Physician Assistant lateral mobility.. Overated?

[scurred09]

So one of the biggest advantage of being a PA versus an MD/DO is their ability to transition to different medical speciality w/o residency training. Are there MDs/DOs bother by the fact that lateral mobility is almost nonexistence for Physicians. The reason why I say that it's almost non existence is due to the fact that it may not be economical or perhaps the satisfaction of a new field may not exceed the opportunity cost to switch speciality. Any Physician feels stuck in their field and frustrated? Last but not least is lateral mobility of a PA overated?

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[Chocolate Bear]

Are you looking for *actual* perspective or speculation/secondhand anecdotes?

This is a pre-med forum, which is why I ask.

 

[scurred09]

It's fair game my friend. I take what you will give.

Are you looking for *actual* perspective or speculation/secondhand anecdotes?

This is a pre-med forum, which is why I ask.

 

[Chocolate Bear]

It's fair game my friend. I take what you will give.

Fair enough.

My old GP told me he wished he had gone IM, since he could have had the same practice, but that would have given him the ability to pursue specialties that he was closed off from, like Endo, which he discovered he loved after it was too late.

I know some PAs, but I've never asked them. There are a few PAs floating around here--hopefully they can chime in.

 

[beckhunter116]

A better question to ask might be how often do PA utilize their ability to switch fields? I tend to think that while it is possible for them to switch most won't because due to their shortened education they do a lot of learning on the job, so most probably don't want to get very comfortable in their field of interest and then change fields and require a few more years to get up to a similar scope of practice that they previously held.

Hopefully a PA will address these questions.

 

[primadonna22274]

Lateral mobility is a nice perk but I think the majority of PAs tend to stick within the same general range of specialties.
e.g. surgical PAs might go into another area of surgery or critical care, but I have rarely seen them move into primary care.
I've spent my whole career (9 years) in primary care (FP/urgent care) but did a year and a half of EM (which is pretty much primary care for a lot of folks...)
Now I'm teaching and lots of smart PA students tell me they chose PA over MD/DO because they didn't want to be stuck in school as long/didn't want the debt/responsibility/yada yada. I think they're snowed personally but I'll let them find out for themselves. Very few of them cite "lateral mobility" as the reason they chose PA.
I certainly could go into a totally different specialty but I would probably stick with what I know (e.g. Internal Medicine-->hospitalist but probably not so likely to go into, say, uro/gyn surgery, just because I don't like surgery that much).
An important sidenote: I think we will be looking at some restriction of lateral mobility for PAs very likely within the next decade as NCCPA develops specialty certification exams for PAs in specific areas. Also there is some talk of requiring residency training for specialty PAs and already at the state licensing & hospital credentialing level we are seeing restrictions. I'm sad to say that the ability of PAs to move laterally with ease will more likely than not become a thing of the past.
My .02, and many may disagree. 😎

 

[sylvanthus]

The reason PAs can so easily switch specialties is because they do not have near the depth of knowledge as the speciality physicians. So, are you the type of person who wants to be more of a generalist with the ability to move around or the person who is "stuck" but knows a lot more?

 

[primadonna22274]

I think that's a gross oversimplification. A PA who has been in, say, a specialty like trauma/critical care for a number of years (7-10) develops a very deep and broad knowledge base within that specialty (which can be pretty broad because of the number of systems involved). A PA who enters a new specialty typically has a very steep learning curve which may take a few years to master, but after that can be pretty darn knowledgeable in his/her field. Not too unlike a residency-trained physician fresh out of training. The trouble is that there is such variation from PA to PA & job to job and without the rigorous checks of residency you don't know for sure what the PA has & hasn't been taught. This, I think, is a reasonable argument for mandated residency training for specialty PAs, but there's plenty of opposition to it for sure. I'm sort of a fence-sitter on the issue. If you've paid attention to enough of my posts you'll see I'm VERY pro-physician so don't get all riled up because I said PAs are a lot like physicians--well duh, we're trained by doctors in medical schools to think like doctors and do what doctors would do if they could do everything themselves....

