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Various Questions

Discussion in 'Clinicians [ RN / NP / PA ]' started by coolthang, Oct 6, 2001.

  1. coolthang

    coolthang Member

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    Ok, here are a few questions which are bugging me so could you please answer me as best as you can.

    1. In a hospital for instance is there like a head PA?

    2. If you are a PA and after abit decide to become a doctor how many years of med school do you have to do?

    Thank You! :)
     
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  3. Freeeedom!

    Freeeedom! Senior Member

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    A head PA? I guess that would be the Physician.

    How many years of med school...the same as anyone else, 4...then residency.
     
  4. rdennisjr

    rdennisjr SDN Super Moderator
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    Coolthang:

    Freedoms response while partially correct was a bit short and sweet but pretty much to the point.

    To address the second question first. Being a PA does not count for anything directly during the MD/DO training process. You don't get to skip anything nor get advanced standing in anything. However, your patient care experience, medical decision making skills, and general training sure won't hurt you in the selection process and will definetly make the studying easier.

    As for the first question, I'm afraid things are not quite as Freedom so quickly put it. Yes, as a PA you will be responsible to your attending/reviewing Physician. However, there are some places in which senior PA's do act in a general supervisory role - not for making the final treatment decision - that role does rest with the Physician, but for general management of the PA corps and some training of the younger / less experienced PA's on their role in the specific institution/office.

    Hope that helps.

    Dennis
     
  5. emedpa

    emedpa GlobalDoc

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    many hospitals in my area(the pacific northwest)have a chief p.a. in charge of scheduling/recruitment/orientation etc. in my hospital I am the associate chief of the emergency dept. and have some input into how the dept. is run, including being on a panel that oversees quality assurance and disciplining md and pa staff.the md staff oversee the pa's only to the extent that they have to be available for questions and to sign our charts within 1 week. most of our patients have no interaction with an md, only those who are atypical, very ill, or pending admission. hope that helps.
     
  6. Mr. happy clown guy

    Mr. happy clown guy Senior Member

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    You know that is pretty sad and bordering on unethical. I have rotated through 4 ED's and not a single occurance like the one you just spoke of happened. We should strive for the best possible care for ALL patients and to funnel so called "less complicated" patients to "less qualified individuals" is disgraceful. Each and every patient should see a doctor...regardless of the current "trends" in cost containment!!
     
  7. emedpa

    emedpa GlobalDoc

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    mr. clown- as long as everyone knows their limits(regardless of the initials after their name)the patients get good care.I don't see trainwreck oncology patients and internists don't suture pediatric lacerations.most systems that utilize a fast track or urgent care model in the E.R. have an md/do available for consultation, but most patients never see them because they have run of the mill presentations.that is the way of the world.I have now worked in 8 emergency departments over the course of my training and work history and they all do this.only 2 of these places were hmo run. statistically, a P.A. can do 90% of what an f.p. doc can do and 80% of what a pediatrician can do in an outpatient situation.before you talk any more about what a p.a. can/should not do,learn a little bit about them at www.aapa.org
     
  8. emedpa

    emedpa GlobalDoc

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    p.s. to above note:
    a significant amount of the rural health care in this country is done by P.A.'s(or nurse practitioners) whose supervising physician is not on site and may be hundreds of miles away and available only by telephone.most of these folks have years of clinical experience; you see it is possible to continue to learn skills outside of a formal school or residency situation.you will recall that the medical model in this country was based on apprenticeship(learn by doing), not by attending classes forever...
     
  9. Mr. happy clown guy

    Mr. happy clown guy Senior Member

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    What you say regarding FP and pediatricians is absolutely INSULTING! Much of what I say I do out of good humor, yet your assertion that a NON residency trained assistant can do what a FP or PEds doc does...and as well is inflammatory and absolutely contradictory to common sense!
    I suggest you re-think your choice to be "pre-DO" (whatever that may mean), and stick to being an assistant. I have worked with many NP's and I will say it again and again...they are absolutely SCARY...and they have been from many different programs. None of them new how to present a patient, nor did they have physical exam knowledge to save their lives. They stick to protocol.

    I hope that others, including PA's and NP's do not feel the same as yourself...it is utterly frightening. Trust me my friend just because you see them in fast track doesn't mean we don't see them again in the ED or hear about it later in conference. A little knowledge can be a dangerous thing...I know this because I used to be a P.T. and just thought I knew it all. I was wrong.
     
