What if they allowed PA students to do Allopathic residencies?

[p1acebo]

It is actually a pretty good read. Dripping with angst, but a good read. If he can't get over being called an "assistant," then either don't be so shallow, or don't go to P.A. school. I find a similarly preposterous argument when Doctorate of Nursing students want to be called Doctor instead of Nurse. Labels only bother people if they let them, but should be used appropriately (ie, if it's in your profession's name...)

If the author wanted to be a doctor, go to friggin' med school. He closed by pointing out that medicine is a team effort, which is an absolute truth, yet spent an entire treatise of an essay writing about how he wants autonomy and doesn't want an MD team leader.

This.

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[HumbleMD]

...especially in hospital settings and also settings where a good PA is most of the time interchangeable with an MD (FP, IM perhaps).

Writing scripts and making referrals, or 1st assisting in surgery does not make someone "interchangeable" with an MD. Agreed, many MDs seem ignorant to the role of a PA, but there seems to be a lack of knowledge about the role/responsibilities of an MD on the other side.

but there is a reason a doctor is called a doctor and a medical assistant is called a medical assistant.

Correct. I'll let you guess what my next statement would be in response.

Obviously this is a physician-dominated site which sees no advantage giving respect to people that work for them that aren't part of their "clan" but definetely makes sense if there wasn't a conflict of interest here.

I will agree with you, and don't see my future as an MD as having nurses or PAs, or MAs that work "for" but rather with. I'm a big fan of "the medical team" and believe people have roles. I don't believe that a PA and an MD are interchangeable in the role of medical team leader.

Plus, i think the physician associate name is bogus. PAs arent assistants in practice, but associate ehh probably isn't any better... i think i heard clinical associate somewhere, seem to agree with it.

Get over the stupid name. Seriously. I'm gay, and my peeps belabor names all the time (which I think is ridiculous).

Do a good job for your patients, and they won't friggin' care what/who calls you what. At least SOME patients currently know what a PA is. Don't further confuse things for them by adding another possibility of what the person coming at them in a white coat could be.

 

[PharmBound2011]

Writing scripts and making referrals, or 1st assisting in surgery does not make someone "interchangeable" with an MD. Agreed, many MDs seem ignorant to the role of a PA, but there seems to be a lack of knowledge about the role/responsibilities of an MD on the other side.

Well, I've shadowed PAs & MDs intensively in PC & specialties. Sure in specialties and subspecialties, there is obvious difference and PAs generally have a low scope of practice when compared to docs. but, as I specified, FP & IM, the scope of practice is relatively interchangeable (more so in FP). Now, I'm not talking about a new grad PA, but PAs already practicing in family practice for example will have a very similar role as the MD in family practice. The MD is obviously higher educated (no doubt here). Primary care & IM midlevels are out there seeing same acuity patients as docs...

I am NOT saying that they are the same. I'm just saying that docs SHOULD be the team leaders, but also respect the person who can do most of what you can do. PAs practice medicine, and do NOT simply assist someones practice of medicine.

 

[HumbleMD]

Well, I've shadowed PAs & MDs intensively in PC & specialties.

Yeah, I stopped reading after your shadowing "expertise" assertion.

Sorry, that's mean. I read it. What you're not seeing while only shadowing (even if it is "intensively") is who is setting the clinical practice guidelines for that practice, and its operating procedures? Who is teaching medical students and residents? Who is teaching the PAs? Who was at the table when they hired the practice coordinator? Who's attending continuing medical education courses?Who's keeping up to date on the latest screening guidelines for breast cancer? Who's out there helping write those screening guidelines for breast cancer? Who is going to refer that patient for their back pain to an Ortho, vs. who is going to manage it medically using an evidence-based approach?

Medicine is more than asking your patient to get a colonoscopy and discussing diabetes. "Assistant" is arbitrary. "Residents" no longer live in hospitals, but we're kind of over the term. Vocabulary shouldn't be changed unless there's a pressing need to. And low self-esteem is not a pressing reason.

 

[45408]

brb PA students outshining med students on every rotation @ my school

Yeah, I have yet to work with a PA student who outshined the med students. We had one really good one with a great work ethic who was more useful than most of the M3s, but your work ethic isn't taught to you.

brb wait.. where did my 20's go

Shaving 1-2 years off wouldn't exactly restore your 20s.

Related essay on KevinMD: http://www.kevinmd.com/blog/2011/04/physician-assistant-writes-doctors-america.html

Fact No. 4. As a PA I am not a technician or an assistant level profession. One cannot be trained to do much of what a physician can do, and then do it well for 10, 20 or 30 years, and still be an “assistant,” still need “supervision,” which is a word that was picked for us by organized medicine. Supervision to the public means “they need to be watched.” It means they’ll NEVER really get “good enough” to do it alone. That is not the basis of a profession. These words hurt and are confusing to patients.

Sure, you can. I think PAs are great and very useful, but their role is not to do "much of what a physician can do." I worked very closely with a number of PAs on a neurosurgery rotation, and most of them had been working for >10 years in that capacity. Not a one of them was remotely close to being a neurosurgeon. There were more than a few things that I was doing better than they were, and I've got 4 more years of residency.

Besides, most PAs don't have 30 years of experience, and even the ones that do have often been in multiple fields. All physicians have completed a residency (with a bare minimum of 3 years), and no one can switch specialties without doing another residency. My wife just saw a PA in the ob/gyn clinic for a usual visit. Two years ago, that same PA was working in the GI clinic. I promise you that the gastroenterologist was not doing Pap smears two years ago.

Even a "new graduate" physician has at least 3 years experience in their specialty. I'll have 5-6 years. Given the hours I work, it's more like 10 years of experience.

One of the comments says:

I suspect that many PA’s who are as experienced as yourself could do well on all 3 steps of the USMLE

I suspect that those PAs would get absolutely smoked on Step 1.

 

[Mattchiavelli]

HumbleMD, awesome posts and excellent job helping define professional boundaries without being a complete d-bag in the process.

It's interesting to see that some schools are paring down pre-clinical coursework. Personally I have a BA in Biochem and didn't get anything new preclinically in biochem or micro that I hadn't gotten in undergrad. I could see that being more widespread but meeting resistance from faculty and administration that's already taken a beating financially d/t the economy.

