PA student vs Med student

[supercut]

I've just found out that we will have a PA student on my current rotation, as well as a M3 student and a sub I.

I've never supervised PA students before. What should the expectations be when compared to MD students. I'm assuming they should be different since PA school is NOT medical school. We don't have any PA on the rotation, but we do have some NP (don't know what role they will have in this). I heard last year, that a NP student got to scrub cases in preference to the MD student (this is trauma so cases can be fairly sparse)

I think the expectations should be different for a PA student, since their role is supposed to be different. But I'm not sure how I should handle this.

My role is the primary ED consultant, and thus I will be the one that student spend a lot of time with.

Any advice is appreciated!

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[kinetic]

Must ...refrain ...from ...cheap shots!

 

[DrDre']

No real personal exp in the medical hierarchy but my friend who is a PA was considered similar/ equal to M3 in rotations. There is less depth of knowledge but similar breadth from the PA students I interact with- they take almost all the M2 classes with us.

 

[Mr_Money]

Must ...refrain ...from ...cheap shots!

Same here! Though it is taking a gargantuan effort on my part not to.

 

[GMO2003]

Same here! Though it is taking a gargantuan effort on my part not to.

get over it...some PAs are great while others are highly suspect..the same goes for physicians as well...how good of a doc or PA you become ultimately depends on how hard you work AFTER med school/PA school

 

[dry dre]

get over it...some PAs are great while others are highly suspect..the same goes for physicians as well...how good of a doc or PA you become ultimately depends on how hard you work AFTER med school/PA school

While many PAs are great, physician training should prioritize physicians in training (particularly when cases are limited).

I don't see the utility in demonstrating something to a student that won't provide them particular utility in their future practice. Why spend time teaching things that won't be used later by the student. It's like trying to explain foreign policy to Pres. Bush or something. If that dog ain't never gonna hunt....

 

[Vukken99]

PA students are in the bottom of teaching.

Medical Students and Residents should have highest priority..

Who are you kidding....

I have seen once an attending was treating the PA student like Goddess because she was attractive...

But, we have to be very objective....teach those who will follow us....

I personally would not teach a PA...I am sorry.....

Tell them to find another soul selling hospital or attending to do so....

My objective and goal is to teach future physicians...

 

[Aloha Kid]

The answer is simple. They chose to train along side medical students. SOOO. 1. Your teaching content should not differ. 2. Your expectations for both should not differ. 3. If one shows more initiative and interest than the other, then teach them more.

 

[njbmd]

Hi there,
There is no difference between teaching a PA student and a medical student on a surgery service. They both have the same learning needs: ward care, scrubbing, surgical indications etc. You may want to provide some extra coaching for the surgery shelf exam for the medical student but other than that, both students need good solid teaching about surgical issues and how to handle them, especially when to consult surgery and when not to.

njbmd

 

[Vukken99]

I give medical students more and harder rotation....

Med studs soon will be Physicians with full responsibilities....

If you care so much about teaching PAs why dont you become a PA..

there are lots of spongy brains in this profession...

 

[DoctorDoom]

Supercut, I generally did not have too much difference in the way I treated the PA vs MD students, as they trained together. Honestly, I had slightly higher expectations for the MD students and made sure they scrubbed more and had somewhat more clinical/ procedural exposure, depending on level of interest. For me, MD students have had more teaching before coming on service and so should have a better general knowledge of medicine. MD students will carry more ultimate responsibility, so they are slightly higher on the student hierarchy, but PA students need to be taught well also because they will play a significant role in patient care. The situations where I had to choose one or the other to go into a case were rare, and the great qualifier here is the interest of the individual student.

Vukken, your position is shortsighted and arrogant. It does no good except satisfy your ego.

 

[Partialdoctor]

Here at Yale, we train alongside PA's during our MS3 year and I always forgot they weren't medical students. They were treated exactly the same and as far as I could tell their knowledge base was the same. 99% of our PAs at Yale are phenomenol, especially on the surgical services. PD

 

[Vukken99]

These are the same people who destroy our profession....

HOw can you compare PA student with Medical Students??????

it is not arrogance...it takes lots of work to be where we are...and you want to share or give the piece of pie to some wannabes...

Did you guys know some big practices in california the PAs call themselves Physicians?????? Is that crazy or what....

That happens some cheese brain like you guys allow that...no excuses...

Plus why we are cheating our patients with substandard care???? huh???

