Whats your opinion on PAs?

[LatinGuitarrist]

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What do you guys honestly think about PAs and their role in the healthcare system? Just open up and speak your minds out, it can be positive/negative...

Ed

 

[dutchman]

easy way out

 

[MedSchoolFool]

I love both my MA and my PA.

 

[medicomel]

i think they're highly educated, competent colleagues, and a vital part of the healthcare system.

 

[Agent Splat]

My personal experience at my family practice clinic when I was that you WANTED the PA to see you and you DIDN'T want the doctor. The PA actually took time and was thorough. He listened, educated his patients, and definitely knew his stuff.

I'd still take him over the spaz doctor at that clinic...too bad he went elsewhere.

 

[Chronic Student]

I'm looking into my crystal ball and...

...I see a vision swirling in the mist...

...There are letters arranging themselves into a phrase and it says...

..."This thread will deteriorate"...

Funny, I probably didn't need the crystal ball for that.

-Mike

 

[LatinGuitarrist]

easy way out

What is the supposed to mean dude?

Ed

 

[mjl1717]

I love both my MA and my PA.

Nice, politically correct and well said!!

 

[mjl1717]

What is the supposed to mean dude?

Ed

I think it means he REALLY can't communicate.

 

[cfdavid]

i think they're highly educated, competent colleagues, and a vital part of the healthcare system.

exactly. pretty simple.

 

[mjl1717]

i think they're highly educated, competent colleagues, and a vital part of the healthcare system.

Agree-well said!

 

[chaser]

I think it is a little bit scary that after only 2 years of school, PAs are givin so much responsibility and are essentialy performing the same roles as Doctors. As far as i know, they have no limitations on prescribing and can pretty much examine and discharge patients without a Dr seeing them. I was actually talking to an ER doc the other day about PAs and he said they were a mixed blessing. If you got a good one, they made life a lot easier, but just as often as you get a good one, you get a bad one, which made life a living hell. So much in fact, his hospital was going to start steering away from PAs and try to hire another couple attendings. My impression from him was there is a huge variance in the quality of PAs coming out of school and it basically was an issue of inexperience. If you get a PA who has been doing it for 8-10 or more years, they know their stuff really well, but I guess the road leading there can be VERY bumpy at times and unfortunetly the patients suffer for it. He told me some stories that just blew my mind about things missed and unfortunetly, it wasnt all that rare. Obviously there are incompetent Doctors as well, but the frequency he was telling me these PAs were making errors was alarming. Again it seemed to come down to inexperience and a huge part of that is the little amount of time they spend in clinical rotations. 1 year of rotations and they are out writing perscriptions? That seems like a joke to me. I think they ought to at least implement a "mini-residency" or something like that for PAs once they get out of school and decide on a field. Nurse practitioners do 400 supervised hours in their specific field on top of their rotations they do in their program before they can get their masters, and I think that would be good for the PAs as well. With the population aging and the shortage of doctors, PAs are going to have/already have a very important role in medicine, but is seems like a little more training is in order before they are thrown out to the wolves.

 

[crazy_cavalier]

Holy hell. They can seriously write Rx's after only 3 years? That's scary!

 

[deleted109597]

i think they're highly educated, competent colleagues, and a vital part of the healthcare system.

Just like some nurses.


Unfortunately, just like MDs, DOs, and the like, not all are, and there are a great number of bad ones out there. (There are more good ones, but lawsuits don't care).

 

[latinfridley]

PA's that I know are very competent and should not be disparaged, especially by med students.

 

[dutchman]

What is the supposed to mean dude?

Ed

You asked for honest opinions so IMO If you want to avoid the length and depth of MD/DO education while still maintaining similar responsibilities then PA is the way to go. It has nothing to do with their competence, it just seems to me like it's an easy way out.

 

[Hurricane95]

The PA who works for my preceptor has taught me tons of stuff...she's super patient, teaches well and gets me to do all the cool procedures. She's awesome. I think PA's can be a great asset to a healthcare system / doc's office, especially those with a very high patient volume. After all, a lot of patients come in with crap CC anyway...sore throat, constipation, etc.

 

[anon-y-mouse]

There's a PA employed by my mother's clinic and whenever someone refers to him as "Dr So-and-so", my mom is always like "he's not a doctor, he's a PA"... she usually doesn't care about titles and formality, but I found it funny that she always cares about this. I'm sure PA's have a role- doing a lot of the bulkier work perhaps. However, I am concerned that they can take away the jobs of IM and family physicians in some cases.

 

[mjl1717]

PA's that I know are very competent and should not be disparaged, especially by med students.