I got into medicine because I saw it as one area where someone could be a modern day renaissance [wo]man and I think the extra training has allowed me to pursue that end, and it's not an option in PA school. I have an older ex that started PA school around when I started med school and we get together every now and then to talk disease, it's interesting to have come across the differences in our training.

Anyway I doubt we will see PAs taking allopathic residency spots b/c that's the current bottleneck in the training pathway in the US. In a way, a PA is a perpetual resident. I think the real problem is people interested in healthcare careers can't figure out what the hell all the professions do or how all this functions and what it means. I know there are some people in med school that would be better suited as PAs and some PAs and high level nurses better suited for being MDs.

 

[393656]

1. At the end of the day you are still a PA-do you really want to tell people you are a physican assist-to everyone that is a second rate doctor that couldnt make it to med school (not necessarily true but most people think of it this way)

2.nobody forced you in med school. Why didnt you just become a PA? Why complain about something you could have done yourself?

makes no sense..

 

[justaregularmed]

Turns out I just don't care that much about this so I deleted my post.

I'll be blunt and just come out and say it. I think anyone who says year one is worthless either got nothing out of it (either a personal problem or institutional problem) or just has no retrospective ability.

Year one is so you can understand year two. Year two is applied in year 3 and 4. Year 3 and specifically year 4 are to prepare you to be an intern (sub-i).

I don't see the flaw in this. Every school has its strength and weaknesses but traditionally this is how its supposed to work.

If you need help i'll illustrate (taken directly from the USMLE website).

Step 1 assesses whether medical school students or graduates understand and can apply important concepts of the sciences basic to the practice of medicine.

Step 2 assesses whether medical school students or graduates can apply medical knowledge, skills and understanding of clinical science essential for provision of patient care under supervision.

Step 3 assesses whether medical school graduates can apply medical knowledge and understanding of biomedical and clinical science essential for the unsupervised practice of medicine.

Now when abouts do you take each of these exams again?

 

[mTOR]

mTOR user name? Leucine/BCAA researcher? Lol. And also you seem like you're from the MISC?

Damn brah wtf lol I've been misc'ing for some time now. I've posted several times in the misc med student thread over there. lmao no one remembers cuz I don't have an avi (and probably will never get one... it'd be wayyy too easy to identify me). And yes I'm a big time basic science research fiend.. oncology not BCAAs though (hence the username).

 

[mTOR]

FROM http://www.carnegiefoundation.org/p...ians-call-reform-medical-school-and-residency :


[-- snip --]

THE MEDICAL DISCIPLINES MODEL. In the discipline-based curriculum
structure recommended by Flexner, which prevailed until the 1960s,
students typically learn normal structures, functions, and processes of the
body organized by disciplines such as anatomy, physiology, microbiology,
histology, and biochemistry, followed by pathophysiology and disease
management. Discipline-specific courses are taught in parallel with other
disciplinary courses; too often, we found, there is little coordination or
reference to clinical relevance. Over time, new content areas such as
evidence-based medicine, genetics, and medical ethics have been added
as independent, concurrent courses.
The purpose of being immersed in science is not just to understand
the human body, according to Flexner, but also to ensure that physicians
in training would learn to use scientific reasoning, or the hypotheticodeductive
reasoning process. Although this approach is plausibly related
to learning to think through certain kinds of difficult problems, major
challenges have arisen with expansion of knowledge and proliferation of
disciplines. Learning in the medical curriculum today is difficult because
of the overwhelming amount of potential information to be mastered and
uncertainty about which information will be most relevant for the future.
Students struggling with factual overload may adopt learning strategies
such as rote memorization that are inimical to scientific reasoning and
inquiry.
Accordingly, today very few schools structure the curriculum entirely
around separate discipline courses. One feature of this curricular
approach that we found to be of particular concern is that it requires
students to be the integrators of knowledge and find appropriate
application to clinical medicine. The curricular format does not integrate
content sequentially, leaving students to determine how the content in
one domain relates to another, and how both relate to patient care.
Curricula organized this way do not honor the premise that learning is
progressive and developmental. Students voice frustration with the lack
of coordination among lecturers who are unaware of the content covered
in preceding lectures or who fail to acknowledge and build on students'
existing knowledge. Students are also critical of lecturers who fail to
discuss the relevance of scientific concepts to the practice of medicine.
A second problem with this curricular structure is its inefficiency.
Students are required to learn the content two entirely different ways,
first organized around basic science content and later organized around
patient signs and symptoms. As a consequence, students arrive in the
clinical setting with abstract knowledge that is difficult for them to
access and apply to patient care. This curricular structure is inconsistent
with the premise that learning is situated and distributed; it fails to
capitalize on the richness of the clinical context early on and to engage
learners authentically in using their knowledge and skills in the care of
patients.
Third, the pedagogies employed in the discipline-based model often
rely heavily on lectures that do not actively engage learners in constructing
conceptual understanding. Because the practical and experiential
aspects of the curriculum are segregated from the biomedical content,
many students fail to understand and appreciate the interconnectedness
of these forms of knowledge. Students have little sense of the context
of the knowledge they are acquiring and the various means by which it
can be used in practice. Finally, the assessment system typically focuses
narrowly on scientific content knowledge and ignores such other important
domains of performance as synthesis, integration, and evaluation
of information and domains beyond bioscience, such as professionalism,
clinical skills, and systems improvement.

[-- snip --]

So apparently I go to one of the "very few schools" that extensively employs the antiquated "medical disciplines model." :-\

Which would clearly explain a lot of the variation in being able to identify with some of my sentiments expressed regarding that year..

 

[mTOR]

Turns out I just don't care that much about this so I deleted my post.

I'll be blunt and just come out and say it. I think anyone who says year one is worthless either got nothing out of it (either a personal problem or institutional problem) or just has no retrospective ability.

Year one is so you can understand year two. Year two is applied in year 3 and 4. Year 3 and specifically year 4 are to prepare you to be an intern (sub-i).

I don't see the flaw in this. Every school has its strength and weaknesses but traditionally this is how its supposed to work.

If you need help i'll illustrate (taken directly from the USMLE website).

Step 1 assesses whether medical school students or graduates understand and can apply important concepts of the sciences basic to the practice of medicine.

Step 2 assesses whether medical school students or graduates can apply medical knowledge, skills and understanding of clinical science essential for provision of patient care under supervision.

Step 3 assesses whether medical school graduates can apply medical knowledge and understanding of biomedical and clinical science essential for the unsupervised practice of medicine.

