PA to Physician

PACmatthew

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    This will probably start the most confrontational debate ever on this forum, but I hope not. My name is Matt, and I have been a PA since 98'. I will be leaving my incredible job in family practice to start medical school in early August. I woke up one morning in July this past summer only to realize that I was not satisfied with my career. Even with a doc who treats me like another doc, and a wonderful salary and benefits, I was not happy.

    I registered for the MCAT and enrolled in Organic and Physics (my last pre-reqs) in the course of a few days. I scored average on the MCAT and was accepted at two medical schools in Texas.I love my patients, and I know that they will miss me as well, but I sort of became tired of the rhetoric that our profession dishes out in regard to "team approach to medicine", when in fact PA's generally work independently. I was tired of feeling like I had to apologize that the doctor was not available, and I felt like I was doing my patients a disservice by being their only source of medical care and not a physician. My patients do not and did not seem to mind, but I did mind. In fact, I began to feel like I was practicing medicine without a license. I honestly feel that PA's have a useful niche in medicine, but I think that niche has been expanded to the point that it now is more common to hire a PA because it is financially appealling to group practices, when in fact the nature of PA's is to use them where physicians will not go. I applaud those PA's who have gone to underserved areas of the country, but most PA's practice in urban areas where patients could just as easily find a physician to see.

    I find it comical how we try to distance ourselves from NP's in order to stay in the good graces of physicians, when most of us all know that we are just as independent if not more than NPS's. I don't know any NP's that operate their own practices, so it is only in the legal sense that PA's are any different than NP's in regard to independence. The bottom line is that we are competition for physicians, so why do we try so hard to hide this fact. An example of this competition is my own position in family practice. My group could easily find and take on a new FP out of residency, but why not hire a PA who they can pay 25% less or so, and who has no real future stake in the practice? I will always respect our profession and the members of our profession, but I hope to see our ranks become more about doing what we were designed to do, promoting care in underserved areas.

    Lastly, I think our political leaders do not do enough to help promote the PA to physician transition because they do not want people to feel that such a transition is appropriate. How many of you know of any real AAPA sanctioned discussion or agreement in place to help PA's transition into medicine more easily as physicians? The only thing similar to such can be found at the end of every issue of PA magazine or the AAPA newsletter, and it is an add for IUHS, a bogus internet medical school designed to make PA's think they can complete a physician education online somehow! I am ashamed that our leaders even allow such an add to be placed. In my transition into becoming a physician, I found nothing that even discussed how to make such a leap, and thus I am doing it the old fashioned way. I think in the future it will become acceptable and most practical for there to somehow be a way to combine the trainging of a PA and a physician. Without such, there will always be frustrated PA's who wish to take the next step, and overqualified 1st year PA-C medical students. It is entirely realistic that a PA could be credited for at least 18 months of medical school, mostly during years 2 and 3.
     

    Emedpa

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      I agree that there should be advanced standing for pa's attending medical school. at the very least we should skip the entire 3rd year because we have already done it as the second year of pa school. same rotations by place and length, same responsibility for patient care.also courses like history taking and ethics could be skipped because they are redundant.there is a move afoot to change the pa title from assistant to associate as this more accurately reflects our scope of practice.I think that is years away and by that time I fully expect to be emedpa, do or md.
       

      MrBob

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        Very good post, Matt.......I can overlook the podiatrist business <LOL> Your point is well made here. ya know, pal you don't owe anyone but your family and yourself any explanations. It isn't any of our business....this is your albatross, you gotta get it off your back however it comes. I venture to say you will be much happier as a MD than you are now....good luck my friend.........

        My E-mail is <[email protected]> if you wanna take it off line............
         
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        Bandit

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          emedpa, I like your post. I have been one of the most vocal advocate to the PA profession and I love what I do. But, if there were indeed advanced placement in med school for PA`s I would give it serios consideration. I am 36 yaers old now (I know there are older that do) but just dont have it in me to start from scratch and not practice for another four years.
           

          efs

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            Just my two cents worth.

            I don't see it (advanced standing for PAs) happening, simply beacuse that would be a loss of revenue for the schools. They would never go for it, as long as they fill their classes.
             