True.....For those who REALLY know this field. An intern or PGY 1 in surgery once told me that in the heirachy that an intern is not even a unicellular organism or protozoa.
Emphasizing how low PGY 1 is he humourously stated that the lowest level would absolutely be "pond scum" Some PAs know more then interns so they would absolutely be above pond scum . And I hate to say it but that would put a med student especially one who has'nt graduated at the level of nothing times nothing.... And all jokes aside. In the real world in the hospital I dont want the intern seeing my parents. And my personal doc must be over 45.
Ill give my final opinion on this topic after a good number of responses.

 

[dilated]

The better question would be "What is your opinion of PAs... while a medical student".

Personally it depends on the field. They can be annoying and condescending in primary care fields where they basically have all the responsibility of a MD, minus some school and residency (although obviously not all are) and sometimes act like you shouldn't be there (psst.. teaching hospital, ace) or they've got a chip on their shoulder for why they didn't go to med school.

Surgical PAs have been pretty much uniformly excellent. They know what they know and don't know, they know how to manage clinic and keep patients happy, and they're pretty knowledgable about what's going on medically, probably because they spend a lot more time with the attending than the primary care ones do so they get a continual education like a resident would. Only downside is some attendings like their PAs so much it sometimes crowds out the fellows and residents from learning.

 

[Law2Doc]

However, I am concerned that they can take away the jobs of IM and family physicians in some cases.

Agree with this. While I too agree that PAs are generally intelligent, educated and competent, they, along with nurse anesthetists, do represent a significant encroachment on the medical monopoly. In the same way that lawyers frequently rally, lobby and run to court to prevent unauthorized practice of law by paralegals, real estate agents and accountants, and keep their monopoly intact, physicians really should be doing the same thing. While you might think that these professionals don't function with the same autonomy, bear in mind that you lose territory in steps, and each subsequent step is harder to defend than the prior one.

 

[8744]

PA's that I know are very competent and should not be disparaged, especially by med students.

That's kind of the point. When you are just starting out as medical student PAs impress you because everybody who knows anything impresses you. You don't even know where they keep the blank forms and from a practical point of view, even the unit coordinator who shows you where they are has more practical knowledge than you have on your first day.

So you tool along in medical school, maybe rotating with PA students who are pretty intelligent and motivated and you start to think, especially if you are thinking about primary care, that maybe all of the extra classes and training might not be that good of a deal. You read SDN and you hear all of the propaganda from PAs with chips on their shoulders and all of the vitriol from those who think that PAs are going to replace doctors and you worry that maybe you made the wrong career decision.

Then you get into residency and as an intern you might work with a PAs and while you may be impressed initially, as you go along a little bit of the luster starts wearing off. You will find that you know more and can do more, especially if you are aggressive and keep up with your reading. You will find yourself in conversations with PAs who are very enthusiastic but you will think to yourself, "What he just said is so wrong and spoken like he doesn't really know what's going on with the patient."

Not to mention that you will be a lot more discriminating the more training you have and the differences in knowledge and ability between PAs and your attendings is going to be extremely obvious. You are going to be an attending some day.

By the time you are a PGY-2 your perceptions are going to flip completely from what they were in medical school.

On the other hand, PAs have a place on the medical team just like you. They don't take many idiots into PA schools so most of them are pretty good at what they do and dependable. If a PA knows more than you then you should listen to his advice respectfully. The key is to be aware of your limitations but to act decisively even if your decisive action is to call your attending for clarification.

As to doctors having a monopoly. Like I said, the difference in knowledge and skill between a PA and an attending is vast. This difference is obvious. If your job can be done by a PA then maybe you need to look for a new job. However, most of medicine in all specialties is "bread and butter" and could probably be handled by a confident and reasonably intelligent high school student if you gave him some specific and intensive training.

It doesn't take a medical degree, for example, to write the appropriate orders for somebody with chest pain. My lovely wife, with no formal training whatsoever, can correctly diagnose the whole range of common pediatric problems and the correct treatment. As we have a child with Asperger's syndrome she even knows a little something about child psychiatry.

But as a physician, you're going to be paid for your ability to handle the ten percent of cases that aren't bread and butter and don't follow a neat algorithm. Additionally, even the easy patients have the potential to turn difficult. It is in this respect that your knowledge and extra training are going to come into play, managing the cascading complexities of difficult patient.

Making ice cream out of ****, as we used to say in the Marines.

 

[8744]

And no, I am not anti-PA. I am willing to admit that a PA, for example, who has worked in the Emergency Department for twenty years, probably knows a thing or two.