  10. emedpa

    emedpa GlobalDoc

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    the 80%/90% figure was not meant to be insulting.that is the actual statistic.most P.A.'s have years of clinical experience before even entering their P.A. training.I was a paramedic for 10 years before I started P.A. school and guess what,I didn't forget how to start an iv or treat chf just because I went back to school.many P.A.'s study for boards using the same material the docs use to study for f.p. boards.I got high honors on my(p.a.) boards and could have passed the f.p. board exam(I took several sample boards).the strength of the p.a. profession is built on the fact that people know something about medicine going into the program, unlike many medical students at the start of their training, so you can't evaluate a p.a. only on their 2-3 years of training.by the way, p.a. students on rotations sre treated as med students-same schedule, same pt. load, same length of rotation as the 3rd year med students.if you don't want to learn what p.a.'s really are and what we can and actually do every day then maybe you should stay out of the p.a. discussion area. :mad:
     
  11. lotchki6

    lotchki6 Member

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    Emedpa,

    Try not to get so angry by the comments of the obsurdly ignorant..ie- Mr. Happy Clown. His ramblings are nothing more than that..ramblings---He is a frustrated individual that feels the need to take his hostility out on those that he PERCEIVES to be inferior...however it is prob very safe to assume he graduated bottom of his med school class, was not taken seriously by his classmates nor the residents/attendings he came into contact with, and very likely questions what HE truly knows about medicine. Are these bold and presumptuous statements...Definately. But they are no more bold/presumptuous than the statements he made about PAs in his postings.

    Mr. Clown: the few experiences that you have had with NPs (NOT EVEN PAs) should not be your justification for trashing a profession you are so obviously clueless about. Practice medicine the way you wish bud...but I hope the day comes that you are in the need of advise or help..and the only one available is a PA that has more knowledge and experience than you (scary thought, huh). You will watch yourself as you sink and jepordize everything you have worked so hard to accomplish (becoming a Doc) because you were too pig-headed to admit that YOU STILL DON'T KNOW EVERYTHING!
     
  12. emedpa

    emedpa GlobalDoc

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    Thanks.I won't waste any more effort trying to educate clown boy. :D
     
  13. tidy_kiwi

    tidy_kiwi Senior Member

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    If this is the case, then isn't it a feasible suggestion to just merge the professions and remove the need for the md vs pa argument? I mean - why differentiate between the two if they both provide professionals with the same capability?

    And to the PA who is thinking about going DO - a couple of questions. Do you think you will be repeating the majority of your course work? Isn't going to med school a bit of a waste of time if you are already a PA? Aren't you essentially just going to be doing another 4 years of school to end up doing the same thing? Or do you get advanced standing? If the 80-90% thing is accurate, couldn't they just have like a one/two year conversion course to turn PA's into MD/DO's? Also why DO over MD?

    Sorry for all the questions - I am just curious that's all.

    Thanks.
     
  14. CVPA

    CVPA Senior Member

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    Tidy:

    However similar the professions are, they are also fundamentally different. The training and capabilities are similar, yes, but they are not the same.

    While the PA training model is fashioned after the medical school model (ie, same courses), PA programs obviously cannot go into the material in the same depth as is done in medical school. Years of practicing can often offset this as well as the difference in residency training, but the function and role of the PA remains different. By design, the PA is supposed to work in tandem with and under the guidance and direction of a physician. One would no sooner merge PAs and physicians then they would Paralegals and attorneys.

    Although I cannot speak for EMEDPA, I can give you my perspective as a PA who has applied to medical school.

    First, yes, I would be repeating many of the courses such as gross anatomy, pharmacology, etc. Again, medical school will obviously go into the material in greater detail, but it will be considerably easier for me than the typical MS-I who has not had the benefit of a PA educational and clinical background. Clerkships will be a breeze for most hospital based PAs who have been practicing for more than a couple of years. There is no advanced standing for PAs. There used to be years ago, but that has since been discontinued.

    Second, I do not believe that going to medical school will be a waste of time at all. Although I have thouroughly enjoyed being a PA for the past 5-years and have been able to do things in cardiac surgery that most people would not think a PA could do, there are limitations inherent to the profession that prevent me (and I suspect other PAs who choose to pursue medical school) from being completely satisfied with it. My role would change considerably in that I would be directing the plan of my patient more directly and completely. I guess, in a nutshell, I just feel that my potential has not been fully reached as a PA.

    The PA/Physician debate will, in my opinion, continue forever. It is usually initiated by medical students and new graduate physicians who feel slighted or offended at the notion that someone who has not gone through medical school and post-graduate training, could ever compare to one who did. Its a pretty pathetic debate, but then again, I too have engaged in it many times. None of us want anyone else to minimize what we do. The bottom line is that both parties feel that the other is doing just that, minimizing their education and capabilities.

    A one to two year conversion from PA to physician would, in my opinion, be a bad thing. It would encourage people to use the PA profession as a stepping stone, which is not really what the profession wants. It wants to be recognized as a profession unto itself, not the predecessor to becoming a physician.

