PA limitation compared to MD

[Makati2008]

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is all of the medical school basic science curriculum really needed to practice medicine.
Makati, as you know at this point having done both pa and do, the big difference between pa school and medschool is the ms1 year. the question is do you really need to have a strong grasp of embryology and histology to be a primary care provider? do you think most fp docs 10 years out of residency could pass the same basic sci. tests they did as ms1's?

1.)Nope. I could only see it useful for a pathologist but I might be wrong on that one.
2.)Honestly if you gave them three months of study time yes but I don't think the margin would be as good as it would be for a fresh MS2.

 

[deleted6669]

1.)Nope. I could only see it useful for a pathologist but I might be wrong on that one.
2.)Honestly if you gave them three months of study time yes but I don't think the margin would be as good as it would be for a fresh MS2.

if you gave ME 3 months of study time to cram with study guides I could probably pass them too. it wouldn't be a glorious pass but it would be a pass.

 

[SpecterGT260]

I would agree if you said primary care and emergency medicine. many em pa's practice essentially independently. I never work with my sponsoring physician as I work solo nights. there is no other clinician in house after midnight. I am also responsible for emergency coverage for a small number of inpatients during this time.
our communication is an email or a note in my box maybe once/mo saying "did you consider this?" or (more often) "this pt is bogus, I know her, don't write her for any more narcs, ok?

I was including EM in that. But I wasn't clear

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[SpecterGT260]

is all of the medical school basic science curriculum really needed to practice medicine.
Makati, as you know at this point having done both pa and do, the big difference between pa school and medschool is the ms1 year. the question is do you really need to have a strong grasp of embryology and histology to be a primary care provider? do you think most fp docs 10 years out of residency could pass the same basic sci. tests they did as ms1's?

I think this misses the point. Is the info itself necessary? No. But didactic training will shape the way people think about things. I currently can't recall 90% of what we did MS1 year verbatim. However I am aware of what I have lost there. This, in my opinion, is very valuable. Exposure to that information will increase the degree to which people know what they don't know.

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[deleted6669]

1.)Nope. I could only see it useful for a pathologist but I might be wrong on that one.
.

medschools are starting to recognize this. yet another medschool goes to a 3 yr curriculum by limiting basic medical science exposure:
http://www.nytimes.com/2012/12/24/e...-courses-through-medical-school.html?hp&_r=1&
" "We're confident that our three-year students are going to get the same depth and core knowledge, that we're not going to turn it into a trade school," said Dr. Steven Abramson, vice dean for education, faculty and academic affairs at N.Y.U. School of Medicine.
Dr. Steven Berk, the dean at Texas Tech, said that 10 or 15 other schools across the country had expressed interest in what his university was doing with a similar program.
You're going to see this kind of three-year pathway become very prominent across the country," Dr. Abramson predicted. "

at what point does medschool become pa school + another semester or 2?

 

[Makati2008]

medschools are starting to recognize this. yet another medschool goes to a 3 yr curriculum by limiting basic medical science exposure:
http://www.nytimes.com/2012/12/24/e...-courses-through-medical-school.html?hp&_r=1&
" “We’re confident that our three-year students are going to get the same depth and core knowledge, that we’re not going to turn it into a trade school,” said Dr. Steven Abramson, vice dean for education, faculty and academic affairs at N.Y.U. School of Medicine.
Dr. Steven Berk, the dean at Texas Tech, said that 10 or 15 other schools across the country had expressed interest in what his university was doing with a similar program.
You’re going to see this kind of three-year pathway become very prominent across the country,” Dr. Abramson predicted. "

at what point does medschool become pa school + another semester or 2?

Isn't there a few PA schools that are almost 3 years now?