But this kind of comparrison is "apples and oranges." You're comparing a guy with twenty years of practical experience with a first year resident. Compare him with an attending with 20 years of experience and the difference is obvious. The angst felt by SDN readers towards PAs is mostly a lack of self-confidence.

 

[Law2Doc]

Additionally, even the easy patients have the potential to turn difficult. It is in this respect that your knowledge and extra training are going to come into play, managing the cascading complexities of difficult patient.

This is the argument physicians' lobbyists should be making to government to restrict the growing powers of non-physicians, not used as an argument in support of them. To non-physicians making the legislation, healthcare is healthcare and cheaper is better. It's only a matter of time before the authority of PAs gets enlarged because it would bring healthcare costs down. While the current status quo is not threatening, it won't stay this way -- expect more encroachment on bread and butter practices in the near future.

 

[Miami_med]

I've got to say that I really don't envy the PA position (most of these things on SDN are about envy). They take 3/4 of the school and many of them have taken a PA "internship." Essentially, the take the worst parts of medical school, miss out on the parts that cement everything and make it fun, and then they move into a position resembling chief resident for the rest of their lives. They work the worst hours, screen all of the worthless midnight calls, and perform scutwork for the rest of their lives.

I am sure that there are many PAs, who with enough years of training, begin to function at the level of many MDs in their specialty. I'm sure this eventually becomes true if they decide to keep up with literature. Osler said that the best way to learn medicine was at the bed side, and PAs do a lot of this. I respect them a lot, and frankly, with the competetive nature of modern PA school, I don't understand why some of them don't go to MD school. Many could have, and they would end up in a better position in the long run.

Also, unlike the NPs who have a separate lobby, PAs are really under the thumb of the MD accrediting bodies in most states. If they gain more autonomy than the doctors want them to, their scope of practice will be reduced. Politics don't look good for PAs in the long run.

So for whoever is sitting there gnawing at their fingernails in sheer terror about how PAs are going to prove your medical degree worthless, I wouldn't. Respect your PA colleagues for what they do. If your smart in business, hire one in the future to help you make more money for your practice.

 

[Law2Doc]

Also, unlike the NPs who have a separate lobby, PAs are really under the thumb of the MD accrediting bodies in most states. If they gain more autonomy than the doctors want them to, their scope of practice will be reduced. Politics don't look good for PAs in the long run.

I'm not sure I would agree with this assessment. PAs are licensed by the state, not doctors, and their scope of authority is a creature of state regulation. And while some states use a common medical or professional licensing board for physicians and other health professionals, or have regulatory boards composed mostly or partly by physicians appointed by the government, that doesn't mean that the medical profession ultimately dictates PAs role. For links to the PA's state regulatory bodies see http://www.aapa.org/gandp/statereg.html . The government has the power to legislate whatever role for PAs it chooses, and people seeking cheaper healthcare options are, in fact, lobbying for greater roles for quasi-physicians. It will be interesting to see where this train is going, but ignoring the encroachment to the profession is probably not wise.

 

[Wizard of Oz]

Anybody who wants to do rural primary care where I live--PA, NP, MD, DO, etc.--has a job and will probably have one twenty years from now, so I'm not concerned about monopoly encroachment in primary care. We need PA's and are still short providers.

I'll preface by saying that I am a PA school reject, but I was admitted first interview round by the same college's med school. The draw of being a PA is a third of the years of training and the quarter of the cost of education. You get to practice autonomously and make a decent salary (one of my friends gets 80-100K starting, better than some pediatricians) while still maintaining a manageable lifestyle. Plus you can switch specialties whenever you feel like it. At my place, attendings have commented that PA students give a better physical when they start clinicals because their training is more clinically-oriented than med students. Being a med student who has dated a PA student, I agree.

If you want to make money as a doc, then hire a PA. Complain about what they know or don't know, whatever, but you will choose what cases they can take (normally acute care), and my state doesn't require that you review all of the charts. If you are a derm, then PA's are like free money to you unless you just love to look at acne.

Docs will be able to fight encroachment as long as they are willing to pay off politicians properly. Considering how much physicians have stolen from Medicare in the 80's, they should be able to afford the proper lobbying to keep their share of the monopoly until our healthcare system ultimately collapses.

