What specialties can least be done by mid-levels?

[KinasePro]

An MD does not qualify you to perform surgery, or manage surgical patients, surgical skill and medical knowledge does. This is why oral surgeons easily gain hospital privileges, and take care of more acute facial trauma per capita than any other specialty.

Not to derail this thread too much, but why even bother with the MD route? Is it for people who may want to jump ship into plastics or ENT? Administering anesthesia? Career in academia?

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[docshop12]

UCSF is a mandatory, 6 year, MD-required OMS residency. You have it completely backwards. In fact, UCSF medical school is so anal, it used to be 7 years, and they required the OMS residents to attend all 4 years of med school.

oh never mind you're right about that program. Guess I saw it wrong. Well anyway there's lots of residency programs out there that don't require a MD and I personally don't think it is totally necessary for OMS.
http://omfs.ucsf.edu/index.php/education/residents-alumni/

 

[druggeek]

Not to derail this thread too much, but why even bother with the MD route? Is it for people who may want to jump ship into plastics or ENT? Administering anesthesia? Career in academia?

Probably prestige and then academica/academic jobs at higher ranked institutions.

 

[armorshell]

Probably prestige and then academica/academic jobs at higher ranked institutions.

You're not too far from the truth.

 

[herkyMD]

2.Military hospitals are well regarded in terms of staffing, training, experience (i.e.trauma) and latest equipment. I am not going to go into a discussion about it though, you can sift into the .mil forum for that. I see enough pre meds critiquing other professions than to care what others think of military medicine. The CRNAs were praised because they were competent anesthesia providers and had vastly more hours and training than their civvy counterparts. I would think "nice" would go away if patient's were dropping dead or having bad outcomes. I have another anecdote about ketamine and PTSD but I am tired haha

If you think that military CRNAs are administering anesthesia to similar patients as PP Anesthesiologists then you're either extremely misinformed or extremely naive. Let me know the next time you hear about a 300+ lb person with diabetes and HTN going in for surgery in a military hospital. The patients in military hospitals are some of the best trained people in the world with minimal co-morbidities which is exactly why military CRNAs are able to provide adequate anesthesia. The complexity of cases is just not seen.

 

[Dranger]

If you think that military CRNAs are administering anesthesia to similar patients as PP Anesthesiologists then you're either extremely misinformed or extremely naive. Let me know the next time you hear about a 300+ lb person with diabetes and HTN going in for surgery in a military hospital. The patients in military hospitals are some of the best trained people in the world with minimal co-morbidities which is exactly why military CRNAs are able to provide adequate anesthesia. The complexity of cases is just not seen.

You speaking from experience or going off assumptions? What branch did you serve with? You do know military hospitals serve retirees and dependents right? In fact most patients in military hospitals are not really military at all and have a good amount of comorbidities. Stop pulling BS judgements out of no where.

300 pound patients with HTN and DM especially at southern bases are an everyday thing.

 

[Druggernaut]

Well here's a newsflash: Medicare and Medicaid can no longer afford however many thousands of dollars are needed for an Anesthesiologist to anesthetize someone. Especially with all you clamoring for tax cuts. Society has reached a point where they will accept marginally lesser quality in return for not being collectively bankrupted by healthcare costs.

This is a fallacy that CRNAs have somehow managed to take advantage of. They bill at the same rate as anesthesiologists, but the supervising physician is taking some of that money since they're overseeing them. The CRNA can claim that they're not making as much money as the anesthesiologist, which is true, but the cost to the system is exactly the same.

It will be interesting to see how DNPs will try to continue making the claim that they're more cost effective as they push for equal billing with physicians.

 

[Slack3r]

This is a fallacy that CRNAs have somehow managed to take advantage of. They bill at the same rate as anesthesiologists, but the supervising physician is taking some of that money since they're overseeing them. The CRNA can claim that they're not making as much money as the anesthesiologist, which is true, but the cost to the system is exactly the same.

It will be interesting to see how DNPs will try to continue making the claim that they're more cost effective as they push for equal billing with physicians.

I'm almost hoping they get it, honestly. 90% of the argument of their existence is based off their "cost-saving". When it costs the same to see a DNP vs. an MD, then what's the point? If Mercedes cost the same as a Kia, how many Optimas do you think you'd see driving around?

 

[SchroedingrsCat]

I'm almost hoping they get it, honestly. 90% of the argument of their existence is based off their "cost-saving". When it costs the same to see a DNP vs. an MD, then what's the point? If Mercedes cost the same as a Kia, how many Optimas do you think you'd see driving around?

This is true but there will just be another cheaper mid-level that pops up and displaces both of us. Doctorate of Physician Assisting? Current medical education is far too lengthy and expensive for the limited resources that are currently available for healthcare our country.

 

[herkyMD]

You speaking from experience or going off assumptions? What branch did you serve with? You do know military hospitals serve retirees and dependents right? In fact most patients in military hospitals are not really military at all and have a good amount of comorbidities. Stop pulling BS judgements out of no where.

300 pound patients with HTN and DM especially at southern bases are an everyday thing.

I will be honest, I have no personal experience. I am basing my comments off of things I have read in the military and anesthesia forums. But I stand by the argument that because something works for the miltary, doesn't mean that it will work in the civilian world. However, I will reserve my comments for things I am more familiar with in the future.

 

[iliketv01]

I think what's being missed here is that the hierarchy and education of medicine needs some revamping.

I think there is a huge potential workforce in medical students that is not being tapped. I'm done with medical school now and about to start my residency in June. My experience has been that I was basically doing what the DNPs and PAs were doing throughout my 3rd and 4th year of school, both inpatient and outpatient. I had a better understanding of pathology, physiology and pharmacology than the mid-levels assisting the medical, surgical team and ER teams.

