Whats your opinion on PAs?

[8744]

My only experience being treated by a PA was very positive. The GP presented her a "doctor just like an MD except without the residency." I dare say I prefered her slightly over the MD in this particular case (having been seen by the MD a few times as well), although both are highly respected and competent from what I can tell. She was more professional and competent than many MD's I've run across in similar situations. She was very "by the book" and seemed to be very detail minded, quick, and smart in covering all the possibilities. She initially guessed what turned out the confirmed diagnosis but went through all the steps to confirm that and rule out other possibilities.

She referred me to a specialist and he told me exactly the same thing that the PA told me almost word for word. However, then the specialist told me there was a "short/less rigorous" way (essentially trying a particular drug based on the symptoms and prior test results) and a "long/more rigorous" way of diagnosing this ... which one would I preferred. I picked the short way and it worked out for me.

I won't begin to claim that my experience is typical or representative, but thought it might be worthwhile to contribute another datapoint (which very well could be an outlier). I know there are plenty incompetent PA's out there and that PA's have their limits both in terms of training and in terms of what they are allowed to do.

In other words, nothing like an MD. Knowing what I know about medical training the phrase "just like an MD but without the residency" would be alarming. Shame on your GP. I guess if you have a bogus residency then the natural assumption is that everyone else does.

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[soonereng]

And I'm sorry, that care isn't going to be given by the average NP/PA acting alone ~no matter how smart that person is. Medical education is longer and more vigorous than any NP/PA program ~flame me if you like~and the finished products show it.

I agree with everything you said about PCPs; however, longer and more vigorous education does not equal better or guarantee better products. Let the PA and NP programs continue to develop their curriculum (remember they are baby programs compared to MD programs), and then we can revisit this issue in the 20-30 yr time frame that I was talking about.

 

[OncoCaP]

In other words, nothing like an MD. Knowing what I know about medical training the phrase "just like an MD but without the residency" would be alarming. Shame on your GP. I guess if you have a bogus residency then the natural assumption is that everyone else does.

Actually, I don't remember that the GP never said she was a PA. There was nothing to tip me off. I didn't realize that until later. Everything about the whole experience gave me the impression that she had the MD training. He just said she was doctor without a residency, so I was actually thinking she was an MD who just didn't do a residency.

I can see PA's adding a 6 month "residency" as we speak .

 

[ANCAdoc]

First, let me say that I am not anti-PA. I have met some that seem to really know their stuff, and PA's certaintly have their place in clinical medicine.

However, I do believe that a PA should always inform their patients that they are not a doctor and the patient can ask for the doctor. Could go something like this:

"Hi Mr. Smith. My name is Susan, and I am a physician assistant for Dr. Bond. Is it OK that I see and treat you today?"

If the patient asks what is a PA, then go ahead and tell them. But be upfront that you are not a doctor.

 

[OHMAN0125]

Actually, I don't remember that the GP never said she was a PA. There was nothing to tip me off. I didn't realize that until later. Everything about the whole experience gave me the impression that she had the MD training. He just said she was doctor without a residency, so I was actually thinking she was an MD who just didn't do a residency.

I can see PA's adding a 6 month "residency" as we speak .

What is up with all this let's put PA at same level as MD business. Is this the allopathic forum or not? Aren't we all going to be MDs? Come on ppl, I have nothing against PA/NPs, but the truth is that MD's are under attack from all other health professions. They are taking things away from us cause we are at the top of the totem pole. No matter how much you want to say that PA/NP are just as good, we must protect our own profession. Conceding that they can do anything we do is erroneous and detrimental to our profession, regardless if ur a specialist or PCP.

 

[deleted6669]

First, let me say that I am not anti-PA. I have met some that seem to really know their stuff, and PA's certaintly have their place in clinical medicine.

However, I do believe that a PA should always inform their patients that they are not a doctor and the patient can ask for the doctor. Could go something like this:

"Hi Mr. Smith. My name is Susan, and I am a physician assistant for Dr. Bond. Is it OK that I see and treat you today?"

