sanctions.Just curious, when PAs are doing procedures like caths... how does the malpractice work? If the PA makes a mistake while the supervising physician isnt there, what happens (since you mentioned that your own supervising physician is rarely there) is the PA held responsible at all?
If not PAs are the best gig in town. Not only do you get to avoid a huge amount of mandatory training, you also get to do procedures and not take on the risk!!
in > 20 yrs of using em pa's at my facility(15 pa's working shifts around the clock seeing hundreds of thousands of pts) there have been a total of 2 suits involving pa's. one was thrown out and the other settled for a trivial amount.
bro... it's like I'm talking to a brick wall with you. This isn't about disrepect and I mean none. It's about you being overly sensitive.
This is from the Materials and Methods section of the 2003 paper:
"All cardiac catheterization procedures at our institution are performed under the direct supervision of an attending physician who, as the primary operator, is present during the entire procedure and is responsible for all clinical decision making. A cardiology fellow-in-training or a trained physician assistant serves as the secondary operator and is involved in all aspects of the procedure."
So yes I read the paper. Did you? The PA did not do the procedure. They were the secondary operator. The PA was doing his job... assist the physician... The PA will always be the secondary operator. As a result they will do less than a fellow who is being trained to become a primary operator. I know this for a fact because I have seen how surgical PAs vs surgical fellows operate and have also seen several interventional procedures with fellows and PAs/NPs involved. So in this study it can be inferred that PAs operated at a static level while fellows operated at a level of increasing responsibility as surgical residents/fellows do (though still as the secondary operator officially as are surgical residents/fellows when they operate).
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deleted87716
Oh, good. It didn't sound like you did.
I guess you also know that Kaiser recognizes that mid-levels and physicians have different capabilities and should not be utilized interchangeably.
Dr. Jeffrey Weisz Has Big Plans for Kaiser Permanente
http://www.thelundreport.org/resource/dr_jeffrey_weisz_has_big_plans_for_kaiser_permanente
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deleted6669
I wasn't trying to claim that pa=cards resident across the board.
my understanding is that the "secondary operator" basically learns and perform all components of the procedure with the primary operator still present, much like a first assistant in the o.r. learns to do an entire procedure over time and takes on more and more responsibility.
maybe I am a little overly sensitive. if so it comes from 26 yrs of taking crap from docs that I don't deserve just because of tyhe initials after my name even when I am doing a good job
we had a hospitalist who for the longest tiem refused to admit pts presented by pa's. he said" have your attending examine the pt and have them call me if they think the pt needs to be admitted" thewn he would slam the phone down. what an assclown. one of our ortho guys still does that.
so, under what circumstance are you going to send home a hypotensive septic 80 yr old just because the pa presented them? total assclown.
my understanding is that the "secondary operator" basically learns and perform all components of the procedure with the primary operator still present, much like a first assistant in the o.r. learns to do an entire procedure over time and takes on more and more responsibility.
maybe I am a little overly sensitive. if so it comes from 26 yrs of taking crap from docs that I don't deserve just because of tyhe initials after my name even when I am doing a good job
we had a hospitalist who for the longest tiem refused to admit pts presented by pa's. he said" have your attending examine the pt and have them call me if they think the pt needs to be admitted" thewn he would slam the phone down. what an assclown. one of our ortho guys still does that.
so, under what circumstance are you going to send home a hypotensive septic 80 yr old just because the pa presented them? total assclown.
I also want to add this from the discussion of that paper:
"At our institution, training of PAs to assist with cardiac catheterizations began in 1996. Because no established guidelines for training PAs existed, the invasive cardiology faculty decided to train them in the same precise manner as the cardiology fellows, with the understanding that the training would likely be longer and that the role of the PA would always be a limited one. PAs were expected to become proficient secondary operators with no direct involvement in clinical decision making."
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deleted6669
kaiser goes through mood swings every 5 years:
we're an insurance company, no, we're a direct provider of health services.
we love midlevels, they should do everything. no, we hate midlevels, they should only do specific tasks.
wait 5 yrs and it will shift again.
the director of kp 10 yrs ago said just the same thing. the guy 5 yrs ago stopped using moonlighting residents in urgent care and hired pa's.
just wait.
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deleted87716
Still, a limitation. You don't see them doing that to physicians.
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deleted6669
yup. kp is basically a training ground for pa's. they learn some skills there then leave when they want more respect and a better scope of practice elsewhere. those who stay make great money but have to leave their pride at the door(because they are a doormat). I took a 30k/yr salary cut to leave kp. it was worth it. they still owe me a pension when I'm 65 so I got what I could from them and left. when I left kp I was making more than the new fp docs there before they made partner due to the structure of the salary scale( I was at the top step). once they made partner after 2 yrs they made 20k more/yr than me.