From what I gathered from the DNPs I spoke with the only training outside of nursing that there doctorate provided were statistics, epidemiology courses. These were courses I covered within my 3rd term of med school. The only difference was clinical exposure and knowledge of the hospital's internal system for doing certain administrative functions. My peers and I were able to get a hang of this within a couple months and from that point forward we were basically doing the same work as the mid-levels but with a greater depth and understanding of basic sciences and the pathology of disease. It got to the point where the nurse practitioners were asking for our advice before presenting a complicated case to an attending.

I really feel if medical students were exposed to clinical training from day one along with their basic science learning, within a couple months they could perform on a level equivalent to a LPN, within half a year they could perform as an RN and within a year they could be utilized in the same role as DNPs or PAs. Most students would probably be willing do it for the cost of their education, which is about half the salary of a DNP or PA. Graduating from medical school without that loan burden would probably allow more students to go the primary care route and probably even accept lower salaries. This utilization of students along with increasing class sizes would probably solve the primary care burden more than anything else. In Australia they already utilize medical students in at triage capacity and pay them for their work.

I really feel the DNP and PA roles are a waste of money in the long run. They weren't doing anything other than scutwork and initial evaluation of patients and even then their lack of knowledge was considerable. My fellow students and I would discuss how we were able to do everything the midlevels could do and were willing to do at a fraction of the cost. We were carrying our own patient load and able to even run free clinics for the uninsured with residents.

I am discussing this option with a few attendings and looking to implement the beginning phases of something like this in a couple years. This will ultimately prove to be the most cost effective option along with maintaining quality standards for our patients.

 

[sportsperson]

I think what's being missed here is that the hierarchy and education of medicine needs some revamping.

I think there is a huge potential workforce in medical students that is not being tapped. I'm done with medical school now and about to start my residency in June. My experience has been that I was basically doing what the DNPs and PAs were doing throughout my 3rd and 4th year of school, both inpatient and outpatient. I had a better understanding of pathology, physiology and pharmacology than the mid-levels assisting the medical, surgical team and ER teams.

From what I gathered from the DNPs I spoke with the only training outside of nursing that there doctorate provided were statistics, epidemiology courses. These were courses I covered within my 3rd term of med school. The only difference was clinical exposure and knowledge of the hospital's internal system for doing certain administrative functions. My peers and I were able to get a hang of this within a couple months and from that point forward we were basically doing the same work as the mid-levels but with a greater depth and understanding of basic sciences and the pathology of disease. It got to the point where the nurse practitioners were asking for our advice before presenting a complicated case to an attending.

I really feel if medical students were exposed to clinical training from day one along with their basic science learning, within a couple months they could perform on a level equivalent to a LPN, within half a year they could perform as an RN and within a year they could be utilized in the same role as DNPs or PAs. Most students would probably be willing do it for the cost of their education, which is about half the salary of a DNP or PA. Graduating from medical school without that loan burden would probably allow more students to go the primary care route and probably even accept lower salaries. This utilization of students along with increasing class sizes would probably solve the primary care burden more than anything else. In Australia they already utilize medical students in at triage capacity and pay them for their work.

I really feel the DNP and PA roles are a waste of money in the long run. They weren't doing anything other than scutwork and initial evaluation of patients and even then their lack of knowledge was considerable. My fellow students and I would discuss how we were able to do everything the midlevels could do and were willing to do at a fraction of the cost. We were carrying our own patient load and able to even run free clinics for the uninsured with residents.

I am discussing this option with a few attendings and looking to implement the beginning phases of something like this in a couple years. This will ultimately prove to be the most cost effective option along with maintaining quality standards for our patients.

I like what I just read.

 

[JackShephard MD]

I think what's being missed here is that the hierarchy and education of medicine needs some revamping.

I think there is a huge potential workforce in medical students that is not being tapped. I'm done with medical school now and about to start my residency in June. My experience has been that I was basically doing what the DNPs and PAs were doing throughout my 3rd and 4th year of school, both inpatient and outpatient. I had a better understanding of pathology, physiology and pharmacology than the mid-levels assisting the medical, surgical team and ER teams.

From what I gathered from the DNPs I spoke with the only training outside of nursing that there doctorate provided were statistics, epidemiology courses. These were courses I covered within my 3rd term of med school. The only difference was clinical exposure and knowledge of the hospital's internal system for doing certain administrative functions. My peers and I were able to get a hang of this within a couple months and from that point forward we were basically doing the same work as the mid-levels but with a greater depth and understanding of basic sciences and the pathology of disease. It got to the point where the nurse practitioners were asking for our advice before presenting a complicated case to an attending.

I really feel if medical students were exposed to clinical training from day one along with their basic science learning, within a couple months they could perform on a level equivalent to a LPN, within half a year they could perform as an RN and within a year they could be utilized in the same role as DNPs or PAs. Most students would probably be willing do it for the cost of their education, which is about half the salary of a DNP or PA. Graduating from medical school without that loan burden would probably allow more students to go the primary care route and probably even accept lower salaries. This utilization of students along with increasing class sizes would probably solve the primary care burden more than anything else. In Australia they already utilize medical students in at triage capacity and pay them for their work.

I really feel the DNP and PA roles are a waste of money in the long run. They weren't doing anything other than scutwork and initial evaluation of patients and even then their lack of knowledge was considerable. My fellow students and I would discuss how we were able to do everything the midlevels could do and were willing to do at a fraction of the cost. We were carrying our own patient load and able to even run free clinics for the uninsured with residents.

I am discussing this option with a few attendings and looking to implement the beginning phases of something like this in a couple years. This will ultimately prove to be the most cost effective option along with maintaining quality standards for our patients.

