(Serious) Why do 4th year students need supervision but midlevels don't?

[Frazier]

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Medical school is hugely inefficient. You learn a ton (TON) of material which either has no functional use in practicing clinical medicine or it is outside your eventual specialty -- and thus forgotten.

A brand new medical school graduate versus a brand new PA graduate : The PA's likely (and should) surpass the brand new MS4's in clinical settings. If you both have to sit and take a pathophys exam, obviously the MS4 will likely score higher... But, medical school as a 4 year traditional venture is just very poor at getting functional real life training across to students. Sure you might have had those 2-3 rotations where you were given something similar to actual REAL LIFE responsibility and decision-making... so keep that in mind: a couple months.

Who is better or more useful in the OR as a "new grad": Surg Tech from a 2-year community college intensive program or the Pre-med that just graduated with his 4 year degree from a competitive undergrad? ...But, but, but 4 years education >>> 2 years education!!!!

I know what you're thinking. "Apples to oranges! The pre-med graduate took a bunch of classes which had nothing to do with being in the OR! How can you expect the pre-med to be on the same footing when they had to take a bunch of classes over those 4 years like philosophy and movie appreciation?"

Exactly. Same idea with med school.

It's okay, when you're an intern getting to the point of managing 10+ at a time and look back at new grad you -- you'll appreciate the message above.

Get over your ego. You'll take the lead soon enough as you grow into a physician - no doubt about it. And it takes time. But, yeah, you are pretty useless as a new grad. Sorry. Good news? That changes.

 

[UnoMas]

Medical school is hugely inefficient. You learn a ton (TON) of material which either has no functional use in practicing clinical medicine or it is outside your eventual specialty -- and thus forgotten.

A brand new medical school graduate versus a brand new PA graduate : The PA's likely (and should) surpass the brand new MS4's in clinical settings. If you both have to sit and take a pathophys exam, obviously the MS4 will likely score higher... But, medical school as a 4 year traditional venture is just very poor at getting functional real life training across to students. Sure you might have had those 2-3 rotations where you were given something similar to actual REAL LIFE responsibility and decision-making... so keep that in mind: a couple months.

Who is better or more useful in the OR as a "new grad": Surg Tech from a 2-year community college intensive program or the Pre-med that just graduated with his 4 year degree from a competitive undergrad? ...But, but, but 4 years education >>> 2 years education!!!!

I know what you're thinking. "Apples to oranges! The pre-med graduate took a bunch of classes which had nothing to do with being in the OR! How can you expect the pre-med to be on the same footing when they had to take a bunch of classes over those 4 years like philosophy and movie appreciation?"

Exactly. Same idea with med school.

It's okay, when you're an intern getting to the point of managing 10+ at a time and look back at new grad you -- you'll appreciate the message above.

Get over your ego. You'll take the lead soon enough as you grow into a physician - no doubt about it. And it takes time. But, yeah, you are pretty useless as a new grad. Sorry. Good news? That changes.

Again, do you even know what is included in a PA curriculum? It's 1.5-2 years of didactic plus 1 year of clinical rotations. I have been on rotations with them. Somehow I learned more during the first 2 years, do more rotations for 2 years and the PA student still comes out ahead? Ridiculous

 

[DocEspana]

It's not black and white. What is the level of supervision exactly over midlevels? Majority of the time: none. Even though they're "supervised" on paper. And then the question, what is the difference between minimal supervision & none?

Fact remains... there are an enormous number of graduating midlevels (far greater than physicians). They are unified and will push for more practice rights. Doctors will become medical managers of half a dozen midlevels (or more). At least what's what every MD/DO on the business side of things says.

Seriously.... walking has to be really hard with that big of a stick up your ass.

Maybe relax a bit when people are making jokes?

 

[DocEspana]

Medical school is hugely inefficient. You learn a ton (TON) of material which either has no functional use in practicing clinical medicine or it is outside your eventual specialty -- and thus forgotten.

A brand new medical school graduate versus a brand new PA graduate : The PA's likely (and should) surpass the brand new MS4's in clinical settings. If you both have to sit and take a pathophys exam, obviously the MS4 will likely score higher... But, medical school as a 4 year traditional venture is just very poor at getting functional real life training across to students. Sure you might have had those 2-3 rotations where you were given something similar to actual REAL LIFE responsibility and decision-making... so keep that in mind: a couple months.

Who is better or more useful in the OR as a "new grad": Surg Tech from a 2-year community college intensive program or the Pre-med that just graduated with his 4 year degree from a competitive undergrad? ...But, but, but 4 years education >>> 2 years education!!!!

I know what you're thinking. "Apples to oranges! The pre-med graduate took a bunch of classes which had nothing to do with being in the OR! How can you expect the pre-med to be on the same footing when they had to take a bunch of classes over those 4 years like philosophy and movie appreciation?"

Exactly. Same idea with med school.

It's okay, when you're an intern getting to the point of managing 10+ at a time and look back at new grad you -- you'll appreciate the message above.

Get over your ego. You'll take the lead soon enough as you grow into a physician - no doubt about it. And it takes time. But, yeah, you are pretty useless as a new grad. Sorry. Good news? That changes.

I would like to love this post.

 

[DocEspana]

Again, do you even know what is included in a PA curriculum? It's 1.5-2 years of didactic plus 1 year of clinical rotations. I have been on rotations with them. Somehow I learned more during the first 2 years, do more rotations for 2 years and the PA student still comes out ahead? Ridiculous

I mean... i teach PA and medical students. Both are a few months away from graduating.