            PACmatthew

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              Hey Eric,

              You might have had a bit of a leg up on me when you argued your Podiatry issues, and I actually respected you for that. But I have to say that you are way out of your league here on the PA forum. First of all, it already happens that PA's get advanced standing at certain med schools. And did you know that most medical schools drool over the idea of having a few transfer or advanced standing candidates because they often lose one or two people in the first year. That is when they really lose revenue, because they often have noone to fill the spot for the next three years. Maybe you are saying that you "don't see that happening" because you hope it doesn't. Would it just offend the hell out of you if a PA could get advanced placement in a medical school. Maybe you should call Duke where it has already occurred. A PA, like a physician, is trained in the unlimited version of medicine, not the limited form like you guys. I know that PA's aren't doctors, but if somehow all the physicians in the country dissappeared, the most useful profession to step up would be the PA profession. PA's hide behind this shield of "team approach" and "supervised medicine", but everyone who is anyone knows that PA's operate independently 99% of the time. And if you want to know the truth, there is noone more qualified to go through medical school than a PA. Not a Pod, not a chiro, not a PhD of any sort, and especially not a Nurse Practitioner. (You notice they don't have a forum on here!)And when I am done with medical school, I can promise you that there will be papers written, phone calls made, and policy changes about considering PA's for advanced standing in medical school. Do you want to know why? Because I am going to do it the hard way and show them what a PA is capable of. I intend to produce "neurology"-like board scores on the COMLEX and USMLE only to use them to do FP. When it is all said and done, I intend to tell my story to the higher ups so that they will consider allowing PA's to enter medical school in advanced standing. I do however think that PA's should be assesed to determine if they are qualified for medical school before being accepted, and I think they should have to pass competency exams of the rigorous sort for any course they wish to be exempt from. It will become more common because there are more PA's than ever. There has always been a small percentage of PA's who have gone on to medical school, but that percentage has grown as the total has grown. Please enlighten us more though Mr. Eric, referencing your extensive knowledge of the practice of medicine.
               

              MrBob

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                ...especially not a Nurse Practitioner. (You notice they don't have a forum on here)...

                Uhhhhhhhhhhhhh....Matt.......there is an NP forum here.............

                Yer not battin' too well here are ya? (LOL)Keep swingin' though....even a blind hog finds a truffle once in a while........

                (you know I'm just kiddin' with you here don't you?)
                 

                Freeeedom!

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                  My 2 cents...
                  My school DID NOT grant advanced standing to ANYONE including 1 PharmD, 1 PA, 4 Nurses, 1 O.T., 2 Chiropractors, 1 Dentist, 2 R.T.'s, and 1 PT (myself)... NONE OF US were in the top 5% of class. We did not deserve advanced standing, though prior experience did help. Advanced standing is both dangerous and irresponsible, because it does not equally assess all students.
                  The best students in our class (of 225) were the hard -core types...they guys/gals that LIVE for studying. One must judge your academic skills against the best in your MEDICAL SCHOOL class and not on your Physician Assistant class, PT class, Pharm D class etc. Advanced standing should not be given to ANY allied health field.
                   

                  PACmatthew

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                    Bob,

                    As I said, NP's don't have THEIR OWN forum on this site! They share is with RN's! And if you have been there, you will see that it gets about as much activity as a "used undergarments section" gets in a resale store! The NP discussion is one that I will not get myself bated into talking about.

                    Advanced standing is left up to the individual schools. I agree that it becomes dangerous and even problematic to try and grant such standing, and thus I am simply doing it the hard and right way. I am asking for no advanced standing whatsoever, mostly because hearing things a second time will make them stick in my mind.

                    And by the way, academics does not make the doctor. People skills make the physician I hate to say, and often the brainiacs go into fields where they are not required to be real personable anyway. Lets face it, medicine isn't PhD physics, and you don't need to be anywhere near the top 5% to be successful.
                     

                    MrBob

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                      I don't want to get into that debate either. It's sort of like my Harley Davidson.....every time I get into a debate of Jap-vs-Harley it turns into a hate thing......

                      One comment I would like to make is that I do not agree with the agenda of our professional organization, the AAPA. I daily become angry at the privildge NP's have of owning their own place of business in my state, that PA's are not afforded. I almost wonder if it isn't a restraint of trade issue. I see the PA profession expanding their borders in the future and I do not agree with the agenda of complete subserviency in all of our work sites. The AAPA is perfectly happy being called an "Assistant" and I agree with a name change to "Associate". In fact if someone were "ballsy" enough to organize an alternative professional organization, I would be one of the first on board. I disagree with the unprofessional (as I see it) riff between the AAPA and the NCCPA. I have been a member of the AAPA for 20+ years and have not reaped ONE personal benefit from them...oh yeah they lobby for this and that and I do appreciate it but you try to call the national headquarters and get a personal answer about issues like the legality of PA's ordering durable medical goods for medicare patients and they have no idea how to, nor any desire to answer the question for you. The only correspondence I ever get from them is solicitation for a new credit card from MBNA or wherever, and a bill once a year for membership. Have you ever priced the silly looking T-shirts?????might as well be buying harley clothes.........
                      Time to get off my soapbox.....this subject does get me upset.............
                       

                      Kimya

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                        ? The reason the RN/NP board is not that busy, and I would guess that the PA board is also not that busy (only 100 or so more posts, compared with the thousands on the other boards), is because this is the student DOCTOR network. 99% of the people who come here are looking for information about becoming a doctor of some sort, and much of the posts on the "allied health" forums are from people from the allied health field that want to become a doctor for some reason or the other. There are other forums for NP's on other sites, and for PA's as well.