And, why are we billing as physician rates for PA services???

Does it mean that PAs are equal to MD????

Think first before opening your mouth cuz people may find out about your puny frontal lobe

 

[GMO2003]

These are the same people who destroy our profession....

HOw can you compare PA student with Medical Students??????

it is not arrogance...it takes lots of work to be where we are...and you want to share or give the piece of pie to some wannabes...

Did you guys know some big practices in california the PAs call themselves Physicians?????? Is that crazy or what....

That happens some cheese brain like you guys allow that...no excuses...

Plus why we are cheating our patients with substandard care???? huh???

And, why are we billing as physician rates for PA services???


Vukken...chill man
Does it mean that PAs are equal to MD????

Think first before opening your mouth cuz people may find out about your puny frontal lobe

 

[DoctorDoom]

These are the same people who destroy our profession....

HOw can you compare PA student with Medical Students??????

it is not arrogance...it takes lots of work to be where we are...and you want to share or give the piece of pie to some wannabes...

Did you guys know some big practices in california the PAs call themselves Physicians?????? Is that crazy or what....

That happens some cheese brain like you guys allow that...no excuses...

Plus why we are cheating our patients with substandard care???? huh???

And, why are we billing as physician rates for PA services???

Does it mean that PAs are equal to MD????

Think first before opening your mouth cuz people may find out about your puny frontal lobe

Up until now I have refrained from replying to your error-filled and often non-sensical posts because I figured it was due to language difficulties. Apparently I was wrong. Your opinions are based on faulty recollection of alarmist anecdotes and your ad hominem attacks are not even the least bit original.

PA students for the time of the rotation should be treated equally with other students for the purpose of their rotation. No one is saying they are exactly equal.

A piece of the pie to wannabe's? PA's have their role, and teaching someone who will assist me and other physicians in patient care to do their job better does not automatically mean that they will some how undermine our profession. How exactly will having bad PA's benefit patients? Not teaching them will not make them go away. Regardless, medicine is not some zero sum game. But if you want to see the profession, alied professions and the industry like some jackal at a giraffe's corpse, and chase away the other jackals, that's your choice.

Medical students are referred to as physicians all the time. So some PA's are called physicians in some random article you read about CA. By whom? Confused patients? There are certainly situations where insurance and administration push the use of PA's beyond appropriate bounds, but you have not offered any concrete examples that are relevant to the issue at hand. How does not teaching a PA student change any of that? Your point only seems to demonstrate the jealous territorialism of someone who is more concerned with their title and the hierarchy, rather than making sure patients get a good provider.

Your behavior helps guarantee the substandard care that you decry. If you are so concerned about proper standards of care and limiting the role of PA's, worry about policy and proper supervision of allied professionals instead of simply focusing on things like nomenclature, billing, and status. PA does not equal substandard, and when we bill for the PA's services that's care provided by my service extender that I get paid for. At the very least get your facts about the system right. And no, it does not mean they are equal to physicians.

Traitors? Who assigned you the informant to the secret police in this medical dictatorship? Alarmist proselytizing equating the teaching of others to a general betrayal of the profession is ridiculous. Our profession is indeed under tremendous pressures, your close-minded adversarial approach is of little utility.

If anyone's capacity for higher order thought processes are in question at this point, it is yours.

 

[shag]

"Physician Assistants"

That should just about sum it up.

As a med student, I had no problem with rotating with PA students (actually SA students), but I was burned on more than one occasion. Several were truly hard workers and took inititiave to learn. Unfortunately, many were not as dependable as medical students, which forced me to waste time double checking them and fixing their mistakes and omissions.

At my med school, med students were treated as bottom of the barrel. When we were on the same service as SA's, they had first pick at call days and often screwed us. In addition, most refused to come in early to help pre-round when we were slammed. The residents felt pressure from above to include these guys, so they ended up going to the OR while we did their floor work.

Now, as an intern, they are in an even greater position to burn me. The attendings want the SA students involved and jump my case because I'm not involving them enough. He!!, one SA on service absolutely refuses to even show up until 7:00am. His responsibility is to assist the medical students in making the list for our service. We round at 7:15, so the only way I could include him would be to give him the list and present patients to him!

As far as knowledge bases being the same, most PA's can roll Kerlix just as well as the med students. Try pimping a PA on the pathophysiology of disease, and the gap in knowledge base is easily demonstrated.

 

[DoctorDoom]

"Physician Assistants"

That should just about sum it up.