 

[deleted6669]

Isn't there a few PA schools that are almost 3 years now?

most are 26-28 months.
a few like use are 3 yrs with 18 mo didactic and 18 mo clinical.
then there are "direct entry " programs for high school grads that are 5 years long and grant an m.s.
not a big fan of these.
http://www.duq.edu/academics/schools/health-sciences/academic-programs/physician-assistant

 

[SpecterGT260]

most are 26-28 months.
a few like use are 3 yrs with 18 mo didactic and 18 mo clinical.
then there are "direct entry " programs for high school grads that are 5 years long and grant an m.s.
not a big fan of these.

I have similar feelings about the direct entry med programs.

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[deleted6669]

I have similar feelings about the direct entry med programs.

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why? they still do a residency on completion.
my problem with direct entry pa is that the students have no prior hce like traditional pathway students. this is the foundation of the pa concept.
med students have an extended residency to learn clinical medicine. pa's have to hit the ground running day 1 at their first job with some modicum of competence.
I considered the direct entry md program at washington university in st. louis as a high school student. in retrospect I should have done it...

 

[duckie99]

medschools are starting to recognize this. yet another medschool goes to a 3 yr curriculum by limiting basic medical science exposure:
http://www.nytimes.com/2012/12/24/e...-courses-through-medical-school.html?hp&_r=1&
" “We’re confident that our three-year students are going to get the same depth and core knowledge, that we’re not going to turn it into a trade school,” said Dr. Steven Abramson, vice dean for education, faculty and academic affairs at N.Y.U. School of Medicine.
Dr. Steven Berk, the dean at Texas Tech, said that 10 or 15 other schools across the country had expressed interest in what his university was doing with a similar program.
You’re going to see this kind of three-year pathway become very prominent across the country,” Dr. Abramson predicted. "

at what point does medschool become pa school + another semester or 2?

hmmmm ...bro you're a PA. That's fine. That's the path you chose. I'm sure you do lots of great work and are good at what you do. But you are not a "doctor". No one sees you as a "doctor" and no one sees PAs as equivalent to doctors. They simply are not.

I'm not going to sit here going through these "PA residencies" and looking for lapses in training. PAs are trained to do specific jobs and this stratification is even more evident with these so-called residencies for you guys. You're putting what is essentially a 3rd year med student at the level of a MD fellow with training. You miss what that fellow learns in his/her 3-5 years of residency training. And so as I said you don't know what you don't know. As a result you may not recognize when such is the case. It is true the same applies to physicians but the training of a physician is such that what they "don't know" is much smaller than what a PA does not know. I've worked with several PA students at a top program and it's evident they are not at the same level of knowledge base as the medical students. So comparing a physician in any field with a similar number or years practicing to a PA the knowledge gaps would also be pretty obvious. The reason you don't see this in your everyday life outside of this forum is because people are polite. But I would bet most of your physician friends would essentially agree with me.

 

[SpecterGT260]

why? they still do a residency on completion.
my problem with direct entry pa is that the students have no prior hce like traditional pathway students. this is the foundation of the pa concept.
med students have an extended residency to learn clinical medicine.
I considered the direct entry md program at washington university in st. louis as a high school student. in retrospect I should have done it...

Because I don't think there is an 18 year old in existence that has any idea what they really want. I think undergrad is valuable for experience. We don't need medical automatons. We need people turned physicians.

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[tco]

The argument part of this thread is idiotic. PAs do not function as physicians. They are meant to be physician ASSISTANTS - to take the workload off of physicians. Yes, you likely function better "as a physician" than many (if not most or all) PGY-1's with your experience. I am also as certain that you function below the level of many PGY-2's, and nearly every (if not all) PGY-3's function better as a physician than you do. I'm assuming you work with IM residents, if not, factor in the proper numbers for 1/3, 2/3, 3/3...That's okay though, PA's. They're *supposed to* function better as physicians than you. That's both of your jobs. Deal with it! In fact, LPNs are closer to physicians than PA's are...They're trained to function at the level of a PCP in the extreme rural areas where PCPs don't want to practice.

Go back to rational discussions now, please.