                        It is too bad that you are frustrated with your current situation, and also that you are taking it out on others. However, it sounds like you are doing what fits best for you. I'm sure that you will be much happier as a physician- no need to bash other professions.

                        Some of the rules and restrictions in this day and age in the medical field seem rather arbitrary. NP's "independent" practice rights vary greatly from state to state. Some states it is possible, some states require collaboration, some require supervision. I've seen programs where PA and NP are trained simultaneously, so the restrictions between the two seem rather artificial to me. The rule about having to do an AOA internship year to practice in a certain 5 states as a DO also seems counterproductive. It seems to be based more on the lobbying ability of a profession than on hard facts.
                         

                        Freeeedom!

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                          Yikes, this is a angry site.

                          My statement regarding advanced standing still holds firm. Though it may be true that you don't need to be in the top 5% to be a great physician...I wouldn't want to be in the bottom 5% of class. Doing well in school pays benefits far outweighing a good "report card"...when the differential becomes difficult, when the pimping becomes rough, when the options are narrowing...it pays to be in the top 5,10,15,25% of class! And please, let us forget about the "smart ones" being nerds, because they aren't. They were some of the most talented, driven, hard working people I had ever met. Their memory saves lives! I have often envied those who remember MOA without a shrug. There should be NO SHORTCUTS!
                          Furthermore, Advanced standing rarely even happens with transfers.
                           

                          MrBob

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                            freeedom.....won't you tell us a little about yourself.....what are you doing now, where (geographically) are you working, are you still a student, or a grad....in what field? Just curious. It will help me (at least)understand where you are coming from in some of your interesting comments.

                            Please!
                             
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                            Bandit

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                              Freedom, I agree there should be no short cuts for anyone. That being said -- is skipping histiry taking, ethics, death and dying and even a few third year rotations a short cut if you have been practicing medicine for several years? Maybe not. I would be the first to say there should never ever be advanced placement in any PD/Clin med/Pharm or any other class that might be used to draw distiction between MD`s and PA`s.
                               

                              PACmatthew

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                                Hey Whiskey Barrel,

                                Where do you get your information that FP is as competitive as neurology. Check out this website and please feel free to tell me if I am misinterpreting it, but how can you say that FP residencies are as competitive as neurology residencies? There were only 5 neurology residency programs in the entire country that did not fill all their positions, while there were over 100 FP programs that went unfilled.

                                .http://www.scutwork.com/Unfilled/index.htm
                                 

                                arraks

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                                  PACMatthew---
                                  You are just getting started with medical school in August and you have absolutely no idea what you are getting yourself into...the workload, the scut work, the stress, and being treated as the lowest of the low on your rotations. Rest assured you are thinking about the end result and not what it takes to get there, and hopefully, when it is all said and done, you will eat your words. This coming from someone who knows first hand what it is like. Until you have experienced every field that medicine has to offer, I would suggest that opinions are just that and no one cares. Have a nice day, and leave everyone else alone.
                                   

                                  PACmatthew

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                                    Hey Arraks, You don't know anything about me I can promise you. And unless you are a faculty board certified physician, then I know I have as much experience in medicine as you. Experience doesn't come from your title, but from your experiences overall. Don't tell me about scutwork. You might have a couple extra years of scutwork under your belt, but I doubt you have as much real patient experience. You are not talking to a boot-medic here. I was clamping off carotids and putting in chest tubes out in the bush while you were enjoying the freedoms I helped provide you. Let me know if your practice of medicine ever involves examining a patient under the barrage of small arms fire and artillery shelling, because until it does, don't make assumptions that your title buys you more experience than everyone else.
                                     

                                    PACmatthew

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                                      I would say it is just a tad bit late to start getting polite Mr. Arrak. You are the one with the inflammatory comments, or did you forget what you wrote the previous post? You were completely out of line. To tell me that I have no idea what I am getting into is rather insulting and blindly emited from your keyboard strokes. To tell me that I have not thought through what it takes to get where I am headed is another statement that you have no proof of. In fact, I would dare to say that you are the rookie here, not me. So what, you have a few years on me toward the "Title" but that means nothing in the end. As a military officer, I understand the chain of command and know how and when to follow orders, even when they seem pointless or callous. Being a medical student will be a vacation away from seeing 200 patients a week and doing 30 chart reviews each evening. You might actually understand this one day I hope. And your last statement about how you hope I eat my words, well this is where I should be saying....HUH? Senor, your inflammatory statements were much deserving of this rhetoric. And in the best interest of this forum, I will not reply to anything else you post because it serves no purpose. Next time drop me a personal email and we can carry on that dialogue if you wish.
                                       

                                      predoc

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                                        PACmatthew,

                                        I'm just a rookie too, but it's not too hard to diagnose your problem. You have a HUGE chip on your shoulder. The way you go off on everyone for making completely benign comments is rather comical. I particularly enjoyed the way you gave Eric an earful for foolishly suggesting that med schools are in the business of making money--shocking!

