PA vs MD

[corpsmanUP]

Hey Adam,

You are head and shoulders above the non-thinkers who litter this place. I don't know if you realize just how right your last post actually was. Right on the freaking money dude!

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[PTOSIS]

Adam,
from the posts that i have read here, u seem like a real intelligent guy, but if u think that a physician sees a challenging case that he really has to dig deep into his knowlege once a lifetime , you are crazy. i have seen my own doctor see more than 1 REALLY unusual case just on my family memebers. the problem is that often the unusual cases are masked as something very common. so lets say it's 1 case out of 500. well, guess what? i don't want my mother, child, etc beeing that pt. I think there's a NEED for PA's. there are certain things that physicians do that require v.little knowlege that we are trained for in school/residency. here's what i would go to a PA for: throat cultures/physicals/pap smears/sutures./vaccines/allergy shots or any things that require repition to learn. i have a friend who is a pa. he does cardiac steninting all day. guess what? he probably does it better than a cardiologist b/c he does it all day. but when it comes to the diagnosis/treatmet/management of serious diseases (which happen much more often then you say) i want a physician for my mom/child. btw, on my own extended family i can tell you that there have been 4 problems that present with a very mild complaint that could easily be dismissed but would be fatal if not picked up. as someone who just took her boards, i am still amazed at the complexity of disease processes. i do not know all of them, but i have the TOOLS to pick up any text and have the v.basics to begin learning it all. anyway, i wish you luck with your career and i look forward to working with you future PAs in the future. ptosis

 

[adamdowannabe]

Adam,
from the posts that i have read here, u seem like a real intelligent guy, but if u think that a physician sees a challenging case that he really has to dig deep into his knowlege once a lifetime , you are crazy. i have seen my own doctor see more than 1 REALLY unusual case just on my family memebers. the problem is that often the unusual cases are masked as something very common. so lets say it's 1 case out of 500. well, guess what? i don't want my mother, child, etc beeing that pt. I think there's a NEED for PA's. there are certain things that physicians do that require v.little knowlege that we are trained for in school/residency. here's what i would go to a PA for: throat cultures/physicals/pap smears/sutures./vaccines/allergy shots or any things that require repition to learn. i have a friend who is a pa. he does cardiac steninting all day. guess what? he probably does it better than a cardiologist b/c he does it all day. but when it comes to the diagnosis/treatmet/management of serious diseases (which happen much more often then you say) i want a physician for my mom/child. btw, on my own extended family i can tell you that there have been 4 problems that present with a very mild complaint that could easily be dismissed but would be fatal if not picked up. as someone who just took her boards, i am still amazed at the complexity of disease processes. i do not know all of them, but i have the TOOLS to pick up any text and have the v.basics to begin learning it all. anyway, i wish you luck with your career and i look forward to working with you future PAs in the future. ptosis

Ptosis, what on earth do you think PA's learn? Everything you just described is CNA/LVN work, you should pick up a PA school's list of coursework and educate yourself a little more. Any PA (or PA student for that matter) has the same TOOLS you claim you have to pick up a medical text, it's called a brain! Re-read my post, nowhere did I mention physicians only see interesting cases once a lifetime, if you can point out anywhere that is stated, I will be more then happy to give you a cookie and pat you on the head, and tell you what a good girl you are, but everything else you wrote is is barely comprehendible english, so please try again. If you want to voice an opinion, and you want people to have the most remote faith in what you write you MUST write intelligently, or your effort is wasted.

Throat cultures and allergy shots, are you kidding? You can't be serious. When was the last time anyone besides a nurse gave an allergy shot or a vaccination?

Wow, peoples ignorance is worse then I had ever imagined!

Ptosis, I challenge you to visit a PA school's list of prereqs, and then view their coursework and maybe even find some syllabi and then come back and tell me a PA is only good for "repetition skills" Hello? If a PA wasn't capable of making difficult clinical decisions and diagnoses why would they be allowed to do so in 50 states and DC? Either you think far too highly of yourself, or you don't know what does into educating physician assistants, I think it's the latter. Vaccines and allergy shots, I'm laughing so hard I'm crying!

 

[adamdowannabe]

Here, check out this thread from PA.net

Cool Cases

Some of the older PA's, a few Emed PA's; when they have interesting cases come through their ED's, have the students and newbies play the Diagnosis game, if you read the thread you can thell that basic Hx and test rslts given, and as people want further applicable test results they ask for them (obviously the test and Tx were Adm, so results are already known.

Take a look and tell me this is along the lines of vaccines and allergy shots.

 

[primadonna22274]

Let's see, what have I done today (Monday, 1:30 p.m., lunch over, just getting ready to start my afternoon):
1 intraarticular corticosteroid injection (shoulder); evaluate shoulder films; two pap smears/well woman exams including follow-up of abnormal pap smears, family history, individual risk factors and health maintenance advising; one follow-up of Type 2 diabetes mellitus in a 26 y/o woman and initial workup of dizziness in same patient (in addition to her pap); one mole check, including counseling on ABCDs of melanoma and age-appropriate health maintenance counseling in a 19 y/o woman; 3 people with miserable allergies (ah, June in Oregon, grass seed capital of the world); one new patient with chronic back pain and depression; a pregnant woman with an otitis media & sinusitis, including appropriate drug choice in pregnancy; psychotrophic drug management in anxiety & depression; management & treatment of refractory UTI resistant to most antibiotics (thank God for the antibiogram); and management and referral of chronic sinusitis.
This was a SLOW morning, btw.
This afternoon: a 50-something woman with terrible bipolar disorder who's concerned because she has body odor for the first time in her life...is she psychotic/delusional or actually sick? she's had diarrhea for the past ten days; a new patient physical; a few rashes; a few people with allergies; a commercial driver's license physical, and a suspicious mole removal.
I was well-trained to do ALL of these things in PA school, at least to do the initial evaluation. After five years of practice, I'm pretty comfortable with "normal" which makes it easier to recognize abnormal. The crucial issue as a PA or NP or whatever is recognizing your limits and knowing when to ask for help.
Funny story: saw a guy last week who had several cryotherapy treatments (we use liquid N2) for genital warts by two other docs in my practice. Over Memorial Day he decided heck, he works for the water & light district, sometimes they use industrial CO2 to freeze water pipes, he could self-treat...yup...he sure as hell won't get those warts back! He'll probably also need a skin graft for a 4x6 cm full-thickness burn in the R inguinal area. Damn.
You can't make this stuff up!
For the record, what I want to learn in medical school is the pathophys, all the nitty-gritty we don't have time to learn in PA school. I do believe a seasoned and bright PA will recognize what is not normal, and I think those who consider PAs mere "technicians" do us a major disservice in underestimating our place in the health care team.
To the person who thinks my practice should be limited to allergies and collecting pap smears, I suggest you get more educated on how PAs are trained, licensed, supervised, and continually educated just like MDs. And for the record, you CAN'T lump NPs & PAs together because our training and practice philosophy are vastly different (that's a whole other discussion thread).
Best wishes...back to work....

Lisa PA-C
Family Practice

Ptosis, what on earth do you think PA's learn? Everything you just described is CNA/LVN work, you should pick up a PA school's list of coursework and educate yourself a little more. Any PA (or PA student for that matter) has the same TOOLS you claim you have to pick up a medical text, it's called a brain! Re-read my post, nowhere did I mention physicians only see interesting cases once a lifetime, if you can point out anywhere that is stated, I will be more then happy to give you a cookie and pat you on the head, and tell you what a good girl you are, but everything else you wrote is is barely comprehendible english, so please try again. If you want to voice an opinion, and you want people to have the most remote faith in what you write you MUST write intelligently, or your effort is wasted.

Throat cultures and allergy shots, are you kidding? You can't be serious. When was the last time anyone besides a nurse gave an allergy shot or a vaccination?

Wow, peoples ignorance is worse then I had ever imagined!

Ptosis, I challenge you to visit a PA school's list of prereqs, and then view their coursework and maybe even find some syllabi and then come back and tell me a PA is only good for "repetition skills" Hello? If a PA wasn't capable of making difficult clinical decisions and diagnoses why would they be allowed to do so in 50 states and DC? Either you think far too highly of yourself, or you don't know what does into educating physician assistants, I think it's the latter. Vaccines and allergy shots, I'm laughing so hard I'm crying!

 

[PTOSIS]

first of all, re comprehension of my posts, i was incredibly tired when i wrote that as i am taking care of my somewhat demented grandmother this week...

didn't u say this?
"I am sure there are many physicians, who spend their whole career and never come across a case that a PA couldn't handle as informed and as effectively as a physician" that's what my post has been directed at.

i am v.familiar w/coursework for PA's, there's a PA school at my med school, have friends, etc. are there PA's that function at the same level as physicians? absolutely. are there PA's who are better clinicians than some? yes. should that be the standard? in my opinion, no. it boils down to this. if a pa can do everything that a MD?DO can, what's the point of med school? don't tell me that we are all smart/can pick stuff up as we go. i do not think that one year of preclinicals is enough to learn all the tools that you need for lifelong learning. btw, the things that i mentioned-paps, throat cultures/paps, shots are not done by nurses. in my short 26 years, they have all been done by my physician. anyway, one of two things is true if we are all doing the same thing: physicians are overtrained or PA/NP are undertrained. one final thought, when you go see a physician, you know that he has at least 3 years of residency training. when you see a PA it could be someone who has been in practice for 30 years and because of the experience knows everything, or it could be someone who finished school last year. a patient never knows. anywho, i hope that you did not perceive animosity from me, like i said all those things that i mentioned are routinelly performed by doctors. i was just saying that i don't agree with your opinion.