 

[Makati2008]

The argument part of this thread is idiotic. PAs do not function as physicians. They are meant to be physician ASSISTANTS - to take the workload off of physicians. Yes, you likely function better "as a physician" than many (if not most or all) PGY-1's with your experience. I am also as certain that you function below the level of many PGY-2's, and nearly every (if not all) PGY-3's function better as a physician than you do. I'm assuming you work with IM residents, if not, factor in the proper numbers for 1/3, 2/3, 3/3...That's okay though, PA's. They're *supposed to* function better as physicians than you. That's both of your jobs. Deal with it! In fact, LPNs are closer to physicians than PA's are...They're trained to function at the level of a PCP in the extreme rural areas where PCPs don't want to practice.Go back to rational discussions now, please.

Well I am assuming your either being sarcastic, made a typo, or much worse........

 

[tco]

Well I am assuming your either being sarcastic, made a typo, or much worse........

Typo. LNP not LPN.

And I'm not kidding about the LNP. That's what they were designed for....

 

[SpecterGT260]

Well I am assuming your either being sarcastic, made a typo, or much worse........

Yes

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[Makati2008]

Typo. LNP not LPN.

And I'm not kidding about the LNP. That's what they were designed for....

Lol what a joke you know nothing about PAs poor guy and its not lnp or lpn. PA and NPs are both trained for that reasoned you mentioned. Now go stir up bs elsewhere

 

[deleted6669]

Typo. LNP not LPN.

And I'm not kidding about the LNP. That's what they were designed for....

wow, you really have no frickin clue at all...amazing...
lpn= licensed practical nurse. that's 1 yr after high school
np=nurse practitioner = 2 yrs after rn. may be done entirely online with "clinicals" arranged by the student.
pa's get a full year of clinical exposure equivalent to the ms3 year.
np's get 500 -800 hrs done part time.
I'm sorry but anyone with half a brain would see pa training> np training.....ask your physician colleagues here. they will all agree.
wow, just, wow.

 

[SouthSideSteve]

Typo. LNP not LPN.

And I'm not kidding about the LNP. That's what they were designed for....

http://www.occupybacon.net/OB/wp-content/uploads/2012/09/Never-Go-Full-******.jpeg

 

[tco]

Lol what a joke you know nothing about PAs poor guy and its not lnp or lpn. PA and NPs are both trained for that reasoned you mentioned. Now go stir up bs elsewhere

Absolutely incorrect. A PA must always have a physician available to see a patient if need be. A licensed nurse practitioner (LNP) can treat certain conditions without the need for consult with a physician. These are legalities, and they can vary by state, but are a general rule.

LNP was a position created during the physician shortage in the 1970's. They now function very similarly to PA's, but that's because the work is easier and they can make more money, not because the training is any different than it was before.

Maybe you should do some homework before you claim that I'm "spouting off bs."

https://portal.utpa.edu/portal/page...me/pasp_home/pasp_jobs/jobs_files/pascope.pdf

http://www.tnaonline.org/Media/pdf/apn-ama-sop-1109.pdf

 

[deleted6669]

. Yes, you likely function better "as a physician" than many (if not most or all) PGY-1's with your experience. I am also as certain that you function below the level of many PGY-2's, and nearly every (if not all) PGY-3's function better as a physician than you do. .

no pgy 1's have my experience. many of them were not even born when I started working in emergency medicine. I teach residents. it's part of my job. I write their evals. 3rd years are pretty good. pgy1 and pgy2 are getting there but they don't know a lot of what I do, either procedurally or just plain clinical knowledge base. ( I am speaking of fp or im residents working in em, not em residents). sure, they can manage primary care pts better than I can, that is what they were trained to do. I can manage urgent and emergent patients better than they can. that is what I was trained to do.

 

[swamprat]

emdpa:
2
The whole clinical exposure prior to PA school is BS. I guarantee if you took 2 fresh out of school PAs we'll call them PA-A and PA-B where PA-B had the healthcare experience prior to PA school and A didn't the outcomes would be the same on their first job. My friend got into PA school with hours racked up as an EMT basic. You could be an xray tech and rack up the hours. All these ancillary healthcare jobs do not even relate to what you do when your a PA so why does it make the newly graduated PA "competent" ? Are you equating a residency to working as an emt basic? I know your not but I really don't get the "prior healthcare experience" line. I think that's more out of tradition because of what the PA was originally created for before this new breed of students who don't want to put in the work so I'll go to PA school came around.