As a med student, I had no problem with rotating with PA students (actually SA students), but I was burned on more than one occasion. Several were truly hard workers and took inititiave to learn. Unfortunately, many were not as dependable as medical students, which forced me to waste time double checking them and fixing their mistakes and omissions.

At my med school, med students were treated as bottom of the barrel. When we were on the same service as SA's, they had first pick at call days and often screwed us. In addition, most refused to come in early to help pre-round when we were slammed. The residents felt pressure from above to include these guys, so they ended up going to the OR while we did their floor work.

Now, as an intern, they are in an even greater position to burn me. The attendings want the SA students involved and jump my case because I'm not involving them enough. He!!, one SA on service absolutely refuses to even show up until 7:00am. His responsibility is to assist the medical students in making the list for our service. We round at 7:15, so the only way I could include him would be to give him the list and present patients to him!

As far as knowledge bases being the same, most PA's can roll Kerlix just as well as the med students. Try pimping a PA on the pathophysiology of disease, and the gap in knowledge base is easily demonstrated.

I'm sorry to hear about this. Your chiefs should have dropped the hammer on the people who show up late. Inclusion is fine, but not catering to disinterested clowns. Inversion of hierarchy to the point of the intern presenting to the PA student is lunacy; I'd fail that student. Sounds like your department lacks leadership, which screws you and sends morale down the toilet.

There is no doubt the knowledge base is different. It may not be apparent to students all the time, but the attentive resident should find the difference in knowledge apparent.

If you would, PM me the name of your institution so I'll never have to work there!

 

[Vukken99]

The greedy old timers.....

And, some zombi followers....
Why dont you look at the current billing status on physician extenders...
The general accounting office will not allow further billing in such a manner...
just look at their website coming from the federal website...

Now, I could never understand Physician extender concept....
Extender???? In some ER not so rural by standards are run by PAs not a single physician on board.

Surgical subspecialists should not be so happy about having a PA as a forever resident kind of attitude.

I remember when I was scrubbing on a neurosurgical case, and the attending asked me regarding the PA student who was retracting for us...If I would hire him when he graduates from PA school. I said he was Okay for hire...then the attending looked at me as if I was not saying something right and later I said only if I had the total control over them...since they are not physicians....

Then my attending told me"that's right....right answer..never relegate your duty of a physician to an undertrained person never. That is equating with butchery versus medicine."

Who the hell are you to judge me....
I defend the right of those coming after me and other fellow colleague.

I have two friends who are in primary care and they were fired and soon to realized some cheap PA labor replaced them so fast...

That is why I am pissed about rest of us...who think PAs will be forever slaves and source of higher billing....

And, who are you kidding so many hospital on financial ruins how can you even dare to say billing is not important you fool. Then work for freee..if you like that....

I really can't understand some cheese airheads in this fields.....
Most med students I have taught during my rotations had gone to stellar places and had become chief residents in their respective programs from general surgery to ER.....

 

[Sage880]

Uh, does PA really stand for "Physician's Assistant"?

Seriously, I don't know what it stands for.

 

[DoctorDoom]

blah blah blah...

Sigh... why did I even bother.

Yes PA is physician's assistant, SA is surgical assistant.

 

[MacGyver]

Here at Yale, we train alongside PA's during our MS3 year and I always forgot they weren't medical students. They were treated exactly the same and as far as I could tell their knowledge base was the same. 99% of our PAs at Yale are phenomenol, especially on the surgical services. PD

So why the HELL are you paying double the money and spending an extra year in school when the PAs have the same knowledge base?

thats a bad decision my friend.

If what you say is true, then in the long term, healthcare market wont allow doctors to get paid 2 or 3 times the amount of PAs if you are right about PAs being functionally equivalent.

 

[MacGyver]

DoctorDoom,

The fundamental faulty premise of your logic is that since PAs are supposedly under MD control, that its OK to give them equal access to knowledge, procedures, responsibilities, etc.

What you dont understand is that this status quo will not always be the case.

When you teach a PA just like a med student, give him the same responsibilities as a med student, he's a de facto med student replacement. The only thing holding the PA in check is the requirement that they be supervised by MDs.

However, this is changing rapidly. Once the PAs get trained to the equivalent of MDs, they start looking around and wondering why the hell they have to be supervised by MDs. Then they take those arguments to the state medical boards and the state legislatures.

