Whats your opinion on PAs?

[Wizard of Oz]

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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.

This sort of "selling out" as you say is the rule more than the exception. This is a business, and if supply can meet demand to maximize profit, docs will see to it. Cynical? Yeah, but it's the reality of the U.S. healthcare system.

As a med tech, I've tried to call attendings before with critical lab values. They yell at me, tell me I'm supposed to call the resident. Their time is too valuable. Too valuable, I say? Well aren't YOU the person who is ultimately billing the patient? To me that sounds a lot like selling out too. Have your residents deal with all of your patients and don't waste time acting when your patient might be septic even when you are supposed to be the doc in charge.

And as for "selling out," when we see a patient with insurance in the hospital, believe you me the consults do come faster. I had a friend who had a baby in our university's hospital, and she had special markings on her door because she had insurance. You can bet that before she left, she was billed by about five docs whose faces she never saw. This is simply how academic medicine works. It's just like our government. Do you think that our politicians actually read the bills before they vote on them? (reference to Fahrenheit 9/11)

 

[Wizard of Oz]

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.

Oh I agree that the family doc will vanish. Nobody wants to go into it anymore because of poor reimbursement and in some cases malpractice. Hell most don't even deliver babies anymore because of lawsuit risks. If NP's or PA's can practice without supervision and without getting sued out the wazoo for malpractice, I say let 'em. Something has to be done about healthcare costs before we face socialization, and since our U.S.-trained docs don't want to do family med anymore, why not let PA's do it?

It is actually sound reasoning to me that reimbursing double for a doc when a PA can do the job at half the price is silly.

The tradition of becoming a doctor is unnecessarily expensive in my view, and we could do a lot better by society if we attempted to look at the causes for high medical tuition. It's just a shame that medicine is too arrogant and traditional to change with the times. We spend a lot of time and money learning detail that we don't need, and we have to pay for four years of college before we can get another four years of basic sciences crammed into two at double or triple the price.

I am not in medicine for the financial reward. I could care less if I am rich as long as I can pay back my loans. It's obvious that many are worried about inviting PA's to the healthcare table, but I say invite the PA's and leave the stockholders and lawyers at home.

Edit: One other thing, if docs don't want PA's to have a place at the table, they can just grease the politicans like the drug companies do.

 

[Law2Doc]

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.

That's exactly my point. Time to circle the wagons already.

 

[primadonna22274]

Wow, busy thread.
I'll chime in: I've been a practicing PA for the past six years and I still have mixed feelings about us. I've worked with great ones. I hope I'm a great one. I've taught some that scare me...enough to worry me about going into PA education, although I love teaching, because I think in my short time in this profession (count 8 years including my training) the number of programs have continued to explode and the end product is less consistent across the board. I worry that people are going into PA because it's the easy way out. (And no, it's not easy.)
I really appreciate Chronic Student's responses above. He's honest, to the point, and humble. He's already said a lot of what I could so I won't repeat. I will say though that a few of the things that keep us honest as PAs are good supervising physicians, CME requirements as mentioned above, and the universal requirement of national recertification every six years.
I came to this forum over a year ago, considering med school for the umpteenth time. I know that I am a competent practitioner, but I am not comfortable with competent. I crave a deeper knowledge base. I want to be able to practice independently. I want to master what I now know adequately so that I can feel confident in teaching. For me, that means I've got to go to med school. The really big frustration though is realizing that my first love, family medicine, may not pay the bills to justify giving up seven years of my PA income and going at least another $100k in educational debt (and this is figuring cheaply).
Why don't more PAs go on to med school? Because it costs so much. Not to mention it is hard on individuals and families. In a lot of ways, it doesn't make a lot of sense for me to go back, which is how I keep talking myself out of it...but here we go again.

 

[FizbanZymogen]

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,

Those 7 years of BS might just save somebody's life. If that is truly how you feel then maybe you need to re-evaluate your motivation for medicine. There is no way no matter the school that the PA gets the same training and education an MD recieves, Period. I have met some good PA's but they are limited to entry level care in most situations. If you want authority, responsibility and greater options than MD is the way to go. PA's are needed but PA does not equal MD.

 

[Wizard of Oz]

Wizard,

Those 7 years of BS might just save somebody's life. If that is truly how you feel then maybe you need to re-evaluate your motivation for medicine. There is no way no matter the school that the PA gets the same training and education an MD recieves, Period. I have met some good PA's but they are limited to entry level care in most situations. If you want authority, responsibility and greater options than MD is the way to go. PA's are needed but PA does not equal MD.

It's not about being equal, and you will see them treated equally in your lifetime. Healthcare is interdisciplinary; it is not like the mafia or the military. Like somebody else said, put a white coat on, and you are equal for a good share of patients, particularly in clinics where they call the PA "doctor" (such as my workman's comp clinic). Only the last 4-5 years of training might lead to saving somebody's life unless you are talking about my CPR certification which I've had since I was in high school. I'm not convinced that a family doc has any greater chance of saving lives than a PA. Actually the cheaper option will probably save more lives in the long run if the patient can't afford care from an MD in the future.