Now when abouts do you take each of these exams again?

lol Perhaps I'm too much of a cynic (or a delusional optomist?) but I truly believe you can take any fresh out of HS grad and -- with enough Goljan audio listens, RR path, First Aid, and UW questions (and maybe a stock supply of adderall) -- have him/her easily pulling some 99 two digit score on Step 1. No ugrad or formal medical education needed. Now it's certainly questionable whether such a student would be as competent knowledge-base wise as your average 1st day on the wards 3rd year, but I find little reason to think why they wouldn't be.

 

[Miscbrah]

in my opinion, the answer to the question is pretty simple

would you ever prioritize a US-educated PA over a foreign-educated MD?

there will never be enough residencies to take all the FMGs and the only way to give PAs allopathic residencies would be to give them residency spots over FMGs.

what do you guys think about letting PAs take over most primary care specialties(FP and IM) instead of opening up more residency spots for primary care specialties which would probably be taken by FMGs? would that be an acceptable drop in quality of care and help universal healthcare be more fiscally responsible or would it be such a disaster that would kill many patients?

 

[ProtossCarrier]

in my opinion, the answer to the question is pretty simple

would you ever prioritize a US-educated PA over a foreign-educated MD?

there will never be enough residencies to take all the FMGs and the only way to give PAs allopathic residencies would be to give them residency spots over FMGs.

what do you guys think about letting PAs take over most primary care specialties(FP and IM) instead of opening up more residency spots for primary care specialties which would probably be taken by FMGs? would that be an acceptable drop in quality of care and help universal healthcare be more fiscally responsible or would it be such a disaster that would kill many patients?

if PA wants residency they can go to medical school, DO school or foreign school. The answer is NO.

 

[Perrotfish]

Sure, you can. I think PAs are great and very useful, but their role is not to do "much of what a physician can do." I worked very closely with a number of PAs on a neurosurgery rotation, and most of them had been working for >10 years in that capacity. Not a one of them was remotely close to being a neurosurgeon. There were more than a few things that I was doing better than they were, and I've got 4 more years of residency..

BUT, like he said, he's not talking about PAs working in neurosurgery, he's talking about PAs in Primary Care. In Primary care PAs often work, basically, independent of physicians. They see the same random assortment of patients, they carry a similar patient load, and they don't present to a physician before they make they make their decision. In many states there are no longer physicians in the same BUILDING, just a periodic review of 10% of the PAs charts done at the end of the month. That's not assisting, that's practicing.

what do you guys think about letting PAs take over most primary care specialties(FP and IM) instead of opening up more residency spots for primary care specialties which would probably be taken by FMGs? would that be an acceptable drop in quality of care and help universal healthcare be more fiscally responsible or would it be such a disaster that would kill many patients?

I feel like this idea just takes primary care doctors and eliminates the one part of their education that I DON'T think is a waste. They still have 4 years of completely pointless undergraduate education. They still get the later years of residency that I think could be replaced by OJT under the supervision of a licensed physician. They do, however, eliminate the medical school education that I think is actually an efficient way to learn the relevant parts of our trade. I'm not a fan.

 

[Marcus Brody]

Good lawd, people are so insecure...

"oh noes what if teh midlevels are allowed to be doctaz too??/"

I say bring em on. If there are rockstar PAs who can get 250 on step 1 and awesome LORs, why not? And if it's at the expense of the MDs who slimed it through school, screw em.

The whole problem with this is that prices aren't set by consumers.

 

[ProtossCarrier]

I think the issue here is that most of us agree that ONLY physicians should have access to allo RESIDENCY

 

[ACSurgeon]

lol Perhaps I'm too much of a cynic (or a delusional optomist?) but I truly believe you can take any fresh out of HS grad and -- with enough Goljan audio listens, RR path, First Aid, and UW questions (and maybe a stock supply of adderall) -- have him/her easily pulling some 99 two digit score on Step 1. No ugrad or formal medical education needed. Now it's certainly questionable whether such a student would be as competent knowledge-base wise as your average 1st day on the wards 3rd year, but I find little reason to think why they wouldn't be.

Really? Maybe the brightest of HS grads, but "any" is pushing it. We do, afterall, graduate a bunch of HS students that NEED years of community college before they can even handle university level courses.

Even with your best HS grads, there would have to be 3-4 years of basic science before step1 and clinicals. A lot like the UK and other countries. I don't think I learned a lot of knew things in third year, just learned how to apply my second year knowledge.

 

[45408]

lol Perhaps I'm too much of a cynic (or a delusional optomist?) but I truly believe you can take any fresh out of HS grad and -- with enough Goljan audio listens, RR path, First Aid, and UW questions (and maybe a stock supply of adderall) -- have him/her easily pulling some 99 two digit score on Step 1. No ugrad or formal medical education needed. Now it's certainly questionable whether such a student would be as competent knowledge-base wise as your average 1st day on the wards 3rd year, but I find little reason to think why they wouldn't be.

Hell no. You're definitely delusional, or your high school was world class (and you think everyone else's is too).

People forget that they understand the idea behind looking at a blood gas because they have a fundamental understanding of what acids and bases are. Trying to interpret values like that or blood electrolytes without understanding how ions function is completely pointless. Knowing why hyperventilation causes hypocapnea and why that causes a shift in the Henderson-Hasselbach equation and what pH will result (and what ventilator settings will get you there) is going to require more than some HS grad staring at FA.

BUT, like he said, he's not talking about PAs working in neurosurgery, he's talking about PAs in Primary Care. In Primary care PAs often work, basically, independent of physicians. They see the same random assortment of patients, they carry a similar patient load, and they don't present to a physician before they make they make their decision. In many states there are no longer physicians in the same BUILDING, just a periodic review of 10% of the PAs charts done at the end of the month. That's not assisting, that's practicing.

There's a fundamental difference between a PA doing much of what a physician does (what you said) and a PA doing "much of what a physician can do," which is what he said. Sure, a lot of primary care can be pretty basic and mindless, but a residency-trained internist can do a lot more than just manage low back pain and uncomplicated UTIs. They've been trained to do a lot more, whether or not they do is up to them.