                                        I suppose it's good that you're starting medical school so that you can feel better about yourself and your profession, but, I hope that your new experiences make you a bit less defensive.
                                         

                                        med student

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                                          •••quote:••• there will always be frustrated PA's who wish to take the next step, and overqualified 1st year PA-C medical students. It is entirely realistic that a PA could be credited for at least 18 months of medical school, mostly during years 2 and 3.
                                          ••••PACmatthew I think it is true that you have lots of experience with patients etc but you still don't know anything about medical school. Until you have been there and done it all don't say you know what it is all about. It would like it if I went to boot camp for the army but never saw any action and then tried to compare myself to someone who has experienced combat. Sure we experienced some of the same things but there are allot of hidden differences that are not apperent until you actually experience them.

                                          It is true that PAs probobly know 75% of what we learn in the first two years of medical school but the problem is that medical school classes go into more depth (I admit that this is an assumption I make because the training is longer and I have not been to PA school) for a given subject than I PA class would. So the extra time we spend in class is not used to go over completely new subjects that PAs have never heard about but instead it is to learn the same genaeral material with more detail put into the class. So how can you pass out of a class you never took. I am sure you think you biochem classes were the same in PA school as they will be in medical school but the fact of the matter is they are likely to have differences that you will not know about until you take the class. I always thought that biochem was biochem no matter where you took it but now that I am done with biochem in medical school I can definately say that the difference between under grad bio-chem and med school biochem is amazing. There are many classes like this but I can agree with you that you maybe able to skip some classes such as physical diagnosis but in the long run it doesn't make a difference because you still have to take the other classes with the rest of the class before you can skip ahead to the next ones. One of the things you fail to realize is even if you skipped out of half the classes each semester of medical school it would still take the same length of time because new subjects are taught to the class as a whole so it would not be possible for you to skip ahead.
                                           

                                          MrBob

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                                            Alright kids...........lets give it a break....PAMATT wants to go to medical school and good for him....He is as entitled to whatever dream he wants as much as any of us are. He has established that he wants to advance from the PA career to the MD thing and that's his right. He is vocal and that has been established but I will say one thing....You MD students can be damned sure a "low life PA" knows exactly what you guys are going through, of have been through or are going to go through. Do you think we get these degrees from comic books? We have to go to a university just like you do, for the most part, and have to do rotations same as you, etc, etc and et al. There are a few programs which are now offering off site programs that some of us don't agree with, but they are here and we are doing the best we can to train those folks too. We have been scut workers just like you and have set in some of the same classes you do. WE have been screwed with by senior and junior residents and attendings just like you are or will be. You don't have the corner on any secret medical education here. This is a job and that's it.

                                            Man........this is no class war here....when are ya'll gonna give up the Me-vs-you thing and just do what youre here to do. either take care of people or LEARN to take care of people at whatever level you chose.....
                                            Medicine is a TEAM effort and until ALL of you get that through your independent little minds and realize that every accepted occupation has a place in the practice of caring for sick people you are gonna be nothing but alone the etire time you are trying to achieve your goals. The successfull practitioner is the one who let's each and every discipline do it's part and forgets the "I AM GOD" bulls*t that pervails among MD's PA's NP's OR techs, Nurses....you get the picture........

                                            Now I guess if I went to school for 12 years and found myself working next to a PA who only went to school 6 years and was making a little less than 100,000$ a year for those years while I was still trying to just pay back my loans, it would probably get under my skin too.....How 'bout ya'll giving the whining and sniping back and forth at each other a little pause?
                                            Or better yet .....maybe I ought to just stop reading this crap and being lured into the garbage.

                                            'Nuff said..........time to ride..........
                                             
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                                            med student

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                                              •••quote:••• You MD students can be damned sure a "low life PA" knows exactly what you guys are going through, of have been through or are going to go through. Do you think we get these degrees from comic books? We have to go to a university just like you do, for the most part, and have to do rotations same as you, etc, etc and et al ••••Damn MrBob it sounds like someone has some pent up rage. Maybe I missed it in this thread but I didn't see anything about someone saying PAs were no good. What we are talking about the similarities and the differences in the training between PA/MD schools. Now sure we all go through universities but if you fail to see the differences in experience between med school and PA school then there is not much I can do about it. What I was trying to say is PACmatthew has not even been to med school yet and he is talking about ways to change it which to seems a little strange because you should at least experience something before deciding it is bad and trying to change it. Also I do not think anyone said PAs can't comment about the health profession because obviously they they have seen I wide variety of it. But when someone who is a PA tries to comment on the training in med school this is where I have a problem. It would be like at my school we have a PT program and they take similar classes to us. If I was like PACmatthew I could try and comment on PT training because I have had similar experiences to theirs. But this would be wrong because there are lots of little differences in the training that you do not see unless you take both programs. So maybe if PACmatthew makes these comments when he is done with med school I will put more weight in them.
                                               

                                              MrBob

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                                                Yeah, Med....yer right...I got outta hand there a little, sure felt good though....