The midlevels are much more abundant and willing to dedicate time to the activities than the medical students. Also, the schools would need to back this.

 

[iliketv01]

This is why I'm stating there needs to be some revamping of the education system, both in increasing the student population which is already under way and beginning clinical training from day one. I think with these changes it'll work quite well. Also, I think you are underestimating medical students and the time they are willing to devote to patient care. We became quite attached to our patients and looked forward to our clinic time with them. Especially during my Sub I's , most of the medical students were already functioning in this capacity as I was stating above. I'm suggesting this can be moved up by a couple of years. It will benefit medical students who'll have a clearer understanding of the clinical setting, inpatient and outpatient. It might even push for one year residencies following med school, so students can take on a GP roles specifically, granted they will have had more exposure to clinical medicine from day one of their education. This will solve the primary care shortage in the most effective way possible.

If you truly want to save primary care from substandard encroachment these are the changes that will need to implemented in a changing market place. The status quo of how things are will not work anymore and there are big changes coming in the near future. If the profession doesn't adapt it's utility will be wiped out.

 

[iliketv01]

sorry repost

 

[Dranger]

I will be honest, I have no personal experience. I am basing my comments off of things I have read in the military and anesthesia forums. But I stand by the argument that because something works for the miltary, doesn't mean that it will work in the civilian world. However, I will reserve my comments for things I am more familiar with in the future.

If you look in the .mil forums you will also see that military CRNAs are A LOT better trained than civvy CRNAs. Civilian CRNA programs vary in quality along a broad spectrum. This info was directly relayed to me by an anesthesiologist on the military subsection and by personal experience in a military hospital.

I am not getting on your case or anything, I just dislike when pre-meds (especially pre meds) and med students alike come on here acting like they know everything about pharmacy, nursing, respiratory therapy etc...

 

[JackShephard MD]

If you look in the .mil forums you will also see that military CRNAs are A LOT better trained than civvy CRNAs. Civilian CRNA programs vary in quality along a broad spectrum. This info was directly relayed to me by an anesthesiologist on the military subsection and by personal experience in a military hospital.

I am not getting on your case or anything, I just dislike when pre-meds (especially pre meds) and med students alike come on here acting like they know everything about pharmacy, nursing, respiratory therapy etc...

Med students can ace multiple choice exams, so they know everything about everything.

 

[docshop12]

I think what's being missed here is that the hierarchy and education of medicine needs some revamping.

I think there is a huge potential workforce in medical students that is not being tapped. I'm done with medical school now and about to start my residency in June. My experience has been that I was basically doing what the DNPs and PAs were doing throughout my 3rd and 4th year of school, both inpatient and outpatient. I had a better understanding of pathology, physiology and pharmacology than the mid-levels assisting the medical, surgical team and ER teams.

From what I gathered from the DNPs I spoke with the only training outside of nursing that there doctorate provided were statistics, epidemiology courses. These were courses I covered within my 3rd term of med school. The only difference was clinical exposure and knowledge of the hospital's internal system for doing certain administrative functions. My peers and I were able to get a hang of this within a couple months and from that point forward we were basically doing the same work as the mid-levels but with a greater depth and understanding of basic sciences and the pathology of disease. It got to the point where the nurse practitioners were asking for our advice before presenting a complicated case to an attending.

I really feel if medical students were exposed to clinical training from day one along with their basic science learning, within a couple months they could perform on a level equivalent to a LPN, within half a year they could perform as an RN and within a year they could be utilized in the same role as DNPs or PAs. Most students would probably be willing do it for the cost of their education, which is about half the salary of a DNP or PA. Graduating from medical school without that loan burden would probably allow more students to go the primary care route and probably even accept lower salaries. This utilization of students along with increasing class sizes would probably solve the primary care burden more than anything else. In Australia they already utilize medical students in at triage capacity and pay them for their work.

I really feel the DNP and PA roles are a waste of money in the long run. They weren't doing anything other than scutwork and initial evaluation of patients and even then their lack of knowledge was considerable. My fellow students and I would discuss how we were able to do everything the midlevels could do and were willing to do at a fraction of the cost. We were carrying our own patient load and able to even run free clinics for the uninsured with residents.

I am discussing this option with a few attendings and looking to implement the beginning phases of something like this in a couple years. This will ultimately prove to be the most cost effective option along with maintaining quality standards for our patients.

wow. No offense but this is one of the dumbest things I have ever read. Med students do not function at the level of a DNP or PA. NPs and PAs can essentially do a lot of things on their own. I'd say midlevels who've been doing their job for several years function at the level of a 3rd year resident in IM for example. You will see this after you start residency - and students will hate you very much if you start treating them like a NP or PA or expect them to act like one (a knowledge of pathology does not mean you can independently treat a patient lol). Oh and your idea about having a student function at the LNP and then RN level?? Let me fill you in on something - LNP are just there to help the RN. RN training is very different and their role is very different than a med student or MD or midlevel. Residents can barely do half the things a RN does. Again you will see in the coming months. I'm not saying an RN is smarter but simply has a different training and role than a resident/MD.

you simply have no idea what you're talking about. Attendings will laugh so hard they won't be able to tell you to leave the room.

Still can't believe how dumb that is.


oh one more thing... midlevels are there because they make doctors more money. Most get paid a fairly low salary but the amount they make the physician more than justifies their presence. Gosh you are so dumb... no offense.

finally you can discuss with attendings all you want but your idea will never ever happen. I wouldn't waste your time.

 

[SCHMITTIE120]

I have to agree with the above. As a PA student on rotations I have worked with many MS3 and MS4 students. I will agree that sometimes their knowledge of pathology and pathophys are superior but more often than not I find myself knowing exactly what they are talking about. It is the residency that separates MD/DO from PAs.