As you know the reason is that there is no standard for PA training. The standard for physician training is medical school followed by residency. A PA could have 0 years of experience and be allowed to go work any situation they desire/hired to do. 3 years of experience for a PA in the ED is not equivalent to 3 years of residency for an EM resident... As such there is no set way to gauge how qualified a PA is to perform any set task while it is clear any EM resident who graduates and passes boards can function as a sole provider in an ED (obviously some would be better than others but there is a standard minimum they must know at least while there is no such thing, as far as I know, for a PA in any field).
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deleted6669
true to some extent.
it is the stupid sp who delegates more to a pa/np than they are capable of doing.
to even the playing field a bit there are now specialty exams for pa's in several specialties, including em. to qualify you have to document didactic training, observed procedures(as in the doc observes you doing them appropriately), hrs in the specialty, etc and have a doc in that specialty sign off that you are competent. I took and passed the em caq(certificate of advanced qualifications) exam the first yr it was offered.
here is the skills list for the em caq:
In determining whether a PA can satisfy the Specialty Procedures and Patient Case Requirement, consideration should be given to the following areas:
Airway Adjuncts: Invasive Airway Management
• Intubation
• Mechanical ventilation
• Capnometry
• Non-invasive ventilatory management
Anesthesia
• Local, digital
• Procedural anesthesia, conscious sedation
Advanced Wound Management
• Incision & drainage, wound debridement
• Superficial/deep wound closure
Diagnostic/Therapeutic Procedures
• Soft tissue and joint aspiration
• Lumbar puncture
• Slit lamp examination
• Thoracentesis, thoracostomy
• Tonometry
• Control of epistaxis
• Electrocardiographic interpretation
• Cardiac pacing
• Defibrillation/cardioversion
• Clearing a cervical spine
• Fracture/dislocation management
Hemodynamic Techniques
• Peripheral venous access
• Arterial access for diagnostics and placement of arterial lines
• Central venous access
• Intraosseous infusion
Radiographic Interpretation
• Chest x-ray
• Plain films (bone, soft tissues, abdominal series, etc.)
• CT scans, MRIs
Resuscitation
• Cardiopulmonary
• Fluid
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deleted87716
Actually, there are plenty of folks arguing that FM residency should be four years, not three. Anyone who thinks primary care is easy either hasn't done it, or isn't any good at it.
I wouldn't really regard this as "evening the playing field" but more as a resume builder for PAs for what it is worth. These things aren't nationally recognized standards that are, without exception, required which is not the case with physicians. Personally I would be extremely surprised if something like this grows to the point that it is required by PAs just based on the structure of the profession. For example, what's the point of doing PA school (which is shorter than med school) if you then have to do a few more years of training (mini residency?) in order to work in the specific field? Why would PAs want to do that? Why take away their ability to move laterally?
Good question, simple answer... the nursing lobby/union is powerful and politicians are ignorant. I bet you no politician gets his/her care from a NP with no supervision.
procedures can be taught to anyone. But I take exception to the following (as I would with MD/DOs who spout they can do the following as well)...
"Radiographic Interpretation"... It takes 4 years of dedicated radiology residency and most often another year of specialized fellowship to learn to "read" these studies. Non-radiologists cannot do it. Now, does it take a radiologist to see a big lobar pneumonia, or a significant epidural hematoma, or an obvious bone fracture, etc? Nah, it shouldn't anyway... But it is exceedingly difficult to interpret CT scans and MRIs of any non major/obvious finding for non-radiologists. Lots of such things could be potentially extremely important (e.g. subdural hematoma or a small spiked lung lesion on CT). Again, you don't know what you don't know. If you see/do one thing over and over and over again (as a surgeon may do with a certain radiographic test - think neurosurgeon for head CT/MRI) then you can get good at "seeing" things that you are looking for. But a radiologist has to be able to "see" everything.
"Radiographic Interpretation"... It takes 4 years of dedicated radiology residency and most often another year of specialized fellowship to learn to "read" these studies. Non-radiologists cannot do it. Now, does it take a radiologist to see a big lobar pneumonia, or a significant epidural hematoma, or an obvious bone fracture, etc? Nah, it shouldn't anyway... But it is exceedingly difficult to interpret CT scans and MRIs of any non major/obvious finding for non-radiologists. Lots of such things could be potentially extremely important (e.g. subdural hematoma or a small spiked lung lesion on CT). Again, you don't know what you don't know. If you see/do one thing over and over and over again (as a surgeon may do with a certain radiographic test - think neurosurgeon for head CT/MRI) then you can get good at "seeing" things that you are looking for. But a radiologist has to be able to "see" everything.