The reason PAs can so easily switch specialties is because they do not have near the depth of knowledge as the speciality physicians. So, are you the type of person who wants to be more of a generalist with the ability to move around or the person who is "stuck" but knows a lot more?

 

[scurred09]

Thank you for sharing your thoughts and experiences. I read some of your post and understand that you would like to be an FP Physician one day. Does the cost of med school education not deter you from pursuing FP? If you end up with 250K med school debt, FP salary will take you some time to pay off. Plus, ur a PA and even if you manage to work part time while attending med school, it would still be a huge sacrifice. Not saying that you can't do it but u got heavy decision to make.

Lateral mobility is a nice perk but I think the majority of PAs tend to stick within the same general range of specialties.
e.g. surgical PAs might go into another area of surgery or critical care, but I have rarely seen them move into primary care.
I've spent my whole career (9 years) in primary care (FP/urgent care) but did a year and a half of EM (which is pretty much primary care for a lot of folks...)
Now I'm teaching and lots of smart PA students tell me they chose PA over MD/DO because they didn't want to be stuck in school as long/didn't want the debt/responsibility/yada yada. I think they're snowed personally but I'll let them find out for themselves. Very few of them cite "lateral mobility" as the reason they chose PA.
I certainly could go into a totally different specialty but I would probably stick with what I know (e.g. Internal Medicine-->hospitalist but probably not so likely to go into, say, uro/gyn surgery, just because I don't like surgery that much).
An important sidenote: I think we will be looking at some restriction of lateral mobility for PAs very likely within the next decade as NCCPA develops specialty certification exams for PAs in specific areas. Also there is some talk of requiring residency training for specialty PAs and already at the state licensing & hospital credentialing level we are seeing restrictions. I'm sad to say that the ability of PAs to move laterally with ease will more likely than not become a thing of the past.
My .02, and many may disagree. 😎

 

[sylvanthus]

"A PA who has been in, say, a specialty like trauma/critical care for a number of years (7-10) develops a very deep and broad knowledge base within that specialty"

Because this is somehow the average experience of working PAs??? Really? In the general sense, what I said is true. But, we all know there will be outliers like your example above. It does not change the fact that my statement is true on average.

 

[NPEMTIV]

PA's don't have any more mobility than an MD/DO. The simple fact that physicians have residency training in a particular specialty doesn't mean they have to ever practice in that specialty or that they must remain in the specialty indefinitely. Many FPs, IMs, etc...move back and forth between various specialties. The only constraint some docs might find is getting hospital privileges (i.e..an FP won't get Surgical privileges), but FPs, IM, EM docs routinely get privileges in fields that aren't their primary field. If you mean they don't have much mobility because of patient responsibilities it'd be important to recognize that PAs have those same requirements.

 

[primadonna22274]

That's precisely what holds me back. I love family medicine but to go into so much more debt to be a family practitioner would be foolish (financially). There are payback programs but I'm now 35 and so military is less likely (although not ruled out, some allow up to 42 now). Also our current economic situation and really not knowing what will happen with healthcare gave me pause, and convinced me to try once again to be a happy PA. For now I'm a PA educator and loving it (although not making as much money as some of our new grads).

Thank you for sharing your thoughts and experiences. I read some of your post and understand that you would like to be an FP Physician one day. Does the cost of med school education not deter you from pursuing FP? If you end up with 250K med school debt, FP salary will take you some time to pay off. Plus, ur a PA and even if you manage to work part time while attending med school, it would still be a huge sacrifice. Not saying that you can't do it but u got heavy decision to make.

 

[scurred09]

Don't be too hard yourself. At 35, you have accomplished so much. I know that you are in a tough situation but you will know what to do when the time comes. Good luck and you have my prayers.

That's precisely what holds me back. I love family medicine but to go into so much more debt to be a family practitioner would be foolish (financially). There are payback programs but I'm now 35 and so military is less likely (although not ruled out, some allow up to 42 now). Also our current economic situation and really not knowing what will happen with healthcare gave me pause, and convinced me to try once again to be a happy PA. For now I'm a PA educator and loving it (although not making as much money as some of our new grads).

 

[tdittyx2x3]

PA's don't have any more mobility than an MD/DO.