If I am only in this because I want authority, responsibility, and greater options, then it is clear that I have chosen poorly. No need to re-evaluate. By the way, I don't really agree with "greater options." PA's can switch between specialties, and the odds of a PA doing derm are better than an MD where I live.

MD is also the way to go if want to be treated badly while learning, take a lot of call, have a lot of debt, and (at least for a few more years) make a lot of money. None of these aspects of medicine interest me, but like I said before, I was rejected to PA school.

 

[dutchman]

It's not about being equal, and you will seem them treated equally in your lifetime. Healthcare is interdisciplinary; it is not like the mafia or the military. Like somebody else said, put a white coat on, and you are equal for a good share of patients, particularly in clinics where they call the PA "doctor" (such as my workman's comp clinic). Only the last 4-5 years of training might lead to saving somebody's life unless you are talking about my CPR certification which I've had since I was in high school. I'm not convinced that a family doc has any greater chance of saving lives than a PA. Actually the cheaper option will probably save more lives in the long run if the patient can't afford care from an MD in the future.

If I am only in this because I want authority, responsibility, and greater options, then it is clear that I have chosen poorly. No need to re-evaluate. By the way, I don't really agree with "greater options." PA's can switch between specialties, and the odds of a PA doing derm are better than an MD where I live.

MD is also the way to go if want to be treated badly while learning, take a lot of call, have a lot of debt, and (at least for a few more years) make a lot of money. None of these aspects of medicine interest me, but like I said before, I was rejected to PA school.

You know you can still apply to PA school right?

 

[MacGyver]

Using PAs is all fine and good, until something like this happens:

http://www.ohiopa.com/PA Bulletin.htm

On January 31, 2006 , Senate Bill 154, which drastically changes Ohio law regarding Physician Assistants (“PAs”), passed the General Assembly. The bill now only awaits final action by Governor Taft, who is expected to sign the bill. The new PA law will become effective ninety days after the Governor's signature.

The most significant areas of change provided by the new PA law are:

PAs may obtain Certificates to Prescribe and, thereafter, prescribe drugs and devices in accordance with the PA Formulary and physician-delegated authority.
Standard utilization plans have been replaced with “physician supervisory plans” and supplemental utilization plans have been replaced with “special services plans.”
PAs who work at hospitals and other defined “health care facilities” are not required to have physician supervisory plans or special services plans. Rather, those PAs may practice in accordance with the credentialing and policies of the hospital or health care facility.
Two major changes increase the autonomy of PAs: (1) physician countersignature of PA orders is no longer required; and (2) the prohibition against PAs treating new patients is eliminated.

All those ohio docs who were making $$$ by using hospitalist PAs can kiss that money stream goodbye. The new law says that they dont need ANY doctor supervision if they work in a hospital.

This is what happens when you give these midlevels an inch, or when you let them usurp your scope of practice so you can make extra money on the side.

 

[MacGyver]

BTW lets talk about surgery for a moment. Somebody said that surgery was basically immune to midlevel penetration.

It is true that midlevels have not penetrated surgery as much as the other fields, but IMO its only a matter of time before they do.

The reason why? AGain it comes down to the unrelenting greed of doctors.

General surgeons average about 250k per year. But I guarantee you right now, there is a surgeon who is pondering letting his PA do all of his routine lap cholys while he does the more "interesting" cases. Why do boring laps all day when you can bill your PA to do 2 or 3 per day while you do your own 3-4 surgeries per day and increase your income by 5 fold?

This is how it starts people. After awhile, other surgeons will catch on and do the same thing. Oh it will start out nice and innocent at first. The PAs will do "only" the boring routine cases. No CABGs or transplants. But of course after a few years, the extra money that surgeons can make is so great that it starts to expand.

You know the rest of the story. Yes, right now surgery has resisted midlevels more than the other fields. But if you think its going to stay that way, you are sorely mistaken.

 

[anon-y-mouse]

As a med tech, I've tried to call attendings before with critical lab values. They yell at me, tell me I'm supposed to call the resident. Their time is too valuable. Too valuable, I say? Well aren't YOU the person who is ultimately billing the patient? To me that sounds a lot like selling out too. Have your residents deal with all of your patients and don't waste time acting when your patient might be septic even when you are supposed to be the doc in charge.

No, this is where you as the med tech did not respect the hierarchy of patient care at a teaching hospital. The resident has an MD, and can deal with sepsis, and should be the one calling the attending if something is urgent. You are out of line, and in fact disrespectful to the resident's status, if you call the attending physician directly if the established route of escalation is through the resident. I suspect that this is also why the attending physician was pissed.