I let my PA students see the patient. Tell me about it. Make the plan of care. And tell me how they want to treat. I obviously scrutinize the hell out of it, because its *my* patient. But they're damn good at it. Theyve been trained to get treatment patterns down. Know what they mess up? Abnormal presentations and knowing when to say "this is enough tests". But they know what to order to not miss anything except abnormal odd diseases. Also they get nervous around stinking sick patients. This is the students we are talking about.

My med students dont leave my side unless i aso them to update a patient about something. What are they good at? H&Ps. Some suck at the P some excel at the P. Theyre all good at the H. Also really good at giving an absurdly thorough differential. Know what theyre bad at? Damn near everything about the assessment and plan. their differential frequently includes chagas disease and takosubo cardiomyopathy. It never seems to include "maybe just... like... regular heart failure". And even if i tell them what a realistic differential is... they dont know their ass frok their elbow on how to treat or what tests to order. Like. Not even the slightest clue.

These are people 2 months out from being interns. They have so much knowledge and so little ability to apply it. That changes when residency goes 'time to learn by doing'. But youve never been trained (as a generalization. Maybe you had 1 or 2 months) to go out there and "do it" as a med student. Youve been trained to think and observe. The PA students are (at my current place, all three hospitals i did residency at, and the program my ex went to) doing close to all of their clinical rotations in "do it mode". They do have less education, but they have more on the job training by day one. Give it a few months and thats totally different.

Also random edit: i believe its 1.5 and 1.5. PA school is 3 years and clinicals begin in january and end in june a year and a half later. Is it possible some are shorter? Maybe, but that would be highly irregular since i can rattle off about 11 schools in three states with the same standard curriculum. Some places are even longer because they require a masters degree in human biology that is taken concurrently as an additional part of the curriculum. This isnt to compare to med school. This is just that your incorrect estimate of the curriculum needed to be addressed because im one of those people who just can't help themselves when someone is just not accurate.

 

[UnoMas]

I mean... i teach PA and medical students. Both are a few months away from graduating.

I let my PA students see the patient. Tell me about it. Make the plan of care. And tell me how they want to treat. I obviously scrutinize the hell out of it, because its *my* patient. But they're damn good at it. Theyve been trained to get treatment patterns down. Know what they mess up? Abnormal presentations and knowing when to say "this is enough tests". But they know what to order to not miss anything except abnormal odd diseases. Also they get nervous around stinking sick patients. This is the students we are talking about.

My med students dont leave my side unless i aso them to update a patient about something. What are they good at? H&Ps. Some suck at the P some excel at the P. Theyre all good at the H. Also really good at giving an absurdly thorough differential. Know what theyre bad at? Damn near everything about the assessment and plan. their differential frequently includes chagas disease and takosubo cardiomyopathy. It never seems to include "maybe just... like... regular heart failure". And even if i tell them what a realistic differential is... they dont know their ass frok their elbow on how to treat or what tests to order. Like. Not even the slightest clue.

These are people 2 months out from being interns. They have so much knowledge and so little ability to apply it. That changes when residency goes 'time to learn by doing'. But youve never been trained (as a generalization. Maybe you had 1 or 2 months) to go out there and "do it" as a med student. Youve been trained to think and observe. The PA students are (at my current place, all three hospitals i did residency at, and the program my ex went to) doing close to all of their clinical rotations in "do it mode". They do have less education, but they have more on the job training by day one. Give it a few months and thats totally different.

Also random edit: i believe its 1.5 and 1.5. PA school is 3 years and clinicals begin in january and end in june a year and a half later. Is it possible some are shorter? Maybe, but that would be highly irregular since i can rattle off about 11 schools in three states with the same standard curriculum. Some places are even longer because they require a masters degree in human biology that is taken concurrently as an additional part of the curriculum. This isnt to compare to med school. This is just that your incorrect estimate of the curriculum needed to be addressed because im one of those people who just can't help themselves when someone is just not accurate.

Tuft, Stanford, Duke, Chatham and a few others. Those are the programs that I am familiar with and know people who are either in school or went there. All have 1 year clinical curriculum. I dont like people who are inaccurate and generalize things either.

Way to hyperpolize things. A 4th year student 2 months to graduation doesn't know the workup and simple management of the bread and butter stuff like CHF should not be allowed to graduate. On my medicine service, toward the tail end I was holding 4 patients on my list doing everything that an intern was supposed to do. Obviously there would still be oversight by interns and senior residents but most of the time I do 80% of the stuff, minus discharge summary and family conversation. This actually makes me feel good about my Walmart clinical education. Maybe good attendings beget good students, ****ty teachers who prioritize PA student's education over his students' beget ****ty students. I should write all my IM attendings thankyou cards

Do it mode or not. I have been on rotations with PA students, they come in see 2 patients and spend most of the time shadowing the PA on the consult service. If that's "do it mode" then maybe I am doing it wrong. I wouldn't spout my mouth if I didnt see it first hand

Whatever, I guess your attending status gives you credibility but I am not buying any of that.

 

[NRP]

Agreed, seems like those medical students didn't have good guidance, were 4th years or were ill prepared. During our subi my colleagues and I had were able to handle 5 patients and do the admission, discharge and work up with intern and resident oversight. Typically we had to have a plan and of course it was revised and changed by the residents recommendations. Taksubo? Yeah who does that. I'm sure most med students would know the general lab tests and trends to follow. I'm really not buying this story about how terrible the med students were compared to the PA students.