 

[corpsmanUP]

first of all, re comprehension of my posts, i was incredibly tired when i wrote that as i am taking care of my somewhat demented grandmother this week...

didn't u say this?
"I am sure there are many physicians, who spend their whole career and never come across a case that a PA couldn't handle as informed and as effectively as a physician" that's what my post has been directed at.

i am v.familiar w/coursework for PA's, there's a PA school at my med school, have friends, etc. are there PA's that function at the same level as physicians? absolutely. are there PA's who are better clinicians than some? yes. should that be the standard? in my opinion, no. it boils down to this. if a pa can do everything that a MD?DO can, what's the point of med school? don't tell me that we are all smart/can pick stuff up as we go. i do not think that one year of preclinicals is enough to learn all the tools that you need for lifelong learning. btw, the things that i mentioned-paps, throat cultures/paps, shots are not done by nurses. in my short 26 years, they have all been done by my physician. anyway, one of two things is true if we are all doing the same thing: physicians are overtrained or PA/NP are undertrained. one final thought, when you go see a physician, you know that he has at least 3 years of residency training. when you see a PA it could be someone who has been in practice for 30 years and because of the experience knows everything, or it could be someone who finished school last year. a patient never knows. anywho, i hope that you did not perceive animosity from me, like i said all those things that i mentioned are routinelly performed by doctors. i was just saying that i don't agree with your opinion.

I actually think that Ptosis and Adam are more on the same page than either realize. Ptosis, I like everything you said except for the mindless tasks you mentioned above. Take it from me, those tasks are NOT routinely done by physicians, PA's, RN's, or even LVN's. They are predominantly done by MA's who have about 6 months-9 months of a meager education. If your physician was doing them, then they are the rare bird. And even if your physician does do them, its not because a physician is needed to do them. Perhaps your doc just likes to do those things. Otherwise I liked the things you said. You probably should look into the differences between a PA and a physician though so yu can be more comfortable knowing the difference.

 

[primadonna22274]

Ptosis:

In your defense, I agree that you kinda sorta get it in regards to what PAs learn and do vs. docs. This is why I want to go back to med school: I don't know enough. I want to learn more than I know now, and there simply are not enough hours in the day after a full day of family practice (nor is there much energy or inclination) to read Cecil's or Harrison's anymore (I did that faithfully, nightly, my first year out of school).

I'm sorry about your grandmother. Best wishes to you,

Lisa PA-C

first of all, re comprehension of my posts, i was incredibly tired when i wrote that as i am taking care of my somewhat demented grandmother this week...

didn't u say this?
"I am sure there are many physicians, who spend their whole career and never come across a case that a PA couldn't handle as informed and as effectively as a physician" that's what my post has been directed at.

i am v.familiar w/coursework for PA's, there's a PA school at my med school, have friends, etc. are there PA's that function at the same level as physicians? absolutely. are there PA's who are better clinicians than some? yes. should that be the standard? in my opinion, no. it boils down to this. if a pa can do everything that a MD?DO can, what's the point of med school? don't tell me that we are all smart/can pick stuff up as we go. i do not think that one year of preclinicals is enough to learn all the tools that you need for lifelong learning. btw, the things that i mentioned-paps, throat cultures/paps, shots are not done by nurses. in my short 26 years, they have all been done by my physician. anyway, one of two things is true if we are all doing the same thing: physicians are overtrained or PA/NP are undertrained. one final thought, when you go see a physician, you know that he has at least 3 years of residency training. when you see a PA it could be someone who has been in practice for 30 years and because of the experience knows everything, or it could be someone who finished school last year. a patient never knows. anywho, i hope that you did not perceive animosity from me, like i said all those things that i mentioned are routinelly performed by doctors. i was just saying that i don't agree with your opinion.

 

[adamdowannabe]

first of all, re comprehension of my posts, i was incredibly tired when i wrote that as i am taking care of my somewhat demented grandmother this week...

didn't u say this?
"I am sure there are many physicians, who spend their whole career and never come across a case that a PA couldn't handle as informed and as effectively as a physician" that's what my post has been directed at.

i am v.familiar w/coursework for PA's, there's a PA school at my med school, have friends, etc. are there PA's that function at the same level as physicians? absolutely. are there PA's who are better clinicians than some? yes. should that be the standard? in my opinion, no. it boils down to this. if a pa can do everything that a MD?DO can, what's the point of med school? don't tell me that we are all smart/can pick stuff up as we go. i do not think that one year of preclinicals is enough to learn all the tools that you need for lifelong learning. btw, the things that i mentioned-paps, throat cultures/paps, shots are not done by nurses. in my short 26 years, they have all been done by my physician. anyway, one of two things is true if we are all doing the same thing: physicians are overtrained or PA/NP are undertrained. one final thought, when you go see a physician, you know that he has at least 3 years of residency training. when you see a PA it could be someone who has been in practice for 30 years and because of the experience knows everything, or it could be someone who finished school last year. a patient never knows. anywho, i hope that you did not perceive animosity from me, like i said all those things that i mentioned are routinelly performed by doctors. i was just saying that i don't agree with your opinion.

I did say exactly that, but you re-worded it to a completely different statement, your re-wording :

but if u think that a physician sees a challenging case that he really has to dig deep into his knowlege once a lifetime , you are crazy.

My stating that some physicians never see a zebra, is in no way remotely similar to your interpretation that it means physicians in general rarely see odd cases.

Also, although this has been said 1000x already, PA schools 1 year of didactic is often ~65-70% the length of a medical school didactic (based on actually scheduled class hours) We all understand medical didactic gives a very thorough education into the normal and abnormal states of each organ system, PA school a not so thorough education into the exact same material, meaning PA's are plenty prepared to (if they want to) to "read the book" and gain the knowledge they were unable to be taught in PA school, they are very capable, with more extensive ungraduate records and past medical experience then tons of medical school students, and yes, it is relevent to the learning curve of a PA student.

I also understand when you visit a physician, who is B.E., or B.C. they have their residency as their experience crutch, and PA's could be fresh faced and lacking experience, and THAT is when a supervising doctor will be (hopefully) putting the PA through their own private training time. Thats why there is a supervising physician to contact; just in case something seems fishy and a PA can't put a finger on it. Nobody hires a PA straight after school and gives them their own clinic and pats them on the back and says... I will be back in 20 days to review your charts. It ain't going to happen. For the same reason that Medical school isn't the culmination of a medical education but more well defined as the mere beggining of learning how to practice medicine. PA's don't pack up their books at the end of two years, it just gives PA's the basics to start REALLY learning this stuff (in their chosen field of medicine), Everyday a PA might see something new, not know the disease process down to the cellular level, but you better relaize that they will probably look it up and know it down to the cellular level after they have seen it. Just as PBL is becoming the "in" method to learning medicine, it's a life committment, PBL doesn't ever end, you just merely start using real patients and real problems to learn, instead of case files.

Maybe I am just too intelligent for my own good, and I can only base my feelings on my own capabilities,(self learning and just plain old comphrension of complicated principles) and people in general aren't able to accomplish this sort of thing, but I hope not.

 

[primadonna22274]

To answer your question succinctly, yes, I learned in PA school what I needed to know to practice effectively and safely as a PA.

My master's project was to answer that very question: to survey the first class of graduates (new program at that time) and their supervising physicians and ask: how well prepared were you by the program for your work as a PA in your first job? The answers were overwhelmingly positive; I can't recall the statistics exactly but somewhere around a 4 out of 5 on a Likert scale. An interesting, although not unique, trend was noted: the supervising physicians consistently rated their PAs as BETTER prepared than did the PAs themselves. This is actually borne out in medical training literature over the past thirty years: those who know what we actually need to know are better evaluators of how much we know than the PAs or MDs being evaluated.

Did PA school prepare me adequately to function as a physician? Well, no...but it wasn't supposed to. I am not a physician. But I will be one when I grow up! The problem is that more and more, PAs in primary care especially are being forced into the role of a physician. I carry a caseload of primary patients who come to ME first and foremost for their healthcare. Some of them are really sick. Some of them make me nervous. When I need help, I get it, and my supervising and collaborating docs are fabulous and always willing to help me, but it's still on my shoulders. This trend isn't going away; fewer MDs & DOs are going into primary care so PAs and NPs are expected to fill that gap. I think in a group practice setting where the clinician has personal and institutional support, that's OK. I think in a rural setting where you put an untested PA or NP out in the sticks because no MD wants to go there, it could be disastrous. Not because they don't know everything, but because when there's something they've not seen before or don't recognize and there's no MD or DO around (or for that matter a seasoned PA or NP) to bounce ideas off of, something serious could get missed. No way in hell would you find me practicing independently in the middle of rural America without close backup and at least five years of experience, but it happens.