 

[anon-y-mouse]

MD is also the way to go if want to be treated badly while learning, take a lot of call, have a lot of debt, and (at least for a few more years) make a lot of money. None of these aspects of medicine interest me, but like I said before, I was rejected to PA school.

Please do your future colleagues a favor and transfer out to a PA school.

 

[dutchman]

PAs will do what they have to do to gain ground and I dont blame them, but the main point here might be exposing the apparent sham in medical education. If we can prove that 3years of PA school is just as effective as the 7years an FP goes through(which includes many years of sleep deprivation of which our sadistic medical educators swear is necessary to train real doctors) then we need to call bull**** on this whole medical school thing and ask those bastards why they are charging an arm and a leg for it. If you look carefully you can actually see the trail of bull****, from the not so basic "basic science" years, which they pretty much jam ephemeral knowledge up your ass followed by clinical years of which half(4th year) is really an expensive vacation, and then you get to residency where they make it clear that "this is where the real training begins". Well ****er I just spent 4years and 200k, you think we might have started this "real" training a lot sooner for less money?

 

[Law2Doc]

PAs will do what they have to do to gain ground and I dont blame them, but the main point here might be exposing the apparent sham in medical education. If we can prove that 3years of PA school is just as effective as the 7years an FP goes through(which includes many years of sleep deprivation of which our sadistic medical educators swear is necessary to train real doctors) then we need to call bull**** on this whole medical school thing and ask those bastards why they are charging an arm and a leg for it. If you look carefully you can actually see the trail of bull****, from the not so basic "basic science" years, which they pretty much jam ephemeral knowledge up your ass followed by clinical years of which half(4th year) is really an expensive vacation, and then you get to residency where they make it clear that "this is where the real training begins". Well ****er I just spent 4years and 200k, you think we might have started this "real" training a lot sooner for less money?

I actually don't think that med school education is a "sham", it's just that it is coming across to the lay public as not the most cost effective. Sure the FP may have learned a lot more in school than a PA, but to 99% of the patients it will make no difference. That 1% is probably SOL if he doesn't see a physician, but if you want a cost effective system, sometimes you have to throw some people under the bus. That doesn't make it a sham. But it certainly puts the profession at risk to be undercut on prices. You are selling a luxury product to a blue collar customer base.

 

[8744]

PAs will do what they have to do to gain ground and I dont blame them, but the main point here might be exposing the apparent sham in medical education. If we can prove that 3years of PA school is just as effective as the 7years an FP goes through(which includes many years of sleep deprivation of which our sadistic medical educators swear is necessary to train real doctors) then we need to call bull**** on this whole medical school thing and ask those bastards why they are charging an arm and a leg for it. If you look carefully you can actually see the trail of bull****, from the not so basic "basic science" years, which they pretty much jam ephemeral knowledge up your ass followed by clinical years of which half(4th year) is really an expensive vacation, and then you get to residency where they make it clear that "this is where the real training begins". Well ****er I just spent 4years and 200k, you think we might have started this "real" training a lot sooner for less money?

Ah, there's the rub. Is residency training necessary or can you throw a guy out there with a little less than three years of mostly clinical experience and expect him to pick up everything he knows by on-the-job-training?

Whatever the public's perception, if you have any experience at all as a reisdent you know that the difference in knowledge and skill between your attending and a PA with a similar number of years is vast and patients would be fools to think that the difference isn't important, even when it comes to routine things.

Somebody said that PAs were like permanent residents but that's laughable. The senior medicine residents, for example, who I have known, can run circles around any PA and even some of the older attendings.

Whatever the politics of it, once you guys get a little experience you won't be so insecure about the necessity for trained physicians.

 

[45408]

The reason why? AGain it comes down to the unrelenting greed of doctors.

🙄

 

[dynx]

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.

They can only do what the doctor they work for will let them. If the doc feels okay about thier skills and judgement then they can give them full on control. BUT they still need to practice under someone elses liscense. That person or institution defines the role they play.

 

[indo]

BTW lets talk about surgery for a moment. Somebody said that surgery was basically immune to midlevel penetration.

It is true that midlevels have not penetrated surgery as much as the other fields, but IMO its only a matter of time before they do.

The reason why? AGain it comes down to the unrelenting greed of doctors.

General surgeons average about 250k per year. But I guarantee you right now, there is a surgeon who is pondering letting his PA do all of his routine lap cholys while he does the more "interesting" cases. Why do boring laps all day when you can bill your PA to do 2 or 3 per day while you do your own 3-4 surgeries per day and increase your income by 5 fold?

This is how it starts people. After awhile, other surgeons will catch on and do the same thing. Oh it will start out nice and innocent at first. The PAs will do "only" the boring routine cases. No CABGs or transplants. But of course after a few years, the extra money that surgeons can make is so great that it starts to expand.

You know the rest of the story. Yes, right now surgery has resisted midlevels more than the other fields. But if you think its going to stay that way, you are sorely mistaken.