 

[Chronic Student]

I'm not sure I would agree with this assessment. PAs are licensed by the state, not doctors, and their scope of authority is a creature of state regulation. And while some states use a common medical or professional licensing board for physicians and other health professionals, or have regulatory boards composed mostly or partly by physicians appointed by the government, that doesn't mean that the medical profession ultimately dictates PAs role. For links to the PA's state regulatory bodies see http://www.aapa.org/gandp/statereg.html . The government has the power to legislate whatever role for PAs it chooses, and people seeking cheaper healthcare options are, in fact, lobbying for greater roles for quasi-physicians. It will be interesting to see where this train is going, but ignoring the encroachment to the profession is probably not wise.

Law2Doc, I agree with you to a point, I don't think that doctors have ultimate say in the PA's role. However, I do think that we are much more under their thumb than others.

I can only speak for Texas, but we are licensed by the Medical Board and most of the members of that board are Doctors. Now granted, they have to play politics and that creates a conflict of interest in some cases.

Secondly, I operate under the license of an MD and if they decide not to hire me or to restrict my practice, then I have no say in the matter whatsoever. However, I also understand economic realities and when a doc can hire an underling that generates income over and above what they pay them and that makes their life easier, then that is pretty hard to pass up. I also was surprised to learn that at the two hospitals where I am credentialed, they impose restrictions on my scope of practice that further limits my utility.

From a PA point of view, I have some concerns about PA's. I do think that there is a vast difference in the quality of PA's being graduated today. Some of them are quite competent and some of them are scary, I know I went to school with both varieties. IMO, the PA students of today are somewhat different than in years past. The students are younger, less experienced and in some ways they are smarter (book-knowledge, that is). The students who were graduated in the past usually were older, had more experience in life and in the medical field. So, I think it is really hard to compare the two, although I think that it is harder for most of the new graduates, sans experience, to hit the ground running. I think that medical schools and more importantly residencies do a much better job of turning out a uniform product.

However, the big check on a PAs quality is supposed to be the supervising physician. I work for a neurosurgeon who is very conservative, even as far as neurosurgeons go. I'm fairly competent and have a pretty good surgical background and he still has kept me on a very short leash, pimps me a lot, looks over all of my documentation very carefully and has scrutinized my histories and my physical exams to the point where he is very confident in my abilities.

I have done a ton of reading since I started working for him and I still read every night and ask questions constantly (I'm sure it is annoying, but he has been very patient). He also wrote into my contract that I would be expected to further my knowledge through reading and attending conference. He also gave me a fair amount of money for CME and conference and has no problem with me grabbing books off his shelves to read at night.

I'm exhausted as hell and busting my butt to learn. Honestly though, this is how it should be done. Every doctor who takes in a PA straight out of school should know that they are not worth what you are paying them the first year out of school and that it is in essence a 'residency' of sorts. Every PA coming out of school is obligated, imo, to bust their behind to learn the specialty that they are going to work in and should not rest on their laurels.

I also honestly think that family medicine would be a much tougher place for a new PA. In surgery, I spend 90% of my time with my surgeon and as such there is a lot of direction and learning going on. In addition, I have around 10 bread and butter conditions, if even that many, and they make up 90-95% of what I do. In family medicine, the PAs see a lot of patients by themselves (less so in the beginning and more so as time passes) and while I could not really give an honest accounting of how many bread and butter conditions they see, surely they need to be able to recongnize hundreds of conditions and be aware of many zebras. Granted zebras are not all that common, but if you see a lot of patients and if you add up all the zebras combined, you will come across some of them eventually.

Just my opinion, yours may differ.

-Mike

 

[dutchman]

I'm not sure I would agree with this assessment. PAs are licensed by the state, not doctors, and their scope of authority is a creature of state regulation. And while some states use a common medical or professional licensing board for physicians and other health professionals, or have regulatory boards composed mostly or partly by physicians appointed by the government, that doesn't mean that the medical profession ultimately dictates PAs role. For links to the PA's state regulatory bodies see http://www.aapa.org/gandp/statereg.html . The government has the power to legislate whatever role for PAs it chooses, and people seeking cheaper healthcare options are, in fact, lobbying for greater roles for quasi-physicians. It will be interesting to see where this train is going, but ignoring the encroachment to the profession is probably not wise.

For as long as your lawyer friends are roaming around hospitals looking for easy med-mal prey, I am not concerned about encroachment by quasi-doctors. If anything they will keep the lawyers busy and out of the way of physicians. I don't know about you but anytime I go to the hospital(even for stuff I think is really basic) I don't exactly want to see a quasi-doctor and if I end up with one I am usually a bit concerned. If you think pts respect for physicians is declining then what manner of respect do you think they have for the physician's assistant? Yeah so they might be cheap right now while the profession is still relatively new and cute but when they enter physician territory they will also face physician challenges and I don't think they will do that stuff for peanuts at that point.