On the other hand, I'm using suburban standard-of-care thinking to apply to rural medicine, and maybe that's unfair. Any other thoughts?

Lisa PA-C
p.s. Iliketocut: I like you but I still think you think PAs are just "good technicians". (Visible shudder.) When I did my CT surg rotation in PA school, one of the masterful surgeons thought he was paying my attending PA a compliment when he said "Mark's a good technician". I knew then and there I couldn't go into CT surg because I didn't want to be just a "technician". Surgical PAs might get roped into the OR so much you forget they are trained as generalists first and foremost, and that's what PAs excel in: general medicine. This generalist training is what makes it possible for PAs more than any other group to move laterally from one specialty to the next. NPs can't do that to nearly the degree we can; nor can MDs (not without doing another residency or fellowship anyway).

I have a general question for current PA's that I think would belong in the current thread. Do you feel the curriculum that PA's receive (generally, I know each school is different) satisfies the interest you have in medicine and the body? I know it isn't quite the detail to which med students are educated, but just wondering if you ever ask yourself "why didn't I learn that" or "I wish we would've covered that in more detail." I'm not really worried about being the "assistant" or not having the final say. I know the PA still plays a very vital role to the healthcare team. I just want to know more about the schooling and quality of class and lab, etc. Thanks so much for any feedback.

Steve

 

[Fond of Cabbage]

Maybe he meant that he had good technical skills. From what I've heard, CT Sx PAs pretty frequently take care of their patients in the CCU, so their knoweldge of medicine would have to be recognized there, unless maybe that wasn't what he was hired to do. I'm just a student, so I don't know, but when I was a nurse in the OR, I heard surgeons compliment other surgeons by saying how technically great they were. Is it possible you just took the wrong meaning?

By the way, this isn't supposed to be a malignant post, I actually respect your posts a lot, even though I haven't met you. You seem to be a very intelligent person, so don't take this post the wrong way.

 

[primadonna22274]

Oh, no offense taken, no worries.
And I realize it may have just been a genuine compliment to his technical skills (he WAS masterful), but at the moment it felt like his entire practice was reduced to "technician" in the eyes of this particular god-complex surgeon (excellent surgeon, definitely full of himself). Eventually this PA moved on to another job where he had more patient care responsibilities and I think he was ultimately happier. When I was training, he spent most of every day in the OR, very little time rounding on CCU/telemetry, and NO time in clinic. Not what he wanted but he was the only PA for 4 very busy CT surgeons.
Lisa PA-C

Maybe he meant that he had good technical skills. From what I've heard, CT Sx PAs pretty frequently take care of their patients in the CCU, so their knoweldge of medicine would have to be recognized there, unless maybe that wasn't what he was hired to do. I'm just a student, so I don't know, but when I was a nurse in the OR, I heard surgeons compliment other surgeons by saying how technically great they were. Is it possible you just took the wrong meaning?

By the way, this isn't supposed to be a malignant post, I actually respect your posts a lot, even though I haven't met you. You seem to be a very intelligent person, so don't take this post the wrong way.

 

[iliketocut]

To answer your question succinctly, yes, I learned in PA school what I needed to know to practice effectively and safely as a PA.

My master's project was to answer that very question: to survey the first class of graduates (new program at that time) and their supervising physicians and ask: how well prepared were you by the program for your work as a PA in your first job? The answers were overwhelmingly positive; I can't recall the statistics exactly but somewhere around a 4 out of 5 on a Likert scale. An interesting, although not unique, trend was noted: the supervising physicians consistently rated their PAs as BETTER prepared than did the PAs themselves. This is actually borne out in medical training literature over the past thirty years: those who know what we actually need to know are better evaluators of how much we know than the PAs or MDs being evaluated.

Did PA school prepare me adequately to function as a physician? Well, no...but it wasn't supposed to. I am not a physician. But I will be one when I grow up! The problem is that more and more, PAs in primary care especially are being forced into the role of a physician. I carry a caseload of primary patients who come to ME first and foremost for their healthcare. Some of them are really sick. Some of them make me nervous. When I need help, I get it, and my supervising and collaborating docs are fabulous and always willing to help me, but it's still on my shoulders. This trend isn't going away; fewer MDs & DOs are going into primary care so PAs and NPs are expected to fill that gap. I think in a group practice setting where the clinician has personal and institutional support, that's OK. I think in a rural setting where you put an untested PA or NP out in the sticks because no MD wants to go there, it could be disastrous. Not because they don't know everything, but because when there's something they've not seen before or don't recognize and there's no MD or DO around (or for that matter a seasoned PA or NP) to bounce ideas off of, something serious could get missed. No way in hell would you find me practicing independently in the middle of rural America without close backup and at least five years of experience, but it happens.

On the other hand, I'm using suburban standard-of-care thinking to apply to rural medicine, and maybe that's unfair. Any other thoughts?

Lisa PA-C
p.s. Iliketocut: I like you but I still think you think PAs are just "good technicians". (Visible shudder.) When I did my CT surg rotation in PA school, one of the masterful surgeons thought he was paying my attending PA a compliment when he said "Mark's a good technician". I knew then and there I couldn't go into CT surg because I didn't want to be just a "technician". Surgical PAs might get roped into the OR so much you forget they are trained as generalists first and foremost, and that's what PAs excel in: general medicine. This generalist training is what makes it possible for PAs more than any other group to move laterally from one specialty to the next. NPs can't do that to nearly the degree we can; nor can MDs (not without doing another residency or fellowship anyway).

Lisa:

The attending you refer to was giving the PA a compliment in this situation. All of us, when we are in the OR, are learning to be technicians. Operating is a technical skill. The term "surgeon" refers to someone who has not only mastered a technical skill, but is able to manage a patient's pre and post op problems (i.e. the medicine aspect) of things as well. I do not agree that MD's cannot move laterally-as a surgeon, I am learning not only to operate independently on my patients, but manage them as well. I went into surgery for this exact reason-unlike general medicine people, you actually get to fix the problem instead of think about it!

 

[primadonna22274]

OK, I can see that. And I'll agree with your point that some MDs can move laterally better than others. I think it's tough for a urogynecologist to move into, say, primary care (but ugh, why would s/he want to?)
I took a medical specialty aptitude quiz the other day. Results were funny. Do you know what came out on the absolute BOTTOM of the list? Family practice. Duh, where I've worked for my entire five years of practice and while I'm damn good at it feel overwhelmed and burned out in just five years. Interestingly, surgical specialties including gen surg, OB-GYN, uro were near the top 20%. I'm good with my hands and like procedures. And dammit, I sure would rather fix a problem than talk about it for 45 minutes
Whaddya think, surgery for me?
(Neurosurg was #2 on the list...ick! I HATE neuro!)
Lisa

Lisa:

The attending you refer to was giving the PA a compliment in this situation. All of us, when we are in the OR, are learning to be technicians. Operating is a technical skill. The term "surgeon" refers to someone who has not only mastered a technical skill, but is able to manage a patient's pre and post op problems (i.e. the medicine aspect) of things as well. I do not agree that MD's cannot move laterally-as a surgeon, I am learning not only to operate independently on my patients, but manage them as well. I went into surgery for this exact reason-unlike general medicine people, you actually get to fix the problem instead of think about it!

 

[hospPA]

Lisa:

The attending you refer to was giving the PA a compliment in this situation. All of us, when we are in the OR, are learning to be technicians. Operating is a technical skill. The term "surgeon" refers to someone who has not only mastered a technical skill, but is able to manage a patient's pre and post op problems (i.e. the medicine aspect) of things as well. I do not agree that MD's cannot move laterally-as a surgeon, I am learning not only to operate independently on my patients, but manage them as well. I went into surgery for this exact reason-unlike general medicine people, you actually get to fix the problem instead of think about it!

Or you get the luxury to have the IM team sit on the patient for a week for you while you decide whether or not to take them to the OR

Sorry, I couldn't resist. And for the record, I have the utmost respect for surgeons, I just run into this sort of thing all the time.

Pat

 

[corpsmanUP]

Or you get the luxury to have the IM team sit on the patient for a week for you while you decide whether or not to take them to the OR

Sorry, I couldn't resist. And for the record, I have the utmost respect for surgeons, I just run into this sort of thing all the time.

Pat

Tell you what though Pat, if there was an impending nuclear detonation approaching that would emit a signal causing either surgeons or internists to be anihilated off the face of the earth, I would try and program it to destroy the internists if I had to sacrifice one for the other. Surgery is an art form that not anyone can do, but medicine can be done by anyone. People at the bottom of their classes go into medicine often because its their only option, and although they might not train at Hopkins, they did train somewhere. Surgery had only 2 categorical spots in the country go unfilled this year in the match. It has been my experience as well that surgeons know a lot more about medicine than they want to admit, because they don't want to deal with it. And why should they? I have seen a whole lot more surgeons who were well rounded physicians with knowledge of medicine than I have ever seen an internist who knows his a$$ from a 5mm scope!!

So no offense to medicine guys, but thats sort of just how the heirarchy of medicine is. Sorry, I couldn't resist!