 

[deleted6669]

Absolutely incorrect. A PA must always have a physician available to see a patient if need be. ]

totally wrong. a pa must be able to be in communication with a physician by phone if needed. I have several good friends who are pa's who work in the aleutians with no physician within 600 miles. I have several other friends who staff rural er's in maine and vermont with no on site physician.
I work solo with no arrangement for an md to see pts.
if I think they need more than I can provide they are transferred to the local trauma ctr which has a cath lab.
in 12 years at my current job I have never called my sponsoring physician at night to come in and if I did he would laugh at me. I call consults on the phone like anyone. if someone "demands " to see a physician I tell them to go to another facility. that isn't an option where I work.

 

[Makati2008]

Absolutely incorrect. A PA must always have a physician available to see a patient if need be. A licensed nurse practitioner (LNP) can treat certain conditions without the need for consult with a physician. These are legalities, and they can vary by state, but are a general rule.

LNP was a position created during the physician shortage in the 1970's. They now function very similarly to PA's, but that's because the work is easier and they can make more money, not because the training is any different than it was before.

Maybe you should do some homework before you claim that I'm "spouting off bs."

https://portal.utpa.edu/portal/page...me/pasp_home/pasp_jobs/jobs_files/pascope.pdf

http://www.tnaonline.org/Media/pdf/apn-ama-sop-1109.pdf

Bro your own colleagues think your a ******. You know nothing about MY profession. As for NPs your wrong compare the hrs in training. But again if your pro-NP that's more on you bser.

If your talking about nps being independent in some states your right.(only way they are closer to being a doc and IMO dangerous)

Lastly why is there a PA-Physician bridge and Nps not included.......also I have tons of real life experience in healthcare how about you?

 

[tco]

totally wrong. a pa must be able to be in communication with a physician by phone if needed. I have several good friends who are pa's who work in the aleutians with no physician within 600 miles. I have several other friends who staff rural er's in maine and vermont with no on site physician.
I work solo with no arrangement for an md to see pts.
if I think they need more than I can provide they are transferred to the local trauma ctr which has a cath lab.
in 12 years at my current job I have never called my sponsoring physician at night to come in and if I did he would laugh at me. I call consults on the phone like anyone. if someone "demands " to see a physician I tell them to go to another facility. that isn't an option where I work.

Interesting, because I had this exact discussion with numerous PA's at my facility, and they've told me exactly what I'm saying. Neither of those documents specifically addresses whether or not a physician needs to be physically present in the facility. What state are you in? I'm in WV...

 

[deleted6669]

emdpa:
2
The whole clinical exposure prior to PA school is BS. I guarantee if you took 2 fresh out of school PAs we'll call them PA-A and PA-B where PA-B had the healthcare experience prior to PA school and A didn't the outcomes would be the same on their first job. My friend got into PA school with hours racked up as an EMT basic. You could be an xray tech and rack up the hours. All these ancillary healthcare jobs do not even relate to what you do when your a PA so why does it make the newly graduated PA "competent" ? Are you equating a residency to working as an emt basic? I know your not but I really don't get the "prior healthcare experience" line. I think that's more out of tradition because of what the PA was originally created for before this new breed of students who don't want to put in the work so I'll go to PA school came around.

no, of course emt-basic doesn't= residency. the importance of prior experience is to learn the language and culture of medicine. as someone who has trained pa students and newly graduated pa's for many years you will just have to believe me that pa's with prior experience are better clinicians for the first several years than those without experience. the newer folks make more mistakes and get more complaints and have more issues with other hospital staff because they don't know enough to not tell the chief of nursing to clean up poop when a tech is standing right there...." well, it said rn on her coat, isn't that why she's here?"
I'm also a fan of high level hce for those going to pa school. by that I mean medic/rn/rt.