 

[DocEspana]

I guess your attending status gives you credibility but I am not buying any of that.

Well glad to see you're finally realizing you dont know what you're talking about. We agree on something. Haha perhaps more honestly - you sort of "dont get it" and cant get out of the way of your own ego here and see the compliments to residents everyone is saying - because a caveat hurts your pride too much

Also tufts looks like its 65 weeks of clinicals. But now im being pedantic because being nice the whole post is hard for me

 

[Anti-PD1]

As a 4th year, I appreciate the supervision. As a soon-to-be PGY-1, I look forward to the supervision. It's called graded autonomy.

We are the end of the line. Our training has to be the best possible so we can render decisions that make a difference.

(The bigger question is what are we paying $60k for during 4th year lol)

 

[UnoMas]

Well glad to see you're finally realizing you dont know what you're talking about. We agree on something. Haha perhaps more honestly - you sort of "dont get it" and cant get out of the way of your own ego here and see the compliments to residents everyone is saying - because a caveat hurts your pride too much

Also tufts looks like its 65 weeks of clinicals. But now im being pedantic because being nice the whole post is hard for me

Lol if your Takosubo bs and the attending card is all you got... This is not being prideful and you know it. You are being prideful and appealing to your attending status

This is the curriculum right out of Tufts website

 

[alpinism]

The idea that graduating PA students are somehow superior to 4th year med students is ridiculous and has no basis in reality.

PA school is essentially watered down med school during both the preclinical and clinical years. At most hospitals the PA students work less hours and have less responsibility than the med students and it shows when you actually test their overall knowledge base and procedural skills. As an example the 4th years in our ED are allowed to do multiple procedures including lac repairs and I/Ds essentially unsupervised once they've proven they're competent. We also allow them to intubate and place central lines under close supervision. The PA students on the other hand are only allowed to do lac repairs and I/Ds under close supervision and aren't allowed to do invasive procedures on sick patients.

 

[DocEspana]

Lol if your Takosubo bs and the attending card is all you got... This is not being prideful and you know it. You are being prideful and appealing to your attending status

This is the curriculum right out of Tufts website

View attachment 231454

Holy **** man. Holy ****. Are you seriously that mentally dense that youd go to a random after the point edited comment and look that up about a damn joke instead of addressing the point of the post?

Literally in a post where i say it sounds like your ego is making you unaware that your superior training takes more time to cultivate into the final product (and ive said at nauseum that there are real functional differences in what you ask the two groups to do as students), your ego made you unable to see the positive reinforcement at the heart of it all and you focused in on a random post hoc jab. Perhapa your egi was too bruised to see what the post was about, and demonstrated my point?

Also yes. I know someone who interviewed there and had the exact schedule they give as an example handy. They confirmed its all 5 weeks (starts on a monday. Finishes 5 fridays later, this occasionally means its closer to 4 than 5 weeks with holidays, but its blocked out in 4 and 5/7th week blocks), with a break and a final month. Go back and add that up. Its 65 weeks.

Good lord in heaven. I try to reassure you that the sky isnt falling, that you're just missing the point being said.. and... you hone in on an edited comment from 15 or 20 minutes after i initially posted where i was just being snarky because someone happened to text me back. AND YOU WERE STILL WRONG!


A diagram od every post by you here lately.

edit: Im fully expecting your next post to be telling me i edited it 12 minutes later, not 15 to 20.

 

[UnoMas]

Holy **** man. Holy ****. Are you seriously that mentally dense that youd go to a random after the point edited comment and look that up about a damn joke instead of addressing the point of the post?

Literally in a post where i say it sounds like your ego is making you unaware that your superior training takes more time to cultivate into the final product (and ive said at nauseum that there are real functional differences in what you ask the two groups to do as students), your ego made you unable to see the positive reinforcement at the heart of it all and you focused in on a random post hoc jab. Perhapa your egi was too bruised to see what the post was about, and demonstrated my point?

Also yes. I know someone who interviewed there and had the exact schedule they give as an example handy. They confirmed its all 5 weeks (starts on a monday. Finishes 5 fridays later, this occasionally means its closer to 4 than 5 weeks with holidays, but its blocked out in 4 and 5/7th week blocks), with a break and a final month. Go back and add that up. Its 65 weeks.

Good lord in heaven. I try to reassure you that the sky isnt falling, that you're just missing the point being said.. and... you hone in on an edited comment from 15 or 20 minutes after i initially posted where i was just being snarky because someone happened to text me back. AND YOU WERE STILL WRONG!


A diagram od every post by you here lately.

Im fully expecting your next post to be telling me i edited it 12 minutes later, not 15.

Lol classic someone texted me copout . All of this right here still make no ****ing sense! I also happen to know someone who goes here RIGHT NOW that's why I used it as an example, and no! many of them are 4 weeks but I am tired of pointing out your BS. I would refrain from running your mouth next time and risk losing your credibility as an attending. And please refuse to take students if you provide them with such subpar education

Your post was supposed to be reassuring? Goddamn you are bad at inspiring people! Go back and reread it, some random PA student will quote it sometime in the future and take it as facts.

Whatever dude!

 

[DocEspana]

Lol classic someone texted me copout . All of this right here still make no ****ing sense! I also happen to know someone who goes here RIGHT NOW that's why I used it as an example, and no! many of them are 4 weeks but I am tired of pointing out your BS. I would refrain from running your mouth next time and risk losing your credibility as an attending. And please refuse to take students if you provide them with such subpar education

Your post was supposed to be reassuring? Goddamn you are bad at inspiring people! Go back and reread it, some random PA student will quote it sometime in the future and take it as facts.