 

[mjl1717]

The better question would be "What is your opinion of PAs... while a medical student".

I agree. From my experience many med students are insecure which makes sense since we are learning (eg. hes never seen a Kerley B line, etc.) And if the 10 year veteran P.A. is around then the med student is damn insecure. And thats it, end of story.

 

[Law2Doc]

For as long as your lawyer friends are roaming around hospitals looking for easy med-mal prey, I am not concerned about encroachment by quasi-doctors. If anything they will keep the lawyers busy and out of the way of physicians. I don't know about you but anytime I go to the hospital(even for stuff I think is really basic) I don't exactly want to see a quasi-doctor and if I end up with one I am usually a bit concerned. If you think pts respect for physicians is declining then what manner of respect do you think they have for the physician's assistant? Yeah so they might be cheap right now while the profession is still relatively new and cute but when they enter physician territory they will also face physician challenges and I don't think they will do that stuff for peanuts at that point.

Virtually all patients who see someone in a white coat treating them are going to assume this person is a doctor, so respect won't be an issue. That is true for PAs, as well as med students. MD-DO-PA-student doctor -- it's all the same to your average Joe patient. In terms of lawsuits, the PA has a get out of court free card to play in that the PA is technically under the supervision of a physician, who bears the risk and the insurance policy. But a PA is frequently pretty competent and is going to be providing "good enough" care most of the time, so I doubt you'll see negligence suits sky-rocket. Which is why you will see more and more PAs. And once the public gets comfortable with this, it's game over for the medical monopoly.

 

[dilated]

In terms of lawsuits, the PA has a get out of court free card to play in that the PA is technically under the supervision of a physician, who bears the risk and the insurance policy. But a PA is frequently pretty competent and is going to be providing "good enough" care most of the time, so I doubt you'll see negligence suits sky-rocket. Which is why you will see more and more PAs. And once the public gets comfortable with this, it's game over for the medical monopoly.

Won't this eventually impact medmal liability though? If a PA misses a tough dx, and the lawyers put the teary widow on the stand and talk about how it's time to send a message that everyone deserves a real doctor, not just rich people... I dunno, it just seems like it'd be very easy to attack in court.

 

[Law2Doc]

Won't this eventually impact medmal liability though? If a PA misses a tough dx, and the lawyers put the teary widow on the stand and talk about how it's time to send a message that everyone deserves a real doctor, not just rich people... I dunno, it just seems like it'd be very easy to attack in court.

If there's always a doctor at the top of the pyramid to blame, then the patient technically had a "real doctor".

 

[ANCAdoc]

I question the level of responsibility they have given their limited education.

First of all, their coursework is not as challenging as the MD courses. Taking anatomy in PA school is not the same as taking anatomy in medical school. The PAs that came into our lab once (just to see a cadaver) talked about how they pretty much had to look at Netter's and the prof simply used the same pics from netters on the exam.

How do they keep up with the literature? Given their limited amt of schooling, what they take from a journal article is likely different from what an MD can extract from a journal article. Just recently, I went to a prompt-med clinic and was seen by a PA. I had a productive cough, sore throat, etc. She immediately prescribed antibiotics without even testing to see if it was bacterial. She didn't even say "OK, I will prescribe this to you, but don't fill it unless your symptoms stay the same for another 3-4 days". This is not the current standard of care (see any journal, AFP, JAMA, NEJM, all recommend the "wait and see" approach or to do a strep beta test).

Lastly, it could very well be that they take over the jobs of some physicians, esp. family practice physicians. Why would a health care group hire an MD at 150K when they can hire a PA at 80K+? All you need is one or two MDs in the group and a bunch of PA's. Scary.

 

[dutchman]

Virtually all patients who see someone in a white coat treating them are going to assume this person is a doctor, so respect won't be an issue. That is true for PAs, as well as med students. MD-DO-PA-student doctor -- it's all the same to your average Joe patient. In terms of lawsuits, the PA has a get out of court free card to play in that the PA is technically under the supervision of a physician, who bears the risk and the insurance policy. But a PA is frequently pretty competent and is going to be providing "good enough" care most of the time, so I doubt you'll see negligence suits sky-rocket. Which is why you will see more and more PAs. And once the public gets comfortable with this, it's game over for the medical monopoly.