 

[deleted6669]

Interesting, because I had this exact discussion with numerous PA's at my facility, and they've told me exactly what I'm saying. Neither of those documents specifically addresses whether or not a physician needs to be physically present in the facility. What state are you in? I'm in WV...

laws vary by state. I will check WV.

 

[tco]

Bro your own colleagues think your a ******. You know nothing about MY profession. As for NPs your wrong compare the hrs in training. But again if your pro-NP that's more on you bser.

If your talking about nps being independent in some states your right.

Lastly why is there a PA-Physician bridge and Nps not included.......also I have tons of real life experience in healthcare how about you?

Fortunately, I couldn't care less what my own colleagues think of me or think of what I say.

Your profession is part of the medical profession - one that is extremely complex. If you work in the United States, I very much doubt that you know the intricacies of the law, even in your profession, in every state. Like I said in my last post, I had this exact discussion with a room full of PA's not three weeks ago and they told me what I'm rehashing here, unless I misunderstood them.

Lastly, I have no healthcare experience outside of medical school. What does that matter in this discussion? I'm very open to being educated.

I would assume that "NPS" (I've never heard them called that) do not have a bridge because they were (as I've said before) created with the idea in mind that they would pick up the slack in areas that physicians were lacking, but that's speculation. "NPS" were meant to patch up the lack of physicians very quickly, but they don't have the same basic science training as medical students (or even PA's for that matter). I never claimed they did...My claim is that they were designed to function more like physicians in rural settings.

 

[swamprat]

no, of course emt-basic doesn't= residency. the importance of prior experience is to learn the language and culture of medicine. as someone who has trained pa students and newly graduated pa's for many years you will just have to believe me that pa's with prior experience are better clinicians for the first several years than those without experience. the newer folks make more mistakes and get more complaints and have more issues with other hospital staff because they don't know enough to not tell the chief of nursing to clean up poop when a tech is standing right there...." well, it said rn on her coat, isn't that why she's here?"
I'm also a fan of high level hce for those going to pa school. by that I mean medic/rn/rt.

But prehospital care they don't really get the lingo of the hospital no? I mean you do know better but I just think its strange since the jobs are so completely opposite.

 

[deleted6669]

But prehospital care they don't really get the lingo of the hospital no? I mean you do know better but I just think its strange since the jobs are so completely opposite.

the first phase of a paramedics clinical training is in a hospital setting. I spent 6 months in a hospital before ever starting my field training.

 

[deleted6669]

I just checked WV pa laws. very restrictive compared to many others but md does not need to be on site for pa to practice:
http://www.aapa.org/uploadedFiles/c...Affairs/Resource_Items/West Virginia 2011.pdf
compare that to wyoming:
http://www.aapa.org/uploadedFiles/c...State_Affairs/Resource_Items/Wyoming 2011.pdf
no required md presence, no required md chart review.

in north carolina(the best state to practice in as a pa) "supervision" is defined as a pa meeting with a physician for 30 min every 6 months to "discuss the practice dynamics" of the pa.
pa's in many states can own their own clinics and hire a doc to push some paper to fulfill the minimal state requirements. some states require md on site 4 hrs/week. others require 10% chart review within 1 month, etc
I think you misunderstood the "room full of pa's" or you work with the most ignorant group of pa's in existence.

 

[Makati2008]

Fortunately, I couldn't care less what my own colleagues think of me or think of what I say.

Your profession is part of the medical profession - one that is extremely complex. If you work in the United States, I very much doubt that you know the intricacies of the law, even in your profession, in every state. Like I said in my last post, I had this exact discussion with a room full of PA's not three weeks ago and they told me what I'm rehashing here, unless I misunderstood them.

Lastly, I have no healthcare experience outside of medical school. What does that matter in this discussion?