CRNAs have already invaded one aspect of surgery.


By the way, what is the role of the physician in a communist society?

 

[logos]

Using PAs is all fine and good, until something like this happens:

http://www.ohiopa.com/PA Bulletin.htm




All those ohio docs who were making $$$ by using hospitalist PAs can kiss that money stream goodbye. The new law says that they dont need ANY doctor supervision if they work in a hospital.

This is what happens when you give these midlevels an inch, or when you let them usurp your scope of practice so you can make extra money on the side.

On the plus side, advanced practice nurses in ohio have had major advantages over PAs for quite a long time. This will bring PAs more in line with them. It is to our advantage to promote PAs over NPs in ohio because the state medical board has authority over PAs but the nursing board holds authority over all nurses, even advanced practice nurses (which is BS in my opinion, nursing board should regualte nursing, if there are nurses capable of being clinicians, practicing medicine, they should fall under the state medical board)

Hopefully this will also be a big boost for AAs, as ohio has one of only of a couple of AA schools in the country. Again, because AAs are under the medical board and CRNAs are under the nursing board. This set up has in the past allowed the nursing board to increase the scope of AP nurses as they see fit (which is pretty much to give them as wide a scope as they can muster...)

 

[bluecephas]

I'm a PA and I'm a DO student now. Here's what I have to say:
1. I was one of the top in my class and still felt half-baked when I graduated.
2. I felt like I was a student the first 2 years of practicing--lots of referring to books and supervising physicians.
3. We can't write prescritions. We call it "drug orders."
4. After a couple of years out in practice, I feel pretty comfortable doing FP and peds. The first few years seemed to serve like a residency training.
5. No matter what I do, there will be people who don't want to see me (infrequent). But there are also those patients who request to see only me.
6. It sure makes a good pre-med preparation.
7. I plan to hire PA's when I graduate.

 

[dilated]

New Rules for PAs Practicing at Hospitals. A physician supervisory plan or special services plan is not required for the services a PA provides in a hospital or other specified health care facility. Instead, the PA's practice is to be governed by the policies of that facility. Thus, hospitals should take steps to prepare policies that will serve as a facility-wide "physician supervisory plan" and "special services plan" governing the scope of practice of PAs working within the hospital; however, hospitals are not limited by what the Medical Board or regulations may believe are appropriate for a PA's scope of practice.

Yikes. So basically hospitals could have PAs do surgery without any MD approval if they'd like (read: would save money). There is exactly 1 thing hospitals are not allowed to have PAs do, which is provide anesthesia (bizarre). That's not exactly what I'd call "Medical Board Oversight" to be happy about.

 

[Wizard of Oz]

No, this is where you as the med tech did not respect the hierarchy of patient care at a teaching hospital. The resident has an MD, and can deal with sepsis, and should be the one calling the attending if something is urgent. You are out of line, and in fact disrespectful to the resident's status, if you call the attending physician directly if the established route of escalation is through the resident. I suspect that this is also why the attending physician was pissed.

I'm talking about situations in which my boss makes me call the attending. It's hospital policy if the patient is a child or if the patient has a history of a bug with an unconventional antibiotic resistance pattern.

So I can be "out-of-line" or I can be fired. Either way, if I'm a patient, I don't think it's too much to ask to spend two minutes verifying an antibiotic according to hospital policy if you are going to be sending me a bill for your services.

Please do your future colleagues a favor and transfer out to a PA school.

They wouldn't take me before, and they surely won't take me now since they view my medical training as contamination to their distinct profession.

Sure the FP may have learned a lot more in school than a PA, but to 99% of the patients it will make no difference.

I agree.

With all of this talk about greed and invasion, I think that what we are failing to recognize is that our government is ultimately elected by our citizenry and/or bribed by our lobbyists. If you want to control the healthcare environment, make your voices heard at the ballot box or have physicians do some educating about why they deserve to be paid more than "midlevels" and why you should want to pay one. Patients can decline treatment by training docs or PA's if they are being billed by an MD/DO.

If "midlevels" can do the job cheaper without getting sued, then evolution will select for their cheaper training regimen if it keeps us away from socialized medicine.

 

[Chronic Student]

Yikes. So basically hospitals could have PAs do surgery without any MD approval if they'd like (read: would save money). There is exactly 1 thing hospitals are not allowed to have PAs do, which is provide anesthesia (bizarre). That's not exactly what I'd call "Medical Board Oversight" to be happy about.

There are a number of reasons why that won't happen.

The most obvious is that medicare, medicaid and private insurance compaines would not reimburse for it.

Secondly, the surgeons would go ape***t and it would stop in its tracks.

Third, those PA's would have to be trained to do the surgeries and I can't imagine very many surgeons would cut their own throats and do that.

Fourth, patients would not stand for it and the media would make sure that it was publicized to the umptenth degree.