Whatever dude!

And again... wow

I assume you're a fourth year and matched. Be thankful. The sort of blissful ignorance to the point and their own (transient) deficits is why a student I liked didnt match at my program back when i was a resident. Given his scores he should have matched somewhere nice easily, but my PD got a feeling he couldnt take criticism and liked to strawman up a new argument when he was just plain wrong. A LOR he had sort of suggested it wasnt just us who noted it. He Should be doing EM somewhere, instead he scrambled FM (admittedly at a big name place). Idk how well it applies to you... but man... like. I hope this is just your internet persona and you're not like this in person. I know im not so snarky in real life - keep the sass to myself. You're gonna be the big man in charge in not that long, dont forget that your nurses and midlevels will save your ass from time to time, but only if you dont make the work environment toxic. Humility and humor goes far. Save the doctor superiority schtick for where it counts - courts, politicians offices, and newspaper op eds.

 

[UnoMas]

And again... wow

I assume you're a fourth year and matched. Be thankful. The sort of blissful ignorance to the point and their own (transient) deficits is why a student I liked didnt match at my program back when i was a resident. Given his scores he should have matched somewhere nice easily, but my PD got a feeling he couldnt take criticism and liked to strawman up a new argument when he was just plain wrong. A LOR he had sort of suggested it wasnt just us who noted it. He Should be doing EM somewhere, instead he scrambled FM (admittedly at a big name place). Idk how well it applies to you... but man... like. I hope this is just your internet persona and you're not like this in person. I know im not so snarky in real life - keep the sass to myself.

Again I am sure that happened. I think I will be fine, thank you! I also hope this is not how you present yourself in real life, cause it's hard to take it seriously

 

[lemurcatta]

Again, do you even know what is included in a PA curriculum? It's 1.5-2 years of didactic plus 1 year of clinical rotations. I have been on rotations with them. Somehow I learned more during the first 2 years, do more rotations for 2 years and the PA student still comes out ahead? Ridiculous

Comes out ahead.. man you need some perspective.

 

[gyngyn]

If civil discourse is impossible, this thread is on its way to a close.

 

[Oso]

If civil discourse is impossible, this thread is on its way to a close.

 

[MedicineZ0Z]

Medical school is hugely inefficient. You learn a ton (TON) of material which either has no functional use in practicing clinical medicine or it is outside your eventual specialty -- and thus forgotten.

A brand new medical school graduate versus a brand new PA graduate : The PA's likely (and should) surpass the brand new MS4's in clinical settings. If you both have to sit and take a pathophys exam, obviously the MS4 will likely score higher... But, medical school as a 4 year traditional venture is just very poor at getting functional real life training across to students. Sure you might have had those 2-3 rotations where you were given something similar to actual REAL LIFE responsibility and decision-making... so keep that in mind: a couple months.

Who is better or more useful in the OR as a "new grad": Surg Tech from a 2-year community college intensive program or the Pre-med that just graduated with his 4 year degree from a competitive undergrad? ...But, but, but 4 years education >>> 2 years education!!!!

I know what you're thinking. "Apples to oranges! The pre-med graduate took a bunch of classes which had nothing to do with being in the OR! How can you expect the pre-med to be on the same footing when they had to take a bunch of classes over those 4 years like philosophy and movie appreciation?"

Exactly. Same idea with med school.

It's okay, when you're an intern getting to the point of managing 10+ at a time and look back at new grad you -- you'll appreciate the message above.

Get over your ego. You'll take the lead soon enough as you grow into a physician - no doubt about it. And it takes time. But, yeah, you are pretty useless as a new grad. Sorry. Good news? That changes.

I want to know if statements like these are being made in a sober clear mind. Do you actually understand what you're saying? A PA does the same clinical rotations a student does, only with LESS responsibility and LESS training. I have no idea how you draw a conclusion that they would be superior in the clinical setting. It's preposterous.

Again, do you even know what is included in a PA curriculum? It's 1.5-2 years of didactic plus 1 year of clinical rotations. I have been on rotations with them. Somehow I learned more during the first 2 years, do more rotations for 2 years and the PA student still comes out ahead? Ridiculous

It's literally insane. No idea what these midlevel defenders are smoking.

I mean... i teach PA and medical students. Both are a few months away from graduating.

I let my PA students see the patient. Tell me about it. Make the plan of care. And tell me how they want to treat. I obviously scrutinize the hell out of it, because its *my* patient. But they're damn good at it. Theyve been trained to get treatment patterns down. Know what they mess up? Abnormal presentations and knowing when to say "this is enough tests". But they know what to order to not miss anything except abnormal odd diseases. Also they get nervous around stinking sick patients. This is the students we are talking about.

My med students dont leave my side unless i aso them to update a patient about something. What are they good at? H&Ps. Some suck at the P some excel at the P. Theyre all good at the H. Also really good at giving an absurdly thorough differential. Know what theyre bad at? Damn near everything about the assessment and plan. their differential frequently includes chagas disease and takosubo cardiomyopathy. It never seems to include "maybe just... like... regular heart failure". And even if i tell them what a realistic differential is... they dont know their ass frok their elbow on how to treat or what tests to order. Like. Not even the slightest clue.