 

[docshop12]

I have to agree with the above. As a PA student on rotations I have worked with many MS3 and MS4 students. I will agree that sometimes their knowledge of pathology and pathophys are superior but more often than not I find myself knowing exactly what they are talking about. It is the residency that separates MD/DO from PAs.

well that is definitely not true. Med students have far more knowledge of pathology and physiology than a PA student. They also have a more in depth knowledge of treatment. However when training is complete for a PA and they have worked for several years in a field the PA can function at the level of a resident. A med student does not function at the level of a fully trained NP or PA (excluding fresh ones). That's ridiculous.

 

[deleted103644]

I have to agree with the above. As a PA student on rotations I have worked with many MS3 and MS4 students. I will agree that sometimes their knowledge of pathology and pathophys are superior but more often than not I find myself knowing exactly what they are talking about. It is the residency that separates MD/DO from PAs.

PA schools are pretty equivalent to medical school - I don't think many are arguing against PAs.

A PA is basically a permanent resident, so PA students are usually at the same level as medical students. Many people who could go to medical school goose to become PAs instead for financial or lifestyle reasons.

Nursing mid levels are another story, and while there should be a nursing to MD pathway, the currently available DNP programs do not seem like a good way to do it.

 

[deleted103644]

well that is definitely not true. Med students have far more knowledge of pathology and physiology than a PA student. They also have a more in depth knowledge of treatment. However when training is complete for a PA and they have worked for several years in a field the PA can function at the level of a resident. A med student does not function at the level of a fully trained NP or PA (excluding fresh ones). That's ridiculous.

Where are you in your training? Your posts have been almost always misinformed.

 

[iliketv01]

First of all it's LPN not LNP and secondly I don't think you're a medical student. Any student would jump at a chance toward reducing their debt burden through their four years of med school especially if it meant gaining more clinical exposure, learning from patients in the process and having more face time with an attending. You have a population of highly motivated and competitive individuals who physicians sympathize with and make great efforts to teach. The cost of utilizing students in 2 or 3 year stints would be far cheaper than bringing on a PA or an NP for a physician tied to a healthcare system. Furthermore, I think you're over estimating the functions of a NP or PA.

I'm not saying that medical students would become LPNs, RNs, DNPs or PAs but they could function in a similar capacity as physician extenders(gain some sort of certification) especially if their clinical training was side by side with their basic science learning from day one. This isn't something that's new, it's utilized in medical education in most countries around the world where physician extenders are non-existent and medical care is far cheaper. And tell me exactly what complicated procedures or input does an RN give in the outpatient setting?
From my experience a 3rd and 4th year medical student could very easily fill the role of a DNP or a PA. The mid-levels that I encountered only acted as physician extenders just as the students. They saw the patient initially; did a history and physical exam, brought the findings to the attending and confirmed the differential and ultimate diagnosis along with a treatment plan. My peers and I did the exact same thing except when the diagnosis became more complicated we were able to form a better differential than the midlevels. The midlevels I encountered were basically stuck with extremely simple cases and scutwork which most students were more than comfortable with. There are already schools pushing the clinical training earlier and earlier into the basic science years for medical education, NYU to name one.

I promise you this will gain more traction as the medical bubble bursts and midlevels will be the first to suffer the ramifications of it. As far as the attendings I spoke with, they were all supportive and sympathetic they just stated the structure and planning of the endeavor needed to be more detailed.

 

[docshop12]

Where are you in your training? Your posts have been almost always misinformed.

Most likely I train at much more prestigious program than you... and because we have a different opinion of the level of knowledge of a PA student you think I'm misinformed. Maybe a PA student has the same knowledge as you. But I promise you a majority of students at my school are much more knowledgeable than the PA students at my school. Jeez I hate people like you. Good thing you're doing radiology... you won't have to make people suffer dealing with you.

 

[docshop12]

First of all it's LPN not LNP and secondly I don't think you're a medical student. Any student would jump at a chance toward reducing their debt burden through their four years of med school especially if it meant gaining more clinical exposure, learning from patients in the process and having more face time with an attending. You have a population of highly motivated and competitive individuals who physicians sympathize with and make great efforts to teach. The cost of utilizing students in 2 or 3 year stints would be far cheaper than bringing on a PA or an NP for a physician tied to a healthcare system. Furthermore, I think you're over estimating the functions of a NP or PA.

I'm not saying that medical students would become LPNs, RNs, DNPs or PAs but they could function in a similar capacity as physician extenders(gain some sort of certification) especially if their clinical training was side by side with their basic science learning from day one. This isn't something that's new, it's utilized in medical education in most countries around the world where physician extenders are non-existent and medical care is far cheaper. And tell me exactly what complicated procedures or input does an RN give in the outpatient setting?
From my experience a 3rd and 4th year medical student could very easily fill the role of a DNP or a PA. The mid-levels that I encountered only acted as physician extenders just as the students. They saw the patient initially; did a history and physical exam, brought the findings to the attending and confirmed the differential and ultimate diagnosis along with a treatment plan. My peers and I did the exact same thing except when the diagnosis became more complicated we were able to form a better differential than the midlevels. The midlevels I encountered were basically stuck with extremely simple cases and scutwork which most students were more than comfortable with. There are already schools pushing the clinical training earlier and earlier into the basic science years for medical education, NYU to name one.

I promise you this will gain more traction as the medical bubble bursts and midlevels will be the first to suffer the ramifications of it. As far as the attendings I spoke with, they were all supportive and sympathetic they just stated the structure and planning of the endeavor needed to be more detailed.