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Bingo. To much bickering over turf issues among Physicians to see the real threat(np) as well
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deleted6669
the fine print on radiographic interpretation is not that the pa needs to be able to read a ct scan for a final read but for classic findings. I don't know why they worded it that way for purposes of the exam. we are held to the same standard as ed docs for plain films though. obvioulsy only a radiologist gets the "final read" on studies but we do prelim reads and act on them all the time in em.
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deleted6669
the caq's are taking off. they have only been around for 1 year already and some of the better jobs are advertising for " em residency trained and/or em caq only". this gets you as a minimum someone with acls/atls/pals/difficult airway training, a physician who signed off on all the procedures listed and a min of 3000 hrs working with a residency trained and board certified er doc as an sp. much better than a new grad or a random pa off the street.
years from now this will be the standard for licensure: pa school+ 1 yr postgrad program in specialty of choice+ passage of caq. lateral mobility of pa's will become a thing of the past. also as more bridge programs open more pa's will transition to becoming physicians.
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Since I put it in another thread in Pre-Allo earlier today in response to the same idea:
Let's look at the failure of one mid-level I wouldn't let anyone I care about be cared for by: Certified Registered Nurse Anesthetist
They handle basic to complex cases where many variables comprising the patient's history, current medications and the status of many, if not most of the organs in the human body when deciding how to put them under. There are many, many cases where a basic surgery goes bad and they have neither the experience, nor the training to handle it and the patient either dies or the one supervising anesthesiologist for 12+ ORs (or none at all in the building) is pulled off his case (and another CRNA takes over!) to run and rescue the patient that may now have brain or organ damage from not being helped by an experienced physician fast enough. My n=1 has seen plenty of this happening, see what you find when you're out there in practice.
There are enough threads, even some still active, on SDN about CRNAs and their propensity for harm to a patient if the slightest variable is off in the OR if anyone's interested in searching for them. While wiki says that they're moving to a Doctoral program, I doubt that many payors will pay close to an anesthesiologist's salary for a person that is not a physician. My favorite quote from there is "Therefore, it was legally established that when a nurse delivers anesthesia, it is the practice of nursing. When a physician delivers anesthesia, it is the practice of medicine." The most hilarious, but telling ads I've seen were for a CRNA offering 160k+ and on the same page advertising for a FP or IM paying almost exactly that much!
Now, let's look at the scope of practice here:
Physician Assistants: Never meant to be a self-governing/sufficient provider. They should have a physician in the building with them, but as long as a physician reviews a certain amount of their charts, they can do pretty much whatever they're comfortable with. They are Physician ASSISTANTS and if more people see them, more of the numbers will be shown of bad outcomes. These bad outcomes may not result in the patient expiring, as is much more possible in the case of CRNAs managing a complex case, but can result in the same. When a patient has more than 4 powerful medications or heart disease with other comorbidities such as Diabetes, COPD or end organ failure, they need to be seen by a physician, and I hope that doesn't change.
Nurse Practitioners: Designed to be a self-governing/sufficient provider with scope of practice for the most basic to the medium complexity cases in many fields. They and advance practice nurses can handle more specific fields than a generalist PA and with less supervision, but they also are to not overstep their training.
Doctorate of Nursing Practice: Soon to be required for teaching RN-based programs but not much added clinical utility and probably not much higher reimbursement, than an NP.
I'm all for them taking on the basic cases that are easily managed, and am glad to bring them in for that purpose, but they will never replace a physician in any field.
I researched this a lot when I was pawned off on a mid-level and wanted to know what I was getting. This thread could go on and on, but if all levels are playing by the rules, there should be no misunderstanding about the training each level requires. I can tell you right now, you learn EVERYTHING that matters in residency!
Have a safe New Years, and may the odds be always in your favor if you have to use the ED this and next year! The ED is truly like a box of chocolates, you never know what/whom you're gonna get...but Medicare will take half the box and leave stones in the little brown wrappers.
Let's look at the failure of one mid-level I wouldn't let anyone I care about be cared for by: Certified Registered Nurse Anesthetist
They handle basic to complex cases where many variables comprising the patient's history, current medications and the status of many, if not most of the organs in the human body when deciding how to put them under. There are many, many cases where a basic surgery goes bad and they have neither the experience, nor the training to handle it and the patient either dies or the one supervising anesthesiologist for 12+ ORs (or none at all in the building) is pulled off his case (and another CRNA takes over!) to run and rescue the patient that may now have brain or organ damage from not being helped by an experienced physician fast enough. My n=1 has seen plenty of this happening, see what you find when you're out there in practice.