Fifth, even a simple hernia repair or lap chole can have complications and as soon as a PA put a trocar into the aorta or some other god-awful complication which they have no idea to handle, there would be a public hue and cry and it would stop.

Lastly, I really don't think our national organization would stand for it. They are very sensitive to displeasing any doctor-run organizations and they would put a stop to it.

-Mike

 

[8744]

There are a number of reasons why that won't happen.

The most obvious is that medicare, medicaid and private insurance compaines would not reimburse for it.

Secondly, the surgeons would go ape***t and it would stop in its tracks.

Third, those PA's would have to be trained to do the surgeries and I can't imagine very many surgeons would cut their own throats and do that.

Fourth, patients would not stand for it and the media would make sure that it was publicized to the umptenth degree.

Fifth, even a simple hernia repair or lap chole can have complications and as soon as a PA put a trocar into the aorta or some other god-awful complication which they have no idea to handle, there would be a public hue and cry and it would stop.

Lastly, I really don't think our national organization would stand for it. They are very sensitive to displeasing any doctor-run organizations and they would put a stop to it.

-Mike

The problem with a lot of PAs, NPs, and other mid-levels is they don't know enough to know what they don't know. If there's one thing you learn in residency, and I bet it goes triple for surgery, it's to know your limitations.

 

[Chronic Student]

The problem with a lot of PAs, NPs, and other mid-levels is they don't know enough to know what they don't know. If there's one thing you learn in residency, and I bet it goes triple for surgery, it's to know your limitations.

I worked as a scrub tech for a number of years and saw a number of seemingly simple surgeries go bad and I really don't think anyone should be doing surgery solo except for a residency trained surgeon.

I also was involved in a case with a young surgeon who was absolutely brillant and gifted. I honestly only saw him make one mistake in the two years I worked with him. However, he struggled a great deal with this particular case because he screwed up and did not know how to get himself out of trouble.

There are times when the surgeons who have made a fair amount of mistakes are the ones who are the coolest under fire because they have been there before and know what to do.

-Mike

 

[dilated]

There are a number of reasons why that won't happen.

The most obvious is that medicare, medicaid and private insurance compaines would not reimburse for it.
-Mike

Well, yes. I don't actually expect to see PAs doing craniotomies or anything. But I find it absolutely unacceptable that it is left purely up to hospital CEOs to define the PA's scope of practice, because a) they are not healthcare professionals, and b) they have a huge conflict of interest ($$$). There is a lot of grey area between opening skulls and starting IVs, and a per-hospital policy allows them to push the boundaries of what PAs should be doing in the interests of saving money, especially in cases where the patient won't know.

 

[mjl1717]

The first program was at Duke in 1967 basically for paramedics out of military without a niche in American society then others joined.

1)Its a mid level healthcare position along with nurse midwife and nurse practioner.
2)unlike nurses they dont have their own union. In New York their is an 1199-Healthcare union.
3)Its a physician dependent position
4)the primary focus is suppose to be primary care but it has branched off!
5)here's the tricky part- in the 60's and 70's their was a bigtime shortage of primary care in indigent or underserved areas. Basically because greedy docs and med students would go into more lucrative and flamboyant specialties eg. derm., optho, ortho, surgery etc..
(I understand this and it makes sense to payback school loans that seem like they will last forever!)
Now in the 90's and past the year 2000 some some specialties like surgery, OBGYN, etc struggle to make ends meet because of malpractice, long residency, forced acceptance of low medicare and medicaid payback, tiny checks from powerful insurance companies and I hate to say this Law 2Doc unscrupulous lawyers. Many have taken advantage of docs not being great buisnessmen--So at this time more docs are going into primary care (2 or 3 year residency)
6)many P.A.s do primary care- they are like the work horse in primary care they make maybe half of what a doc makes, moneywise.
Many patients prefer to see the PA since the PA develops better rapport and compassion with patients while a hurried, in a frenzy doc worries about insurance powerbrokers and overhead. [And the public is thinking the doc makes an easy $250,000+/year]
7) in the medical arena a 5 or 10 year veteran PA is better the an intern.
A surgical resident I know once made this analogy about the heirachy in medicine or surgery. First pond scum, then algae, then one celled organisms. Basically the med student is pond scum. A veteren PA is WAY above pond scum.
8)And to the pundits who say "only 2 years and prescribing meds" P.A.s do the same pre med requirments! Also fight the nurse practioner and nurse mid wife also because they prescribe meds also.
8a)Hospitals limit docs to maybe 3 or 4 P.A.s.
9)Basically P.A.s get to play doctor. (realizing its a physician dependent posiiton) they are no threat to the doc but maybe a percieved threat to an insecure med student. P.A.s in general do not have to make the BIG decisions and the doc takes on maybe 3 or 4 times more pressure. Thats the deal on the P.A. field.
First pond scum, algae, then one celled organisms.
And(lol) whatever you do,- do NOT compare a P.A. to William Osler. Because Osler was a pathologist first,{I can't say thats unfair} then zoomed into a presidency at John Hopkins.