PA's have MUCH more mobility. There is no residency period when a PA switches specialties. They'll receive the same however many hour work week for X pay that's probably comparable to the typical PA salaries in the area (with exceptions of course). And the PA's learning curve is nothing like the physicians. Not even close.

Meanwhile, a physician switching to an unrelated specialty is back to square one. Residency pay. Residency hours. Most people never want to repeat that experience. Of course people do, because what good is a certification in a specialty you don't enjoy?

 

[NPEMTIV]

Meanwhile, a physician switching to an unrelated specialty is back to square one. Residency pay. Residency hours. Most people never want to repeat that experience. Of course people do, because what good is a certification in a specialty you don't enjoy?

Completely untrue. Physicians rarely go back to residency. For one, residencies very rarely accept you after you've completed another residency since they won't be funded for your position. Also, there's no law or rationale for a physician to become residency trained in a second field under the vast majority of situations (excluding the FP who wants to now be a surgeon since without BE/BC he won't get staff privileges). Most physicians who switch specialties merely do so while maintaining their previous BE/BC status.

 

[tdittyx2x3]

Are you saying that someone who is BC in Emergency Medicine that wants to switch to Radiology, Pathology, Psychiatry, Anesthesiology, etc. doesn't have to complete a second residency? Where does the training in the new field occur without a residency to prepare you?

My understanding was that most of the time the intern year can count toward the second certification but either way you must complete a second residency. I could be wrong.

 

[tdittyx2x3]

I may have misunderstood your post, NPEMTIV.. I do agree that it is rare for a physician to go back and complete a second residency for the obvious reasons (though it definitely still happens). Doesn't the fact that this is rare support the claim that PA's have an easier, more expansive mobility?

 

[NPEMTIV]

Are you saying that someone who is BC in Emergency Medicine that wants to switch to Radiology, Pathology, Psychiatry, Anesthesiology, etc. doesn't have to complete a second residency? Where does the training in the new field occur without a residency to prepare you?

My understanding was that most of the time the intern year can count toward the second certification but either way you must complete a second residency. I could be wrong.

You are correct that sometimes the intern year can count toward a second certification in some situations, but a lot of specialties don't even complete internship these days (some still will count PGY1). But you are not required to complete a second residency. Most states require only 1 year of post-graduate education for physicians before issuing them a license. That license is good for medicine & surgery. There is no law requiring residency beyond that first year (some states actually require two years, but most one). That being said technically a doc who finishes internship can legally go out and start practicing in any field he so desires and may switch fields at his liking. Where the problem comes in is that no hospital will ever give him privileges to admit patients to their services and if the recent intern graduate performs open heart surgery on someone and they die he is in for a large malpractice suit. That's where my statement regarding physician mobility comes from. A physician can decide at anytime to pursue a different specialty and does not need any additional training to be legally able to do so. The specialties you mentioned (path, rads, gas, etc) can be technically practices by an FP, EM, IM, Surgery, Psych, ect trained doctor, but again, the problem with those specialty fields is that the hospital won't hire them. That would be the same for the PA in most of those situations too, though. A hospital is not likely to hire a PA pathologist, radiologist, etc....especially if they have no prior experience in those fields. The fields physicians and PAs would typically have little trouble with mobility would be your FP, EM, and IM categories. And in those categories I believe their mobility would be equal, if not slightly higher for the physician. Some docs do go on to second residencies if they want to make a huge jump (med -> surg) but its not as common as one just moving to a new specialty. Make sense? I wasn't trying to start an argument..sorry if it came off that way.

 

[tdittyx2x3]

So what you are saying is that theoretically licensed physicians (ie: those that have completed an intern year) can work in whatever field they want.. even though in reality they can't be hired as specialists and are likely to be sued. Well that doesn't do any good to someone who wants to change specialties, does it?

Realistically a doctor cannot switch specialties without a second residency. And this actually happens more often than you think.. there are examples all over the residency forums. Some who have completed their residency and some only part way.. Panda Bear comes to mind. He switched from FM to EM and had to very inconveniently start over. Those are two closely related fields that require separate residencies to practice.