Think again. I know a school in the midwest that is notorious for banging out lowgrade PAs and I am sure there are plenty more around the country. I know there are lots of good programs out there but I won't be too quick to classify all PAs as competent, as you will find that there is an unusual variation in quality when it comes to PAs. As far as lawsuits go, speaking as a layman juror, if the plaintiff's argument starts with "this physician ASSISTANT made --- mistake" I will be sold a lot quicker, and when lawyers notice those cases are a lot easier to win I am sure they will exploit that route to the maximum.
BTW as far as "physician monopoly" goes I think physicians are trying to eat their cake and have it. First physicians complain about work hours and pt volume, but turn around and complain when PAs and NPs take up some of that work. IMO if you find yourself hustling to maintain artificial monopoly then whatever you are selling probably lacks real value.

 

[Law2Doc]

IMO if you find yourself hustling to maintain artificial monopoly then whatever you are selling probably lacks real value.

Most monopolies by their nature are artificial and need to be maintained -- either through regulation, or patent, or defensive market share practices. It is a rarity to be the ONLY one capable of providing a good or service due to skill or know-how. Lawyers battle their encroachers, doctors should too.
And I don't think I said all PAs were competent, just that they frequently were.

 

[Law2Doc]

As far as lawsuits go, speaking as a layman juror, if the plaintiff's argument starts with "this physician ASSISTANT made --- mistake" I will be sold a lot quicker, and when lawyers notice those cases are a lot easier to win I am sure they will exploit that route to the maximum.

Because such a case is easier to win, it never gets presented to the plaintiff this way. The PA is working with and under the physician, whether or not that is the case.

 

[dilated]

Because such a case is easier to win, it never gets presented to the plaintiff this way. The PA is working with and under the physician, whether or not that is the case.

Yes, but that only makes it look worse. One presumes if it becomes a real issue eventually MDs will not want to cover PAs on their malpractice.

So you're a physician's assistant? Who works under the physician? But the physician didn't see the patient? Or take five minutes out of his day to look at his chart? And as a result your missed diagnosis cost Mr. X his life?

The thing about this is, we can go around and around about how big the difference between MD and PA/NP actually is. But I think the public perception is that there is a difference. I wonder if in ten years having a MD as your PCP will be seen as a status symbol like a Gucci handbag or something.

 

[Chronic Student]

I question the level of responsibility they have given their limited education.

First of all, their coursework is not as challenging as the MD courses. Taking anatomy in PA school is not the same as taking anatomy in medical school. The PAs that came into our lab once (just to see a cadaver) talked about how they pretty much had to look at Netter's and the prof simply used the same pics from netters on the exam.

How do they keep up with the literature? Given their limited amt of schooling, what they take from a journal article is likely different from what an MD can extract from a journal article. Just recently, I went to a prompt-med clinic and was seen by a PA. I had a productive cough, sore throat, etc. She immediately prescribed antibiotics without even testing to see if it was bacterial. She didn't even say "OK, I will prescribe this to you, but don't fill it unless your symptoms stay the same for another 3-4 days". This is not the current standard of care (see any journal, AFP, JAMA, NEJM, all recommend the "wait and see" approach or to do a strep beta test).

Lastly, it could very well be that they take over the jobs of some physicians, esp. family practice physicians. Why would a health care group hire an MD at 150K when they can hire a PA at 80K+? All you need is one or two MDs in the group and a bunch of PA's. Scary.

That is exactly what I'm talking about, as far as the difference in quality.

My gross anatomy was very different. We took the same course as the med students. The same instructors, notes, dissections, tests, everything. Unfortunately, it varies a great deal from school to school.

You are speaking from anecdotal experience and may or may not reflect what is actually out there. We were taught to review literature critically and to not make generalizations based solely on anecdotal experience. In addition, the programs vary widely and unless you have done a lot of research or have attended one them it is very hard to judge their quality without wider experience.

At my school we actually go more in-depth into some subjects than the med students at the same institution. EKG's are one of the things that come to mind. I cannot speak to other schools, but where I was at the med students got almost no exposure to EKG's and we had an entire class on it. It was frequently cited by the MD faculty as a place where we were superior and our clinical skills were also ranked higher by many of the doctors as well. We also worked side-by-side with the med students on the wards and were treated the same as far as pimping, duties and expectations.

Does that make any PA the equal of an MD?

I for one don't think so. Most of us get very little training in histology or biochemical pathways and frequently we fall short in other areas as well.

As far as keeping current, we have CME requirements from the state as well as our national organization. 40 hours (1/2 cat I and 1/2 cat II) every year from my state and 100 hours (1/2 cat I and 1/2 cat II) every two years from the national organization. My physician also has suscribed me to several neurosurgical journals which I am expected to read, just like him.

So once again, I state that a lot of how the PA that you go see in the office performs, is dependent upon the standards his supervising physician holds them up to.