 

[dAnthony1918]

This entire thread is a joke.. Seriously quit venting about your career choice in such an insulting manner. If a PA really was as smart as a doctor, they would be a doctor. Don't give me this bs about how many years it takes, whatever. If you can stick it through all those years, sacrifice your 20s, go be a PA. A PA has zero responsibility for a reason. A doctor needs to have that dedication and sacrifice so that the patient can receive those rewards. Medicine is at a critical junction right now, where technology is changing everything. Most of the specialties you want to go into won't exist or exist under a different definition in 30-50years. PA's won't exist, Anesthesiology Assistants will not exist, the need for nurses will be cut dramatically. Primary med docs will take business away from the specialists. Medicine will go the way of a licensed engineer. You learn basics but not enough to be a physicist, a biochemist, etc. You will learn to design treatment approaches, not spit out memorized information. Everything will be applied. Just like a calculator took away the need to be a mathematician from the engineer, technology will do the same. Doctors will need to think as if they were doing "differential equations," finding variables that fit or don't fit a preconceived model and adjusting those models to simulate patient responses to pharma, nutrition, etc. Computers will eliminate most of the differential diagnosis by giving it to you in percentages of certainty. Genetics will dictate your lifestyle based on genetic susceptibility to high blood pressure etc. Quit being so naive. As someone at the forefront of Biotechnology, engineering, etc. This is already happening. Blood pressure, history, anything routine that nurses, PA's etc. that are hired to do will be done automatically. The specificity of over the counter tests, consumer healthcare products, already is making it possible for people to manage basic needs without insurance, physicians, etc. Tech will allow the distance between the specialist and the primary care physician to collapse as a physician will no longer need to "know/ be an expert" at a certain level, but need to apply information generated from a patient and cross referenced between databases and millions of patients. You don't believe me, just look at dentistry. Cavities are soon a thing of the past with genetically engineered oral bacteria. Those technicians that clean your mouth are gone. The dentist will still be around. Thats my 2 cents. Believe me or not, its already happening. Jump on the wagon or dont

 

[PharmBound2011]

This entire thread is a joke.. Seriously quit venting about your career choice in such an insulting manner. If a PA really was as smart as a doctor, they would be a doctor. Don't give me this bs about how many years it takes, whatever. If you can stick it through all those years, sacrifice your 20s, go be a PA. A PA has zero responsibility for a reason. A doctor needs to have that dedication and sacrifice so that the patient can receive those rewards. Medicine is at a critical junction right now, where technology is changing everything. Most of the specialties you want to go into won't exist or exist under a different definition in 30-50years. PA's won't exist, Anesthesiology Assistants will not exist, the need for nurses will be cut dramatically. Primary med docs will take business away from the specialists. Medicine will go the way of a licensed engineer. You learn basics but not enough to be a physicist, a biochemist, etc. You will learn to design treatment approaches, not spit out memorized information. Everything will be applied. Just like a calculator took away the need to be a mathematician from the engineer, technology will do the same. Doctors will need to think as if they were doing "differential equations," finding variables that fit or don't fit a preconceived model and adjusting those models to simulate patient responses to pharma, nutrition, etc. Computers will eliminate most of the differential diagnosis by giving it to you in percentages of certainty. Genetics will dictate your lifestyle based on genetic susceptibility to high blood pressure etc. Quit being so naive. As someone at the forefront of Biotechnology, engineering, etc. This is already happening. Blood pressure, history, anything routine that nurses, PA's etc. that are hired to do will be done automatically. The specificity of over the counter tests, consumer healthcare products, already is making it possible for people to manage basic needs without insurance, physicians, etc. Tech will allow the distance between the specialist and the primary care physician to collapse as a physician will no longer need to "know/ be an expert" at a certain level, but need to apply information generated from a patient and cross referenced between databases and millions of patients. You don't believe me, just look at dentistry. Cavities are soon a thing of the past with genetically engineered oral bacteria. Those technicians that clean your mouth are gone. The dentist will still be around. Thats my 2 cents. Believe me or not, its already happening. Jump on the wagon or dont

think before you talk. it should help.

 

[DrDrToBe]

The thing I don't get is why folks in other careers think it's okay to try to just "hop on over and be a doctor". If you want to be a physician, no one is stopping you- just go to medical school! That's what MDs/DOs do. It's simple- you want to be a nurse- go to nursing school. You want to be a PA- go to PA school. You want to be a MD/DO- go to medical school. You made your career choice knowing what the options were; if you feel short changed by your scope of practice, that's your fault for not researching what you were signing up for. I personally worked my butt off in undergrad to get into med school (not PA or nursing school- medical school), and am now doing the same in med school so I can get into a good residency. What makes nurses/ physicians assistants so special that they should be able to bypass the required training that every other practicing physician goes through? Are they somehow innately smarter or better trained than medical students? Get over yourselves already!!

 

[Perrotfish]

There's a fundamental difference between a PA doing much of what a physician does (what you said) and a PA doing "much of what a physician can do," which is what he said. Sure, a lot of primary care can be pretty basic and mindless, but a residency-trained internist can do a lot more than just manage low back pain and uncomplicated UTIs. They've been trained to do a lot more, whether or not they do is up to them.

I would argue that the difference between what a physician can do and what physicians actually do is the part of training that we don't need

 

[PharmBound2011]

There's a fundamental difference between a PA doing much of what a physician does (what you said) and a PA doing "much of what a physician can do," which is what he said. Sure, a lot of primary care can be pretty basic and mindless, but a residency-trained internist can do a lot more than just manage low back pain and uncomplicated UTIs. They've been trained to do a lot more, whether or not they do is up to them.

yupp ofcourse they can. But by saying that you're alluding that a PAs scope of practice ends there?

 

[Mattchiavelli]

BUT, like he said, he's not talking about PAs working in neurosurgery, he's talking about PAs in Primary Care. In Primary care PAs often work, basically, independent of physicians. They see the same random assortment of patients, they carry a similar patient load, and they don't present to a physician before they make they make their decision. In many states there are no longer physicians in the same BUILDING, just a periodic review of 10% of the PAs charts done at the end of the month. That's not assisting, that's practicing.