This makes me think that it is MUCH easier to switch specialties as a PA where your salary and hours don't change as drastically. You also mentioned that they wouldn't be likely to hire a PA without experience in the field... yet PA's do all of their training in the field they choose, so every surgery PA must at some point take the job without previous experience in that field.

Someone who knows more about this please chime in..

 

[NPEMTIV]

He switched from FM to EM and had to very inconveniently start over. Those are two closely related fields that require separate residencies to practice.

They do not require a separate residency to practice. He/She chose to do this. FPs practice in ERs all across the country without any additional training. It's very common. What I said was there are a few specialties that would probably require residency training to gain hospital privileges (Surgery, Radiology, etc..) but there are also numerous specialties where physicians migrate to and from without any additional training (EM, IM, FP, Peds, CC, Hosp, Geriatrics, etc...).

 

[foreverLaur]

I'm one of those who is choosing to pursue PA largely because of lateral mobility.

I have a love and a passion for trauma surgery. However, if I went to medical school and picked that specialty, I would have terrible hours for a family life, which is also extremely important for me. I'd have to pick between a specialty that I am passionate about or my idea family lifestyle and I don't want to have to pick.

As a PA, I can work in trauma surgery, switch to working part-time in derm or peds, and later in life go back into trauma surgery to maybe another surgical branch or EM.

As a doctor, I'd have to give up my idea family life to pursue my passions or be stuck in a specialty that I am not that into.

So, PA > MD for me.

 

[NPEMTIV]

I'm one of those who is choosing to pursue PA largely because of lateral mobility.

I have a love and a passion for trauma surgery. However, if I went to medical school and picked that specialty, I would have terrible hours for a family life, which is also extremely important for me. I'd have to pick between a specialty that I am passionate about or my idea family lifestyle and I don't want to have to pick.

As a PA, I can work in trauma surgery, switch to working part-time in derm or peds, and later in life go back into trauma surgery to maybe another surgical branch or EM.

As a doctor, I'd have to give up my idea family life to pursue my passions or be stuck in a specialty that I am not that into.

So, PA > MD for me.

I think lots of people are going the same route for very similar reasons. It is a lot of sacrifice, and I think from my experiences one can maintain a family life, but I also think PA is a great profession and there's a HUGE need. Good luck in your applications when you get there!!

 

[scpod]

I can't tell you how many times I've asked the PAs that I have worked with in the last year or so, "How did you pick your specialty?" Almost all of them told me, "Because that was the only job I could find that offered me decent money." I have yet to meet a PA that is working in his or her first choice. Yes, this is only anecdotal evidence at best... but it goes to show that all is not rosy in the PA world.

In Florida where I am, in theory, a PA can own his or her practice and "hire" a doctor to sign off on his or her charts. In reality, it doesn't work that way. PM me if you have questions. You will NEVER have the autonomy of of doctor and it isn't all that much harder to get a DO or MD than it is to become a PA.

Think long and hard before you make this decision.

 

[scurred09]

Where I had bolded is why I chose to pursue med school instead. PA school is pretty tough and the programs is about 2-3 long. Excluding the residency, why go thru hell and come out a PA? If I'm going to duke it out with the insurance company in the future, I'll be more equipped for battle as a Physician.

I can't tell you how many times I've asked the PAs that I have worked with in the last year or so, "How did you pick your specialty?" Almost all of them told me, "Because that was the only job I could find that offered me decent money." I have yet to meet a PA that is working in his or her first choice. Yes, this is only anecdotal evidence at best... but it goes to show that all is not rosy in the PA world.

In Florida where I am, in theory, a PA can own his or her practice and "hire" a doctor to sign off on his or her charts. In reality, it doesn't work that way. PM me if you have questions. You will NEVER have the autonomy of of doctor and it isn't all that much harder to get a DO or MD than it is to become a PA.

Think long and hard before you make this decision.

 

[foreverLaur]

Where I had bolded is why I chose to pursue med school instead. PA school is pretty tough and the programs is about 2-3 long. Excluding the residency, why go thru hell and come out a PA? If I'm going to duke it out with the insurance company in the future, I'll be more equipped for battle as a Physician.