    As far as the MD vs DO thing, :rolleyes: , please, thats a topic that has been pummeled on this forum longer than the PA/Physician debate. I would refer you to the Pre-DO forum for that answer.
     
  15. tidy_kiwi

    tidy_kiwi Senior Member

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    CVPA:

    Thanks for your informative post, it was greatly appreciated. I wish you the best of luck in your medical school endeavours.

    An re: the MD/DO thing - I was merely asking for emed's personal perspective - I am all too familiar with the standardised debates in some of the pther forums! ;)

    Once again thanks - you have cleared up some confusion on my part (we don't have PA's over here).
     
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  17. emedpa

    emedpa GlobalDoc

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    Thanks cvpa, your response was accurate and appropriate.
    kiwi: thanks for your interest.my reasons for wanting to become a physician arise from the fact that I am tired of seeing the 80-90% of patients within my initial p.a. training.I previously worked as a paramedic before going to P.a. school and I miss treating chest pain, dka, cardiac arrests major fractures, etc.I want to work in emergency medicine seeing the most critically ill patients.there are places in the u.s. where a p.a. can do this but at the present time I do not want to work in a very rural environment on the east coast or in a major inner city trauma service.I want to see sick folks at a community ER or level 2 trauma center in a nice area.I have even considered going back to work as a paramedic part time, but I can't see doing that as a 50-60 year old. as for being a d.o. over an md: as a 32 year old taking several community college classes to meet entry requirements, I think the d.o. adcoms would be more appreciative of my past life experiences.I also like the d.o. focus on maintaining health as well as treating disease(yes some md's do this as well). also, in my personal experience, d.o.'s are more laid back and less anal.the teaching style is more relaxed in a d.o. program with the same material covered.I do not mean to offend my md colleagues with this statement, it is only a personal observation having worked in health care for 15 years. as for the 2 year conversion program, such an idea was recently proposed by eugene stead, md, the founder of the p.a. program at duke in the late 1960's. I think this could work and I would certainly apply. I do not think it will ever come to pass due to pressure from physician groups.
     
  18. Mr. happy clown guy

    Mr. happy clown guy Senior Member

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    It is always fun to listen to Pre-meds discuss how their "past experience" will make them the superior candidate.
    Oh yes, you will simply destroy everyone else...get for real.

    These students are the best of the best. I have seen it in a class of 220. I had already acheived an advanced degree as did at least 30% of my class. And yes we had a PA in our class...funny thing he did not get past the top 50% in the class...the year before, a former Dentist nearly failed out of class and a Chiropractor did fail. I can say that I passed, but it was a difficult ride.

    Don't any of you realize that Med school is a different ball game? It is the NFL...it is your job to show them you won't FAIL. Regardless if you took anatomy before, you probably didn't have it for 6-9 months 2-3 days a week in addition to cell bio, bio chem, pharm, micro, etc. You all are smart, undoubtedly...but I can tell extremely egotistical.
    Listen, perhaps similar people can do similar jobs...but why would ANYONE choose a lesser profession to do the same job as a physician?? My uncle "Ted" could probably fix my car...but I think I would prefer a mechanic.


    EMEDPA, dude, I want you to enter my ED someday...you can be my student. I will see how smart you are toughguy. Why don't you leave me a private message, tell me where you want to go, and your name, and I will look for you during your third year. We'll see how much of a doctor you are by your third year...or, we will see just how much pride you have swallowed.
     
  19. CVPA

    CVPA Senior Member

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    Clown Guy:

    First of all, I never said that I would be the "superior candidate". Those are your smug words, not mine or anyone else. All I said was that it would be easier, not to be confused with easy. That hardly qualifies as egotistical. Anyone who knows me would laugh if they heard you refer to me as egotistical....and talk about the pot calling the kettle black!

    I realize that medical school would be hard, very hard, but I also think you underestimate PA education and the years of clinical experience that can benefit one in a medical school curriculum. Just because you had one student who was a PA who didn't do that well doesn't mean that being a PA won't help considerably. I have spoken to countless medical students over the years here in S. Florida both at the Univ. of Miami and NSU-COM as well as the Dean of Admissions at U of M. They unanimously have said that my PA education and experience would help during medical school.....but you, the person who calls himself "The Happy Clown Guy", knows better than all those people.

    I don't anticipate that I will "destroy" anyone, but I will do well. More than anything else, I will because of my determination to do so.
     
  20. Mr. happy clown guy

    Mr. happy clown guy Senior Member

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    Listen, your background will be helpful...but you have got to get over yourself! I will repeat myself, these are the best of the best and you MAY find yourself struggling to survive. Maybe not.
    Just be prepared.
    And when you become a DOCTOR, perhaps you also will have pride in your credentials and insist only the BEST for your patients.
     