If you are going to treat PAs the same as med students, then trying to put arbitrary restrictions on them in later practice just wont fly. Hell, if you really believe that a PA student should be treated the same as a MD student, then how in the hell can you justify not letting the PA continue into residency just like a normal MD student would?

The arbitrary limitations you impose on PAs, while they exert de facto MD-equivalent powers in practice is a method that the market will not support long term. Eventually, the PAs will win the right to practice solo, and then your paradigm of MDs supervising PAs is going to fall apart. They will become just like the NPs.

Consider this: in most rural areas, PAs are already functionally equivalent to MDs and independent from them as well. Its routine in these areas to find PAs that NEVER see an MD on sight. The MD instead reviewes their charts OVER THE INTERNET weeks later after the patient has already been treated and released. Does that sound like supervision to you?

If that happens in a rural area, then how can you expect it not to spread to urban areas as well? Thats a purely arbitrary distinction, and the logic supporting such a two-tiered supervision system WILL NOT STAND IN THE LONG TERM.

 

[doc05]

the PA students should assist the medical students.

 

[fourthyear]

DoctorDoom,
"If you are going to treat PAs the same as med students, then trying to put arbitrary restrictions on them in later practice just wont fly. Hell, if you really believe that a PA student should be treated the same as a MD student, then how in the hell can you justify not letting the PA continue into residency just like a normal MD student would?"

This IS the difference - we don't learn everything about being a doctor in med school, we learn much more of in it residency. PA's don't get to go to residency programs and I doubt they ever will - it's tough enough for DO's of or MD's from outside the US to match into many residencies.

I guess I see the fear of the threat of PA's taking over more of our responsibilities. But I think this fear is similar to that anesthesiologists had about the CRNA's in the early 90's - if you don't know there was a huge fear CRNA's would take over their jobs, so serious that residency programs went unfilled b/c MD's thought they'd have no jobs when they finished...we all know that fear did not come true, anesthesiologists are among the best paid specialists currently.

My view is we should all help educate all health care professionals we happen to interact with. We don't have any PA's or PA students, but I often find myself teaching the nursing students around the hospital b/c they happen to be around observing procedures and asking questions - why shouldn't they benefit from our knowlege like our med students do? Don't I want them to become informed and useful nurses who can be helpful to me in the future? Sure I do, so why would I withold information for them to somehow try to protect the security of my own job? - just plain silly and selfish.

 

[Vukken99]

Sure you can do lots of teaching...

But, in primary care area the competition in jobs are already affecting Physician's market.

PAs pay like 2k a year on malpractice and they can secure multiple jobs.

Physicians have to pay a lot more so they dont have the luxury of being independent contractor always an employee type of arrangement.

And, why PAs are getting almost same pay in primary care setting???
why???

it is not the fear..
I see it happening....

why would we teach PA students so much...so they can go and bluff on some physician's face????

Nothing wrong with teaching but the reality is teaching is not free....
It is a priviledge to be taught in medicine and it is something you have to earn
after proving with your numbers and hardous work....

Just because your hospital makes some money making arrangement with some BS school, that does not mean that they are allowing qualified people to be taught. The implied permission to touch someone's body for healing also it is an earned priviledge.

Respect yourself.
Respect and protect your profession and
guide those who come after us.......

 

[DoctorDoom]

DoctorDoom,

The fundamental faulty premise of your logic is that since PAs are supposedly under MD control, that its OK to give them equal access to knowledge, procedures, responsibilities, etc.

What you dont understand is that this status quo will not always be the case.

When you teach a PA just like a med student, give him the same responsibilities as a med student, he's a de facto med student replacement. The only thing holding the PA in check is the requirement that they be supervised by MDs.

However, this is changing rapidly. Once the PAs get trained to the equivalent of MDs, they start looking around and wondering why the hell they have to be supervised by MDs. Then they take those arguments to the state medical boards and the state legislatures.

If you are going to treat PAs the same as med students, then trying to put arbitrary restrictions on them in later practice just wont fly. Hell, if you really believe that a PA student should be treated the same as a MD student, then how in the hell can you justify not letting the PA continue into residency just like a normal MD student would?

The arbitrary limitations you impose on PAs, while they exert de facto MD-equivalent powers in practice is a method that the market will not support long term. Eventually, the PAs will win the right to practice solo, and then your paradigm of MDs supervising PAs is going to fall apart. They will become just like the NPs.