 

[helpfuldoc2b]

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

PAs are a great asset to the medical profession. A lot of my friends who were in my undergrad Bomecial Scieces undergrad went to PA school since my undergrad had a PA school and no Med School.
Just a side note, i went to a major hospital in town for a urology physical (suspect of kidney stones), and I was seen by the PA and the PA only. The embarrassing thing, is when the PA was playing with my penis and rotating it around and all, she looked very familiar. Turned out i asked her while she was playing with my penis where she went to school, turned out she went to mine and remembered me in some of her undergrad classes. It was wierd to have a young female PA that you had classes with playing with my penis while we were reflecting what classes we might of had together and how we remember each other.
Just a side note🙄

 

[Doc 2b]

This may have been mentioned, but in my opinion, having worked with both PA's and NP's in my prior career. I'd take a PA anyday. They are trained similar to physicians by physicians most of the time. NP's are trained soley by nurses. NP's are generally adversarial with physicians as are most nurses with their little chips on their shoulder. And you RN's who want to flame me, stop, I come from an entire family of nurses, so I'm telling you the same as I tell them. Oh and this may be news to most of you, did you know that many FNP programs are applying to have their degrees changed to a doctorate instead of a masters level. That's right they want us to call them Dr. or Dr. Nurse, don't know how that will go. Someone should just tell them, if you want to be a Dr. go to medical school, and quit walking around with your second rate community college NP playing Dr. At least PA's know their place, it's in their title. Rant over 😳)

 

[mjl1717]

This may have been mentioned, but in my opinion, having worked with both PA's and NP's in my prior career. I'd take a PA anyday. They are trained similar to physicians by physicians most of the time. NP's are trained soley by nurses. NP's are generally adversarial with physicians as are most nurses with their little chips on their shoulder. And you RN's who want to flame me, stop, I come from an entire family of nurses, so I'm telling you the same as I tell them. Oh and this may be news to most of you, did you know that many FNP programs are applying to have their degrees changed to a doctorate instead of a masters level. That's right they want us to call them Dr. or Dr. Nurse, don't know how that will go. Someone should just tell them, if you want to be a Dr. go to medical school, and quit walking around with your second rate community college NP playing Dr. At least PA's know their place, it's in their title. Rant over 😳)

This and my last post basically covers the entire P.A., N.P., M.D. gambit.

 

[Law2Doc]

Now in the 90's and past the year 2000 some some specialties like surgery, OBGYN, etc struggle to make ends meet because of malpractice, long residency, forced acceptance of low medicare and medicaid payback, tiny checks from powerful insurance companies and I hate to say this Law 2Doc unscrupulous lawyers. Many have taken advantage of docs not being great buisnessmen--So at this time more docs are going into primary care (2 or 3 year residency)

Doesn't bother me that you say that, I never touched medmal or insurance law. But FWIW lawyers didn't drive this train, they are just facilitators -- hired guns -- not initiators of healthcare changes -- they are the franchise players in a game designed and started by others. The public had to bring suits, and grant large jury awards against physicians driving up healthcare costs, the government had to embrace the insurance industry and HMOs as having the answer to healthcare costs, and physicians had to be remarkably inefficient at lobbying, and have a very narrow future outlook, to get to this playing field.

 

[georgia_md]

The problem with a lot of PAs, NPs, and other mid-levels is they don't know enough to know what they don't know. If there's one thing you learn in residency, and I bet it goes triple for surgery, it's to know your limitations.

Personally, I don't think there is nothing wrong in being a PA. But I would be very embarrassed if a patient calls me a "Doctor", and then have somebody correct the patient by saying , "oh no he's not a doctor. He's just a PA".

 

[deleted6669]

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

and no pa thread would be complete without macgyvers jaded commentary,thanks bill.

"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."

actually most docs make very little off pa owned and operated clinics in nc. they get a basic yearly stipend of a few thousand bucks for being the consulting doc of record, hardly "greatly increasing their income"......


"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."

thanks-e

"Nurse practitioners do 400 supervised hours in their specific field on top of their rotations they do in their program "
actually they do 500-800 hrs total in their programs compared to 2000 hrs + for a pa student.....

 

[georgia_md]

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

PA stands for "Punk Ass". A lot of PA's think they are the ****z, but in actuality they are just pieces of it.


The PA's I have worked with were all arrogant lazy fat slobs who thinks they are smarter and better than the doctor. And when someone dies or gets hurt, they point their finger to the doctor. Saying, "hey, I am just a PA." Hell yeah, you're right! You're just a PA, "punk ass" .

They are scum sucking , finger pointing, nose twitching, eyeball rolling, lolly-gagging, smelly farting doctor wannabes/neverwillbes.