  21. CVPA

    CVPA Senior Member

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    There really is nothing for me to get over, Clown Guy. I am not stuck on myself at all and again, if you knew me you would know that. You are absolutely right, I may have to struggle especially during the first two years. I don't dismiss that as a possibility for one minute. I also realize that I will be with the best of the best, however, I am not competing against them, only the exams administered by the professors. Sure, you compete for residency slots and maybe even for grades when taking curved exams. Other than that, it doesn't matter who is sitting to my left. It only matters when I am trying to get in.

    I will only allow the best for my patients, on that you can be assured. I know that you feel that PAs and NPs are not the best for patients and you are entitled to feel that way. If used correctly, however, they are part of "the best" for patients. I, and thousands of physicians who use them, have seen this for many years. When they are substituted for a physician, it is a compromise. When added to a physician's care, they are a valuable adjunct. Hopefully, someday you too will see this rather than viewing them as an unqualified alternative.

    I would ask of you one thing and then I'm going to end this thread, at least for me. In your upcoming years as a physician, try to open your mind to the possibility that your personal and singular experiences, although valuable, may not necessarily represent the larger picture to which you may not be privy.

    Good luck in your future studies.
     
  22. Mr. happy clown guy

    Mr. happy clown guy Senior Member

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    My worry, and many of those in the AMA and AOA, is that NP's and PA's will attempt to push and push to broaden their scope. Then, a patient will suffer or die. I have already heard stories from friends at St. Louis U. school of Law, that "PA's are litigation waiting to happen".
    I would prefer it would never come to that...but I can see it easily happening.
     
  23. CVPA

    CVPA Senior Member

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    OK, maybe I won't end it now since it has gotten to a civil level and your concern is understandable. I would like to make three points which will hopefully alleviate some of your concerns:

    First of all, you and those who share your concerns need to understand that the individuals who may be lobbying to broaden the scope of practice for PAs, do not represent mainstream PA philosophy. I have said this on previous posts; the AAPA (American Academy of Physician Assistants) has not been behind those who wish to expand our scope of practice. Without AAPA backing, they will have a difficult time obtaining such an objective. They are a select group of individuals with a personal agenda in mind that is not in the best interest of the profession as a whole. Personally, I am opposed to expanding our scope as I believe that 1) it is broad enough, and 2) it goes against who and what we are. Additionally, I believe it will serve no function other than to alienate physicians who we are dependant upon by nature.

    Secondly, even if by some fluke it comes to pass that the scope of practice is broadened, each hospital has the ability to restrict a PA's/NP's scope of practice through it's bylaws.

    EXAMPLE: Although I am qualified, competant, and allowed by state law to insert swan ganz catheters as a cardiothoracic surgical PA, the hospital bylaws where I work, prohibit me from doing so.

    This is part of the checks and balances system in this country that would prevent PAs from ever gaining enough autonomy to practice independantly to the point where patient care would be compromised.

    Thirdly, I disagree with you friend's analysis that PAs are litigation waiting to happen. You have to remember that PAs have been around since 1965. If what he/she said were true, we would have seen high amounts of litigation against them by now, starting in the late 1980s and early 1990s when PA popularity really began to expand. Current statistics show that the amount of law suits against PAs (I don't know about NPs) is 1/4 that of physicians. It just doesn't happen that often. Granted, attorneys will tend to go after the supervising physician who usually has the higher medical malpractice insurance limits. However, the 25% stat reflects lawsuits aginst either PA or MD/DO as a result of the PA's actions.

    Hope this helps alleviate some of your concerns. PAs are a good thing, Clown Guy, and they can be a real plus to delivering quality care. From what I can ascertain, your exposure to them has been extremely limited. You are basically in the infancy of your career as a physician. Hold your final judgement of them until you have had a fair exposure to a variety of them over a significant period of time.

    Again, I wish you the best of luck.
     
  24. coolthang

    coolthang Member

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    Woo, this thread has grown more than i thought. :)
     
  25. Mr. happy clown guy

    Mr. happy clown guy Senior Member

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    We shall agree to disagree.
     
  26. tidy_kiwi

    tidy_kiwi Senior Member

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    I guess what would be interesting woud be to hear from some ex-PA's who have gone throught he entire process of med school and residency. I would like to know how they felt about the way they practiced medicine as PA's compared to being a doctor and if they thought it was safe in retrospect.
     
  27. vixen

    vixen I like members

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    yes tidy...I think a former PA med student would be the most knowledgable about this...I'm interested...anyone here in this position?
     
  28. Neurogirl

    Neurogirl Resident Extraordinaire

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    I know of someone in that position...one of our attendings used to be a PA. The next time I see him I'll ask.
     

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