Excluding residency is a better big factor and there is a lot more to choosing to be a PA over MD than just the initial schooling.

 

[beckhunter116]

Excluding residency is a better big factor and there is a lot more to choosing to be a PA over MD than just the initial schooling.

I'm not sure if you have spent anytime over at the PA Forum; however, they address these issues often enough and your thoughts that as a PA you will have better hours than an MD/DO aren't always true.

Originally, I was going to go the PA route, and my best arguement for going PA was the mobility that it would provide. When you think about it though I doubt that people want to change specialties all that often. Yes, you have a valid reason to want to do something time intense until you have children and then scale back, but you have to think about a few different factors. I think in your signiature it states that you aren't applying to school until 2012, by then a residency may be required as a PA to do Trauma. Personally, I don't think I could scale back if I was doing something I loved to something you may or may not have any interest in--that's just me though. Last, I think people who decide to completely change specialties are going to have to take a pay cut since you may not be as familiar with that type of practice and they could easily get a new graduate to start for less, so if you want that job you need to lower your salary expectations.

This isn't to distract you from going PA at all, but just things that I thought over when I made the decision to choose DO and how they relate to the topic posted.

 

[foreverLaur]

I promise I've put a lot of thought and research into this. I wanted to be a doctor since I was 4 years old and only switched to PA about 1.5 years ago. I've done a lot of shadowing and interviewing since then.

I'm okay with taking a paycut - I'm not the primary income in the house anyways. I'm doing it because I love it, not because I need to. We'd be more than okay without any salary from my end.

So, if I went to medical school which route would I take? Would I go into trauma surgery and be 36 when I am done and either be having kids during residency and missing out on a lot or being a lot older when I have kids but loving my job orrr do I go into a family friendly specialty such as Pediatrics and never really love my job and somewhat regret never getting to do surgery, but being able to have the family life I want?

Neither option sounds good to me. I want both. I'm okay with PAs being required to do a residency. They are only 1 year and I was planning to do one anyways. One year is a lot less than six. Also, PA school = $30,000. How much does medical school cost?

I've put a lot of thought into this. Yes, there are cons to being a PA and pluses to being a doctor, but to me, the pros outweigh the cons with being a PA.

And I've spent a lot of time on the PA forum.

 

[scurred09]

I had thought about going PA because I wanted flexible work hours. However, that is just a myth. PA are hired by docs to work the hours that docs don't want to work. They will also end up working more hours because they are cost effective.

I promise I've put a lot of thought and research into this. I wanted to be a doctor since I was 4 years old and only switched to PA about 1.5 years ago. I've done a lot of shadowing and interviewing since then.

I'm okay with taking a paycut - I'm not the primary income in the house anyways. I'm doing it because I love it, not because I need to. We'd be more than okay without any salary from my end.

So, if I went to medical school which route would I take? Would I go into trauma surgery and be 36 when I am done and either be having kids during residency and missing out on a lot or being a lot older when I have kids but loving my job orrr do I go into a family friendly specialty such as Pediatrics and never really love my job and somewhat regret never getting to do surgery, but being able to have the family life I want?

Neither option sounds good to me. I want both. I'm okay with PAs being required to do a residency. They are only 1 year and I was planning to do one anyways. One year is a lot less than six. Also, PA school = $30,000. How much does medical school cost?

I've put a lot of thought into this. Yes, there are cons to being a PA and pluses to being a doctor, but to me, the pros outweigh the cons with being a PA.

And I've spent a lot of time on the PA forum.

 

[foreverLaur]

I had thought about going PA because I wanted flexible work hours. However, that is just a myth. PA are hired by docs to work the hours that docs don't want to work. They will also end up working more hours because they are cost effective.

Not always true. PAs hired by hospitals tend to work about the same schedule as the docs. My dermatologist has a PA who I usually see. She used to work three 12s in EM before switching to dermatologist when she had kids. She works 9-3 so she can take her kids to school and pick them up after. Plus most doctors prefer days and I prefer nights so that works. I have done a lot of interviewing and shadowing of doctors, PAs, and NPs. I am making a well informed decision. No sense in anyone wAsting heir time trying to convince me otherwise. I am happy with my decision.