                                                PaMatt can get a little vocal at times and I have noticed that but it isn't up to me to police that sort of stuff (or any stuff for that matter).

                                                I really don't have any pent up rage...I just get tired of the bitching between professions. When ya'll get outta school there will be eonough of it out ther to choke you, so why waste a wonderful college and post grad period fooling with it now. What I need to learn to do is either quit reading this stuff or learn to read it and laugh at the foolishness of the whole thing and not respond.........Sounds almost like "my high school is better than yours..." type of stuff, don't you agree?

                                                I really apologize for getting the wand out and letting sparks fly outta it (read Harry Potter if you haven't...it really lets you be a kid again and forget real life)

                                                I am a grand father and the father of two grown children..so my natural instinct is to set in the recliner and yell "hey.....you two are getting way too loud in there...knock that **** off"(LOL)

                                                I'll step back now.............
                                                 

                                                Bandit

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                                                  This is indeed a silly arguement. I stated before that I entertained thoughts of going to med school (and still do every now and then). But to tell you the truth, and some wont like this, it has been my opinion and that of many many others (PA/MD/DO) that A good PA will know more about medicine than any med student ---even a first or second year resident. After the second year of residency then the MD`s definetely take the lead. Remind you that there are always exceptions. My point?? Not class warfare -- but many med students have no idea what the PA education is all about. Oh sure, the Med student has a MUCH stonger embryology and histology foundation ( and probably others)-- but rreally what the hell good is that when someone is code! Just respect each other. Relationships will form.
                                                   

                                                  med student

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                                                    •••quote:••• What I need to learn to do is either quit reading this stuff or learn to read it and laugh at the foolishness of the whole thing and not respond.........Sounds almost like "my high school is better than yours..." type of stuff, don't you agree?

                                                    I really apologize for getting the wand out and letting sparks fly outta it (read Harry Potter if you haven't...it really lets you be a kid again and forget real life)
                                                    ••••I have to agree with you MrBob. I think the worst bickering about who is better is pre-meds/pre-PAs, pre-whoevers. Now that I am in med school I really try and be careful and not do it myself. I also have the attitude that the most useful person in the hospital to both the patients and the doctors in the nurses they rock. So I think it is important to realize that everyone has an important role in the hospital. Harry potter is awesome!!!!!!!1

                                                    •••quote:••• but many med students have no idea what the PA education is all about. Oh sure, the Med student has a MUCH stonger embryology and histology foundation ( and probably others)-- but rreally what the hell good is that when someone is code! Just respect each other. Relationships will form. ••••I would have to agree that non of use know exactly what the others are going through. We see little bits of the field and we are wrong to try and use this little bits of info to try and make judgements about another field. That was my whole point when I was refering to PACmatthew trying to judge the medical school education process before he has even started it. I would also have to agree that all the crap I learned in histo will not help me much during a code.
                                                     

                                                    MrBob

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                                                      "Harry potter is awesome!!!!!!!1"

                                                      Ain't it though???? I've read all 4 books and my wife just laughs at me but my kid patients love it....we talk about Hagrid and that little ass "what's his name" (having a 3rd degree brain block here). See the movie!!

                                                      I saw a kid interviewed on TV who said it perfectly...You don't read Harry Potter...you watch it..........

                                                      Kept my attention way more than Guyton (physiology, you guys still using that book?)
                                                      or Harrisons.............

                                                      BANDIT........you are absolutely right and obviously have been doing this a few years...sound like a wise old fellow........
                                                       

                                                      Freeeedom!

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                                                        Bandit and Mr.Bob...are you the same person? You guys pat each other on the back like you are related or owe each other money!
                                                        Listen, I like PA's...but your statements are so anti-physician, I can't tell if you are terribly frustrated with your life or you two are Physician Assistant Lobbyist! Regarding your anti-academic stance, well it is as silly as this "going nowhere" debate is.
                                                        By the way, I think someone wanted to know my age and "rank" (as if this matters)...I am in my 30's, was a PT, recieved a Masters of Science, was a Certified Strength and Conditioning Specialist and now I am graduating from medical school.
                                                         

                                                        Bandit

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                                                          We are not one in the same! I never ever meant to come across anti physician. My brother and two best friends are physicians. I have the utmost respect for medical docs and Osteopaths. I even thought of going to med school per the discussion about "short cuts" were I sided with you that there should be NO short cuts. That being said -- is skipping history taking, ethics, death and dying and even a few third year rotations a short cut if you have been practicing medicine for several years? Maybe not. I would be the first to say there should never ever be advanced placement in any PD/Clin med/Pharm or any other class that might be used to draw distiction between MD`s and PA`s.

                                                          Hmmm, not everything that can be measured matters, and not eveything that matters can be measured. (A.I)
                                                           

                                                          MrBob

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                                                            No, we aren't the same person...but we are obviously two folks who have been around this occupation a while..........