If the patient asks what is a PA, then go ahead and tell them. But be upfront that you are not a doctor.

or in my case....hi my name is emedpa. I am the only clinician here tonight in the emergency dept.
if you want someone else you can leave because I'm it....the doc on day shift will be here in 12 hrs...feel free to sit in the waiting room with chest pain, etc until then. have a nice day.....

 

[8744]

Actually, I don't remember that the GP never said she was a PA. There was nothing to tip me off. I didn't realize that until later. Everything about the whole experience gave me the impression that she had the MD training. He just said she was doctor without a residency, so I was actually thinking she was an MD who just didn't do a residency.

I can see PA's adding a 6 month "residency" as we speak .

Anybody can pretend to be a doctor. That's why they get actors who play doctors to star in commercials. Additionally, anyone can sound authoritative on any narrow subject if they know a lot about it. It doesn't take too much to impress (set at ease?) most patients if all you're talking about is their garden variety diabetes.

 

[soonereng]

Aren't we all going to be MDs?

Uhuh...

They are taking things away from us cause we are at the top of the totem pole.

Exactly what I was talking about with the reference to The Innovator's Dilemma.

 

[OHMAN0125]

Uhuh...



Exactly what I was talking about with the reference to The Innovator's Dilemma.

After u get through ur first year of med school and then pathology/pathophysiology, then maybe u'll understand truly what the difference in education level is.
However, I take nothing away from PA/NPs, they are crucial in the healthcare team. I just REALLY don't feel they have the same level of education or training. I'm not sure if you're implying this or not, my apologies if i've misunderstood your post.

 

[soonereng]

After u get through ur first year of med school and then pathology/pathophysiology, then maybe u'll understand truly what the difference in education level is.

Which is why I prefaced my original post with I could tell you next year in a direct comparison. I remember helping my wife study for pathophys...hard class.

I just REALLY don't feel they have the same level of education or training. I'm not sure if you're implying this or not, my apologies if i've misunderstood your post.

Agreed that they don't have the same level of education or training; however, I submit that the level of education and training that they receive is more than adequate for a majority of primary care patients.

 

[anon-y-mouse]

or in my case....hi my name is emedpa. I am the only clinician here tonight in the emergency dept.
if you want someone else you can leave because I'm it....the doc on day shift will be here in 12 hrs...feel free to sit in the waiting room with chest pain, etc until then. have a nice day.....

"I am the only clinician" translates into people assuming you're a doctor... you're technically right, but it's still the common assumption since people just assume everyone who is in a white coat is a doctor. I personally feel that for the interest of public safety, non-physicians treating people should be required by law to say "I am not a physician" or the equivalent, before they start treatment.

I submit that the level of education and training that they receive is more than adequate for a majority of primary care patients

That's the thing, physicians are paid so much because they are trained to recognize and manage the zebras.

 

[soonereng]

That's the thing, physicians are paid so much because they are trained to recognize and manage the zebras.

Exactly, and a PA or NP could then refer them to an MD who learned how to recognize and deal with zebras. It reduces patient load on MDs and reduces the cost of healthcare, both positive factors. It's a win-win situation, which is why it will continue to grow.

 

[MystikBliss]

Ummm to the previous post...MD's get paid so well because look at the crap we have to go through to get there. Before I went to med school I wasn't sure of why either, but my first month, I knew why. Who the hell would go through med school only to get paid what other health care professionals get??

As for PA's...some good...some bad...depends on the person. I would NEVER turn my nose up at a PA, but at the same time, having to go through what MD/DO's do, I have a lot more respect for them and think they should get all the benefits that they do.

 

[anon-y-mouse]

Exactly, and a PA or NP could then refer them to an MD who learned how to recognize and deal with zebras. It reduces patient load on MDs and reduces the cost of healthcare, both positive factors. It's a win-win situation, which is why it will continue to grow.

Learning to recognize when to refer is yet another art. Also, not everyone is going to have "complicated" medical problems... reducing patient load also reduces physician compensation, and as the midlevel power grab increases, this problem is going to continue. What a shame, America is the only country where people are too cheap to pay for proper healthcare, hence all these shortcuts and halfassed treatment. Also, on another note, since you're not even in med school, please refrain from making any assumptions, comparisons or characterizations of what the education is like... if you make it one day, your perspective will surely change.