 

[hospPA]

Tell you what though Pat, if there was an impending nuclear detonation approaching that would emit a signal causing either surgeons or internists to be anihilated off the face of the earth, I would try and program it to destroy the internists if I had to sacrifice one for the other. Surgery is an art form that not anyone can do, but medicine can be done by anyone. People at the bottom of their classes go into medicine often because its their only option, and although they might not train at Hopkins, they did train somewhere. Surgery had only 2 categorical spots in the country go unfilled this year in the match. It has been my experience as well that surgeons know a lot more about medicine than they want to admit, because they don't want to deal with it. And why should they? I have seen a whole lot more surgeons who were well rounded physicians with knowledge of medicine than I have ever seen an internist who knows his a$$ from a 5mm scope!!

So no offense to medicine guys, but thats sort of just how the heirarchy of medicine is. Sorry, I couldn't resist!

So, cardiologists, rheumatologists, endocrinologists, gastroenterologists were all in the bottom of their medical school class? Come on.

The other thing I see is that the top candidates from medical school enter orthopedics in a lot of instances. What I see must be a secret pact or agreement they must sign that says they must immediately, upon entering residency, forget everything they know about EVERY medical condition including diabetes, heart disease, hypertension, etc.

I do not see this from the general surgery type guys. Maybe because "general" type practices have to remember something about everything, not forget everything but their specific specialty.

There are more spots in medicine, so obviously you will get some underachievers. I take issue that all or most of those who go into medicine are such. That is just not true.

The pseudo-hierarchy you have envisioned only exists in the minds of those who possess the dreaded "god complex".

Good day,

Pat

 

[corpsmanUP]

So, cardiologists, rheumatologists, endocrinologists, gastroenterologists were all in the bottom of their medical school class? Come on.

The other thing I see is that the top candidates from medical school enter orthopedics in a lot of instances. What I see must be a secret pact or agreement they must sign that says they must immediately, upon entering residency, forget everything they know about EVERY medical condition including diabetes, heart disease, hypertension, etc.

I do not see this from the general surgery type guys. Maybe because "general" type practices have to remember something about everything, not forget everything but their specific specialty.

There are more spots in medicine, so obviously you will get some underachievers. I take issue that all or most of those who go into medicine are such. That is just not true.

The pseudo-hierarchy you have envisioned only exists in the minds of those who possess the dreaded "god complex".

Good day,

Pat

Pat, PA, friend, pal, the English language is a beautiful thing to embrace. Sometimes things get merky though even among 2 experts of said language. If you read my previous post again, you will see that I said "People at the bottom of their classes go into medicine often because its their only option". What this means is exactly what it says. It means that there ARE people in the bottom of every class (probably 50% of the bottom quarter) that go into medicine, because there are plenty of spots, and plenty of bodies to fill them. But as you pointed out, the rubber meets the road somewhere in the application process for subspecialty. I did not, however, state that all those who go into medicine are in the bottom of their class. I merely said that the bottom of the class has a lot more internists than it has surgeons. No one will dispute that fact. Its darn rare to find a surgeon who was not above the mean across the board with grades and board scores. For medicine, you can find a spot with a passing score and the worst class rank. Thats just life.

True, ortho is at the top of the list. But the fact that they don't want to deal with anything medical is the same reason the internists call ortho at 3AM for simple cellulitis of an extremity, simple non-displaced fractures that can wait a day, and for emergency back pain. It goes both ways.

I am going into family medicine where I won't have the excuse that either of these groups use to turn a blind eye to a condition. Instead, I'll just close both of mine and try something!!

 

[hospPA]

Pat, PA, friend, pal, the English language is a beautiful thing to embrace. Sometimes things get merky though even among 2 experts of said language. If you read my previous post again, you will see that I said "People at the bottom of their classes go into medicine often because its their only option". What this means is exactly what it says. It means that there ARE people in the bottom of every class (probably 50% of the bottom quarter) that go into medicine, because there are plenty of spots, and plenty of bodies to fill them. But as you pointed out, the rubber meets the road somewhere in the application process for subspecialty. I did not, however, state that all those who go into medicine are in the bottom of their class. I merely said that the bottom of the class has a lot more internists than it has surgeons. No one will dispute that fact. Its darn rare to find a surgeon who was not above the mean across the board with grades and board scores. For medicine, you can find a spot with a passing score and the worst class rank. Thats just life.

True, ortho is at the top of the list. But the fact that they don't want to deal with anything medical is the same reason the internists call ortho at 3AM for simple cellulitis of an extremity, simple non-displaced fractures that can wait a day, and for emergency back pain. It goes both ways.

I am going into family medicine where I won't have the excuse that either of these groups use to turn a blind eye to a condition. Instead, I'll just close both of mine and try something!!

I agree with your point in the first paragraph.

And I have never called ortho for simple cellulitis of an extremity. One that doesn't improve in big gun antibiotics after 2-3 days, yes I admit back pain all the time, and never call ortho unless they have a fracture or neurological dysfunction. I do get your point, and am sure that stuff happens.

Good luck in your career!

Pat

 

[cali7925]

You making a blanketed comment that MD's would not want to trade places with a PA can't be more wrong, I have met a LOT of physicians, who have been practicing medicine for 25-30 years, who have told me if they even knew about the career of physician assistant, or if it was available such as medical school was available, they would have become a PA instead of becoming a physician.

I am wondering if you are still young, a resident? Still new to your career, and not having been faced with a lot of what being a doctor involves? (just a guess.......on my part)

Every M.D./D.O. has to deal with nurse's, P.A.'s, P.T.'s etc. thinking that they could do the job of a doctor...so many of these professionals are p***** off that they dont make the money docs make and claim that they, "know just as much" and would be able to "diagnose just as well". I have this to say, get your heads out of your as***. P.A.'s have so many fewer years of training in physiology and medicine, there is NO WAY they could replace doctors. I mean, I understand docs are arrogant as H*** and it is a real Pain in the a** to work with a lot of them, but when nurse's P.A's and other members of the health care team get just as arrogant, all hell breaks loose and they function as a dysfunctional team providing substandard care. Each member of the team has their own responsibilities....the P.A. is to ASSIST the physician, not compete with them. If you wanted an M.D. or want one, go get one. Nuff said.

 

[primadonna22274]

One of my primary beefs is the number of times I get put in a position of being the "doc" to the undesirables. People with problem lists a mile long and polypharmacy, social problems galore, and somehow they end up on my schedule because I have an opening and they glom on to me and I can never seem to shake 'em loose! I have one patient with severe COPD on nasal O2, 66 years old, still smoking (tough thing to quit), who decomps in a hurry and ends up in the ER with bronchitis exacerbations. I've tried 2 or 3 x to hand her off to internal medicine and she still keeps coming back to see me. The ER doc actually paged the on-call internist about her the other night and FOR THE LOVE OF GOD the internist told her to come in and see ME the next day!!! WTF?!?!?
Most of the reason I'm going to med school is to get out of this primary care PA cycle which I haven't figured out how to break in 5 years of practice.
And I'm NOT going back into primary care. I'm gonna do something where I get to say "you need to go back to your primary for that". (Wishful thinking? maybe).
Lisa PA-C

Every M.D./D.O. has to deal with nurse's, P.A.'s, P.T.'s etc. thinking that they could do the job of a doctor...so many of these professionals are p***** off that they dont make the money docs make and claim that they, "know just as much" and would be able to "diagnose just as well". I have this to say, get your heads out of your as***. P.A.'s have so many fewer years of training in physiology and medicine, there is NO WAY they could replace doctors. I mean, I understand docs are arrogant as H*** and it is a real Pain in the a** to work with a lot of them, but when nurse's P.A's and other members of the health care team get just as arrogant, all hell breaks loose and they function as a dysfunctional team providing substandard care. Each member of the team has their own responsibilities....the P.A. is to ASSIST the physician, not compete with them. If you wanted an M.D. or want one, go get one. Nuff said.

 

[mx_599]

the avg md applicant does not qualify for pa school admission.there is this little requirement called "prior healthcare experience", something most premeds don't have. take a kaplan course, retake the mcat and go to medschool. also look into carib med schools -they are less picky about mcats.

I would have to say many pre-med students DO have health care experience

 

[adamdowannabe]

Every M.D./D.O. has to deal with nurse's, P.A.'s, P.T.'s etc. thinking that they could do the job of a doctor...so many of these professionals are p***** off that they dont make the money docs make and claim that they, "know just as much" and would be able to "diagnose just as well". I have this to say, get your heads out of your as***. P.A.'s have so many fewer years of training in physiology and medicine, there is NO WAY they could replace doctors. I mean, I understand docs are arrogant as H*** and it is a real Pain in the a** to work with a lot of them, but when nurse's P.A's and other members of the health care team get just as arrogant, all hell breaks loose and they function as a dysfunctional team providing substandard care. Each member of the team has their own responsibilities....the P.A. is to ASSIST the physician, not compete with them. If you wanted an M.D. or want one, go get one. Nuff said.

P.A.'s have so many fewer years of training in physiology and medicine, there is NO WAY they could replace doctors.

I am not sure where you went to med school, or are attending med school. But, last time I checked, the didactic portion was still only two years tops, a class in every system. Would you agree medical school is a physoligical systems breakdown, then once you know how it's all supposed to work, and what can go wrong with it, then you learn how to diagnose it and fix it? (for about 18-20 months?