I made that comment because academic medicine is a bit different then private practice. Also as EMED mentioned rules vary by state. Some are very restrictive(oh for ex) while others are pretty open.

And to throw the ball back at you I doubt you know the finer points of Mlp education. Again if NPs are so much closer to Docs why are they not included in the bridge programs? I don't know maybe you can educate me.

 

[swamprat]

the first phase of a paramedics clinical training is in a hospital setting. I spent 6 months in a hospital before ever starting my field training.

Yeah and its 10 hours in an ER for an emt

 

[tco]

I made that comment because academic medicine is a bit different then private practice. Also as EMED mentioned rules vary by state. Some are very restrictive(oh for ex) while others are pretty open.

And to throw the ball back at you I doubt you know the finer points of Mlp education. Again if NPs so much closer to Docs why are they not included in the bridge programs? I don't know maybe you can educate me.

I've never talked to LNPs (NPs, nps, NPS?) about their training. I've only talked to PA's here about the difference between the two and how their scope of practice differs. I can't answer the questions you pose here. I speculated in my previous response in an edit.

It seems, to me, that NPs were slapped together to patch the wound of the previous physician shortage. After that was resolved through that program plus subsidizing medical education to pump out physicians faster, NPs really had nowhere to go, especially when PA's were refined to ease the burden on physicians. NPs blurred their scope of practice with PA's to get better jobs, and to avoid being phased out. Talking with my PA friends that are currently going through school, they have more rigorous training than nursing school that is very similar to medical school, but it's not quite the same (we go into greater depth of the basic sciences). The bridge is much simpler to make between PA and MD, but NPs are (like I've said) still trained to be able to patch the wound in rural medicine. They choose not to, and we end up right back at our original problem. If laws vary enough state to state that PA's can do it as well, I apologize, but that's not their original intent (and not how they're used here).

 

[deleted6669]

Yeah and its 10 hours in an ER for an emt

as I mentioned before I believe every pa school applicant should first be a paramedic, rn, or resp. therapist for several years before going to pa school.
even an emt-basic with 5 years of experience knows something about the language and culture of medicine.

 

[tco]

I just checked WV pa laws. very restrictive compared to many others but md does not need to be on site for pa to practice:
http://www.aapa.org/uploadedFiles/c...Affairs/Resource_Items/West Virginia 2011.pdf
compare that to wyoming:
http://www.aapa.org/uploadedFiles/c...State_Affairs/Resource_Items/Wyoming 2011.pdf
no required md presence, no required md chart review.

in north carolina(the best state to practice in as a pa) "supervision" is defined as a pa meeting with a physician for 30 min every 6 months to "discuss the practice dynamics" of the pa.
pa's in many states can own their own clinics and hire a doc to push some paper to fulfill the minimal state requirements. some states require md on site 4 hrs/week. others require 10% chart review within 1 month, etc
I think you misunderstood the "room full of pa's" or you work with the most ignorant group of pa's in existence.

I'd rather not talk about the exact syntax of the conversation. We'll just say that I'm 99% sure that I understood them correctly. They were complaining and repeated it several times.

 

[SpecterGT260]

Fortunately, I couldn't care less what my own colleagues think of me or think of what I say.

Your profession is part of the medical profession - one that is extremely complex. If you work in the United States, I very much doubt that you know the intricacies of the law, even in your profession, in every state. Like I said in my last post, I had this exact discussion with a room full of PA's not three weeks ago and they told me what I'm rehashing here, unless I misunderstood them.

Lastly, I have no healthcare experience outside of medical school. What does that matter in this discussion? I'm very open to being educated.

I would assume that "NPS" (I've never heard them called that) do not have a bridge because they were (as I've said before) created with the idea in mind that they would pick up the slack in areas that physicians were lacking, but that's speculation. "NPS" were meant to patch up the lack of physicians very quickly, but they don't have the same basic science training as medical students (or even PA's for that matter). I never claimed they did...My claim is that they were designed to function more like physicians in rural settings.