These are people 2 months out from being interns. They have so much knowledge and so little ability to apply it. That changes when residency goes 'time to learn by doing'. But youve never been trained (as a generalization. Maybe you had 1 or 2 months) to go out there and "do it" as a med student. Youve been trained to think and observe. The PA students are (at my current place, all three hospitals i did residency at, and the program my ex went to) doing close to all of their clinical rotations in "do it mode". They do have less education, but they have more on the job training by day one. Give it a few months and thats totally different.

Also random edit: i believe its 1.5 and 1.5. PA school is 3 years and clinicals begin in january and end in june a year and a half later. Is it possible some are shorter? Maybe, but that would be highly irregular since i can rattle off about 11 schools in three states with the same standard curriculum. Some places are even longer because they require a masters degree in human biology that is taken concurrently as an additional part of the curriculum. This isnt to compare to med school. This is just that your incorrect estimate of the curriculum needed to be addressed because im one of those people who just can't help themselves when someone is just not accurate.

Sounds like you're doing a very poor job of being an educator.

I've seen both sets of students in different setting from different schools and the PAs always had much less responsibility and did HALF of the work only (responsible for half the patients).
And most 3rd year students will not throw zebras onto a differential like you suggest.

Also dude, keeping med students by your side and having PAs do the plan? lolwat.

Agreed, seems like those medical students didn't have good guidance, were 4th years or were ill prepared. During our subi my colleagues and I had were able to handle 5 patients and do the admission, discharge and work up with intern and resident oversight. Typically we had to have a plan and of course it was revised and changed by the residents recommendations. Taksubo? Yeah who does that. I'm sure most med students would know the general lab tests and trends to follow. I'm really not buying this story about how terrible the med students were compared to the PA students.

Most commonly it's the PA students who have no idea what's going on at all whereas the med students are 80%+ there.

The idea that graduating PA students are somehow superior to 4th year med students is ridiculous and has no basis in reality.

PA school is essentially watered down med school during both the preclinical and clinical years. At most hospitals the PA students work less hours and have less responsibility than the med students and it shows when you actually test their overall knowledge base and procedural skills. As an example the 4th years in our ED are allowed to do multiple procedures including lac repairs and I/Ds essentially unsupervised once they've proven they're competent. We also allow them to intubate and place central lines under close supervision. The PA students on the other hand are only allowed to do lac repairs and I/Ds under close supervision and aren't allowed to do invasive procedures on sick patients.

The workload for a PA is often literally 50% of a med student. Yet they magically with the waive of a wand are superior to a 4th year student.

 

[UnoMas]

And again... wow

I assume you're a fourth year and matched. Be thankful. The sort of blissful ignorance to the point and their own (transient) deficits is why a student I liked didnt match at my program back when i was a resident. Given his scores he should have matched somewhere nice easily, but my PD got a feeling he couldnt take criticism and liked to strawman up a new argument when he was just plain wrong. A LOR he had sort of suggested it wasnt just us who noted it. He Should be doing EM somewhere, instead he scrambled FM (admittedly at a big name place). Idk how well it applies to you... but man... like. I hope this is just your internet persona and you're not like this in person. I know im not so snarky in real life - keep the sass to myself. You're gonna be the big man in charge in not that long, dont forget that your nurses and midlevels will save your ass from time to time, but only if you dont make the work environment toxic. Humility and humor goes far. Save the doctor superiority schtick for where it counts - courts, politicians offices, and newspaper op eds.

Again, why is it not appropriate for medical students to wonder if their 4 years of education measures up? It is forbidden by the mid level overlords? Where in this entire thread did I marginalize or put down mid level provider?

I don't need your advice, don't assume everyone here is a 24 years old medical student, I know how to handle myself in a professional manner.

 

[DocEspana]

If civil discourse is impossible, this thread is on its way to a close.

Haha i already excused myself with that last post. Im just repeating the same stuff in different ways now.

 

[W19]

Well glad to see you're finally realizing you dont know what you're talking about. We agree on something. Haha perhaps more honestly - you sort of "dont get it" and cant get out of the way of your own ego here and see the compliments to residents everyone is saying - because a caveat hurts your pride too much

Also tufts looks like its 65 weeks of clinicals. But now im being pedantic because being nice the whole post is hard for me

No one will believe your anecdotes because we all have rotated with PA students... And also on paper our preclinical and clinical curricula are more rigorous, but magically they are better. Give me a break!

 

[DocEspana]

No one will believe your anecdotes because we all have rotated with PA students... And also on paper our preclinical and clinical curricula are more rigorous, but magically they are better. Give me a break!

Could i ask you what reason id have for this? Id like to point out to you that my full time paid career for a year and hobby whenever i could for almost a full decade has been fighting for the primacy of the physician and defending pphysicians from PA and NP encroachment into unsafe practice situations.

If you want to reread my posts with that context in mind, youll probably notice im just being honest that there are different expectations for what each needs to do and it shapes things and time frames. Especially if people keep wanting to know about *day one* which is such an absurd point in time to ask for.

 

[Cryc_to_the_point]

DocEspana,

Do you see a trend in performance down the line? At the 1 or 5 year marks? Or is it too subtle to see a pattern?

 

[W19]

\

Could i ask you what reason id have for this? Id like to point out to you that my full time paid career for a year and hobby whenever i could for almost a full decade has been fighting for the primacy of the physician and defending pphysicians from PA and NP encroachment into unsafe practice situations.

If you want to reread my posts with that context in mind, youll probably notice im just being honest that there are different expectations for what each needs to do and it shapes things and time frames. Especially if people keep wanting to know about *day one* which is such an absurd point in time to ask for.