There are enough threads, even some still active, on SDN about CRNAs and their propensity for harm to a patient if the slightest variable is off in the OR if anyone's interested in searching for them. While wiki says that they're moving to a Doctoral program, I doubt that many payors will pay close to an anesthesiologist's salary for a person that is not a physician. My favorite quote from there is "Therefore, it was legally established that when a nurse delivers anesthesia, it is the practice of nursing. When a physician delivers anesthesia, it is the practice of medicine." The most hilarious, but telling ads I've seen were for a CRNA offering 160k+ and on the same page advertising for a FP or IM paying almost exactly that much!
Now, let's look at the scope of practice here:
Physician Assistants: Never meant to be a self-governing/sufficient provider. They should have a physician in the building with them, but as long as a physician reviews a certain amount of their charts, they can do pretty much whatever they're comfortable with. They are Physician ASSISTANTS and if more people see them, more of the numbers will be shown of bad outcomes. These bad outcomes may not result in the patient expiring, as is much more possible in the case of CRNAs managing a complex case, but can result in the same. When a patient has more than 4 powerful medications or heart disease with other comorbidities such as Diabetes, COPD or end organ failure, they need to be seen by a physician, and I hope that doesn't change.
Nurse Practitioners: Designed to be a self-governing/sufficient provider with scope of practice for the most basic to the medium complexity cases in many fields. They and advance practice nurses can handle more specific fields than a generalist PA and with less supervision, but they also are to not overstep their training.
Doctorate of Nursing Practice: Soon to be required for teaching RN-based programs but not much added clinical utility and probably not much higher reimbursement, than an NP.
I'm all for them taking on the basic cases that are easily managed, and am glad to bring them in for that purpose, but they will never replace a physician in any field.
I researched this a lot when I was pawned off on a mid-level and wanted to know what I was getting. This thread could go on and on, but if all levels are playing by the rules, there should be no misunderstanding about the training each level requires. I can tell you right now, you learn EVERYTHING that matters in residency!
Have a safe New Years, and may the odds be always in your favor if you have to use the ED this and next year! The ED is truly like a box of chocolates, you never know what/whom you're gonna get...but Medicare will take half the box and leave stones in the little brown wrappers.
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Yet for a physician to change specialties (from one primary care field to another) is a big ordeal as they have tyo do undergo another several year residency. Even you acknowledge that the future of PA education will be that "lateral mobility for pa's will go away." The fact that PA's can switch so easily tells me that their breadth of knowledge isn't as deep. Pointing this out is not a personal attack, insult or slight.
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Yeah. Anyone who thinks it is med school that defines the difference is either grossly misinformed or intentionally misrepresenting reality.
Sent from my DROID RAZR using SDN Mobile
this sentence is literally the first I have heard about the existence of any such program... and even if you did such a thing (as some very quick research shows at least a few programs are out there) you still have to match into and complete residency in the field you want to work in... I also believe, by the way, as time goes on this will be exceedingly difficult for PAs as programs in every field highly desire US senior medical students and there are more and more of them coming along. A PA cannot do accelerated residency as those are funded by the state and need accreditation as well. So you start at the pgy1 level no matter how many years of experience you have. Otherwise you cannot be board certified in the respective field (even for family medicine). A MD/DO degree by itself is totally worthless unless you are board certified and I don't think anyone is allowed to take any board exam they want. Also any such program would need to be accredited by the AAMC which I'm sure is not easy.
If a PA has to go back and pass all the required board exams (step 1 to step 3) with an "accelerated med school type program" and train in residency after going through the match process I have no problem with them skipping the MCAT to be a physician. Personally, I don't see why a person who chose the PA path would desire to do so but more power to you if it's your dream. No one would higher you as a MD/DO w/o board certification from residency/fellowship training. The "you" I refer to is "you" in the general sense.
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Not really... and even if they did good for them. Your posts initially highlighted the line and now they blur it. Pulling the two professions closer together does not validate either. It negates the need for PAs and.... that's it. PA was meant to act to full gaps. If it stops doing that it is no longer needed. If they become physicians it is more rational to just train them as physicians the first time around right?
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A point of clarification; as you approach your post-GME job search, the job ads will often say BE/BC preferred by them. This means that you would have to be Board Eligible or Board Certified to apply for them. You can get hired straight out of GME if you're BE (rare to not be), but most employers have a track you will be on that requires that you be Board Certified in a certain amount of years to be eligible for contract renewal or promotion.