Consider this: in most rural areas, PAs are already functionally equivalent to MDs and independent from them as well. Its routine in these areas to find PAs that NEVER see an MD on sight. The MD instead reviewes their charts OVER THE INTERNET weeks later after the patient has already been treated and released. Does that sound like supervision to you?

If that happens in a rural area, then how can you expect it not to spread to urban areas as well? Thats a purely arbitrary distinction, and the logic supporting such a two-tiered supervision system WILL NOT STAND IN THE LONG TERM.

Firstly, I never said that there should be total equal access to teaching for a PA and an MD student. Reread what I actually posted. My comments are limited to the role of a resident for the period of an introductory rotation for students.

Restrictions on PA's are not arbitrary, but are well established. Educational differences abound. Right from the beginning their educational exposure is different, and equating access to the introductory functions of junior members of a service with the slippery slope of total equivalence allowing PA's into residency is ludicrous.

In rural areas the reason there is PA practice is because of two reasons: physician's not wanting to practice in those areas and attempts to save on costs. The former is how things work, the latter is addressed by policy based oncertification and training in areas where physicians do involve themselves. NEITHER has anything to do with treating PA and MD students similarly on a 6 week rotation block where they are being exposed to the very basic functions of junior clerks as appropriate to their prior training leading to PA encroachment on MD turf.

Your posts reveal an amazing lack of reading comprehension and factual knowledge, much less logical rigor. Now, I've asked you this before and I'll ask again, what level of training are you?

 

[jmattwilson]

Sure you can do lots of teaching...

But, in primary care area the competition in jobs are already affecting Physician's market.

PAs pay like 2k a year on malpractice and they can secure multiple jobs.

Physicians have to pay a lot more so they dont have the luxury of being independent contractor always an employee type of arrangement.

And, why PAs are getting almost same pay in primary care setting???
why???

it is not the fear..
I see it happening....

why would we teach PA students so much...so they can go and bluff on some physician's face????

Nothing wrong with teaching but the reality is teaching is not free....
It is a priviledge to be taught in medicine and it is something you have to earn
after proving with your numbers and hardous work....

Just because your hospital makes some money making arrangement with some BS school, that does not mean that they are allowing qualified people to be taught. The implied permission to touch someone's body for healing also it is an earned priviledge.

Respect yourself.
Respect and protect your profession and
guide those who come after us.......

"Hardous" what the H#$% is that

 

[niko327]

FYI, there are surgical as well as many other residency programs for PAs. These programs have PAs working side by side with residents, sharing call, etc. Check out the Montefiore Surgical PA residency for your own edification.
By the way, the PA mindset concerning independent practice without any physician supervision is virtually non-existent. PAs for the most part seem to be very happy with their role, and take much pride in their relationship with physicians and medical board oversight. You may want to check out the "physician associate" website (spell the two words as a single word and add the com at the end)to get some sense of the current attitude towards PA independent practice, I think you may find that the sky isn't falling afterall.
Medical students who have no practical experience do not need assistants. The "heirarchy" does not exist when you are a student. It is inappropriate to suggest that a medical student should have a PA student assist them. When you're a medical student, PA student, nursing student, you are on rotation to learn what you'll need to be competent in your position. so relax, you'll have plenty of time to make an ass out of yourself in front of other professionals after you've graduated if you chose to.

 

[Teufelhunden]

Hell, if you really believe that a PA student should be treated the same as a MD student, then how in the hell can you justify not letting the PA continue into residency just like a normal MD student would?

Brilliant point.

Listen, I'm not going to get into this whole PA vs MD/DO debate. IMHO, there probably isn't much of a difference between an M3 and a PA student. In fact, I'm now realizing that just about all of college and my M1 and M2 years were a total waste of time (or at least could have been condensed considerably).

Honestly, I think you could probably sneak PA students into internship/residency and I guarantee you that no one could tell them apart.

With that said....as someone who's been in school now going on 8 years...I have a lot vested in protecting my future profession. So naturally I don't want PAs and NPs coming in and taking my job (or watering down the salaries).

I don't know what I'm saying...I just finished a 13.5 hour day on surgery and my brain is fryed. I'll post on this topic again later when I'm rested. In summary though, my point was just that even if PAs can function as physicians, we should do all we can to prevent that they do....cuz we're the ones that jumped through all the f***ing hoops and go to school for a million years.