 

[deleted6669]

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

pa's get the same yr of pharm that md's do skippy.....

 

[deleted6669]

PA stands for "Punk Ass". A lot of PA's think they are the ****z, but in actuality they are just pieces of it.


The PA's I have worked with were all arrogant lazy fat slobs who thinks they are smarter and better than the doctor. And when someone dies or gets hurt, they point their finger to the doctor. Saying, "hey, I am just a PA." Hell yeah, you're right! You're just a PA, "punk ass" .

They are scum sucking , finger pointing, nose twitching, eyeball rolling, lolly-gagging, smelly farting doctor wannabes/neverwillbes.

you forgot no debt, specialty changing, wave of the future, high rollers.....

 

[indo]

PA stands for "Punk Ass". A lot of PA's think they are the ****z, but in actuality they are just pieces of it.


The PA's I have worked with were all arrogant lazy fat slobs who thinks they are smarter and better than the doctor. And when someone dies or gets hurt, they point their finger to the doctor. Saying, "hey, I am just a PA." Hell yeah, you're right! You're just a PA, "punk ass" .

They are scum sucking , finger pointing, nose twitching, eyeball rolling, lolly-gagging, smelly farting doctor wannabes/neverwillbes.

But you were just the filing person so you couldn't ever say anything to the PA.

 

[da8s0859q]

I am sure there are many good PA's out there. I am just saying that I haven't encountered many good ones.

That's kinda the impression we got.

 

[mjl1717]

PA stands for "Punk Ass". A lot of PA's think they are the ****z, but in actuality they are just pieces of it.


The PA's I have worked with were all arrogant lazy fat slobs who thinks they are smarter and better than the doctor. And when someone dies or gets hurt, they point their finger to the doctor. Saying, "hey, I am just a PA." Hell yeah, you're right! You're just a PA, "punk ass" .

They are scum sucking , finger pointing, nose twitching, eyeball rolling, lolly-gagging, smelly farting doctor wannabes/neverwillbes.

If nothing else, like Howard Stern. Your post willl make a lot of people laugh real hard. Also no one can flame you because the guy said speak positively or negatively about P.A.s!!

 

[georgia_md]

med tech = filing tech + "where are the O2 bottles stored"

Oh boy, you're dumb! You don't even know what is a medical technologist! http://www.ascp.org

 

[indo]

Oh boy, you're dumb! You don't even know what is a medical technologist! http://www.ascp.org

You deliver pills to old people in nursing homes? Wow! Now I totally respect your ******ed view of PAs.

 

[mjl1717]

Personally, I don't think there is nothing wrong in being a PA. But I would be very embarrassed if a patient calls me a "Doctor", and then have somebody correct the patient by saying , "oh no he's not a doctor. He's just a PA".

good point.

 

[georgia_md]

You deliver pills to old people in nursing homes? Wow! Now I totally respect your ******ed view of PAs.

Wow, you can't be serious!? Anybody believe this guy? You don't know what is a medical technologist ?!? Wow! You must be a high school student punk! Okay, let me explain this to you, you little punk. Medical technologists are clinical laboratory scientists that work in all areas of the clinical laboratory including blood banking, chemistry, hematology, immunology, and microbiology. We perform a full range of laboratory tests from simple premarital blood tests, to more complex tests to uncover diseases such as HIV/AIDS, diabetes, and cancer. We are also responsible for confirming the accuracy of test results, and reporting laboratory findings to pathologists and other physicians. The information that a medical technologist gives to the doctor influences the medical treatment a patient will receive. Medical technologists operate complex electronic equipment, computers, and precision instruments costing millions of dollars.

I apolgozie if I offended you, you are obviously very "pro-PA" .

 

[deleted6669]

"I apolgozie if I offended you, you are obviously very "pro-PA" ."

I am too but I caught the humor.....🙂

 

[indo]

Wow, you can't be serious!? Anybody believe this guy? You don't know what is a medical technologist ?!? Wow! You must be a high school student punk! Okay, let me explain this to you, you little punk. Medical technologists are clinical laboratory scientists that work in all areas of the clinical laboratory including blood banking, chemistry, hematology, immunology, and microbiology. We perform a full range of laboratory tests from simple premarital blood tests, to more complex tests to uncover diseases such as HIV/AIDS, diabetes, and cancer. We are also responsible for confirming the accuracy of test results, and reporting laboratory findings to pathologists and other physicians. The information that a medical technologist gives to the doctor influences the medical treatment a patient will receive. Medical technologists operate complex electronic equipment, computers, and precision instruments costing millions of dollars.

I apolgozie if I offended you, you are obviously very "pro-PA" .

Sounds like the volunteer work I did at the red cross with very little training. Also, the Pulse-Ox is not considered "complicated electronic" equipment.

 

[Wizard of Oz]

Not sure what this thread deteriorated into.