PA school is still 12-15 months of didactic. Although the classes are more "generic" where as, instead of having a class in every system, there is a different route to learning the basics, and the intricasies are left out. Your exclamation of "SO MANY MORE YEARS" is far from an acceptable claim. Also, one must realize, to get into PA school, a student must have completed an entire year of physiology in undergrad, which is applicable to learning medicine, although Med students know that physics/chem/ochem have little carry-over application into basic medicine, the Physiology of undergrad DOES, so that can count towards a PA students total time spent learning physiology. So, rejustify your comment about time spent learning physiology.

We all know, the medical education of a physician gets into pathophys at a more detailed level, it's been discussed 100x's.

You rebutted my statement, with an argument that had no application to my comment whatsoever. I simply stated, there are quite a few physicians whom I am aquainted with, who admitted they feel they would enjoy being a PA more so then being a physician, based on their experiences having practiced medicine for quite a while, and what else is involved in owning a medical practice besides just being a good physician.

Nowhere in the statement you so kindly quoted and replied to, did I mention PA's learn everything a physician learns, nor did I mention a PA is better at diagnosis then physicians are, (although team up new and old PA's and new and old MD's and I bet the tendency for proper diagnosis on both sides will prove to be a similar distribution)

Now, you're brain might be totally fried based on your spending WAY MORE YEARS learning physiology then any PA ever does, but might I suggest you read the posts you are quoting, and make sure what you write in response to said post at least has the smallest amount of direct relationship to the words you are trying refute. Or else, people begin to think you are just an idiot, another one of the people that give physicians a bad public image, by jumping onto your soap box and yelling " I went to medical school!!! I went to medical school!!!" in an attempt to have people assume you have credibility and personality. Unfortunately, you are about 20 years too late. The public view of medicine is filled with admiration anylonger

If you spent so many more years learning physiology, be proud of yourself, in your knowledge and your ability, and do your job and don't hire a PA, but don't bitch about it.

By the way, the only PA's that truly, merely "assist" a physician, are people in surgery. Most PA's working in FP,IM,Derm,EM etc, they have their own patient load, and see them independantly, they don't stand next to a doctor and follow orders, they make decisions, and practice medicine. And, as more and more PA's have been in practice for 20+ years, it is becoming quite common, for PA's to help in the education of new medical residents.

Similar in nature to the DA, and Deputy DA dynamic, they do their own things, individually, but the DA is always in charge.


P.S. If I had wanted to get my DO, I would have matriculated to one of the three acceptances I got to Medical school. I headed the warnings from my family friend physicians, and took the PA spot. The more I hear the new med students, and residents talk, the more happy I am about my decision.

What I want to know, is why do med students feel so threatened by PA's and NP's? If you know in your heart of hearts, that you can "school" each and every PA and NP at medicine, then why worry. You ever notice, the more people know, and the more they KNOW, that they know, typically the more humble they become. Yet, the people that aren't bad asses, the ones that don't have it all in their back pocket are typically the ones who must "be better then someone" to justify their own postition. Who are you proving it to, yourself or to others? You want to prove you know more, don't tell people you know more because of how much school you underwent, prove it to people in your skills and professionalism. Sheesh, I think if life has taught me one thing. It's that usually it is the insecure who try to present themselves as being better then any one other person in this world.(goes back to the whole kids teasing kids thing) Those that are truely comfortable with who they are, are accepting of even the most uneducated/fat/ugly/arrogant/ people.

Shoot, maybe i should be a motivational speaker!

*this ramble was not checked for spelling or grammar errors, if you find them, please be happy in your triumph, but realize, they do not alone make me stupid, it's the other aspects of me that truely make me stupid!

 

[primadonna22274]

GO ADAM!!!
How's PA school treating ya?

Lisa

 

[deleted6669]

I would have to say many pre-med students DO have health care experience

I'm not talking about volunteer stuff here....paid/professional full time medical experience as required by most good pa programs.....
how many paramedics, resp. therapists, rn's, and physical therapists in a typical medschool class of 100? maybe 3 or 4?.....more so for D.O. because they value older applicants more so than MD programs but even then we are probably talking about 10-15 out of 100......

 

[mx_599]

I'm not talking about volunteer stuff here....paid/professional full time medical experience as required by most good pa programs.....
how many paramedics, resp. therapists, rn's, and physical therapists in a typical medschool class of 100? maybe 3 or 4?.....more so for D.O. because they value older applicants more so than MD programs but even then we are probably talking about 10-15 out of 100......

I guess...maybe I have worked harder than many premeds. I have tons of paid healthcare work throughout college.

 

[corpsmanUP]

I feel really bad for your Adam. If you think that your speech is going to make anyone but yourself feel better about your predicament, then you are wrong. You are not quite at that point where you can justify your own decision to become a PA, and thus you continue to make points that you feel strengthen your stance.

1) You continue to gloat about your Do acceptances.

2) You say that medicine is no longer a respected profession and that physicians are somehow not the top of the food chain any longer.

3) You arrogantly try to make comparissons using terribly incorrect analogies like the DA, assistant DA thing. IN case you forgot, the DA and assistant DA are both attorneys in the end and have the EXACT same license.

4) You try to inflate the PA curriculum and deflate the medical school curriculum by stating the only real difference is the more in depth pathology. I hate to tell you this, but that is only the beginning of the differences. The main difference is that medical students take incredibly painful and difficult national board shelf exams after each 3rd year rotation, each equivilant in difficulty to the PA's 1 board exam. Then med students take 2 steps of the USMLE, and 1 additional step in residency. The post residency there is a board exam for your specialty. I realize in PA school there are exams after each rotation, but these are internal and not standardized. We too take the internal exams, added to the hassle of the external board for EACH rotation.

A PA's basic science curriculum as standardized by the council is quite "basic". And you cannot possibly use that argument about how PA students have much more in depth undergrad sciences, because the vast majority of med students have a biomedical science degree. A year of undergrad A&P is like taking a stroll on the beach compared to medical school level A&P.

Then you add in residency. A lot of PA's will say that their first few years out of school are their residency. Until you have gone through 3 years of incrementally expanded scope of practice under "real" supervision, having averaged well close to 80 hours per week, then you have not done a residency. And in the end, it is honestly the residency that separates a PA from an MD. So please don't try and argue that physicians do not have a significant more training than a PA, because we all know that they do. And until a time that you have been to medical school, you are not capable of commenting on the true difference anyway.

I can tell you are headed toward dissatisfaction and being illcontent as a PA. if you are already arguing so hard for a case you don't even have the experience to know about, you are never going to be satisfied. The best PA's are the ones who do their jobs incredibly and earn their respect through deeds. You cannot expect that an entire profession of competing providers is going to be embraced by an entire profession of physicians. The PA's level of respect and status among his/her peers is an individual fight that must be fought and won by each individual PA. Its not about trying to make an argument for the profession as a whole. That argument will never get you anywhere.

I hope you really can stomach being a PA, because in the end the only person who has to be happy with it is you. But right now you aren't convincing anyone that you are a happy little PA.

 

[adamdowannabe]

What predicament?

And, you have to admit, courses are dependant on who teaches the course. I had a bio class in highschool that was more in depth then some I encountered in undergad. So, generalities can't be applicable.

As for the comment of doctors not being the top of the food chain, I wasn't refering to the medicine heirarchy, I was refering to general public opinion. Working in healthcare (in general) doesn't have the same stigma it did 20 years ago, or 30 or 40........... to most, it's just another career. At least on the west coast. It could be totally different in other geographics.

But, the message I continually see , is most of you med students come to the clinicians forum and talk trash, if it in no way affected you, why do you continually have to refute the things said here, let me on my merry way, with false thoughts crowding my head. Doesn't hurt you at all, now does it? It speaks to the type of person you are, but thats about it.

Yes, your tests, and yes your horrible residencies, and all these horrible things you must undergo for your coveted medical license.

I give you two points (like... +2) about the D.DA and DA, yes true they hold the same BAR, but I was trying to present a point about the PA/MD dynamic, which isn't merely being a beck and call assistant to a physician. It's a subordinate colleague role. Which isn't really caparable to any professional relationship where the educations are different, but the roles are more similar then different. Am I right?

Ok, now I wil go cry in my bed, because the big bad medical students will always be there to tell me how hard they have it, and how easy the PA has it. My feelings are hurt, by a stranger I can only call Corpsman! To what I refute, if you have it so hard, and PA's have it so easy.... and being a PA affords you the ability to practice some darn good medicine (if you so choose) whats wrong with taking the PA route? Nothing!

 

[adamdowannabe]

Oh yeah,

The majority of my post, was concerned with the idea that I was quoted as saying I know physicians who would like to have the role of PA if given the option, which was refuted by an argument about the amount of medical school time devoted to the study of PHYSIOLOGY (which had no relevence to my comment whatsoever), and only PHYSIOLOGY, it wasn't an argument about about complete undergrad curriculum, or comparing the undergrad of the PA student to the Medical student, it was merely that of the requirement of PHYSIOLOGY, but I appreciate having words put in my mouth, next time, just ask me for my sign on info, and you can write my posts for me, save me the trouble from trying to have a little fun!