 

[primadonna22274]

More often in my 9 years experience as a PA, PAs are hired by physicians/groups--not by hospitals. Certainly there are hospitals who DO hire PAs, I've just never worked for any of them. And yes, the last 2 PA jobs I've had I worked all the undesirable hours (evenings/weekends/holidays) while the docs enjoyed time off with their families. Honestly I've not seen the family-friendly side of being a PA in my entire PA career... 😕
Such that I've actually considered it would be EASIER (in some ways) for me to have a family while in med school/residency than it would have been thus far in my full-time PA working career.
Sure, if you can become a PA with very little debt and you don't have to work, fine. Not all of us working women are in that position though. I easily make 3 times what my husband does as a poor teacher. We could never live even semi-comfortably without my income Had I done a less expensive PA program, perhaps--but that's the dirty little secret of PA education, it's a hot commodity and a money-maker for colleges/medical schools these days.

On another note, somebody mentioned the feasibility of an MD/DO changing specialties laterally--just gotta point out that getting hired/credentialed by the hospital is only PART of the picture. Say a generalist FP wants to transition to pathology. Insurance companies would never "credential" him/her to do this, so s/he could never get paid....so where's the advantage in that? 👎

 

[scpod]

There isn't a lot of room for MDs and DOs to change specialties outright, because they won't get board certified, but they can change their prectice, particularly family practicioners. I know a doc who's board certified in Family Medicine, but he gave up on adults years ago when he decided he likes kids better. Now, he refers to himself as a pediatrician. Some FPs have very big OB/Gyn practices, although mostly in areas where OB coverage is limited. Yet, you don't have to drive far out of the major cities in quite a few states to find this hapening. I can't tell you how many FPs are practicing derm stuff-- botox, laser and even skin grafts. The FP organizations are really big into teaching procedures to their members these days so that they can supplement their income.

I've seen a few specialists go back to primary care over time as well. I know a cardiologist and a hem/onc guy who now do primary care. After all, they were also boarded in IM befre they began their fellowships. There are always ways to tailor your practice to make it more appealing to you as time goes by.

 

[NPEMTIV]

There isn't a lot of room for MDs and DOs to change specialties outright, because they won't get board certified, but they can change their prectice, particularly family practicioners. I know a doc who's board certified in Family Medicine, but he gave up on adults years ago when he decided he likes kids better. Now, he refers to himself as a pediatrician. Some FPs have very big OB/Gyn practices, although mostly in areas where OB coverage is limited. Yet, you don't have to drive far out of the major cities in quite a few states to find this hapening. I can't tell you how many FPs are practicing derm stuff-- botox, laser and even skin grafts. The FP organizations are really big into teaching procedures to their members these days so that they can supplement their income.

I've seen a few specialists go back to primary care over time as well. I know a cardiologist and a hem/onc guy who now do primary care. After all, they were also boarded in IM befre they began their fellowships. There are always ways to tailor your practice to make it more appealing to you as time goes by.

This is exactly what I was talking about in my earlier posts. Yes, there are the docs who decide to go from generalist to specialists like the pathology example above that would have to go back for more training, but that's really the minority situation from my experience. It's much more common to see what scpod mentioned and that happens A LOT hence my rationale for saying physicians do have lateral mobility.

 

[primadonna22274]

Definitely. And plenty of FP/IM docs give up on outpatient practice altogether and become hospitalists...oh wait, that's a whole new discussion....
Actually I think I might like hospitalist work. Is that a boarded specialty now is or is it still generalist training & you're hired?
🙄

This is exactly what I was talking about in my earlier posts. Yes, there are the docs who decide to go from generalist to specialists like the pathology example above that would have to go back for more training, but that's really the minority situation from my experience. It's much more common to see what scpod mentioned and that happens A LOT hence my rationale for saying physicians do have lateral mobility.

 

[scpod]

Actually I think I might like hospitalist work. Is that a boarded specialty now is or is it still generalist training & you're hired?
🙄

It's what I plan on doing. I really love working with folks in the hospital. A lot of IM residencies now have hospitalist tracks where you do very little outpatient work. But, it's not its own specialty. A lot of the groups now do seven days on and seven off. For me, that would be a pretty sweet schedule-- plenty of time to be with the family on those off weeks.