In what context? Everywhere I have rotated with PA and NP students, the attendings ALWAYS expect more from med students and they say it unequivocally. I really don't know what hospitals you work at, but my experience is completely different from what you are saying

 

[HomeSkool]

@DocEspana: You've made a lot of outstanding points, and as one who works with midlevels daily I agree with virtually everything you've said. But he's never going to hear you, and all you can do is shake your head and walk away.

(I mean this as it relates to UnoMas, not the thread in general.)

@UnoMas: Saying it because I care.

DocEspana hit the nail right on the head. PAs, NPs, and physicians come up through very different training pathways. Midlevel training focuses on common presentations and practical skills, the goal being to have a simpler but more functional product on graduation day. By the end of their training, physicians have a much deeper, broader fund of knowledge and skill set, which provides a more comprehensive ability to provide patient care. But it takes time for the physician training pathway to overtake the midlevel one. I'll give a brand-new CRNA a modest amount of leash, but I wouldn't trust an intern alone in the OR for a single second. By the last few months of their residency, though, my senior residents get more autonomy than I give any but the best, most experienced CRNAs.

TL;DR: If you're jealous of how quickly midlevels get autonomy, go become a midlevel but understand that it comes at the cost of a much lower ceiling.

 

[Giovanotto]

It would be great if we could work towards increasing resident pay above what amounts (hourly) to minimum wage or close to it. That's as much as I'll say on this thread, way too over-it to say anything else.

 

[FindMeOnTheLinks]

This thread is a joke. We can debate all day on whether graduating PA students or MS4s are better.

But that attending who is saying that his FOURTH year med students don't know how to recognize basic heart failure, is a joke. Either he speaks solely in hyperbole, or he works at the world's worst medical school. Your experience is definitely not generalizable. Maybe my experience is not generalizable (is that a word?) either, but I can assure you that at my school, 95% of MS3's can walk into any patient room, write a decent H&P, formulate a reasonable differential with a reasonable plan, and then present it to the attending in a decent manner. Obviously some are better than others, but nobody is as clueless as this guy would make it seem. And it's not like my med school is special, we're just a mid-tier state school.

We sometimes have PA students rotate with us as well, and they seem to do fine. They obviously don't have the depth of knowledge and don't really understand pathophysiology or pharmacology as well as the med students, but they do okay. The average PA student is probably comparable to a below average med student clinically, while the best med students are miles ahead of the best PA students.

And the fact that he doesn't let his med students go see patients on their own, WHAT IN THE WORLD? Please step down from your role as a med student educator, you are not helping anybody.

 

[MedicineZ0Z]

@DocEspana: You've made a lot of outstanding points, and as one who works with midlevels daily I agree with virtually everything you've said. But he's never going to hear you, and all you can do is shake your head and walk away.
View attachment 231461
(I mean this as it relates to UnoMas, not the thread in general.)

@UnoMas: Saying it because I care.
View attachment 231462

DocEspana hit the nail right on the head. PAs, NPs, and physicians come up through very different training pathways. Midlevel training focuses on common presentations and practical skills, the goal being to have a simpler but more functional product on graduation day. By the end of their training, physicians have a much deeper, broader fund of knowledge and skill set, which provides a more comprehensive ability to provide patient care. But it takes time for the physician training pathway to overtake the midlevel one. I'll give a brand-new CRNA a modest amount of leash, but I wouldn't trust an intern alone in the OR for a single second. By the last few months of their residency, though, my senior residents get more autonomy than I give any but the best, most experienced CRNAs.

TL;DR: If you're jealous of how quickly midlevels get autonomy, go become a midlevel but understand that it comes at the cost of a much lower ceiling.

You keep missing the point here. PAs rotate WITH med students and do half of the SAME stuff. Literally by definition, it is impossible that a med student is less prepared.

 

[HomeSkool]

You keep missing the point here. PAs rotate WITH med students and do half of the SAME stuff.

How do I keep doing anything on my first post?

And it seems to me the whole point of that single post escaped you. PAs and med students may spend some time together during clinicals, but the preclinical education is very different. Theirs focuses on being field-ready, i.e., identifying and treating the most common problems and presentations. Ours is directed toward laying the groundwork for greater critical thinking, reasoning, and recognizing the atypical or rare ones. For that reason, PA training and MD/DO training are not interchangeable. The MD/DO incubation period is longer but allows more top-end growth.

Literally by definition, it is impossible that a med student is less prepared.

FTFY.

I'm extricating myself from this dumpster fire of a thread.

 

[W19]

How do I keep doing anything on my first post?

And it seems to me the whole point of that single post escaped you. PAs and med students may spend some time together during clinicals, but the preclinical education is very different. Theirs focuses on being field-ready, i.e., identifying and treating the most common problems and presentations. Ours is directed toward laying the groundwork for greater critical thinking, reasoning, and recognizing the atypical or rare ones. For that reason, PA training and MD/DO training are not interchangeable. The MD/DO incubation period is longer but allows more top-end growth.


FTFY.

I'm extricating myself from this dumpster fire of a thread.

Can you explain that in details? Our path and pharm class are more in depth than PAs'. Common presentations! HTN, DM, URI, Pneumonia, Acute abdomen, UTI, ACS etc.. Med students understand these common presentations better than PA overall. Is there something magic about newly minted PA/NP that I don't know?

You guys make ZERO sense..

 

[MedicineZ0Z]

How do I keep doing anything on my first post?