What?! I guess I've only seen physician extenders in clinical practice where they're truly being used appropriately- where they take the low hanging fruit clinically speaking [INR/warfarin checks, uncomplicated UTIs, stable asthmatics in for checkups] and always with a physician on site that they can bump up to if the clinical scenario becomes more complex. Just like people are getting snitty that not all premedical education gives a background appropriate for med school [which I really doubt MS1 was the first time you encountered acid-base chemistry and titration curves, unless you went to that highschool in Dangerous Minds followed by undergrad at McDonald's Hamburger University], not all PAs are guaranteed the training that will allow them to handle more clinically complex scenarios. If the few PAs that can handle those scenarios want to throw a fit about it, tough cookies, go to med school or advocate for an additional training that will reasonably guarantee that all PA's going through the program will obtain the skills needed [obviously not through online coursework, but that's a different rant for a different time].

One thing that's made me proud about physicians is even though the AMA has historically low participation, two docs that before were at each other's throats about private vs government health care will join hands to beat down any encroachment on turf. And that's a good thing.

 

[dilated]

I say bring em on. If there are rockstar PAs who can get 250 on step 1 and awesome LORs, why not? And if it's at the expense of the MDs who slimed it through school, screw em.

This is ******ed. I see this posted all the time. How could you possibly take the steps and think they're evidence that you are ready to practice on human beings?

They're tests to see if you picked up the bare minimum knowledge IN THE CONTEXT OF MEDICAL SCHOOL. They already assume that you had that dumb "how to interview people" class, that you spent two months on IM having annoying medicine people nitpick your 47 page H&Ps, etc. etc. They were never designed to test "are you ready to be unleashed on people based solely on this test" precisely because they are not hard to game with a first aid review book.

 

[mTOR]

Hell no. You're definitely delusional, or your high school was world class (and you think everyone else's is too).

People forget that they understand the idea behind looking at a blood gas because they have a fundamental understanding of what acids and bases are. Trying to interpret values like that or blood electrolytes without understanding how ions function is completely pointless. Knowing why hyperventilation causes hypocapnea and why that causes a shift in the Henderson-Hasselbach equation and what pH will result (and what ventilator settings will get you there) is going to require more than some HS grad staring at FA.

lol dude that's some serious trees for the forest crap.

#1 reason med students **** up an answer to a Question: Making **** too hard.

Knowing the H-H equation is not essential to clinically relevant physio understanding. I bet very few of your colleagues can tell you the precise equation on the spot (hell I know I have to look it up every time). What IS essential, however, is having a rough Goljan-esque basic idea of the formula and, more importantly, an understanding of it's implications. I suspect that such an understanding probably requires little more than HS chemistry at best. Anything more is probably forgotten. Give a kid a BRS, a Costanza, and perhaps a reference text PRN and, for the most part, he'll be straight. I seriously doubt a wholesale ugrad level gen chem, physics, and orgo series is needed.

Does having taken and tested on (and likely now forgotten) detailed stoichiometry matrices, ideal gas law equations, specific heat and heat of fusion calculations, mastery of le chatelier's principle, or knowing how to calculate entropy really give you that solid knowledge base necessary to do well on the USMLE's?

Did knowing how to do this problem

31.5 g of H2O is being melted at its melting point of 0 °C. How many kJ is required?

really facilitate your ability to perform well on Step 1, or -- more importantly, medicine in general -- at all?

Similarly, even many concepts in formally taught human physio courses are forgotten as they have no standalone clinical utility. For instance, I'm pretty sure you would be able to explain (or at least understand) why thrombi would cause blood flow in a vessel to become turbulent and thereby cause a bruit without having to reference the who-the-hell-cares concept of the relatively esoteric Reynolds number.

 

[HumbleMD]

Ugh, this thread is devolving.

It's impossible to have a balanced view here (yay medical team! everyone has their unique role!). No, PAs aren't dumb pieces of ****, and no, Doctors aren't all enlightened golden children.

But to claim that the training is similar is a joke - it's not. The only person who could ever the viewpoint necessary to say they are the same is someone who did both training programs - and none of those are here. There are some people voicing opinions who haven't been through either training program. Sorry boo, but that kind of sinks your opinion to the lowest level of evidence.

Are there exceptions? Are there PAs who are better than MDs in delivering primary care? Sure. But (hopefulluy) in your 4 years of MD training you've learned that exceptions do not a pattern make.

Whether or not PAs should be allowed into Allopathic residency spots is pretty irrelevant anyway. The AMA (hopefully you've heard of them) is a pretty big lobby who has held back (for the most part) multitudes of other allied and complementary care for decades. To think it's going to turn around tomorrow is pretty silly.

 

[bruinhd]

It'll never happen due to this great lobbying body we have called the AMA. Same reason this talk of doctorate of nursing isn't grounded in reality.

PA is a very good option if all you want to do is practice medicine, or be first assist on a surgery. You make great money with very little investment and opportunity cost.

If you think of yourself as a technician, then yes, you made the wrong choice by going the MD route. I recommend PA school to a number of my older friends.

PAs, however, will never be allowed to do residency - they're trained to do resident level work, and stay there. There's very little career advancement, and you're basically a med tech rather than a team manager as an MD. It's easy to get jealous when you see PAs doing more than chief residents, and certainly more than a rotating med student.

Stick in there - if you love teaching, coordinating care teams, administration and leading the field of medicine, then you haven't made the wrong choice. If you wanted to put in your 40 hours and make bank, then, yes, medicine was a poor choice.

If you ever learned anything in medical school, it is that "NEVER" is always the wrong answer.

The AMA is not as powerful of a negotiating body as you think. There's a reason that ANP's are allowed to do neuro and derm residencies now. It's cuz we suck at advocating for ourselves, and doctors would never go on strike because of our ethics basis.

 

[BigRedder]

If you ever learned anything in medical school, it is that "NEVER" is always the wrong answer.

The AMA is not as powerful of a negotiating body as you think. There's a reason that ANP's are allowed to do neuro and derm residencies now. It's cuz we suck at advocating for ourselves, and doctors would never go on strike because of our ethics basis.

Actually, doctors cannot go on strike in this country. It is generally illegal for us to organize as a union. It's been tried, and blocked. It has been done in other countries.

 

[Dr Oops]

Ugh, this thread is devolving.

It's impossible to have a balanced view here (yay medical team! everyone has their unique role!). No, PAs aren't dumb pieces of ****, and no, Doctors aren't all enlightened golden children.

But to claim that the training is similar is a joke - it's not. The only person who could ever the viewpoint necessary to say they are the same is someone who did both training programs - and none of those are here. There are some people voicing opinions who haven't been through either training program. Sorry boo, but that kind of sinks your opinion to the lowest level of evidence.