 

[primadonna22274]

That's what I thought. I worked with some pretty happy hospitalists when I was in the ED...and a pretty even mix of FP/IM. Some had never practiced in primary care. Some gave up their primary care practices to work full-time hospital. They were mostly great.
I think it's odd though that there's not a Hospitalist certification if Palliative Care has been approved as its own residency/board...which I know about because that's my new baby, creating a Palliative Care curriculum for the PA students at my program. I'm learning a lot and enjoy the subject matter but I don't think I would want to focus on that exclusively.

It's what I plan on doing. I really love working with folks in the hospital. A lot of IM residencies now have hospitalist tracks where you do very little outpatient work. But, it's not its own specialty. A lot of the groups now do seven days on and seven off. For me, that would be a pretty sweet schedule-- plenty of time to be with the family on those off weeks.

 

[NPEMTIV]

That's what I thought. I worked with some pretty happy hospitalists when I was in the ED...and a pretty even mix of FP/IM. Some had never practiced in primary care. Some gave up their primary care practices to work full-time hospital. They were mostly great.
I think it's odd though that there's not a Hospitalist certification if Palliative Care has been approved as its own residency/board...which I know about because that's my new baby, creating a Palliative Care curriculum for the PA students at my program. I'm learning a lot and enjoy the subject matter but I don't think I would want to focus on that exclusively.

I think the Hospitalist curriculum has just been approved (within the past year) to start working towards residencies, etc, but I don't think any programs have had enough time to start. Especially since IM/FP residencies can produce hospitalists and some even have geared pathways (I think...).

 

[primadonna22274]

That sounds right. I have also thought of Med/Peds although in reality I like Medicine more than I do Peds. I like most of FP but have zero interest in OB. Yup, I'm an abnormal girl 😉
I'm still working on PA job satisfaction and have been far happier in my last 6 months in academics than I was in most of the last 9 years in the rat race of clinical practice...but we'll see.

I think the Hospitalist curriculum has just been approved (within the past year) to start working towards residencies, etc, but I don't think any programs have had enough time to start. Especially since IM/FP residencies can produce hospitalists and some even have geared pathways (I think...).

 

[PrimaryDO]

Sylvanthus, this is a medical team environment if you have lost sight of it you're xenophobic you have no place in medicine. DO/MD/PA have the same background knowledge FP/Peds/IM. PAs have the adequate generalist medical model training except they're mandated to work with a physician. PA training FP/Peds/IM - fever, flu, cough, etc. High paying medical specialties sub/specialty PA is around $110k. PA to PA physician to PA FP/Peds/IM/sub/specialty varies. PA works with the physician in the clinic, assesses patients, follow-ups, patient sees the physician one visit, the PA the next, or FP/Peds/IM physician does the consult, the FP/Peds/IM PA does the follow-ups or consult. Other PAs examine the patient on their own, without the physician seeing the patient, give their own diagnosis, prescribes medications, implement their own treatment plans, with the "supervision" of a physician.

PA sees patients, does medical histories, does physical exams, orders MRI or lab, diagnose, does treatment plans, including injections, medications, or surgical procedures. PAs generally do well in subspecialties with prolonged training in a hospital or specialty practice. PA delivers a cost effective medical care with minimal "supervision." They're well trained does much of what physicians do after getting residency training. PAs medical care cost effectiveness.

In my clinic most of the surgeons have PAs who first-assists them in surgery, clinic consults as well as rounds in hosptals. The rheumatologists have rheumatology PA who works on his own, seeing his own patients, rheumatoid arthritis, osteoporosis, etc. I work 45-60 hours a week. PAs have lateral mobility. Compare clinic settings as well. We have several ortho surgeons who have ortho PAs. Most sports medicine patients are short-term or intermittent/episodic patients. Sports medicine physicians don't see chronic patients for monthly follow-ups. Thus the sports medicine PA sees the episodic patients. Sports medicine PA writes for opioid medications, and refers cases to other specialty clinics, does fluoro injections, does a lot of EMGs, etc.