 

[SOUNDMAN]

I was wondering whether to reply to this thread even in the first place, but there are so many misconceptions about PA's here that it would take a week to go through them all. The main ones are these:

PA's MUST be supervised by a physician. What supervision is defined as is determined by the state you are licensed in.

PA's are NOT lobbying to practice without supervision from a physician. It would totally defeat the purpose of being a PA.

PA's have their place in medicine. Primarily in the beginning to provide in underserved areas that YOU physicians refused to go to. PA's are here to stay, you might as well teach them so they can provide the best care for your patient, not because your worried about your job or your 150-200 K salary.

 

[pikachu]

um, question: if all PA's "must be supervised by a physician" then who is supervising them in the areas "that YOU [i.e. trained doctors] refused to go to" (where, presumably, there are no actual doctors to do the supervising)?

 

[MacGyver]

um, question: if all PA's "must be supervised by a physician" then who is supervising them in the areas "that YOU [i.e. trained doctors] refused to go to" (where, presumably, there are no actual doctors to do the supervising)?

Answer: "supervision" is a useless word to describe the duties of many PAs.

this is what constitutes "supervision" for many PAs:

1) "Supervising" doctor absolutely never sees them in person.

2) "Supervising" doctor reviews 10% of charts over the internet 5 weeks after the patient is discharged.

if thats "supervision" then I'm Micky Mouse!

 

[DoctorDoom]

Brilliant point.
Honestly, I think you could probably sneak PA students into internship/residency and I guarantee you that no one could tell them apart.

With that said....as someone who's been in school now going on 8 years...I have a lot vested in protecting my future profession. So naturally I don't want PAs and NPs coming in and taking my job (or watering down the salaries).

I totally disagree... the difference would be tremendous, especially once diagnostic and other clinical critical skills came into play. The assumption that the only hurdle to PA students entering MD/DO residencies is based on keeping PA students away from basic clinical education during clinical clerkships/rotations misses the big picture and does not reflect a real appreciation of your education, your knowledge base and your abilities gained during the rest of medical school. Not to mention the less than arbitrary standards that are in place preventing just such a replacement from happening.

Should there be delineation between appropriate physician and PA roles? Sure. However, the idea that teaching basic functional skills on a junior clerkship to PA students leading to the replacement of MD/DO students in residencies is a bogeyman, and not a brilliant point at all.

 

[pikachu]

Answer: "supervision" is a useless word to describe the duties of many PAs.

this is what constitutes "supervision" for many PAs:

1) "Supervising" doctor absolutely never sees them in person.

2) "Supervising" doctor reviews 10% of charts over the internet 5 weeks after the patient is discharged.

if thats "supervision" then I'm Micky Mouse!

and don't forget 3) "Supervising" doctor takes the legal hit when the PA screws up and the practice gets sued...

 

[Paulista]

The concept of supervision does not exist with PAs.

In many medium sized cities, PAs are opening their own offices!!!

I see the demise of FP specialty very soon!

 

[bobby6]

You're an absolute idiot if you think patients would rather see a PA than a doctor, especially in metro areas where doctors are easily accessible. Many patient will change doctors if they are repeated relegated to seeing the PA and not the doctor. Put yourself in the patient shoes and think about it. Would you rather see a PA when you can easily see a doctor? Family practice is here to stay and many do quite well in large metro areas making well over $150K.

 

[TheBestEver]

Let me start off by answering the original post: No you should NOT teach those PA students. Like Doc5, one of my medical student couterparts said "PA-Students should assist Medical Students" We should not let some PA come along and take from us what is rightfully ours, our divine right. Everyone (PA, DDS, DPM, CEOs, etc) just wants to be like us because we are DOCTORS.

I did not go through 8 years of college and med school and hopefully 10 years of Residency (CT-Surgery/Heart transplant here I come) AND rack up more than $300,000 in loans to be replaced by some PA student.

They do provide substandard care just like VUKKEN99 said. For instance, I once saw a PA student almost kill a pt by injecting KCL percutaneously through the subxyphoid region into the LV, but I saved the day. If I didn't step in and show him that it was supposed to be in an IV the pt would have died. Good thing I memorized Harrison's. I once heard PA students learn by using "Books-on-tape", they dont even know how to read.

FP is going to be extinct? I thought it already was. I heard the ACGME was disbanding all FP residencies as of October 2004. It must be true, I read it on SDN posted by one of my brilliant med student counterparts. PA are trying to take over what is ours. The sky is falling!!!