BTW, as far as working up a sore throat. We were taught the AAFP criteria of looking at history of fever, tonsillar exudate, lack of cough, swollen and tender ant. cerv. LAD. All four and you gave the abx, two or three and you do a RST. If positive, treat with ABX and if negative culture. If negative give them a scrip to use in case or call them if it comes out positive and call-in a scrip.

Treatment is amoxil (or PCN) if no allergy to PCN (I also would not prescribe if they have had a previous reaction to a cephalosporin, 30% cross-reactivity is enough for me.). They get erythromycin if they do have a PCN allergy. I also might give them Pen G if I was worried about compliance. In case of treatment failure or non-compliance you can upgrade to augmentin.

Then you also have to consider how the patient looks, are they dehydrated, what is their medical history (Smoker, COPD, CA, HIV, immunocompromised in some other way), how do their lungs sound, have they lost any weight, night sweats, sick contacts, travel , etc. As you well know, there is a lot that needs to be considered in your differential for what seems like a 'simple' viral URI. You need to plan your approach, the likelyhood of it being something more serious and whether or not they need more of a workup (CXR, CBC, lytes, etc).

Family practice especially has some problems when it comes to pleasing their patients. Sometimes (even though it is not good medicine) they prescribe ABX to keep their patients happy, because it is what they expect.

This is just from memory and not too shabby for a neurosurgical PA and we're really not all idiots with our finger on the Rx trigger. I for one hate writing scrips for anything I'm not completely familiar with. I know in school they taught us to pick twenty or thirty drugs that we were comfortable with and most likely to use and know them cold.

-Mike

 

[Law2Doc]

But I think the public perception is that there is a difference.

The public just sees a white coat and thinks doctor. The rest is just alphabet soup to them. They don't process MD/DO/PA/med student/etc. If an orderly came in in a white coat folks would probably give him a full history and let him do a physical exam on them.

 

[Wizard of Oz]

The public just sees a white coat and thinks doctor. The rest is just alphabet soup to them. They don't process MD/DO/PA/med student/etc. If an orderly came in in a white coat folks would probably give him a full history and let him do a physical exam on them.

Trudat.

 

[dutchman]

The public just sees a white coat and thinks doctor. The rest is just alphabet soup to them. They don't process MD/DO/PA/med student/etc. If an orderly came in in a white coat folks would probably give him a full history and let him do a physical exam on them.

I disagree, the public is not as dumb as you think and even the illiterates in this society are still very much aware of things. Infact you will be surprised how often DOs have to explain their roles to the public let alone a PA.

 

[Law2Doc]

I disagree, the public is not as dumb as you think and even the illiterates in this society are still very much aware of things. Infact you will be surprised how often DOs have to explain their roles to the public let alone a PA.

I can only base my opinions on the number of times patients have decided I was their doctor despite my even having told them I was a medical student. And I would not call these people particularly dumb nor illiterate. It's just a system they are not familiar with, a time they are particularly vulnerable, and that a white coat and a stethoscope are all they feel they need to see in terms of licensure.

 

[crazy_cavalier]

I dont think a PA should be able to write prescriptions. The PA is to an MD as a psychologist is to a psychiatrist. That's how I see it. Granted there are many psychologists out there who are better at healing mental health than psychiatrists. It doesnt say anything about who is the better professional. But I think you damn well better have a strong academic background in all the science that goes into writing an Rx

 

[ForbiddenComma]

You asked for honest opinions so IMO If you want to avoid the length and depth of MD/DO education while still maintaining similar responsibilities then PA is the way to go. It has nothing to do with their competence, it just seems to me like it's an easy way out.

This is more true of NPs than PAs.

Go to the NP forums at allnurse.com http://allnurses.com/forums/f34/ and you'll see most of them insisting that NPs should be treated as equals to MD/DO, especially in primary care. "The letters after your name don't matter," they say, although of course the person saying that makes sure you know about all the letters after THEIR name (ARNP, MSN, BC, FNP)

If that is the case, then I guess I am a world-class sucker for busting my ass to get into med school and not settling for nursing school. Sorry... it pisses me off 😡

but back to the thread... no, PAs in general do not have this attitude and are a great addition to most programs.

 

[MacGyver]

I'm surprised emedpa hasnt chimed in on this yet. HE's the SDN resident PA-defender.

Anyways, when he comes onboard he will tell you how he does everything that an emergency room doc does, only better.