And, also, don't snap at me for choosing a career path that will take me 1/4 the time to give myself a similar job description. You can take all your medical school hassles, shelf exams, worries about matching in what you want, and all the ulitmate decision making responsiblity and all the pain in the ass everyone says the entirety of residency is, the hassles of billing, and getting your money from reimbursement, and enjoy the specialty which you committed to, without really knowing if you will love it for then next 30 years, enjoy it, you earned it! And I am sure I will enjoy being an PA for all the exact same reasons, and the freedoms it allows. And from now on, I will change my SDN name and never bring up medical school again. I don't mean to use it as a crutch to prove my points.
SoRRy.


I will go back into my sad little PA fantasy world, the one where PA's get to see patients, and make diagnosis, and prescribe medications, and problem solve, and have patients.......oh who are we kidding, we all know all a PA does is follow an MD around and get them coffee and stuff right?

 

[corpsmanUP]

Oh yeah,

The majority of my post, was concerned with the idea that I was quoted as saying I know physicians who would like to have the role of PA if given the option, which was refuted by an argument about the amount of medical school time devoted to the study of PHYSIOLOGY (which had no relevence to my comment whatsoever), and only PHYSIOLOGY, it wasn't an argument about about complete undergrad curriculum, or comparing the undergrad of the PA student to the Medical student, it was merely that of the requirement of PHYSIOLOGY, but I appreciate having words put in my mouth, next time, just ask me for my sign on info, and you can write my posts for me, save me the trouble from trying to have a little fun!

And, also, don't snap at me for choosing a career path that will take me 1/4 the time to give myself a similar job description. You can take all your medical school hassles, shelf exams, worries about matching in what you want, and all the ulitmate decision making responsiblity and all the pain in the ass everyone says the entirety of residency is, the hassles of billing, and getting your money from reimbursement, and enjoy the specialty which you committed to, without really knowing if you will love it for then next 30 years, enjoy it, you earned it! And I am sure I will enjoy being an PA for all the exact same reasons, and the freedoms it allows. And from now on, I will change my SDN name and never bring up medical school again. I don't mean to use it as a crutch to prove my points.
SoRRy.


I will go back into my sad little PA fantasy world, the one where PA's get to see patients, and make diagnosis, and prescribe medications, and problem solve, and have patients.......oh who are we kidding, we all know all a PA does is follow an MD around and get them coffee and stuff right?

Well if its all as good as you say it is perhaps I should have stayed a PA heh? But I guess you know everything about the PA world and all that comes with it. Trust me, unless you are one of the oldtimers with a niche practice, you are not going to be the PA that you mentioned. Good times have past for new PA's, and its only the emeds and Bandits of the world that live the high life. Everything I said came from your post. If the words fit, wear them. Until you have walked in both a PA and a physician's shoes, you will not ever truly know the difference. I thought I knew once, and I was wrong. I'll tell you for sure real soon when I start residency

I am not trying to bring you down, just bring you down to earth. If you think the conversations we all share here are bad, wait until you explain yourself daily and still have your friends asking you how you drive a Lexus drawing blood for a living. PA's deserve more respect for what they do, but so do garbage men and iron workers. Life stinks sometimes.

 

[primadonna22274]

Corpsman: you've been found out!
I suspected you were a PA like me who had seen the light and decided to go back to med school. Are we idiots?!?! All my MD mentors keep trying to talk me out of it, but the truth is, all my reasons for NOT going back to med school aren't just as convincing as they used to be. And it's comforting to know there are others who've done it and feel good about their choice. Sure, I've known plenty of docs who've told me they would've chosen to be PAs if they had known it was an option way back when--but I suspect there are more PAs who ask themselves on a daily basis "what if???" as I've done.
Unless I wanted to be a surgical PA as some of my buddies are, I will never make the six figures you hear about. I work damn hard--12 hour days usually just to keep up with the paperwork etc. I bring in very nearly as much as the rest of our family physicians and a good deal more than one of the internists (he doesn't do hospital, go figure) and yet I'm paid a straight salary, no bonus, no productivity incentive. I keep on keeping on 'cuz I like the people I work with and I love my little house but when I get into med school I'll be moving on.
Adam, listen: your enthusiasm is understandable. We've all been there. I remember it vividly. But something has happened in five years of primary care practice that has taken the wind out of my sails. I won't go back into primary care. It's not that I'm any less energetic about providing excellent patient care and knowing as much about every problem I encounter as I possibly can--I am probably one of the least complacent PAs you'll meet. I have a dear friend (OK, an old flame) who would dearly love to go back to med school but he's pushing 46 and he has 4 kids to support and a wife's lifestyle to keep up. I don't have those restrictions--just two dogs, three cats and a mortgage and plenty of educational debt to start off, but 31 isn't such a bad time to start over.
But let's not get into a "my career choice is better than your career choice" war. It's been done. Blech! When it all comes down to it, we all work together. Spend your energy focusing on learning now--you won't get that time back, and it's hard to make up down the road once you're working a zillion hours a week and exhausted. It's a VERY steep learning curve the first 2-3 years out of school and it's easier if you know as much as you can about everything you can before you get there.
Lisa

Well if its all as good as you say it is perhaps I should have stayed a PA heh? But I guess you know everything about the PA world and all that comes with it. Trust me, unless you are one of the oldtimers with a niche practice, you are not going to be the PA that you mentioned. Good times have past for new PA's, and its only the emeds and Bandits of the world that live the high life. Everything I said came from your post. If the words fit, wear them. Until you have walked in both a PA and a physician's shoes, you will not ever truly know the difference. I thought I knew once, and I was wrong. I'll tell you for sure real soon when I start residency

I am not trying to bring you down, just bring you down to earth. If you think the conversations we all share here are bad, wait until you explain yourself daily and still have your friends asking you how you drive a Lexus drawing blood for a living. PA's deserve more respect for what they do, but so do garbage men and iron workers. Life stinks sometimes.

 

[niko327]

You try to inflate the PA curriculum and deflate the medical school curriculum by stating the only real difference is the more in depth pathology. I hate to tell you this, but that is only the beginning of the differences. The main difference is that medical students take incredibly painful and difficult national board shelf exams after each 3rd year rotation, each equivilant in difficulty to the PA's 1 board exam. Then med students take 2 steps of the USMLE, and 1 additional step in residency. The post residency there is a board exam for your specialty. I realize in PA school there are exams after each rotation, but these are internal and not standardized. We too take the internal exams, added to the hassle of the external board for EACH rotation.

A PA's basic science curriculum as standardized by the council is quite "basic". And you cannot possibly use that argument about how PA students have much more in depth undergrad sciences, because the vast majority of med students have a biomedical science degree. A year of undergrad A&P is like taking a stroll on the beach compared to medical school level A&P.

Then you add in residency. A lot of PA's will say that their first few years out of school are their residency. Until you have gone through 3 years of incrementally expanded scope of practice under "real" supervision, having averaged well close to 80 hours per week, then you have not done a residency. And in the end, it is honestly the residency that separates a PA from an MD. So please don't try and argue that physicians do not have a significant more training than a PA, because we all know that they do. And until a time that you have been to medical school, you are not capable of commenting on the true difference anyway.

I can tell you are headed toward dissatisfaction and being illcontent as a PA. if you are already arguing so hard for a case you don't even have the experience to know about, you are never going to be satisfied. The best PA's are the ones who do their jobs incredibly and earn their respect through deeds. You cannot expect that an entire profession of competing providers is going to be embraced by an entire profession of physicians. The PA's level of respect and status among his/her peers is an individual fight that must be fought and won by each individual PA. Its not about trying to make an argument for the profession as a whole. That argument will never get you anywhere.

I hope you really can stomach being a PA, because in the end the only person who has to be happy with it is you. But right now you aren't convincing anyone that you are a happy little PA.

Dude you are right. Alot of PA school hopefuls might not want to believe it, but I think you're right. I am about to graduate the PA program. I have met medical students during my clinical training and I have to say that I was quite often very impressed with their level of knowledge (clinical skills were same as any other PA student honestly). From what I've seen I can definitely see what you're talking about. Take this and couple it with the residency requirements of 80+ hours and I can see why the doc is the doc. That being said, I can also say that PA school was no walk in the park (as I'm sure you know). If I had only one word to describe PA school it would be: INTENSE. No doubt that med school will literally teach you MORE about everything, but I wonder if it will be as INTENSE. Maybe you could tell us when you get through the first couple of years of it, I'd really like to know. In the end I can think of no better way to prepare for becoming a physician than becoming a PA first. I hope to get the opportunity to do this very thing in the near future.

 

[corpsmanUP]

Dude you are right. Alot of PA school hopefuls might not want to believe it, but I think you're right. I am about to graduate the PA program. I have met medical students during my clinical training and I have to say that I was quite often very impressed with their level of knowledge (clinical skills were same as any other PA student honestly). From what I've seen I can definitely see what you're talking about. Take this and couple it with the residency requirements of 80+ hours and I can see why the doc is the doc. That being said, I can also say that PA school was no walk in the park (as I'm sure you know). If I had only one word to describe PA school it would be: INTENSE. No doubt that med school will literally teach you MORE about everything, but I wonder if it will be as INTENSE. Maybe you could tell us when you get through the first couple of years of it, I'd really like to know. In the end I can think of no better way to prepare for becoming a physician than becoming a PA first. I hope to get the opportunity to do this very thing in the near future.