We should not teach those PA Students. True, I am only twenty something and I am only in my fourth year of medical school but I am going to be a DOCTOR, so what I think must be right.

Let us all band together in a grass roots movement, and kick them out of modern medicine; soon they will be as extinct as the dinosaur. Then once again, it will be us and the nurses. We will reign supreme. Who is with me? Vukken99...Papilloma...Macgyver....We are the future of modern medicine....The Brain Trust.

TheBestEver

 

[Amik25]

TheBestEver,

I once saw a physician order Nimbex for a patient who was not intubated (nor did he need to be) because he could not insert an art line due to the patient's agitation. By suggesting a little versed instead, I saved this patient's life. Does that mean that all physicians provide substandard care? Obviously not! Just because one PA did something stupid, does not mean that all PA's are incompetent.

 

[pikachu]

Just because one PA did something stupid, does not mean that all PA's are incompetent.

perhaps, but what about a PA who can't detect sarcasm?

 

[Amik25]

Pikachu,

I am not a PA but you are correct about not detecting sarcasm because I did not read the entire post. I simply skimmed through....my mistake. However, I have seen several posts on this board referring to PA's, CRNA's, nurses, etc...as being inferior and unintelligent and using an example of one particular practitioner who made a mistake or did not know something he or she should have known. I simply wanted to point out that we all make mistakes and we all learn something from our patients and colleagues every day!

 

[TheBestEver]

Who was being sarcastic?

 

[Seaglass]

The concept of supervision does not exist with PAs.

In many medium sized cities, PAs are opening their own offices!!!

I see the demise of FP specialty very soon!

Vukken? Vukken is that you?

 

[Dr. Dix]

One thing I never understood - medical students rotate with doctors, nursing students rotate with nurses, pharmacy students rotate with pharmacists...

HOW COME PA-STUDENTS DON'T EXCLUSIVELY ROTATE WITH PAs??

How is a doctor going to teach a PA-student how to be a good PA?

As a med student, I had the pleasure of rotating with PA students. Just like there's a "nursing school of thought", I think there is a "PA school of thought". The things theyl learn in their preclinical year is different from what we learned in our preclinical years.

Notice - I did NOT say better, worse, superior, inferior... I said different.

The fact is that physicians get more years of schooling and training than PAs. It would be unfair to the PA students to compare them to med students.

Personally, I found that PA students - at least the good ones - knew a lot about clinical protocols and diagnostic algorithms. However, they do not know all the pathophysiology, the biochemistry, etc. that we know.

If you or a family member got deathly ill, would you rather see a physician or a PA?? PAs serve a purpose and they have a place in the healthcare system. Their place, however, is NOT equivalent to that of physicians.

Since 3rd/4th years of medical school are mostly clinical -> teach them the same as med students. It would be scary to suggest that PA students not be given the opportunity to scrub into cases and do procedures - since they do not go through residency, this is their only opportunity to learn.

 

[niko327]

Hey Dr. Dix,
PA students are training to be medical care providers. Medical Care Provider is not a generic term, it means a health care provider capable of diagnosing, working/up, treating etc. Included in the group of medical care providers are PAs, NPs, MDs and DOs only. They need to be competent, they're dealing with people's health and lives (obvious right?) accepting substandard medical training is simply not acceptable for the type of responsibilities that PAs will be responsible for. What if a PA is staffing a rural ER without an MD onsite. What does he tell the trauma pt who needs a thoracotomy, "sorry I didn't think I really needed to know about doing one of these." Training under experienced MDs affords the greatest opportunity to get the best training possible. I agree with some of what you said but not the PA philosophy thing. What exactly is the difference between MD vs PA philosophy? Please, I seriously want to know.

 

[dry dre]

Hey Dr. Dix,
PA students are training to be medical care providers. Medical Care Provider is not a generic term, it means a health care provider capable of diagnosing, working/up, treating etc. Included in the group of medical care providers are PAs, NPs, MDs and DOs only. They need to be competent, they're dealing with people's health and lives (obvious right?) accepting substandard medical training is simply not acceptable for the type of responsibilities that PAs will be responsible for. What if a PA is staffing a rural ER without an MD onsite. What does he tell the trauma pt who needs a thoracotomy, "sorry I didn't think I really needed to know about doing one of these." Training under experienced MDs affords the greatest opportunity to get the best training possible. I agree with some of what you said but not the PA philosophy thing. What exactly is the difference between MD vs PA philosophy? Please, I seriously want to know.