I am a practicing registered med tech who was a PA school reject, and I am a current MS 1. There are some med techs who support PA's wholeheartedly. (Plus I don't do any filing, operating a pulse ox, or pill passing, sorry--did do that stuff as a nurse tech though).

I just didn't want others to feel like med techs are united in their opposition to distinct groups of medial practitioners.

 

[SOUNDMAN]

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.

As a practicing PA returning to medical school this post is right on. Most PA's know there place as well in the medical field. If a PA is not being properly supervised that is both the PA's fault and the supervising physicians fault. PA's have a place in medicine and serve it well, it's when this scope is breached that there probably tends to be problems.

 

[Chronic Student]

Sounds like the volunteer work I did at the red cross with very little training. Also, the Pulse-Ox is not considered "complicated electronic" equipment.

I'm not quite sure if you're deliberately being obtuse or if you're trying to be funny. I am a PA who used to be an MT.

A medical technologist and a medical assisstant are divergent fields.

A medical technologist is a bachelors degree in laboratory science. We take most of the same pre-reqs as medical students and take classes to include clinical chemistry, hematology, immunology, biochemistry, molecular biology, coagulation, UA and body fluids, immunohematology, parasitology, etc.

All of the lab tests you order are the ones we perform or supervise being performed.

What's that you patient has a hemolytic anemia or heriditary spherocytosis or a warm-autoantibody, we'll work them up. Oh, do they have TB or coccidiomycosis, we'll work them up. Oh, you need someone to identify the species of malaria your patient has, we'll do that. You need someone to identify what bug your patient has, that'd be Vibrio vulnificus. What, you think they might have AIDS, who's gonna do that western blot for you.

You get the idea! I don't ever recall handling a pulse-ox as a med tech, although I do remember doing QC on a coulter counter worth a few million.

You really might want to learn something about the professionals who help make things happen in the medical field. I'm sure that you think there is some black box in the sky that spits out lab results. However, there is more than you will ever know that goes into all of that stuff behind the scenes and that will make your job possible in the future. There are also a lot of dedicated professionals who get damn little credit for all that they do!

-Mike

 

[anon-y-mouse]

pa's get the same yr of pharm that md's do skippy.....

Of course taking a year of pharm means one's fully capable of writing prescriptions. Don't pharmacists take even more than a year of pharm along with anatomy, physiology, path, that sort of stuff? Arguably the folks at Walgreens should be able to write me a prescription.

Oh, and

actually most docs make very little off pa owned and operated clinics in nc. they get a basic yearly stipend of a few thousand bucks for being the consulting doc of record, hardly "greatly increasing their income"......

if that's true, I think I'll have some pretty ******ed MD colleagues if I choose to practice in NC... who the hell would risk their medical license to support a non-MD to "practice" medicine if they get basically next to nothing in financial return? Not that any amount of money, for me personally, would be worth putting my career on the line like that.

 

[deleted6669]

"if that's true, I think I'll have some pretty ******ed MD colleagues if I choose to practice in NC... who the hell would risk their medical license to support a non-MD to "practice" medicine if they get basically next to nothing in financial return? Not that any amount of money, for me personally, would be worth putting my career on the line like that."

Pretty low risk. pa pays doc 500 dollars/month or so and buys them their own malpractice policy. they answer very occassional questions by phone during business hrs.
anyone really sick goes to the er so the doc not involved. on site requirement = 30 min every 6 months for a lunch meeting. 6000 dollars a yr for no work with a 3 million dollar malpractice policy thrown in....lots of folks would( and do) say yes to that.
if docs didn't sign up for this it just wouldn't work, but yet it does.

 

[indo]

I'm not quite sure if you're deliberately being obtuse or if you're trying to be funny. I am a PA who used to be an MT.

A medical technologist and a medical assisstant are divergent fields.

A medical technologist is a bachelors degree in laboratory science. We take most of the same pre-reqs as medical students and take classes to include clinical chemistry, hematology, immunology, biochemistry, molecular biology, coagulation, UA and body fluids, immunohematology, parasitology, etc.

All of the lab tests you order are the ones we perform or supervise being performed.

What's that you patient has a hemolytic anemia or heriditary spherocytosis or a warm-autoantibody, we'll work them up. Oh, do they have TB or coccidiomycosis, we'll work them up. Oh, you need someone to identify the species of malaria your patient has, we'll do that. You need someone to identify what bug your patient has, that'd be Vibrio vulnificus. What, you think they might have AIDS, who's gonna do that western blot for you.

You get the idea! I don't ever recall handling a pulse-ox as a med tech, although I do remember doing QC on a coulter counter worth a few million.

You really might want to learn something about the professionals who help make things happen in the medical field. I'm sure that you think there is some black box in the sky that spits out lab results. However, there is more than you will ever know that goes into all of that stuff behind the scenes and that will make your job possible in the future. There are also a lot of dedicated professionals who get damn little credit for all that they do!

-Mike

I know, I was just goofing off.