I can tell you now. PA school was very challenging. Medical school is even more challenging and intense enough that this PA spent a great deal of time stressing, to the point where it bought me a scope in year 2!! I was living off coffee and Advil. It was tough as hec. Just when you finished one small block, yu started a new one. Unlike PA school, the end was never in site until recently. And just like in sports or in any competition, you do best when you see the light at the end of the tunnel. Shelf exams are incredibly difficult. You are taking an exam that compares you with every other person taking that exam in the entire country. There is a book called Robbins Pathophysiology of Disease. If you have never had the experience of reading this book cover to cover in 2 semesters, all the while carrying 25+ other credits each of those semesters, you are unikely to understand what I am talking about. The first 2 years were like running some sort of marathon at a 400 meter pace!! 3rd year was much better because they let me do a lot more than most med students. I have met a lot of PA's in med school and if my little part of the world has this many, there are probably a hundred or more in school around the country. I am not even sure how you could give advanced credit for PA school except probably in the clinical medicine course. No one PA course is equal to any one MD course. The bar is raised at each level. And there is no way to only learn what you missed before.

Hey Primadonna- You sound like you may be trying to go to medical school for the wrong reasons. I was not in your situation at all. I had supportive colleagues who paid me very very well. I had all the autonomy I wanted, bonus for production, and staff that treated me the same as a physician. It was simply me who needed to do it for me. You sound like you might just need to have a sit down with your docs and tell them what you feel you really deserve. You need to know how much you are bringing in so that you can know how much to ask for. But production bonus is a MUST in today's world, otherwise they are losing out on your potential as well.

Adam- I am glad you are cool with your decision. I suggest you just stop worrying about what everyone else thinks of you as a PA, and be happy being one. Good luck all of you.

 

[primadonna22274]

Hey Corpsman,
Thanks for your thoughts. No, although I probably didn't make my point as clearly to you as I meant to, the primary reason for going back to med school is NOT financial. If it were, I'd be giving up $600,000 + in earned income over the next seven years for a very slow return to a good income. You do make some thoughtful points about the long haul of med school though and I appreciate that very much.
The truth is, I've never been at peace with my decision to be a PA. I applaud all of you who are--but I chose to be a PA for the wrong reasons. It was a compromise with an ex-husband who was utterly unsupportive of my desire to be a physician. As it turned out, he was unsupportive of me working as a PA too because at the end of the day I couldn't take care of him after taking care of people all day long. When the marriage ended (it wasn't all bad either), I had to take a long hard look at where I was and what I was doing and I've realized I want more.
I think a happy PA is a content PA--someone who has let go of the need for respect, the title, the independence. This may be a character flaw of mine but I've just never been a content PA. (My ex would point out that I'm not content overall but I'm working on that one.)
I do have reservations about going back to med school. I wonder if it's the right choice or if my motivations are correct. My boyfriend's brother (who had entertained the idea of med school and decided against it) told me I should apply, get accepted, and make peace with that i.e. not go. ??? On some level he made sense. On the other, it seems a shame to do all the prep and not go.
At this point, I'm fairly sure if I do go I won't be able to afford it until 2007. Sorry guys...I'm rambling here. I'll wrap up.
Anyway, good luck to all of you,
Lisa














Hey Primadonna- You sound like you may be trying to go to medical school for the wrong reasons. I was not in your situation at all. I had supportive colleagues who paid me very very well. I had all the autonomy I wanted, bonus for production, and staff that treated me the same as a physician. It was simply me who needed to do it for me. You sound like you might just need to have a sit down with your docs and tell them what you feel you really deserve. You need to know how much you are bringing in so that you can know how much to ask for. But production bonus is a MUST in today's world, otherwise they are losing out on your potential as well.

 

[adamdowannabe]

So, CorpsmanUP!

What was it that had you deciding to quit a career that had you in a nice job, paid very well, as autonomous as you wanted to..... to get the medical education. If I have read between the lines correctly, it wasn't because you were treated badly as a midlevel, so my guess is it has everything to do with your internal drive to learn MORE MORE MORE about medicine! An MSII at the one of the schools I got into sat down and talked with me about my choice, he said "what happens after 5-8 years in practice as a PA, and you are as proficient as your supervisor, and you hit that "glass ceiling" as far as being a PA affords. What do you do then?" (that was his argument that I should "go all the way") my response to him was....... look for a new position in a new specialty, and start the growth all over again.

I am one of those strange people, that finds more joy in the struggle, then reaching a goal. Once the goal has been met, I need a new struggle. Hence the idea of switching specialties, that and my extreme ADHD.

I am sure you have had words with the other PA to Med students at your school, is the explanation usually the same? IS it about the mastery of medicine, or other goals that drive you to medical school?

I didn't have much time to thoroughly think all this through, and so it is true, I still think about it, (although the options are now gone) But, at least in the case of becoming a PA, the option of medical school still exisits, although the revearse cenario doesn't exisit. It's one of those situations, where you have to ask people questions, ad take what they tell you as the truth and helpful advice, But it's obvious, the right decision cannot be made until after the experiences are first person.

*about the lexus on a blood drawers salary, if you can drive a porsche on a bartenders salary, people shouldn't be shocked at anything. Just say you dabble in the market!

 

[primadonna22274]

I've thought about this a bit. I've thought about changing specialties. Certainly after five years in primary care I'm pretty well-grounded in general medicine. The only thing I can tell you that makes any sense, Adam, is there's some underlying NEED to be a doctor. Something about the ancient profession that lures me. It isn't entirely rational. It doesn't make short-term financial sense (although long-term it would be well worth it).
I think if you can find contentment as a PA, you should be a PA. I'm just not there, and in five years I haven't gotten there.
I do think (my unscientific opinion, don't flame me) it seems more PAs than NPs struggle with this. Perhaps because NPs are nurses first and comfortable with their role as a nurse. "Advanced practice nursing" makes sense as an extension of the nurse. There's also a great deal of flexibility within nursing to do different things and become specialized even with being an APN. My sister is a NICU nurse--very specialized, and she likes it that way. That specialization doesn't prevent her from moving into another field of nursing but she chooses to stay where she is and become the best damn NICU nurse she can be. I would certainly trust her with my 28 weeker if I had one (thank God I don't).
PAs also have a great deal of lateral mobility--the ability to move from one specialty to another with relative ease by virtue of getting a doc to hire & train you in a particular specialty. I just don't know that there's any other specialty I'd like to be a PA in--I would still be a PA.
I dunno...food for thought.
As it is I have to get to work (ugh...it's Sunday).
L.

So, CorpsmanUP!

What was it that had you deciding to quit a career that had you in a nice job, paid very well, as autonomous as you wanted to..... to get the medical education. If I have read between the lines correctly, it wasn't because you were treated badly as a midlevel, so my guess is it has everything to do with your internal drive to learn MORE MORE MORE about medicine! An MSII at the one of the schools I got into sat down and talked with me about my choice, he said "what happens after 5-8 years in practice as a PA, and you are as proficient as your supervisor, and you hit that "glass ceiling" as far as being a PA affords. What do you do then?" (that was his argument that I should "go all the way") my response to him was....... look for a new position in a new specialty, and start the growth all over again.

I am one of those strange people, that finds more joy in the struggle, then reaching a goal. Once the goal has been met, I need a new struggle. Hence the idea of switching specialties, that and my extreme ADHD.

I am sure you have had words with the other PA to Med students at your school, is the explanation usually the same? IS it about the mastery of medicine, or other goals that drive you to medical school?

I didn't have much time to thoroughly think all this through, and so it is true, I still think about it, (although the options are now gone) But, at least in the case of becoming a PA, the option of medical school still exisits, although the revearse cenario doesn't exisit. It's one of those situations, where you have to ask people questions, ad take what they tell you as the truth and helpful advice, But it's obvious, the right decision cannot be made until after the experiences are first person.

*about the lexus on a blood drawers salary, if you can drive a porsche on a bartenders salary, people shouldn't be shocked at anything. Just say you dabble in the market!

 

[mx_599]

I feel really bad for your Adam. If you think that your speech is going to make anyone but yourself feel better about your predicament, then you are wrong. You are not quite at that point where you can justify your own decision to become a PA, and thus you continue to make points that you feel strengthen your stance.

Adam, I have to agree to an extent here with the above poster. You seem to be very bright and write well, but it takes too long to read your posts! You must be a fast typist or spend lots of time here! (me- I hunt and peck still combined with too much time here)
It does kind of seem like you are "over promoting" the PA field.
I have to agree with the Human A&P comments by the above poster. I had A&P in undergrad and they'll probably be cakewalk compared to what I will have this Fall.
Please don't take this as a personal attack at all. I have learned quite a bit from your posts in the past few days. I think your posts would be more effective if they were shorter and concise.