Also, he'll tell you that in North Carolina for example, the "supervision" for PAs is something like telephone or internet 10% chart review every 6 months. Think about that for a minute. You got PAs running solo in NC with a doctor NEVER on sight. The chart review can occur up to 6 MONTHS AFTER THE PATIENT has left the clinic, and furthermore the PA GETS TO CHOOSE WHICH 10% OF THE CHARTS GET REVIEWED BY THE MD.

So that begs the question, how is it that PAs in NC got these sham "supervision" regs? Its becaue the state medical board in NC ALLOWED it to happen. Why would they do that? $$$$$$$$

Why be restricted to directly supervising 3 PAs on site when you can do "remote supervision" of over 20 PAs and bill for everything they do? The reason PAs have such autonomy in NC has nothing to do with lobbying and everything to do with the fact that NC doctors got greedy and saw this as a way to greatly increase their income.

For every PA working with these sham supervision rules, there are greedy ass MDs making a killing off of them. YOu want somebody to blame, blame them for selling out hte profession.

 

[dilated]

For every PA working with these sham supervision rules, there are greedy ass MDs making a killing off of them. YOu want somebody to blame, blame them for selling out hte profession.

I don't have a problem with PAs in terms of career, they can just be frustrating when you're a student. Fact of the matter is that there are not enough MDs for the increase in health care and not enough money to go around. So the options are: a) mint more MDs, devaluing the degree, and pay each MD less b) employ more cheap midlevels so that the MDs can cover more ground. I'll take the PAs any day. That being said, replaceability by midlevels (NPs are much more of a threat than PAs) is a consideration in what specialty to pursue - FP'd better be watching their backs, but surgeons aren't sweating it too much.

 

[Wizard of Oz]

I dont think a PA should be able to write prescriptions. The PA is to an MD as a psychologist is to a psychiatrist. That's how I see it. Granted there are many psychologists out there who are better at healing mental health than psychiatrists. It doesnt say anything about who is the better professional. But I think you damn well better have a strong academic background in all the science that goes into writing an Rx

I've been treated by more unknowledgable primary care docs than PA's so I'm not buying the academic background angle. I've had ten or so primary care personal physicians, and two or three could tell me the difference in mechanism between two different classes of antibiotics as they were prescribing them to me. I know this because I am a micro med tech, and I want to know if they know what their prescribing me. Usually, they don't. They just know what is supposed to work for this or that type of infection (as would an experienced PA).

Last time I went to a family doc, he wanted to give me HCTZ for my hypertension. I said, "Is that Potassium sparing or wasting?" He said, "I don't know, let me look at my Palm Pilot." Come on, I learned that as an undergrad.

If you take a family doc with 20 years of experience vs. a PA with 20 years of experience, I highly doubt that you'd be able to detect a difference in their "strong science background." In fact, I think that I would bet on the PA because in my state, they have to take a recertification exam every seven years.

If you want to make money off of having a PA, you have to have them prescribing. It's very simple. The whole reason that they are there are to circulate patients in need of healthcare and save you work on the easy cases.

I will defend PA's wholeheartedly, because my state needs them! Our only problem is that we don't have enough resources to train more than we do. If they did, then I would have gotten into PA school; and I wouldn't have had to go 200K into debt learning a bunch of unnecessary BS for 7 years.

 

[Wizard of Oz]

FP'd better be watching their backs, but surgeons aren't sweating it too much.

Family practitioners in my state and the state that I am from have waiting lines out the door every day full of insured people that they just can't see. They welcome PA's, pay 'em what they want, offer loan repayment, build 'em a statue, whatever. They are not watching their backs, they are turning around and hugging PAs.

I go to school in an urban area, and I still have to wait six weeks to get into see a primary care doc. I ask for the PA because I don't want to wait so long. Many of our family med faculty are so busy that they can't even consider taking new patients. I am quite sure that they are not feeling a need to watch their backs. If they ever do feel "threatened," they can solve the "threat" themselves. Just don't hire them! Ultimately the PA is an employee of the doctor's group.

 

[dilated]

Family practitioners in my state and the state that I am from have waiting lines out the door every day full of insured people that they just can't see. They welcome PA's, pay 'em what they want, offer loan repayment, build 'em a statue, whatever. They are not watching their backs, they are turning around and hugging PAs.

Yeah, for now. But eventually insurance/the government will say, hey, PAs are cheaper than MDs. And the PA/NPs don't seem to be killing people. So why exactly are we paying the MDs twice as much? Then the scope of practice regulations will be loosened, especially on the NP side because the board of nursing isn't exactly against giving nurses everything MDs have. It's already happening in Britain. I don't think it's going to happen next year or even in five years, but we're deciding what we'll do for the next 30 years, and I think within that time frame the FP doc as we know it may very well vanish.