Are there exceptions? Are there PAs who are better than MDs in delivering primary care? Sure. But (hopefulluy) in your 4 years of MD training you've learned that exceptions do not a pattern make.

Whether or not PAs should be allowed into Allopathic residency spots is pretty irrelevant anyway. The AMA (hopefully you've heard of them) is a pretty big lobby who has held back (for the most part) multitudes of other allied and complementary care for decades. To think it's going to turn around tomorrow is pretty silly.

Ive talked to classmates who were PAs and are now, medical students. They have told me themselves, that medical school is ALOT more work and ALOT more sciences.

PAs are great, and some are very ntelligent people, but they are not physician-lite.

my first year was just an important as my second year.

 

[Charles_Carmichael]

lol Perhaps I'm too much of a cynic (or a delusional optomist?) but I truly believe you can take any fresh out of HS grad and -- with enough Goljan audio listens, RR path, First Aid, and UW questions (and maybe a stock supply of adderall) -- have him/her easily pulling some 99 two digit score on Step 1. No ugrad or formal medical education needed. Now it's certainly questionable whether such a student would be as competent knowledge-base wise as your average 1st day on the wards 3rd year, but I find little reason to think why they wouldn't be.

Just curious, but are you in a medical school outside of the US? I've never seen anyone on SDN talk about the two digit score on Step 1 (which isn't a percentile) who attended a US med school; everyone, in my experience, who mentioned/suggested that a 99 was good/great was an FMG/IMG. If you're training outside of the US, it might explain why you're dissatisfied with your medical education.

lol dude that's some serious trees for the forest crap.

#1 reason med students **** up an answer to a Question: Making **** too hard.

Knowing the H-H equation is not essential to clinically relevant physio understanding. I bet very few of your colleagues can tell you the precise equation on the spot (hell I know I have to look it up every time). What IS essential, however, is having a rough Goljan-esque basic idea of the formula and, more importantly, an understanding of it's implications. I suspect that such an understanding probably requires little more than HS chemistry at best. Anything more is probably forgotten. Give a kid a BRS, a Costanza, and perhaps a reference text PRN and, for the most part, he'll be straight. I seriously doubt a wholesale ugrad level gen chem, physics, and orgo series is needed.

Does having taken and tested on (and likely now forgotten) detailed stoichiometry matrices, ideal gas law equations, specific heat and heat of fusion calculations, mastery of le chatelier's principle, or knowing how to calculate entropy really give you that solid knowledge base necessary to do well on the USMLE's?

Did knowing how to do this problem



really facilitate your ability to perform well on Step 1, or -- more importantly, medicine in general -- at all?

Similarly, even many concepts in formally taught human physio courses are forgotten as they have no standalone clinical utility. For instance, I'm pretty sure you would be able to explain (or at least understand) why thrombi would cause blood flow in a vessel to become turbulent and thereby cause a bruit without having to reference the who-the-hell-cares concept of the relatively esoteric Reynolds number.

I've never heard of med school in the US teaching the bolded stuff (since you're expected to have undergone that as a premed already). You started off the thread arguing against the length of medical training. Now you're mentioning dissatisfaction with what's considered a prereq to med school. I'm a little confused...

I would actually argue that a solid foundation in physics and gen chem is needed for a solid understanding of physio. Cardiovascular physio? Fluid dynamics, pressure, and some basic E&M concepts. Renal physio? Acid/base chemistry. Respiratory physio? Pressure gradients, etc. I've used all of those concepts in physio and it's certainly helped in making things a lot easier, IMO.

 

[adaptation1]

You missed his point. He's arguing exactly that. Understanding of the bolded concepts learned in high school, he's arguing, doesn't facilitate better med school performance, and it doesn't add to the understanding of relevant medical concepts for the boards and the wards.

Physiology in med school was the only class I did relatively well on, consistently beating the average and actually doing decently on the shelf. I did not need to know any of the concepts you mentioned.

Just curious, but are you in a medical school outside of the US? I've never seen anyone on SDN talk about the two digit score on Step 1 (which isn't a percentile) who attended a US med school; everyone, in my experience, who mentioned/suggested that a 99 was good/great was an FMG/IMG. If you're training outside of the US, it might explain why you're dissatisfied with your medical education.


I've never heard of med school in the US teaching the bolded stuff (since you're expected to have undergone that as a premed already). You started off the thread arguing against the length of medical training. Now you're mentioning dissatisfaction with what's considered a prereq to med school. I'm a little confused...

I would actually argue that a solid foundation in physics and gen chem is needed for a solid understanding of physio. Cardiovascular physio? Fluid dynamics, pressure, and some basic E&M concepts. Renal physio? Acid/base chemistry. Respiratory physio? Pressure gradients, etc. I've used all of those concepts in physio and it's certainly helped in making things a lot easier, IMO.

 

[Socrates25]

actually 1/2 the class has to choose primary care. the other 1/2 does not.

Exactly, which is PRECISELY what I told YOU would happen with this ridiculous program from the very beginning.

Your response: "No that will never happen, this is ONLY for primary care slots."

5 years from now, it will be 75%; 10 years from now it will be 100%

Dr Mark Kauffman (the idiot who set this program up) is a fool -- he lied to everybody from the beginning that this program was supposed to be about primary care. In 10 years when all the PA/DO grads are in subspecialties, he'll have some SERIOUS explaining to do. His program is a joke.

 

[Miscbrah]

Exactly, which is PRECISELY what I told YOU would happen with this ridiculous program from the very beginning.

Your response: "No that will never happen, this is ONLY for primary care slots."

wrong thread? aware me brah!

either way, with US/DO medical graduates starting to exceed the amount of residency spots, i highly doubt there will be significant spots given to PAs.

 

[mTOR]

Just curious, but are you in a medical school outside of the US? I've never seen anyone on SDN talk about the two digit score on Step 1 (which isn't a percentile) who attended a US med school; everyone, in my experience, who mentioned/suggested that a 99 was good/great was an FMG/IMG. If you're training outside of the US, it might explain why you're dissatisfied with your medical education.

Cool story bro. 1) I didn't say the two digit score of 99 was good or great. 2) I'm at a generously ranked US allopathic school (per US News Research Rankings list). Thx for trying though

I've never heard of med school in the US teaching the bolded stuff (since you're expected to have undergone that as a premed already). You started off the thread arguing against the length of medical training. Now you're mentioning dissatisfaction with what's considered a prereq to med school. I'm a little confused...