Do what you want. Your idea will go nowhere I assure you. So I'm not even going to bother wasting time arguing against it.

btw no student would jump at the chance of having to pay hundreds of thousands to do the work of a nurse when there are more than enough nurses and nursing students. There are also not enough med students to replace RNs. Gosh I'm sorry but your idea is just so dumb. Please go talk to someone with power and see what they think. Someone who is the head of a hospital division or the dean of a med school. You'll be laughed out of the room. Oh and good luck getting a hospital to let go of nurses and replace them with med students hahahaha.

 

[SCHMITTIE120]

well that is definitely not true. Med students have far more knowledge of pathology and physiology than a PA student. They also have a more in depth knowledge of treatment. However when training is complete for a PA and they have worked for several years in a field the PA can function at the level of a resident. A med student does not function at the level of a fully trained NP or PA (excluding fresh ones). That's ridiculous.

I guess we will have to disagree on this topic then, basically it is your experiences vs. mine. In the end it does not matter. I think it is often more about the individual.

 

[docshop12]

I guess we will have to disagree on this topic then, basically it is your experiences vs. mine. In the end it does not matter.

agree to disagree. I can respect that. Thanks for being civil unlike that enemabag johnnydrama.

 

[sportsperson]

PA schools are pretty equivalent to medical school - I don't think many are arguing against PAs.

A PA is basically a permanent resident, so PA students are usually at the same level as medical students. Many people who could go to medical school goose to become PAs instead for financial or lifestyle reasons.

Nursing mid levels are another story, and while there should be a nursing to MD pathway, the currently available DNP programs do not seem like a good way to do it.

you mean like applying to med school like everyone else? if so, then yes.

 

[deleted103644]

you mean like applying to med school like everyone else? if so, then yes.

Eh, the experience should count for something, so maybe a combined MD/residency program in 5 years?

I don't know, but an online DNP doesn't cut it.

 

[deleted103644]

agree to disagree. I can respect that. Thanks for being civil unlike that enemabag johnnydrama.

Aww... How sweet. Glad to know you're thinking of me.

To answer your previous post, nope, I'm probably at a better school than you and almost certainly did better on my MCAT and boards.

I haven't met many PA students, but the few I've met have been women who could have easily been accepted into medical school, but didn't want to make the lifestyle/family sacrifices required for an MD. While that's not a path I would take, I don't blame them for it. If you're female and want to have kids before you're 40, medical school + residency is a tough pill to swallow.

I'm sure there are bad PA programs out there, especially if they're associated with a medical school dumb enough to take you.

 

[Oxer45]

I'm going to play devil's advocate here for a minute, and say that physicians have managed to legally secure a monopoly on doing a lot of stuff that it's not clear they deserve. Dermatologists charge many hundreds of dollars to spend a few minutes and tens of cents worth of supplies freezing warts off, a task that requires no particular skill or medical knowledge to do, and which a teenager could probably be trained to safely do in a kiosk at your local mall. If nurses are willing and able to break this monopoly and offer the same service at a cheaper price, I say more power to them.

Total bull. My mom went to a derm to get a mole removed but it was actually removed by his PA. After the PA removed the mole, she later got an infection at the site!!! How the F do you get someone infected by removing a mole? I'm assuming he didn't sterilize the site/his equipments. Anyone can remove a mole, but it takes a doctor not to cause infections afterwards.

 

[NotAsking4Much]

Total bull. My mom went to a derm to get a mole removed but it was actually removed by his PA. After the PA removed the mole, she later got an infection at the site!!! How the F do you get someone infected by removing a mole? I'm assuming he didn't sterilize the site/his equipments. Anyone can remove a mole, but it takes a doctor not to cause infections afterwards.

You're being incredibly biased here. Ok - that PA was probably bad, but I've seen and been on rounds with PA who clearly know their stuff.

You're taking one case and generalizing to so many others. How many nosocomial infections happen in the hospital each year (>1.7 million) do you think happen each year because doctors don't wash their hands or sanitize properly? (>40%)

well that is definitely not true. Med students have far more knowledge of pathology and physiology than a PA student. They also have a more in depth knowledge of treatment. However when training is complete for a PA and they have worked for several years in a field the PA can function at the level of a resident. A med student does not function at the level of a fully trained NP or PA (excluding fresh ones). That's ridiculous.

I agree a PA can function at the same level as a resident. However, I do not agree that med students necessarily know that much more than PA students. PAs go through the same rotations as do med students, and they spend their first year learning the same path and physio we med students do. Granted, a lot of the basic science like biochem and mechanisms are cut out, but on an everyday basis, that information is rather unlikely to be called upon. A good PA with experience can do many things an internist can do. It's going to happen, and I think our country needs it. Many people choose PA not because they couldn't get into medical school, but because it's a great profession.

There aren't that many occupations out there where you can work normal day hours, do meaningful work, only 2-3 years of graduate education, stable job, and make 80k+ on average.

 

[PrideNeverDie]

in my opinion, no non-surgical specialty is safe

most procedural specialties should be safe

out of all the non-procedural specialties, i feel like psychiatry is the safest. not because midlevels can't do it, but because untrusting psych patients would respond unfavorable to midlevels handling their cases.

 

[Morsetlis]

Total bull. My mom went to a derm to get a mole removed but it was actually removed by his PA. After the PA removed the mole, she later got an infection at the site!!! How the F do you get someone infected by removing a mole? I'm assuming he didn't sterilize the site/his equipments. Anyone can remove a mole, but it takes a doctor not to cause infections afterwards.

I think this is why the answer to the posed question should be, none of them.