                                                            I'm not anti- MD, BTW.....I am anti "I'm-better-than-you.....my-eductaion-outdoes-yours.....My-club/occupation-is-better-than-yours.....My Dad can bet up your dad" Bullsh*t though

                                                            As I pointed out earlier...this is....oh never mind....If I have to explain then you wouldn't understand.

                                                            Ya know...."patting each other on the back" certainly is preferable to making each other miserable by sniping at each other though....you guys ought to try it a little.......
                                                             
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                                                            MrBob

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                                                              It's the end of my day...I've seen 30+ folks in the office today and I have been thinking about this forum off and on today.

                                                              Here's the picture of me....I'm slightly graying and have a huge moustache. Imagine me sitting at a table on a Saturday afternoon with a cold brew and my bike sitting outside. I'm wearing jeans and a beat up HD t-shirt from somewhere in the world and I run across a young PA student who just wants to talk about his life and what he goes through while in school. I have been doing this a long time (been a PA, that is). I come to this forum with that same attitude. A lot of water has been under this bridge. I have worked in states where a PA could not tell a patient to continue taking aspirin, much less write a script. I have been in this state when we had to have every medication we were going to prescribe listed on an approved "formulary" and if you wrote, by some chance, off formulary, you were in a bit of trouble. Today we have narcotic privileges and can have a bit of autonomy. I remember when on call MD's would not even talk to a PA in the ER about a problem...and all that has changed (at least where I am).

                                                              I am not on this forum to start any flames....don't need any. I have a job! And a damn fine one at that. I come to this forum with the idea that I might be able to share the benefit of years of experience in the life of being a PA and what one might expect, perhaps not to trip over some of the speed bumps that some of us older guys have tripped over.

                                                              I really, honestly don't care about all this PA-to-Doc stuff and whether anyone is anything beyond a caring, compassionate human in the medical work force. I really don't care whether they are PA's or not...and have tried to make that point.

                                                              I have made the mistake of trying to make a point about bickering among each other and realize that it's like trying to make countries not fight, religions understand each other and HD riders understand why anyone would buy a foreign bike and vice-versa. Ya know what...It ain't none of my business and that is that.....

                                                              That said....I am gonna lurk this thread and just watch to see what is said. My silence (if I'm strong enough to keep my fingers off the keys) will not imply my consent with the subject, nor will it imply that I have been run off. I recognize that folks like to argue and they are gonna do it on whatever forum they choose.

                                                              My only point before I close this comment is that medicine is a team approach. If one cannot respect the other members of that group, at whatever level they are working at and let them try to do the best they can do...then that person will have a lonely unrespected career...might make plenty of $'s but when yer dead..no one will cry.

                                                              You are judged on your demeanor and professionalism....remember that students. You are judged on how you do your job...not your title. there will be dissenting comments here and I expect them...but that, folks, is it...that's the secret to being professionally successful out here. Act professional and you will be treated in kind that way.

                                                              Good luck to all of you..............
                                                               

                                                              rdennisjr

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                                                                Well said Mr. Bob and clearly from someone who has been arond the block a few times. I'm sure the crowd appreciates your input and while not everyone will always agree, it's good to see a voice of experience chime in.

                                                                I just wanted to say thanks folks for not getting too personal and out of control on this topic - I've been watching it closely and I appreciate that the discussion hasn't gotten bitter and unfriendly - just heated.

                                                                Dennis :clap:
                                                                 

                                                                MrBob

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                                                                  Bandit...can I post a picture of my Nighttrain here somewhere?. My wife rides her own Sporty. I would like to see your Lowrider.....got an E-mail address?....have you ever posted or seen the Harley & More forum on Delphi? I am MrBob1 there....come on over and post there....only bike bikering.....

                                                                  MyE-mail is [email protected] if you wanna take it outta here.......
                                                                   

                                                                  PACmatthew

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                                                                    Good old Ft. Sam! I just came back from there in December. It was the first time I had done "goat lab". That experience rivals any I have ever had! I really envy you older PA's, for many reasons. It was guys like you that mentored me when I was a medic (I was actually a corpsman with the Marines, but you know what we do). I really think you guys did a great service for the PA profession, but I just don't like some of the change in direction our leaders have taken us. I just really feel that they could have been doing a better job spending our money, especially when it came to educating the public about what we do. Hell, the only PA on TV was on ER and they wrote her out of the script with HIV complications.

                                                                    I do though appreciate what you guys went through, and just because I am becoming a physician does not at all mean that I am leaving the profession behind. I hope to actually be able to influence the profession as a physician, and be an advocate for the proper utilization of PA's.

                                                                    I wish I had the personality that could simply enjoy 6 figures, 3000 square feet, my jet ski, four wheeler, farm, and the best PA job known to man! I just have some defect that makes me dissatisfied with all that, and I don't blame anyone on the forum for thinking so. As for Mr. Liver Fluke, show me a resident or for that matter most FP's who live this life, and then I'll listen to your crap about how PA's aren't a comparrison to docs.
                                                                     

                                                                    Freeeedom!