Herp derp. Tends to happen when you don't read. Please look over the post I was replying to again to understand what I was replying to... again.

 

[Makati2008]

Exactly, which is PRECISELY what I told YOU would happen with this ridiculous program from the very beginning.

Your response: "No that will never happen, this is ONLY for primary care slots."

5 years from now, it will be 75%; 10 years from now it will be 100%

Dr Mark Kauffman (the idiot who set this program up) is a fool -- he lied to everybody from the beginning that this program was supposed to be about primary care. In 10 years when all the PA/DO grads are in subspecialties, he'll have some SERIOUS explaining to do. His program is a joke.[/QUOTE]

So why does he have to be an "idiot". Show the man a tad of respect and use some tact to disagree with the bridge program. I am personally all for it and I am a PA.(I applied and got into MD and DO schools both before you think I am in the bridge program buddy). Also since you have not been through both programs you don't know what a PA's education really entails(only what you have read or heard from others) before you go down that path.

You seem to really dislike midlevels for some reason, and I am betting you are not someone who is helping with the Primary care shortage are you? Will you be wiling to work in the middle of nowhere without any specialities on site? Even if these PA''s do go into specialities they are no worse than yourself IMHO.

Remember its easier to catch flies with honey socrates!

 

[BigRedder]

I have worked with some awesome PAs, and from what I gathered they simply wanted the work of a doctor with a more predictable schedule and less liability. Sure, they often sacrifice some salary, but they are generally flirting with six figures in primary care and exceeding that in surgical specialties. They don't need to be the big dog, they just like the work. I certainly respect that and can appreciate the attraction of the job. However, one must emphasize that they become PAs because they don't want the ultimate responsibility. Residency is about learning how to take responsibility for medical decisions. If a PA wants complete autonomy and responsibility, they should go to medical school.

 

[Makati2008]

I have worked with some awesome PAs, and from what I gathered they simply wanted the work of a doctor with a more predictable schedule and less liability. Sure, they often sacrifice some salary, but they are generally flirting with six figures in primary care and exceeding that in surgical specialties. They don't need to be the big dog, they just like the work. I certainly respect that and can appreciate the attraction of the job. However, one must emphasize that they become PAs because they don't want the ultimate responsibility. Residency is about learning how to take responsibility for medical decisions. If a PA wants complete autonomy and responsibility, they should go to medical school.

Agreed.

 

[Brigade4Radiant]

Cool story bro. 1) I didn't say the two digit score of 99 was good or great. 2) I'm at a generously ranked US allopathic school (per US News Research Rankings list). Thx for trying though



Herp derp. Tends to happen when you don't read. Please look over the post I was replying to again to understand what I was replying to... again.

So what did you get on STEP 1? Also many IMG medstudents can't pass STEP 1 and you think the avg Highschool student can given enough prep? Even when only 60% of college freshman graduate within 6 years?

 

[medigull]

science informs medicine, sure. a medical education will teach you to appreciate the scientific method and to be able to critically evaluate the literature. but we aren't scientists. there's just a lot more to it than that. you do know that clinical medicine is practiced largely out of meta-reviews and databases like UpToDate, don't you? there isn't much time to pore over primary sources in the real world....

You have never been around a practicing physician outside of the office have you? They do and you will too read the primary literature when they are in practice. No they dont read it in between pts. thats why Uptodate is there. However, I have seen it firsthand, reading articles in the primary source at home somewhat leisurely is very very common. Does it happen as much as it happened in residency no probably not but its assumed that leaving residency you are equipped and up to date coming out so once in practice you just have to keep up with the new stuff.
We are never done learning.

 

[mTOR]

So what did you get on STEP 1? Also many IMG medstudents can't pass STEP 1 and you think the avg Highschool student can given enough prep? Even when only 60% of college freshman graduate within 6 years?

Step 1 - 252 / Step 2 - 260, i.e., around SDN's self-selected mean (lulz).. despite struggling with an untreated ADHD-PI (rendering all didactic lectures as a complete waste of time for me), forgetting absolutely everything from undergrad, and retaining virtually nothing from my school's basic science curricula.

So yes, I absolutely do think any HS graduate can perform decently on this exam even in light of those statistics you highlighted. It's certainly a difficult test, chiefly by virtue of it necessitating extensive preparation in order to even just pass. However, I'm confident the vast majority of the prep necessary to pass (or do moderately well) may be found in the known aforementioned study resources. Using those as the primary study materials with occasional class texts as references for the more difficult concepts should really be all that's needed. Further, I doubt such a study approach would take any longer than a year of focused, dedicated, daily effort (lack of such an effort towards prep or academic engagement -- regardless of the culpable reasons, distractions, or extenuating circumstances -- are the typical root causes of the stats you highlighted... so the issue here would be appropriate incentivization and motivation along with distraction mitigation, if possible).

Formal undergrad and pre-clinical medical coursework may be helpful, but I don't think it is at all essential (particularly with the ugrad BCPM courses, as it is mostly irrelevant to the USMLEs).

Obviously these are bold and as of yet, untested, statements which so far can only be supported by anecdotal and circumstantial evidence. But I think it's an issue worthy of methodical scientific inquiry. Hopefully, these claims can be convincingly substantiated with the increased recognition of the benefits and importance of personalized learning along with the recent interest in the effective online dissemination of well-structured and organized information (e.g., with sites like http://www.khanacademy.org/ ).

 

[45408]

So yes, I absolutely do think any HS graduate can perform decently on this exam even in light of those statistics you highlighted. It's certainly a difficult test, chiefly by virtue of it necessitating extensive preparation in order to even just pass. However, I'm confident the vast majority of the prep necessary to pass (or do moderately well) may be found in the known aforementioned study resources.

What a stupid and unfounded notion. "Here's a Rapid Review and First Aid. I'm sure this will be enough to help you pass a test that challenges people with 4-5 years more education than you." High schoolers don't even know how to study for a test like that, let alone actually learn the material and do well on it.

 

[justaregularmed]

What a stupid and unfounded notion. "Here's a Rapid Review and First Aid. I'm sure this will be enough to help you pass a test that challenges people with 4-5 years more education than you." High schoolers don't even know how to study for a test like that, let alone actually learn the material and do well on it.