PAs will be able to start working right out of their training and usually start over with as much on the job training as they can handle to also move up the food chain, but there is definitely a ceiling for how far up they can go.
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deleted6669
and you became an expert on the pa job market when?
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So much PA bashing...I don't get why people just can't accept they fit a much needed niche in health care. I guess people are just protective of their professional territory.
I must say...PA is a great profession. 60-80k starting salary, can be equally as "rewarding" as any provider, good lifestyle, good job security. I think it's a great field for anyone who wants to be part of healthcare but may be turned off by the obligatory time to jump through all the hoops. Obviously, there are limitations but just saying...
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deleted6669
I know folks in these programs. some are here on sdn. they fully intend to complete a full residency program and all steps needed to become "legit".
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deleted6669
60 would be very low.
most new grads start at 70+
after 2 yrs the avg is 90k
in some specialties the avg is > 100k after 2 yrs(em, derm, neurosurg, ct surg).
it's not as rewarding if you are treated like crap and doubted by everyone regardless of how good you are.
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deleted6669
nice collection of quotes out of context....
anyway, when a pa switches specialties they start at the bottom and work their way back up. new grads in em or folks new to the specialty generally start in fast track and don't see more complex pts for at least a yr and then only with fairly stringent supervision which decreases with time.
if I switched to ct surgery tomorrow I would be doing clinic scut and very minor assisting for a long time unless I did a residency first.
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Right before you misread my post, if you needed a point in time
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deleted6669
I totally agree. a new grad from pa school or med school is ready to be a safe beginner. the med student has a stronger background in basic medical sciences to their advantage. the medstudent becomes a strong clinician by doing a residency. the pa becomes a strong clinician by training on the job in their respective specialty. this training is not equivalent but in some fields(fp, derm, and em for example) there is a lot of overlap. in others(surgery for example) there is far less.
maybe you mean this or not but I interpret your statement as being as if PAs are already "legit" doctors and this whole med school/residency/fellowship thing is just a formality...
In any case my point still stands. All the power to PAs who want to do this. But as time goes on and more US med schools open it is going to be extremely difficult for non-US senior med students or at the minimum non-US med school grads to match. It is already beyond competitive for surgical fields. And medical fields are going to be taken up by more US grads squeezing out independent applicants (as the PAs in such programs, which I assume must be accredited, are).
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deleted6669
I said the caq's are taking off and some employers are requiring them
you said not really.
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deleted6669
what I meant was pa's completing the bridge program to become physicians go through all the steps including residency/boards/etc to become "legit" specialty physicians. sorry if I was confusing. a point of clarification, these are DO programs so they have fewer folks to compete with for DO residency slots. (at present they are required to do an osteopathic residency).
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Ok. If that is the only thing in your post that I could have said not really to (and coupling that with the context from the rest of my post which you erased from your quote) then my bad
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oh alright. This whole bridge program stuff is sort of interesting because I don't understand why a PA would want to do this. 1. It takes a long long long time, lots of debt, tons of work, etc. 2. Doing so gives up a lot of perks of being a PA of which there are many. 3. if a person wants more independence they can work in fields or jobs which provide more. 4. There is no guarantee that a PA who does this will match.
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deleted6669
1. more respect( don't knock it until you don't get it)
2. more money( 2-3x as much in most fields)
3.it takes 6 yrs during which you can supplement your income by working as a pa. the pa's I know who have gone to medschool work a few shifts/week, especially during ms 2-4, not so much 1st yr.
4. there is only so much independence you can get as a pa. I think there are probably a dozen em pa jobs in the entire country at which I would be truly happy. they are all very rural and no way in hell my wife would want to live in any of those places.
5. most pa's who go back to school either go into family medicine which is less competitive or have an "in " at a residency program before they go back to school. I know some folks who matched at places they used to work for example. regarding specifically the bridge folks, they have to go to DO residencies which tend to be less competitive than allopathic residencies. also, believe it or not, most pa's who go back to school do better than the avg student because much of 2nd -4th yr is review so they can take more time to focus on the stuff they don't know. I guarantee you no pa will learn much new material in their history and physical exam course for example. we already did the same class, at many places alongside medical students.
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Personally respect, to learn more and lastly money. My debt will be only 16k unless I break my contract with my job.
I have a feeling a lot of PAs can keep the debt low
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deleted6669
yup. and a lot of these folks opt for nhsc, military, etc for repayment.
if someone offered to pay for my medschool and give me a living stoipend I would go back.
right now my opportunity cost though is > 1 million dollars(lost salary + costs associated with school).
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