 

[deleted103644]

Total bull. My mom went to a derm to get a mole removed but it was actually removed by his PA. After the PA removed the mole, she later got an infection at the site!!! How the F do you get someone infected by removing a mole? I'm assuming he didn't sterilize the site/his equipments. Anyone can remove a mole, but it takes a doctor not to cause infections afterwards.

It's not hard at all to learn sterile technique, that guy's degree is not the issue.

Probably they were cutting corners by being cheap, or just lazy and rushed.

 

[phltz]

Total bull. My mom went to a derm to get a mole removed but it was actually removed by his PA. After the PA removed the mole, she later got an infection at the site!!! How the F do you get someone infected by removing a mole? I'm assuming he didn't sterilize the site/his equipments. Anyone can remove a mole, but it takes a doctor not to cause infections afterwards.

So when a PA causes an infection, it's evidence that PAs can't be trusted to perform that procedure? Every time an MD causes an infection in the process of performing a procedure, will you now argue that MDs should no longer be allowed to perform procedures? Because then no one will do any procedures at all. Even if you do everything completely right, any invasive procedure has a small risk of causing an infection. Brushing your teeth has a small risk of causing infection. And let's not kid ourselves about things - MDs make plenty of mistakes. They cause a lot of preventable infections.

Unless you have actual data suggesting that appropriately trained PAs are more likely to cause a preventable infection than an MD, your anecdote means precisely squat.

 

[Druggernaut]

I think there is a huge potential workforce in medical students that is not being tapped. I'm done with medical school now and about to start my residency in June. My experience has been that I was basically doing what the DNPs and PAs were doing throughout my 3rd and 4th year of school, both inpatient and outpatient. I had a better understanding of pathology, physiology and pharmacology than the mid-levels assisting the medical, surgical team and ER teams.

From what I gathered from the DNPs I spoke with the only training outside of nursing that there doctorate provided were statistics, epidemiology courses. These were courses I covered within my 3rd term of med school. The only difference was clinical exposure and knowledge of the hospital's internal system for doing certain administrative functions. My peers and I were able to get a hang of this within a couple months and from that point forward we were basically doing the same work as the mid-levels but with a greater depth and understanding of basic sciences and the pathology of disease. It got to the point where the nurse practitioners were asking for our advice before presenting a complicated case to an attending.

I really feel if medical students were exposed to clinical training from day one along with their basic science learning, within a couple months they could perform on a level equivalent to a LPN, within half a year they could perform as an RN and within a year they could be utilized in the same role as DNPs or PAs. Most students would probably be willing do it for the cost of their education, which is about half the salary of a DNP or PA. Graduating from medical school without that loan burden would probably allow more students to go the primary care route and probably even accept lower salaries. This utilization of students along with increasing class sizes would probably solve the primary care burden more than anything else. In Australia they already utilize medical students in at triage capacity and pay them for their work.

I really feel the DNP and PA roles are a waste of money in the long run. They weren't doing anything other than scutwork and initial evaluation of patients and even then their lack of knowledge was considerable. My fellow students and I would discuss how we were able to do everything the midlevels could do and were willing to do at a fraction of the cost. We were carrying our own patient load and able to even run free clinics for the uninsured with residents.

I am discussing this option with a few attendings and looking to implement the beginning phases of something like this in a couple years. This will ultimately prove to be the most cost effective option along with maintaining quality standards for our patients.

But when will the medical students learn to be doctors when they're spending all their time working as nurses and PAs? You say that the midlevels only handle simple stuff that's beneath physicians, so what's the value of making student doctors deal with it all?

Eh, the experience should count for something, so maybe a combined MD/residency program in 5 years?

I don't know, but an online DNP doesn't cut it.

LECOM's PA to DO bridge program is three years of medical school with the summer after M1 being used for rotations instead of vacation, after which they still have to do residency. There's no way that a BSN is on par with a PA in terms of medical knowledge. I think a biology or chemistry major is probably more suited to a shortened program than nurses. They don't have the basic science background, and their clinicals teach vastly different things than those of medical school.

I'm fine with the PAs having a little shorter course, but I don't think anyone else, DNPs included, should have that option, unless they managed to prune down medical school to three years for anyone with a bachelors degree.

in my opinion, no non-surgical specialty is safe

most procedural specialties should be safe

out of all the non-procedural specialties, i feel like psychiatry is the safest. not because midlevels can't do it, but because untrusting psych patients would respond unfavorable to midlevels handling their cases.

Psych NPs exist. I'm not sure what their scope of practice includes, but I believe some are doing therapy in addition to prescribing medications.

 

[Oxer45]

So when a PA causes an infection, it's evidence that PAs can't be trusted to perform that procedure? Every time an MD causes an infection in the process of performing a procedure, will you now argue that MDs should no longer be allowed to perform procedures? Because then no one will do any procedures at all. Even if you do everything completely right, any invasive procedure has a small risk of causing an infection. Brushing your teeth has a small risk of causing infection. And let's not kid ourselves about things - MDs make plenty of mistakes. They cause a lot of preventable infections.

Unless you have actual data suggesting that appropriately trained PAs are more likely to cause a preventable infection than an MD, your anecdote means precisely squat.

Obviously I'm biased based on personal experience. There are great PA's out there and bad doctors and anyone can cause infections if they are not careful. PAs who have a few years of experience are actually very good. The danger comes when a freshly minted PA who had 1 yr of clinical rotations is doing the same thing as an experienced PA. As a 4th yr med student, I saw new PAs (who have the same amount of clinical experience as me) doing things I wouldn't trust myself or other 4th yrs med students to do.