NP or DNP. Not NPS. There is also not an "LNP". You haven't heard that one either even if you think you have you are mixing and matching

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[Makati2008]

I've never talked to LNPs (NPs, nps, NPS?) about their training. I've only talked to PA's here about the difference between the two and how their scope of practice differs. I can't answer the questions you pose here. I speculated in my previous response in an edit.

It seems, to me, that NPs were slapped together to patch the wound of the previous physician shortage. After that was resolved through that program plus subsidizing medical education to pump out physicians faster, NPs really had nowhere to go, especially when PA's were refined to ease the burden on physicians. NPs blurred their scope of practice with PA's to get better jobs, and to avoid being phased out. Talking with my PA friends that are currently going through school, they have more rigorous training than nursing school that is very similar to medical school, but it's not quite the same (we go into greater depth of the basic sciences). The bridge is much simpler to make between PA and MD, but NPs are (like I've said) still trained to be able to patch the wound in rural medicine. They choose not to, and we end up right back at our original problem. If laws vary enough state to state that PA's can do it as well, I apologize, but that's not their original intent (and not how they're used here).

I'll give you a heads up on this. There are different flavors of NPs. Psych. NP,FNP,etc... and some of those "NPs" can't even do what you just mentioned. In my first job I had to replace an ACNP because the state where I was told her that ACNP can only see adults and they are not allowed to see pediatric patients. So how could they truly solve the rural medicine problem in all areas....they can't.

 

[SpecterGT260]

I'd rather not talk about the exact syntax of the conversation. We'll just say that I'm 99% sure that I understood them correctly. They were complaining and repeated it several times.

If I am following correctly you are suggesting we buy hearsay of a couple PAs that may themselves be misinformed over produced cited regulations?


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[deleted6669]

pa's were designed to do the work physicians don't want to do at the times and places they don't want to do it. almost since the beginning of the profession almost 50 years ago pa's have been working on indian reservations and in rural practices. we are trained to practice medicine AND to know when to consult a physician.
if there were enough docs to go around pa's would not be necessary. I get that. and in a perfect world every pt would see a seasoned physician. I get that. this isn't a perfect world. even with all the md/do/pa/np folks out there healthcare in the u.s. is headed for a cliff in a few years with a huge shortage of providers.

np's are licensed by nursing boards to practice in a single specialty. look at the programs:
family np
psych np
women's health np
acute care np
peds np
etc.

if a peds np wants to practice adult medicine they have to go back to school. pa's have a much more broad based clinical exposure and are able to switch specialties(especially primary care specialties) without additional training. I could go work as a fp pcp tomorrow in a rural area with no onsite md fairly easily(and take a 40% pay cut). if I wanted to work in surgery I could get a job but would have a really sharp learning curve because I haven't been in the o.r. in years.

 

[Makati2008]

I'd rather not talk about the exact syntax of the conversation. We'll just say that I'm 99% sure that I understood them correctly. They were complaining and repeated it several times.

That exact syntax could probably clear up a lot of confusion. But I can understand to keep yourself discrete you don't want to divulge the conversations contents which I can understand.

Also I doubt if your 99% sure of the entire conversation. If your a medical student like me I am thinking your day is more than busy enough to remember a convo with a bunch of PAs with 99% content.

 

[Wilf]

totally wrong. a pa must be able to be in communication with a physician by phone if needed. I have several good friends who are pa's who work in the aleutians with no physician within 600 miles. I have several other friends who staff rural er's in maine and vermont with no on site physician.
I work solo with no arrangement for an md to see pts.
if I think they need more than I can provide they are transferred to the local trauma ctr which has a cath lab.
in 12 years at my current job I have never called my sponsoring physician at night to come in and if I did he would laugh at me. I call consults on the phone like anyone. if someone "demands " to see a physician I tell them to go to another facility. that isn't an option where I work.

I would be very angry if I went to the ER and only a PA was there to see patients. I don't know what patient population you are dealing with but most middle class and upper class patients would not put up with that level of care.