 

[mx_599]

My boyfriend's brother (who had entertained the idea of med school and decided against it) told me I should apply, get accepted, and make peace with that i.e. not go. ??? On some level he made sense. On the other, it seems a shame to do all the prep and not go.
At this point, I'm fairly sure if I do go I won't be able to afford it until 2007. Sorry guys...I'm rambling here. I'll wrap up.
Anyway, good luck to all of you,
Lisa

Lisa,
I think your BF brother made a good suggestion. Don't worry about what you might go through and then decide not to follow through. Worry about it when the time comes.
Brian

 

[primadonna22274]

Thanks all.
I dunno...gotta think a bit. There are times (like this morning) when I think gee, do I really want to work all the time and not have time for a family, my garden, my puppies? All for a bit more R-E-S-P-E-C-T? Hmmm. Maybe I just need a career change (specialty change).
You've all got me thinking anyway. That's never a bad thing.

L.

Lisa,
I think your BF brother made a good suggestion. Don't worry about what you might go through and then decide not to follow through. Worry about it when the time comes.
Brian

 

[mx_599]

Thanks all.
I dunno...gotta think a bit. There are times (like this morning) when I think gee, do I really want to work all the time and not have time for a family, my garden, my puppies? All for a bit more R-E-S-P-E-C-T? Hmmm. Maybe I just need a career change (specialty change).
You've all got me thinking anyway. That's never a bad thing.

L.

you're only 31...you have plenty of time for all that stuff and a family. furthermore, depending on what you want to do after medical school, you don't need to be at the top of your class.

so after specializing in another area of PA for 6-8 years don't you think you might look back and say, "I could have been done with medical school by now and in a residency....I wish I could be 31 again"

don't think the excitement and freshness of a new PA field will last forever. the longing/wonderment of becoming a physician will surely creep back.

at least if you go for it, get accepted, and decide not to go you will always know that you "could have" (the drop out rate is very low)

 

[corpsmanUP]

Like Prima, my reasons for wanting to be the doctor were more than just knowledge. I firmly believe that in life, one should reap the rewards for the career they choose, even outside of work. My close friends include guys who are teachers, coaches, bankers, lawyers, plumbers, and salesmen. Each of them is completely happy with who they have become. I though probably have some unmet childhood need to feel important, who knows! I probably could have got the same level of contentment as going to medical school by simply paying for a therapist for the same timeframe!!

Think about that one Lisa before you spend all the money to be important! But in the process I have realized that being a doctor is who I want to be. I want to be in a small town being a doctor for a place where no one else wants to go. I want to have people say hello to me at the movies, and at the grocery store. I want my kids to be know as "docs kids". I want my wife to enjoy life and not have to work. But I am not just someone seeking importance, because I also seek to make a HUGE difference. I felt I could not make that big a difference as a PA.

About the cost though Lisa, you will never be able to afford medical school, and you have to be better off than most now. One rule about med school like no other professional school is that they don't care how much debt you have from before, they will still throw all the money at you that you can sign for. If you want to do it, take it in stages, MCAT, application, interview, waiting......, 1st year, 2nd year. etc......

It flies by I can promise you. I'll still a few years shy of 40 when I am done with residency, but I look young

Being just a bit older in med school pays dividends for faculty and staff acceptance and treatment. I have had nothing but complete respect from the physicians I have trained under and they are all very impressed that I would take this route!

FYI, if you want to have a family, med school is actually not a barrier. Residency is to a degree, but who knows, you might find your man in your class!! It happens so often that I can't even count!

 

[primadonna22274]

*Sigh*
I know you're right, Brian, thanks.
This is what I keep telling myself.
I THOUGHT I had let go of the MD life until 2 or 3 months ago my baby sis (premed) emailed me and said "Hey Lisa! I think you should go to medical school! I think you should be an OB-GYN and then we can go into practice together!!" yada yada yada.
And I'm thinking of it seriously for the first time in a couple of years. After I got divorced 3 years ago I thought for sure I would go back, but there was no way I could afford it. Now, $28000 in bad debt paid off (so THAT'S where all my money goes...) I'm in a much better financial position. Sure, if I had a rich husband it would be a no-brainer but then I'm an independent woman and I'm not looking for a sugar daddy. I also don't think I'll do OB but you never know. And yes, I really don't want to be 38 and wish I'd gone back to med school at 32.
OK, thanks again, back to work....
L.
!

you're only 31...you have plenty of time for all that stuff and a family. furthermore, depending on what you want to do after medical school, you don't need to be at the top of your class.

so after specializing in another area of PA for 6-8 years don't you think you might look back and say, "I could have been done with medical school by now and in a residency....I wish I could be 31 again"

don't think the excitement and freshness of a new PA field will last forever. the longing/wonderment of becoming a physician will surely creep back.

at least if you go for it, get accepted, and decide not to go you will always know that you "could have" (the drop out rate is very low)

 

[mx_599]

I want to be in a small town being a doctor for a place where no one else wants to go. I want to have people say hello to me at the movies, and at the grocery store. I want my kids to be know as "docs kids".

Isn't that what the tv show Northern Exposure was like?

 

[primadonna22274]

Hey,
Just coming back to this thread after several days. Didn't realize you'd responded to me Brian--thanks.
(Heh heh...considering how difficult it is to find someone to date these days, half the appeal of going back to med school is to meet someone wonderful!)
You're right though. I know it doesn't make financial sense--but it DOES make emotional sense to me. The time isn't quite right though--I've decided to put off applying until the 2007 cycle (just don't feel ready to do the best I can do on the MCAT in August and I can't afford to quit work in a year if I DID get in, and it hardly seems right to get accepted and defer, potentially keeping some other worthy candidate out of the pipeline).
I LOVED Northern Exposure!
L.

Like Prima, my reasons for wanting to be the doctor were more than just knowledge. I firmly believe that in life, one should reap the rewards for the career they choose, even outside of work. My close friends include guys who are teachers, coaches, bankers, lawyers, plumbers, and salesmen. Each of them is completely happy with who they have become. I though probably have some unmet childhood need to feel important, who knows! I probably could have got the same level of contentment as going to medical school by simply paying for a therapist for the same timeframe!!

Think about that one Lisa before you spend all the money to be important! But in the process I have realized that being a doctor is who I want to be. I want to be in a small town being a doctor for a place where no one else wants to go. I want to have people say hello to me at the movies, and at the grocery store. I want my kids to be know as "docs kids". I want my wife to enjoy life and not have to work. But I am not just someone seeking importance, because I also seek to make a HUGE difference. I felt I could not make that big a difference as a PA.

About the cost though Lisa, you will never be able to afford medical school, and you have to be better off than most now. One rule about med school like no other professional school is that they don't care how much debt you have from before, they will still throw all the money at you that you can sign for. If you want to do it, take it in stages, MCAT, application, interview, waiting......, 1st year, 2nd year. etc......

It flies by I can promise you. I'll still a few years shy of 40 when I am done with residency, but I look young

Being just a bit older in med school pays dividends for faculty and staff acceptance and treatment. I have had nothing but complete respect from the physicians I have trained under and they are all very impressed that I would take this route!

FYI, if you want to have a family, med school is actually not a barrier. Residency is to a degree, but who knows, you might find your man in your class!! It happens so often that I can't even count!

 

[primadonna22274]

Oops sorry--that was Corpsman. Well, thanks to you and Brian too.

L.
p.s. We need some SERIOUS pro-PA posts in response to the "200k" thread MacGyver's got going on the "Everyone" and "General Residency" forums. PLEASE READ and correct this ill-advised dude.
Thanks all!

 

[RAMPA]

although there has been alot of arguing on this forum, it does make a pre-PA wonder. I'm in a situation where I value family and religion very much. I dont want to be the doc working 6a-11p everyday, yet at the same time I dont want to be the PA who after 5-10 yrs (38-40 yrs old) hits the glass ceiling and wants more. Sure I could change specialties (I really love cardiology and radiology), but that means starting all over again at the bottom. This is a big debate because not until you are in a MD or PAs shoes will you really know if you like it or would have done things a different way. PA to MD may be more feasible but not MD to PA (excluding FMGs). Pros and cons play a role but ultimately its....am i having "fun" doing this?
I still lean towards PA (I am shadowing one right now), but for others who may be in my shoes.........what was that "thing, factor, etc" that you choose one over the other????????

 

[guetzow]

There are other ways to make money. Do both. Be a PA And make money...
(Play the maeket, real estate, whatever). Think outside the box.

 

[Monika]

I still lean towards PA (I am shadowing one right now), but for others who may be in my shoes.........what was that "thing, factor, etc" that you choose one over the other????????

My reasons for choosing the Physician Assistant profession:

1) I do not need nor have any inclination to be the 'top dog'.
2) Professional career in MEDICINE!!
3) Can work in any field of medicine, as long as their is a supervising physician who needs me.
4) plenty of autonomy
5) the ability to move between any area of medicine that I choose at any time in my career
6) great salary
7) work as an integral part of the healthcare team
8) ability to move into academics, research, government/political, or administrative positions
9) good career for someone who wants to practice medicine & still have time for family
10) The United States Bureau of Labor Statistics (BLS) projects that the number of PA jobs will increase by 49 percent between 2002 and 2012.