 

[phltz]

Obviously I'm biased based on personal experience. There are great PA's out there and bad doctors and anyone can cause infections if they are not careful. PAs who have a few years of experience are actually very good. The danger comes when a freshly minted PA who had 1 yr of clinical rotations is doing the same thing as an experienced PA. As a 4th yr med student, I saw new PAs (who have the same amount of clinical experience as me) doing things I wouldn't trust myself or other 4th yrs med students to do.

So now your argument is that a newly minted PA with minimal supervision is a hazard in the clinic? How is that different than MDs, lab techs, or hospital janitorial staff? Hell, how is that different than barbers, plumbers are bartenders?

I've seen attendings do boneheaded stuff too. We could sit around and trade anecdotes about relative risks of having different types of practitioners do different procedures, but it'd be absolutely worthless. If you think there's a difference, bring some real data.

There's no elite complicated formula for avoiding most infections. It's about being conscientious, and anally following established procedures. It's not ultimately that tricky.

 

[sportsperson]

Eh, the experience should count for something, so maybe a combined MD/residency program in 5 years?

I don't know, but an online DNP doesn't cut it.

Nursing experience does not count for becoming a physician. If so, we should do this for pharmacists first (given their greater knowledge on drugs as well as general treatment plans). But since neither of these plans are logical, it makes much more sense to tell everyone to apply and go to medical school like everyone else does who's an MD/DO.

A DNP is just a joke in my opinion. They have minimally greater clinical knowledge than an NP. Conclusion? They arent qualified enough to make a diagnosis and it can be risky.

 

[badasshairday]

I haven't met many PA students, but the few I've met have been women who could have easily been accepted into medical school, but didn't want to make the lifestyle/family sacrifices required for an MD. While that's not a path I would take, I don't blame them for it. If you're female and want to have kids before you're 40, medical school + residency is a tough pill to swallow.

This has been my experience as well, which is extensive.

 

[Dranger]

Total bull. My mom went to a derm to get a mole removed but it was actually removed by his PA. After the PA removed the mole, she later got an infection at the site!!! How the F do you get someone infected by removing a mole? I'm assuming he didn't sterilize the site/his equipments. Anyone can remove a mole, but it takes a doctor not to cause infections afterwards.

Are you even a med student? Do you know how many nosocomial infections occur in a hospital? Nice anecdote, I am most certainly enthralled.

 

[Dranger]

But when will the medical students learn to be doctors when they're spending all their time working as nurses and PAs? You say that the midlevels only handle simple stuff that's beneath physicians, so what's the value of making student doctors deal with it all?



LECOM's PA to DO bridge program is three years of medical school with the summer after M1 being used for rotations instead of vacation, after which they still have to do residency.There's no way that a BSN is on par with a PA in terms of medical knowledge. I think a biology or chemistry major is probably more suited to a shortened program than nurses.They don't have the basic science background, and their clinicals teach vastly different things than those of medical school.

I'm fine with the PAs having a little shorter course, but I don't think anyone else, DNPs included, should have that option, unless they managed to prune down medical school to three years for anyone with a bachelors degree.



Psych NPs exist. I'm not sure what their scope of practice includes, but I believe some are doing therapy in addition to prescribing medications.

I lol'd out loud at this. I did both BS in Nursing and a few classes (2-3) short of a Biology degree. Firstly, I will agree the science courses (besides patho) are not as hard as the regular Bio major course load. HOWEVER, all nursing science classes A/P, microbiology, pathophysiology, pharmacology, lab/hematology differentials etc are all focused on the HUMAN. How many bio courses did you take that were focused around mammalian physiology, plant physiology or any other upper division class that had extraneous information that will never help in medicine. There is a reason why you only need general biology and gen/org chem for the MCAT, you take all the rest in med school. Chemistry is even more useless as you move into physical and analytic chemistry.

Of course a PA knows more than a BSN about medical knowledge. Who suggested that?

At least with nursing you get patient/physician interaction, become familiar with pharmokinetics/dynamics and treatments, presenting symptoms and lab values/indications.

Sure nursing is a lot different then medicine but its not like I have seen MIII/IVs do anything besides follow a doc around and do PBL. But I digress I don't know everything they do because I am not in there position there yet, just like how you don't know what ARNPs/RNs do or what exactly they know.

To say nursing counts for nothing but some random general bio/chem major is more suited for a shortened med school is silly. Both need to do the full 4 year process, I just see nursing giving the clinical edge when rotation starts (as do many attendings I have talked to).

 

[Druggernaut]

I lol'd out loud at this. I did both BS in Nursing and a few classes (2-3) short of a Biology degree. Firstly, I will agree the science courses (besides patho) are not as hard as the regular Bio major course load. HOWEVER, all nursing science classes A/P, microbiology, pathophysiology, pharmacology, lab/hematology differentials etc are all focused on the HUMAN. How many bio courses did you take that were focused around mammalian physiology, plant physiology or any other upper division class that had extraneous information that will never help in medicine. There is a reason why you only need general biology and gen/org chem for the MCAT, you take all the rest in med school. Chemistry is even more useless as you move into physical and analytic chemistry.

There's a fair amount of variability between how universities structure their nursing courses. Some are in bio and organic chemistry with the pre-meds and majors in those disciplines. Others have "chemistry for nursing" or "physics for the health professions". There's a considerable difference in difficulty between them.

Of course a PA knows more than a BSN about medical knowledge. Who suggested that?

No one. Someone suggested that BSNs should be able to do an abbreviated medical education that had medical school and residency in 5 years. I referenced the existing PA to DO bridges that make that possible in 6 years without vacations as a reason that wouldn't be enough, since RNs obviously don't have the same level of training as PAs.

At least with nursing you get patient/physician interaction, become familiar with pharmokinetics/dynamics and treatments, presenting symptoms and lab values/indications.