Often times one of the components of the education that contributes to the length is learning how to learn, very much second this. I mean do you think the average high-schooler or even college student can sit down and pound out a few hundred qbank questions a day? I know in college I was incapable for studying effectivly 8-12 hours a day like I can now, for me this change was not learned overnight.

 

[adaptation1]

If I'm not mistaken, in countries like Japan high school students go directly to med school, without whole the college thing. Maturity is a problem, but they seem to handle material decently.


QUOTE=TheProwler;10926596]What a stupid and unfounded notion. "Here's a Rapid Review and First Aid. I'm sure this will be enough to help you pass a test that challenges people with 4-5 years more education than you." High schoolers don't even know how to study for a test like that, let alone actually learn the material and do well on it.[/QUOTE]

 

[CatFactorial]

Penn, Pitt, TJ, Drexel, PSU?

I think PA students are qualified for allopathic residencies.

 

[todds]

All this talk about working with smart PAs or PAs on par with physicians from non board certified or close to finished residency physicians is ridiculous.

in medicine, you get paid to use you brain. How does anyone who has not been through both PA school and medical school know what the other person is thinking? How do you know the differential, the breadth of knowledge that a person has accumulated in either of the professions?

Its ridiculous to guess on either side. Even medical students don't have any idea about the thinking process that goes on once you are done with residency so how can they evaluate the intelligence/capacity of PAs? Furthermore, PAs because of the limited training have no idea what they DONT know. you can't know how deep the rabbit hole goes until you are forced to look. In the same respect, medical students have no idea about the depth of knowledge/thinking PAs students get so they should comment on PAs either.

Things like procedures or anything a PA might be better thhan a med student at, anybody even with HS degree can learn to do provided they give enough practice. Its the THINKING behind the WHY to do the procedure and In what circumstances that makes the difference.

The only real insight we have on this topic is from PAs who have made the transition to MD. There a few on this site and they have all proclaimed how much more advanced medical school is compared ot PA school and it is ridiculous to compare the two. It should seem from these opinions that it should also be considered ridiculous to consider PAs for allopathic residencies.

Both medical students and PAs and probably even physicians do not have the experience to comment about this topic because neither knows the thinking process that goes on. But it seems from those who have gone through both think there is legit reason for going through all that training.

 

[FiremedicMike]

Pre med, not inciting a riot, I just want a clarifiction here...

A common theme within this thread is that PA school is no where near as intense as medical school. It's my opinion from my own research, as well as what's written in this thread, that no one is debating that medical school is much more intense than PA school. I believe the heart of the debate is this; is all that extra intensity necessary IN THE END. If a PA went through the OJT training of residency, isn't there a potential that they might be just as effective as anyone else finishing a residency?

I ask this because time and time again we read about people who state they have forgotten much of their basic sciences, and continue to forget more the longer they practice. This seems to beg the question, were they really necessary in the first place?

I am more than prepared for the "shutup pre-med" responses that tend to dominate these threads as they continue to degenerate, so please understand up front that I'm not trying put anyone on the offensive, I am presenting an honest query for the sake of this discussion.

 

[motomed]

You seem to really dislike midlevels for some reason, and I am betting you are not someone who is helping with the Primary care shortage are you? Will you be wiling to work in the middle of nowhere without any specialities on site? Even if these PA''s do go into specialities they are no worse than yourself IMHO.

Remember its easier to catch flies with honey socrates!

where's the evidence that PA's are doing anything at all to help the primary care shortage? I hear this often, never really see any data. what percentage of PA's go on to actually fill a hole in some underserved area? what percentage chase the money and live in the suburbs? how many would be primary care docs choose something else due to the current midlevel love-fest?

For me personally, I pursued medicine with every intention of going into primary care. I'm not so confident anymore. I don't want to manage a bunch of midlevels and I don't want to be told that someone with a fraction of my education can do my job just as well as I can. The cynic in me thinks that is probably a bunch of crap, but if it turns out to be the case, then there's no way on earth physicians will continue to choose primary care. your two options are 1) midlevels decrease the level of care provided and the overall quality of primary care decreases, or 2) midlevels do just as well in which case by the time I retire there will be no such thing as primary care doctors. both options would be reason enough for many med students to stay the hell away from primary care. primary care shortage problem solved???

 

[motomed]

If a PA went through the OJT training of residency, isn't there a potential that they might be just as effective as anyone else finishing a residency?

I ask this because time and time again we read about people who state they have forgotten much of their basic sciences, and continue to forget more the longer they practice. This seems to beg the question, were they really necessary in the first place?

as to the first question, no. I have no idea how I was taught to read in first grade, I remember none of this, but I am quite confident that the rest of my education would have been far less meaningful to me if I didn't in fact know how to read. when you get to look back on the totality of your education, just because you didn't remember something from the beginning doesn't mean it wasn't necessary and helpful in contributing to the level of education you received at some point along the way.

 

[badasshairday]

My soon to be wife is in PA school. PA school is hard, Med School is harder. As for the OP's comment about "PA's outshining Med Students on every clinical rotation," you must go to a pretty crappy school or have really lazy classmates. I'm sorry about that. Am I saying that PA students in their clinical year don't hold a candle to MS3's? No. They are comparable at that point. But after MS3, things change.

PA's are very good in their respective field with on the job training. They are very good at their job's, which tend to have a very narrow scope.

As a physician, your scope is larger. I have worked with a PA who was 8 months out of school, and had been working in CT surgery during that time. She is good at some technical skills and placing standard orders. If things are out of the ordinary, she did not have the knowledge to deal with it. When I was with one of the CT surgeons, he was sort of annoyed that his PA's functioned as "technicians," compared to residents.

Another example is in primary care. A pediatrics PA who works in the office setting does a great job in their narrow scope care. Said PA will have completed MS3 clinical work before graduating, which may have included 6 weeks in a peds inpatient/outpatient setting. A physician pediatrician has done that, plus a residency in which they rotate through the NICU, PICU, Inpatient wards, Outpatient, Specialty Peds such as GI/Cardio/Pulm/Neph/ENT/Optho Etc. You do not get that experience with on the job training as a PA. But PA's definitely work well in their scope of practice. I'd argue that doing a peds residency and seeing/understanding what certain specialists can do, and seeing the full extent of disease (ie. through the ICU) you understand the pathology better. You know when to refer and who to refer to. You can refer less things to specialists as well due to the knowledge.