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                                                                      Well, all I can say is lifestyle differs person to person, place to place. My attending (FP) has a great life working 4 days a week doing everything he wants to do. My primary point, is that if attending physicians read what many (not all) PA's post...they may react differently than many of you think. I hear what they say about PA's, when you aren't around. You are a valuable member of a team, very similar to a perpetual intern. The older Assistants I have met are very nice and seem to be great people. But when I read this forum (sometimes, not all the time) I get so heated when some say the things they do.
                                                                      I love my prospects in life, and I love the journey I have traveled. I would love to pursue fellowship or perhaps return and get an MPH...perhaps I get frustrated when others lack that same drive (regardless of professional title).
                                                                       

                                                                      Bandit

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                                                                        Freedom, you can not always measure profssional drive in that one manner. I understand your frustration, but suggest that you still dont understand (not an insult) what SOME of us are saying. Just as some med students dont know---some PA students need to get their head out of there asses as well. That being said, " perpetual intern"? hmm, maybe to some (and about some) but trust me when I tell you that a good PA will run circles around first and second year residents and earn twice as much. I am in charge of several residents! NOT an insult -- they dont see it that why and niether should you or any other students.
                                                                         

                                                                        PACmatthew

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                                                                          Freedom,
                                                                          I sort of understand what you mean about how PA's are sort of the perpetual "intern", but in reality I think you will see that they are more along the lines of the perpetual 3rd year resident. For instance, Dr. Red Duke, world reknown surgeon who worked on JFK in Dallas, still practices at UTHHouston in the Texas Medical Center. He has had the same PA for about ten years, and the PA is the glue of the whole trauma service. The residents rotate every few months, but the PA stays there. The PA basically functions like a 3rd year resident for floorwork, but doesn't go to surgery. To say that a PA is a perpetual intern is incorrect. If this were the case, it would be hard to justify paying them what they get. The "perpetualness" of a PA on a service like this is the real advantage of having the PA. As residents come and go, the PA frees up the attending from having to indoctrinate the new guys every few months, and keeps continuity of care way up.
                                                                           

                                                                          Freeeedom!

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                                                                            Listen, I have worked with many WISE Assistants in surgery (10 years + experience) who where absolutely great but they NEVER considered themselves "above or in charge of " residents! That is insane! They acted as if it was their JOB, and wanted things done correctly ...just as I have worked with surgical techs who did the EXACT same thing as a PA during surgery, in many cases. Regardless they are valuable.
                                                                            As far as residents reporting to a PA, well, if that was truly the case, I would probably consider that a weakness in the program...just as if a PA would have to report to a Nurse during their training. Sure, during residency we all learn from the different professionals. EM residents learn a bit from EMT's in the field, PM&R docs learn a bit from PT's etc. But the expectations for PA's, PT's, NP's etc are TOTALLY different than that of doctors/residents and med students! TOTALLY! As well it should be. Our schooling is longer, and we take 3 board exams over 5 years that require a higher level of learning (HELL, I took and passed both the USMLE steps 1 &2 as well as COMLEX 1 & 2)... I appreciate what you do, but an Assistant cannot possibly be judged in the same category as a physician or resident, because the qualifications are much much different. If a PA or PA student gets a question wrong, it gets shrugged off, but if a Med Student gets it wrong-different story. I have seen it time and time again.
                                                                            My point has been this...if I were to post this line of conversations on your employer's email or perhaps any residencies server...how do you think THEY would respond? My guess is not exactly as you may think.
                                                                             

                                                                            Bandit

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                                                                              Freedom my friend, you are just wrong on this one. We will disagree and thats fine, but once you get out there you will learn that you are wrong. Many residents wont like yo admit it, but I run circles around them until they are in third year. Thats it -- thats all! Dude, you are simply wrong. Try to get past the "assistant" thing. Nobody is trying to take anything from you!

                                                                              PS that is not to say that there are not some real weak PA`s out there -- there really is.
                                                                               

                                                                              MrBob

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                                                                                Freeedom......
                                                                                Why does it bother you when others "lack the drive" you seem to hold yourself to? How do you judge their lack of drive? perhaps their journey has carried them to their goal and yours hasn't yet. Enjoy your trip and let the others not be your business. You waste your time and energy on such matters. You then judge others by your standards. Everyones standards are different. Don't you reckon you might be judged as a "slacker" by one whose goals are loftier even than yours? I have found that if I enjoy the life I was given and nourish my own grass that It is even greener than yours or others.

                                                                                We are not all destined to chiefs or in charge...there has to be Indians in this tribe. Judging their lack of ambition is fruitless and insulting (at least to them)

                                                                                Worry about your ambitions and leave the others to worry about theirs...............