Sure nursing is a lot different then medicine but its not like I have seen MIII/IVs do anything besides follow a doc around and do PBL. But I digress I don't know everything they do because I am not in there position there yet, just like how you don't know what ARNPs/RNs do or what exactly they know.

Those medical students aren't getting a very good education, then. Some rotations are essentially shadowing, but those are bad rotations. But I'm not sure how that's relevant, unless you're saying that nursing clinicals and work experience are better than medical school rotations (and I don't think that this was your angle), which I would disagree with. They aren't learning to do the same things.

To say nursing counts for nothing but some random general bio/chem major is more suited for a shortened med school is silly. Both need to do the full 4 year process, I just see nursing giving the clinical edge when rotation starts (as do many attendings I have talked to).

I'd agree that nurses would have an advantage on clinicals. I disagree with the notion that was suggested earlier that their education is at a level that would justify trimming off some time in medical school. I'm not advocating that any one group gets a shortened curriculum from their bachelors degree.

 

[Dranger]

There's a fair amount of variability between how universities structure their nursing courses. Some are in bio and organic chemistry with the pre-meds and majors in those disciplines. Others have "chemistry for nursing" or "physics for the health professions". There's a considerable difference in difficulty between them.



No one. Someone suggested that BSNs should be able to do an abbreviated medical education that had medical school and residency in 5 years. I referenced the existing PA to DO bridges that make that possible in 6 years without vacations as a reason that wouldn't be enough, since RNs obviously don't have the same level of training as PAs.

[/B]

Those medical students aren't getting a very good education, then. Some rotations are essentially shadowing, but those are bad rotations. But I'm not sure how that's relevant, unless you're saying that nursing clinicals and work experience are better than medical school rotations (and I don't think that this was your angle), which I would disagree with. They aren't learning to do the same things.



I'd agree that nurses would have an advantage on clinicals. I disagree with the notion that was suggested earlier that their education is at a level that would justify trimming off some time in medical school. I'm not advocating that any one group gets a shortened curriculum from their bachelors degree.

Yes, I agree there is some variability between universities especially with chemistry. The physiology on the nursing side is rather solid though.

Ya I wouldn't like the idea of a bridge for BSNs at all, maybe for NPs with significant clinical experience but no other exceptions. Even with PA to DO bridge, isn't there only one program that even does that?

It wasn't my angle, just a statement regarding the notion that they are two different clinical experiences. Me observing the med student doesn't make me an expert on what he/she knows or is capable of and vice versa with nursing

Essentially that was the only statement I was making. Nursing is not a bad undergraduate degree prior to medical school. You have some medical familiarity/experience and a good idea of why you want to be doctor because you have been in hospital and worked extensively with doctors. It's a long and more time intensive route than other majors but I see it as an advantage (obviously if the MCAT/GPA is solid) over some 22 pre med who has at best nominal health care experience.

Trimming med school seems like a no no even with PAs, NPs....

Quoting and paragraph insertions are tweaking out on my droid...

 

[Dranger]

so now your argument is that a newly minted pa with minimal supervision is a hazard in the clinic? How is that different than mds, lab techs, or hospital janitorial staff? Hell, how is that different than barbers, plumbers are bartenders?

I've seen attendings do boneheaded stuff too. We could sit around and trade anecdotes about relative risks of having different types of practitioners do different procedures, but it'd be absolutely worthless. If you think there's a difference, bring some real data.

There's no elite complicated formula for avoiding most infections. It's about being conscientious, and anally following established procedures. It's not ultimately that tricky.

+1

 

[thomprya]

So now your argument is that a newly minted PA with minimal supervision is a hazard in the clinic? How is that different than MDs, lab techs, or hospital janitorial staff? Hell, how is that different than barbers, plumbers are bartenders?

I've seen attendings do boneheaded stuff too. We could sit around and trade anecdotes about relative risks of having different types of practitioners do different procedures, but it'd be absolutely worthless. If you think there's a difference, bring some real data.

There's no elite complicated formula for avoiding most infections. It's about being conscientious, and anally following established procedures. It's not ultimately that tricky.

You sir are wrong. Doctors with their massive intellect naturally disinfect things better. This is known. Additionally, I read somewhere that once you get your doctorate antiseptics actually become more potent so physicians need to use less and this consequentially lowers health care costs. End thread.

 

[deleted103644]

Someone suggested that BSNs should be able to do an abbreviated medical education that had medical school and residency in 5 years. I referenced the existing PA to DO bridges that make that possible in 6 years without vacations as a reason that wouldn't be enough, since RNs obviously don't have the same level of training as PAs.

Yup, that was me. I pulled the 5 yr idea out of thin air, but I don't think they would need the full 4 + 3 years of school and residency.

Let's be honest - med school has some unnecessary filler included.

4th year is mainly wasted, and preclinicals can be compressed to 1.5 years.

So that's really only 2.5 years of essential training.

Throw in a built-in IM or FM residency, and at most that's then 5.5 years.

As long as you require the MCAT and USMLEs, that's more than enough training for someone to enter primary care (from almost any starting point, not just nursing).

 

[Mr RADical]

You sir are wrong. Doctors with their massive intellect naturally disinfect things better. This is known. Additionally, I read somewhere that once you get your doctorate antiseptics actually become more potent so physicians need to use less and this consequentially lowers health care costs. End thread.

I think I heard that somewhere too...

 

[JP2740]

Many people choose PA not because they couldn't get into medical school, but because it's a great profession.

People choose PA because they don't want to go through the lengthy training of medicine or can't get in. Period. I'm not looking down on PAs. They have their role to play, and I have a few friends in PA school, but saying that they went to PA school because they prefer it just for the work PA's do is rubbish. They admit that too (if they're not in total denial).