MD vs PA philosophical differences?

The most striking difference to me is the apparent level of comfort many midlevels have in being a "medical care provider" without having the same level of training (7-11 years physician vs 2-3 years + OJT). I personally would not work as the sole staffer for a rural ER if I wasn't fully trained and qualified. There is no way in hell that I'd feel qualified to staff an ED (or many other roles taken by midlevels) after 2 years of midlevel training + OJT. I would feel as though I were cheating my patients in not bringing before them what is traditionally referred to as the standard of care. I went to medical school for this reason (I had considered PA school).

I used to accept the notion that a midlevel in Nowhere, Idaho is better than nothing. I don't feel this way any longer, in particular because patients deserve better (i.e. the standard of care). If there is a shortage of docs, we need to make more (not create and industry based on stop-gap practitioners).

The more you know, the more you recognize what you don't know. What you don't know can allow patients to experience an increase in morbidity, or result in death. You may never recognize your contribution to an increase in morbidity/mortality if you don't have a comprehensive understanding of human disease (and of course treatment if you recognize the disease). Not everyone has routine illness... Having worked with PA students I have often been struck by the lack of familiarity of many diseases that often came up in differential diagnoses. It's as though the top 5-7 diseases of every system is familiar but the knowledge base has, thereafter, a steep drop-off.

Certainly docs miss a hell of a lot of stuff. Certainly there are a lot of midlevels that are as smart and keen as docs. I'm not anti midlevel, though I don't think that midlevels are (by definition of title and/or skill) sole practitioners. I can't imagine that patients will accept, in the long run, to be seen by a mid-level when they come to understand the differences in medical doctor vs midlevel training in recognizing, understanding, and treating disease.

 

[niko327]

OK, that's all very nice, but the question of philosophical difference was not answered. You talk about how MDs know more, and I don't disagree, but the disparity in knowledge base is not a philosophical difference. I must confess (before I go on any further) that I suspect very little difference in the philosophies between the two professions.
Despite any pre-existing disdain for the PA profession it's here to stay, it increases the public's access to healthcare and it fills many voids. PAs are a financial and healthcare reality. Since PAs are going to be involved in healthcare as medical care providers (even as dependent as they may be) they should still get the best training possible.

 

[dry dre]

Since PAs are going to be involved in healthcare as medical care providers (even as dependent as they may be) they should still get the best training possible.

I agree with this and I think most other people here do as well. Just not at the expense of a medical student's training/education.

 

[Neuron]

Let me start off by answering the original post: No you should NOT teach those PA students. Like Doc5, one of my medical student couterparts said "PA-Students should assist Medical Students" We should not let some PA come along and take from us what is rightfully ours, our divine right. Everyone (PA, DDS, DPM, CEOs, etc) just wants to be like us because we are DOCTORS.

I did not go through 8 years of college and med school and hopefully 10 years of Residency (CT-Surgery/Heart transplant here I come) AND rack up more than $300,000 in loans to be replaced by some PA student.

They do provide substandard care just like VUKKEN99 said. For instance, I once saw a PA student almost kill a pt by injecting KCL percutaneously through the subxyphoid region into the LV, but I saved the day. If I didn't step in and show him that it was supposed to be in an IV the pt would have died. Good thing I memorized Harrison's. I once heard PA students learn by using "Books-on-tape", they dont even know how to read.

FP is going to be extinct? I thought it already was. I heard the ACGME was disbanding all FP residencies as of October 2004. It must be true, I read it on SDN posted by one of my brilliant med student counterparts. PA are trying to take over what is ours. The sky is falling!!!

We should not teach those PA Students. True, I am only twenty something and I am only in my fourth year of medical school but I am going to be a DOCTOR, so what I think must be right.

Let us all band together in a grass roots movement, and kick them out of modern medicine; soon they will be as extinct as the dinosaur. Then once again, it will be us and the nurses. We will reign supreme. Who is with me? Vukken99...Papilloma...Macgyver....We are the future of modern medicine....The Brain Trust.

TheBestEver

 

[emtp2pac]

so I should stop teaching medstudents and interns when they rotate with me for their er procedures month?
come on folks, if you have something to teach please do so without regard to degree. I teach high school students/emt's/medics/nurses/pa's/np's/medstudents/residents, whoever is assigned a rotation in the er. when I have the priviledge of interacting with a specialist I try to learn as much as I can from them.there is no exclusive right to medical knowledge......