 

[deleted6669]

NP or DNP. Not NPS. There is also not an "LNP". You haven't heard that one either even if you think you have you are mixing and matching

Sent from my DROID RAZR using SDN Mobile

check his post count. the devil is in the details:

Senior Member
Status: Medical Student
Join Date: Apr 2008
Posts: 666

 

[tco]

If I am following correctly you are suggesting we buy hearsay of a couple PAs that may themselves be misinformed over produced cited regulations?


Sent from my DROID RAZR using SDN Mobile

No. I was explaining why I was so misinformed. Now I'm not.

np's are licensed by nursing boards to practice in a single specialty. look at the programs:
family np
psych np
women's health np
acute care np
peds np
etc.

Most of the time, it seems, that if NPs practice rural medicine, they end up as a family NP. You take what you can get.

 

[tco]

check his post count. the devil is in the details:

Senior Member
Status: Medical Student
Join Date: Apr 2008
Posts: 666

I saw that too.

 

[Makati2008]

I would be very angry if I went to the ER and only a PA was there to see patients. I don't know what patient population you are dealing with but most middle class and upper class patients would not put up with that level of care.

It happens all the time bro/sis. And I will tell you I take my family member to a HUGE private practice(so huge it engulfs the town with its docs in this speciality(I know I suck at spelling lol)) and they were told they HAVE to see a NP. I sat in the chair and tried to explain for her and needless to say I lost that battle. And the clientele there was/is pretty affluent.

 

[deleted6669]

I would be very angry if I went to the ER and only a PA was there to see patients. I don't know what patient population you are dealing with but most middle class and upper class patients would not put up with that level of care.

most of my patients are either uninsured or on state assistance. many have no pcp at all. maybe 10% have "real" insurance and they seem happy to see me as most of the time at night my facility only has a 1-2 hr wait while the local trauma ctr often has a 3-4 hr wait. 1/2 of the er staff at the trauma facility is pa's (we are part of the same group) so even going to a major medical ctr doesn't guarantee you a doc although there I suppose you could ask for one. your chart would then go to the back of the rack with a "wants md only" sticker on it and several hours later you would be seen. if it was for something procedural the doc would then ask the same pa you refused to see earlier to do the procedure because we do most of the procedures in the dept and are likely better at them. I have personally sutured up facial lacs on the small kids of several of my physician partners. one of my physician partners recently told me he has not done an I+D or sutured a lac in over 10 years.

 

[tco]

I would be very angry if I went to the ER and only a PA was there to see patients. I don't know what patient population you are dealing with but most middle class and upper class patients would not put up with that level of care.

Like I hinted at in my previous post, sometimes you have no choice. What do you do if there isn't a physician within 3 or 4 hours of you? In southern WV, there are places that literally have no physicians within a reasonable driving distance. The nearest hospitals are hours away because of the mountains. If you show up and there's a PA that will treat you right away, you'll be grateful.

 

[deleted6669]

Like I hinted at in my previous post, sometimes you have no choice. What do you do if there isn't a physician within 3 or 4 hours of you? In southern WV, there are places that literally have no physicians within a reasonable driving distance. The nearest hospitals are hours away because of the mountains. If you show up and there's a PA that will treat you right away, you'll be grateful.

yup, and if you treat them with disrespect they won't help you out as much as they might otherwise.
maybe once or twice a year folks tell me they want to wait for a physician. " Ok. it's midnight, a doc will be here at noon. have a seat in the waiting room"
we staff pa's 24/7 and have a single doc as double coverage on dayshift only.

 

[rog411]

yup, and if you treat them with disrespect they won't help you out as much as they might otherwise.
maybe once or twice a year folks tell me they want to wait for a physician. " Ok. it's midnight, a doc will be here at noon. have a seat in the waiting room"
we staff pa's 24/7 and have a single doc as double coverage on dayshift only.

if one wants to do rural family med or EM, would you recommend doing PA school instead of MD? (considering time and cost investments)

 

[VisionaryTics]