And it seems to me the whole point of that single post escaped you. PAs and med students may spend some time together during clinicals, but the preclinical education is very different. Theirs focuses on being field-ready, i.e., identifying and treating the most common problems and presentations. Ours is directed toward laying the groundwork for greater critical thinking, reasoning, and recognizing the atypical or rare ones. For that reason, PA training and MD/DO training are not interchangeable. The MD/DO incubation period is longer but allows more top-end growth.


FTFY.

I'm extricating myself from this dumpster fire of a thread.

Because more than one person has repeated the same point over and over again in this thread.

Med student preclinical education teaches you how to approach basics fundamentals in extensive detail vs. PA school. Next, step 2 ensures you know how to work up and treat all the same things PAs can... only much better. You make it sound like there's two different types of medicine and that PAs learn things med students don't. Couldn't be further from the truth.

Can you explain that in details? Our path and pharm class are more in depth than PAs'. Common presentations! HTN, DM, URI, Pneumonia, Acute abdomen, UTI, ACS etc.. Med students understand these common presentations better than PA overall. Is there something magic about newly minted PA/NP that I don't know?

You guys make ZERO sense..

They enjoy the cash midlevels bring them. It's easy to defend your pocket (in exchange for your profession) when you have an escape plan (retirement).

But really I can't wrap my head around their logic. Any decent med student half way through 3rd year can tell you what to order for all those common complaints. They would also suspect those diagnoses when given their common presentation. PA students may certainly suspect those diagnoses but I've seen on countless occasions that they struggle with the proper work up.

 

[jw3600]

Are there people saying brand new graduates of a 2 year PA program (2.5 years or whatever) are better clinically and more knowledgeable than an end of MS4 matched medical student?

 

[MedicineZ0Z]

Are there people saying brand new graduates of a 2 year PA program (2.5 years or whatever) are better clinically and more knowledgeable than an end of MS4 matched medical student?

Exactly what they're saying yes.

 

[W19]

truth.
They enjoy the cash midlevels bring them. It's easy to defend your pocket (in exchange for your profession) when you have an escape plan (retirement).

But really I can't wrap my head around their logic. Any decent med student half way through 3rd year can tell you what to order for all those common complaints. They would also suspect those diagnoses when given their common presentation. PA students may certainly suspect those diagnoses but I've seen on countless occasions that they struggle with the proper work up.

I can't either... You can not say our preclinical and clinical are better but they somehow are better at managing common complaints... Not even counting the fact that med students on average (emphasis on average here) are smarter than PA students due to med school admission process.

I like PA and I don't want to disparage the profession... PAs' knowledge in psych and obgyn is practically non existent.

 

[UnoMas]

Because more than one person has repeated the same point over and over again in this thread.

Med student preclinical education teaches you how to approach basics fundamentals in extensive detail vs. PA school. Next, step 2 ensures you know how to work up and treat all the same things PAs can... only much better. You make it sound like there's two different types of medicine and that PAs learn things med students don't. Couldn't be further from the truth.


They enjoy the cash midlevels bring them. It's easy to defend your pocket (in exchange for your profession) when you have an escape plan (retirement).

But really I can't wrap my head around their logic. Any decent med student half way through 3rd year can tell you what to order for all those common complaints. They would also suspect those diagnoses when given their common presentation. PA students may certainly suspect those diagnoses but I've seen on countless occasions that they struggle with the proper work up.

I doubt that is the case for HomeSkool but whatever, I respect him for helping students matching into Gas so I'll shut up. Still don't understand their logic. I guess it's similar to how when you become a 2nd year you think 1st years are a bunch of snot-nosed brats, then 2nd year to 3rd year etc. It's baffling to know this is how these attendings view 4th years/interns

 

[Dr.Housexoxo]

I doubt that is the case for HomeSkool but whatever, I respect him for helping students matching into Gas so I'll shut up. Still don't understand their logic. I guess it's similar to how when you become a 2nd year you think 1st years are a bunch of snot-nosed brats, then 2nd year to 3rd year etc. It's baffling to know this is how these attendings view 4th years/interns

It’s really sad and pathetic how threatened you guys feel. There are actual attending letting you guys know the reality of mid levels vs physicians yet you guys refuse to listen. You guys need to get over your egos and focus on becoming a good doctor. Midlevels are going to be your future colleagues so get over it. If this worries you so much then maybe find another career lol.

 

[jw3600]

It’s really sad and pathetic how threatened you guys feel. There are actual attending letting you guys know the reality of mid levels vs physicians yet you guys refuse to listen. You guys need to get over your egos and focus on becoming a good doctor. Midlevels are going to be your future colleagues so get over it. If this worries you so much then maybe find another career lol.

Thanks pre med.

 

[RNtoMD87]

It would be great if we could work towards increasing resident pay above what amounts (hourly) to minimum wage or close to it. That's as much as I'll say on this thread, way too over-it to say anything else.

Definitely agree with this.

 

[RNtoMD87]

It’s really sad and pathetic how threatened you guys feel. There are actual attending letting you guys know the reality of mid levels vs physicians yet you guys refuse to listen. You guys need to get over your egos and focus on becoming a good doctor. Midlevels are going to be your future colleagues so get over it. If this worries you so much then maybe find another career lol.

I don't understand why there is so much tension. Since MDs have a much higher ceiling, midlevels are not a threat to them. They'll never be as good in the long term regardless of who's ahead in the beginning.