                                                                                Now.................
                                                                                How about a cold one?
                                                                                 

                                                                                PACmatthew

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                                                                                  Freedom,

                                                                                  Listen bud, I really do understand what you mean, and won't even go as far as to say you are wrong. This is because I think you are a bit naive if you think that three certification exams make you so much more qualified than a PA. Ask me this question in a few years, and I will tell you the gospel truth. I may make it though four years and agree with you wholeheartedly, but I doubt it. I spent 3 years in a PA program that was equally as intense as any 3 years of ANY medical school. I rotated the EXACT rotations as a 3rd year med student but 4 months longer to be exact. We were held to the same standards as the med students I can promise you.

                                                                                  Now Freedom, my thinking is that you are a young whipper snapper with a lot on the ball, but that you are lacking the real world experience to truly appreciate what you are saying. A PA is never superior to a physician based on title, but a PA can be more experienced than some physicians. Here is a life example that shows this reality. In an Army infantry unit, the PA is often times the former Army medic, special forces or ranger, who went to PA school after already being experienced for many years. The batallion surgeon is often a Army physician right out of med school or internship. This physician spends countless hours listening to and learning from the PA who understands the system, the environment, and the common injuries better than the physician. So does the physician all of a sudden show up and start running the shots because he has had extra months of embryo, histo, or biochem than the PA? Not in a million years.

                                                                                  Just as young officers are taught how to do their jobs by senior enlisted in other job specialties in the military, often times PA's help young doctors learn the ropes. At my practice currently, one of my supervising phyicians is my same age, 30, yet I have 4 years of medical practice in the real world as he just came out of residency. He relies on me to help him with a lot of things, and yes, even medical questions. Having seen that rash, or tried that medicine countless times, it would be stupid for him to not use my experience for his benefit. We are colleagues, friends, and the relationship is mutually beneficial. And I myself never stated that a resident would report to a PA. Instead, I stated that I knew of a situation where a PA was an "extension of the attending", where he was the glue of a department where residents were ever changing. I agree, a resident should not report to a PA, but I do think it is possible for a resident to learn a tremendous amount from a PA. And although I realize that residents report to attendings, don't forget who is the attending's right arm! In essence, you may indirectly be reporting to a PA because the PA may "speak for" the attending at times.

                                                                                  Just keep an open mind about our role as you progress through the ranks.

                                                                                  Matt, MPAS, PA-C, DO2B-class of 2006.
                                                                                   

                                                                                  Bandit

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                                                                                    Funnt thing today -- I had two med students for 8 hrs. Both were shocked to learn that they were schedualed with a PA today, but a few cases in they realized I had much to teach them. I not only have been teaching med students for some years now, I still have residents report to me on my floor. If they dont like it -- find another hospital -- and do it quietly, if you complain to my supervisor you will be in for one hell of an ass chewing!!

                                                                                    Freedom does bring up a good point. I think it is absolute bull**** that PA`s are not required to take national exams DURING school. Many schools now are popping out students with sub-par qualifications in order to get the money. This is going to ruin the PA profession. I have noticed many weak PA students in the past few years and it serves noone! Those will be over paid med techs and do DRE`s and H and P`s for their entire carreers.
                                                                                     

                                                                                    PACmatthew

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                                                                                      It has been so long since I posted that so I will clarify. There is no person more qualified to go through all that med school requires than a PA, because no other profession gets the amount of "across the board" education in medicine that a PA gets, except for physicians. Absolutely, a PhD in any science field has a leg up in the basic sciences, but training to become a physician is only two years of basic sciences. In reality, if a PA can hunker down and get through the first two years of basic sciences, it is all down hill from there. For someone like myself, 3rd and 4th year of med school, along with most of residency (assuming FP, which is what most PA's do best) is extremely familiar territory. So, yes, many professions make it easier to get through med school, but I was just stating that PA's as a group are overall the most qualified for the "whole experience". Why do you think that PA's are given so much latitude by legislation to practice medicine? It is because their training is most reflective of the physician medical model. But what I said was not meant to put down a PhD education by any means.
                                                                                       

                                                                                      Freeeedom!

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                                                                                        MrBob, you are absolutely correct. I appreciate your patience and understanding with this frustrating topic. You are right, lets have a cold one man.

                                                                                        PACMat, nope, neither naive nor totally young (I guess 30's are young...remember dude, this is my second career-PT was first). I do sense quite of bit of a patronizing tone in your voice which will bite you in the ass one day (ie someone who doesn't agree with you is somehow naive, young, med student etc?!). The reason I say much of what i say is because I have seen "supposedly" qualified post-grad students nearly FAIL med school (DC's, DDS's, RN's and PA's). Hell we had a PA to DO student not match because he was so damned arrogant and everybody caught on to his crap! Don't be that guy. I appreciate the jobs that Assistants do...I just don't want any physician extender talking [email protected] about residents or physicians (something they have not accomplished). This was the hardest thing I have ever done, and I am thankful to God for my endurance and I am proud to have earned the right to be called "doctor". Matt, I hope you are able to achieve this goal as well...and perhaps you will take a different tone when someone challenges your doctorate/residency/board certified training.
                                                                                         
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