The way I see it (because of where I've been) is CNAs versus RNs/LPNs. When I was a brand new nurse, I listened closely to what the 20+ year CNAs had to say. They can be really good at telling when a patient "doesn't look right" as well as other things, that a brand new nurse may miss. As I developed as a nurse, there was less that they were able to help me with, but I still listen to them, because they learned a thing or two in 20 years.

Likewise, I would really listen to what an NP/PA (or an RN for that matter) with a lot of experience says. They may not know everything, but they are still quite invaluable. It isn't a cock measuring contest.

As far as whether a brand new NP/PA should practice without a physician CLOSE by? Absolutely not. I don't think youll find anyone to debate this. As well as I think it should be a requirement for one to have several years of experience nursing in the specific area that they plan to be an NP in. Its crazy that you can go straight through RN->NP training with no experience.

 

[MedicineZ0Z]

It’s really sad and pathetic how threatened you guys feel. There are actual attending letting you guys know the reality of mid levels vs physicians yet you guys refuse to listen. You guys need to get over your egos and focus on becoming a good doctor. Midlevels are going to be your future colleagues so get over it. If this worries you so much then maybe find another career lol.

Please premed, tell me more. Surely attendings who profit off midlevels & will retire before sh&t hits the fan won't be biased, right?

 

[RNtoMD87]

Healthcare is going to sh** even without the midlevel business. We have a grossly unsustainable healthcare system and its going to be pretty scary in the future.

 

[Rendar5]

Healthcare is going to sh** even without the midlevel business. We have a grossly unsustainable healthcare system and its going to be pretty scary in the future.

That’s what they said in the 80’s when I was growing up, they said it in the 90’s when I was growing up and my own doctors told me medicine wasn’t the same as it used to be and tried to talk me out of medicine. In the 2000’s it was also all going to ****, the sky was falling as I went into med school. It’s still going that way now that I completed residency and an attending for several years and it will still be going that way in another 20 years. It probably will collapse at some point but honestly all this pessimism about medicine is several decades old and nothing new. No need to panic. It might collapse in a couple years but most likely we still have several decades.

Btw I was told going into residency that mid levels were trying to steal my job opportunities and kill my patients. I reject several job offers a month, and still have yet to feel threatened by them,nor am i jumping in to save their patients from them. Mid levels who feel they don’t need any attendings ever usually find themselves fired in my field. Y’all are getting worked up over a lot of nothing. But I doubt that many of you have the perspective to realize that just yet.

That said the second paragraph is from the perspective of emergency medicine. I won’t try and speak for other fields though I haven’t really seen attendings in other fields complain about the quality or quantity of midlevels or about encroachment. Just med students and occasionally residents.

 

[RNtoMD87]

I don't know when its going to happen, but I mean with the cost of healthcare, the amount of waste, and peoples terrible health, I don't know what else could happen. Antibiotic resistance is another huge concern.

Im not panicking but I'm all stocked up on supplies for the collapse and have a farm far from civilization. It's going to get bad eventually.

 

[HomeSkool]

I made the mistake of clicking into this thread again and saw some questions I may have tried once again to answer. Then I saw this:

Thanks pre med.

Please premed, tell me more.

WOW. How old are you, six? Thank you for clearly announcing your true poverty of maturity and critical thinking processes. I'll stop wasting my time on you now and focus on conversing with those who behave like grownups.

@Dr.Housexoxo, what they're trying to say is they lack the rhetorical ability to reply to your comment in an intellectually mature way, so they've resorted to ad hominem attacks in an attempt to discredit you. Translation: you won.

 

[VA Hopeful Dr]

It would be great if we could work towards increasing resident pay above what amounts (hourly) to minimum wage or close to it. That's as much as I'll say on this thread, way too over-it to say anything else.

That's funny, I just did the math at my program and assuming an 80 hour week every week for 50 weeks a year, the hourly pay is $14/hour.

Or you know twice minimum wage...

 

[NRP]

Good thing it's twice the minimum wage. If it was only minimum wage there would be no way for residents to ever pay off their loans! Now we're like the general population with minimum wage and 300k in loans! No need to complain about it!

 

[RNtoMD87]

Im just glad medschool wont cost me hardly anything.

 

[Dr.Housexoxo]

Please premed, tell me more. Surely attendings who profit off midlevels & will retire before sh&t hits the fan won't be biased, right?

I am actually a MS2. Your insecurity is showing my friend.

 

[Dr.Housexoxo]

I don't understand why there is so much tension. Since MDs have a much higher ceiling, midlevels are not a threat to them. They'll never be as good in the long term regardless of who's ahead in the beginning.

The way I see it (because of where I've been) is CNAs versus RNs/LPNs. When I was a brand new nurse, I listened closely to what the 20+ year CNAs had to say. They can be really good at telling when a patient "doesn't look right" as well as other things, that a brand new nurse may miss. As I developed as a nurse, there was less that they were able to help me with, but I still listen to them, because they learned a thing or two in 20 years.

Likewise, I would really listen to what an NP/PA (or an RN for that matter) with a lot of experience says. They may not know everything, but they are still quite invaluable. It isn't a cock measuring contest.

As far as whether a brand new NP/PA should practice without a physician CLOSE by? Absolutely not. I don't think youll find anyone to debate this. As well as I think it should be a requirement for one to have several years of experience nursing in the specific area that they plan to be an NP in. Its crazy that you can go straight through RN->NP training with no experience.

Agreed. Experience is important. I do not understand why people are not understanding. Patient care involves so much more than just pre-clinical knowledge.