 

[soonereng]

if you make it one day, your perspective will surely change.

Since you haven't attended PA or NP school please refrain from making judgments about their curriculum as well.

If I make it...you doubt my skills or perseverance? And I am sure my perspective will surely change, although I am pretty sure my conclusion will not.

 

[deleted6669]

"I am the only clinician" translates into people assuming you're a doctor... you're technically right, but it's still the common assumption since people just assume everyone who is in a white coat is a doctor. I personally feel that for the interest of public safety, non-physicians treating people should be required by law to say "I am not a physician" or the equivalent, before they start treatment.
That's the thing, physicians are paid so much because they are trained to recognize and manage the zebras.

I have stuff all over me that screams "pa"
my lab coat says
emedpa, pa-c, emt-p

my hospital id says" emergency medicine physician assistant" in huge letters and all my aftervisit summaries and prescriptions say
emedpa, pa-c

also when I introduce myself I say" hi' I'm emedpa, one of the staff pa's here"

if they don't know I am a pa they are brain dead....

and regarding money....I make 20/hr more than fp docs who moonlight in the dept so they are actually paying more for my em experience vs using an fp doc. if they wanted to save money they would staff all fp docs all the time.
I make less than em docs( obviously) because they have a better skills and experience base than I do and I make more than the fp docs for the same reason.

"What a shame, America is the only country where people are too cheap to pay for proper healthcare, hence all these shortcuts and halfassed treatment."

other places that currently use pa's or will by the end of the decade:
england, scotland, austrailia, holland, canada, singapore, taiwan

other places that will probably start pa programs within 20 yrs: everywhere else.....

 

[deleted6669]

"I can see PA's adding a 6 month "residency" as we speak ."

www.appap.org

you will notice that many of these are at no name places like duke, hopkins, yale, etc.....

 

[MacGyver]

"I can see PA's adding a 6 month "residency" as we speak ."

www.appap.org

you will notice that many of these are at no name places like duke, hopkins, yale, etc.....

Info from the Duke program:

As required by state law, the PA Resident's supervising physician will supervise all clinical activities of the PA Resident.

Isnt this the same state that allows MDs to "supervise" PAs by only a 5 minute meeting once a year with zero on-site time? I'm wondering why Duke doesnt follow this model. Surely the PAs at duke are good enough to work totally unsupervised except a 5 minute block each year.

 

[anon-y-mouse]

"What a shame, America is the only country where people are too cheap to pay for proper healthcare, hence all these shortcuts and halfassed treatment."

other places that currently use pa's or will by the end of the decade:
england, scotland, austrailia, holland, canada, singapore, taiwan

other places that will probably start pa programs within 20 yrs: everywhere else.....

Too bad. I'm sure the situation in those countries is quite a lot different than in America, and the way in which they are being incorporated. Even if not, the last thing the world needs is more wannabes playing doctor. There is a place for midlevel providers, but it should definitely complement a physician's touch rather than replace it.

 

[8744]

...Agreed that they don't have the same level of education or training; however, I submit that the level of education and training that they receive is more than adequate for a majority of primary care patients...

That's why as long as primary care, especially Family Medicine, continues to embrace the role of "gatekeeper" they will be squeezed out by mid-levels.

But as you will generally find, and I'm repeating myself here, the difference in knowledge and skill between a trained PA and an attending physician is vast. Amateurs, which is what most medical students are, don't see the obvious distinction because, with apologies, they don't know that much. The majority of your medical training is in residency which is why I have to laugh when I hear PAs insist that they are equivalent to "permanent residents." I know they mean that they always need supervision but it is obvious to anybody in residency that there are very few few PAs who can even hold a small candle to a senior resident in any specialty you care to name.

Doesn't mean that mid-levels aren't smart. from a purely economic point of view maybe going to PA school is a smarter decision than going to medical school. Doesn't mean they don't know things either. The respiratory therapists at our hospital are better at intubating and managing airways then I am so I keep my mouth shut and listen to what they say. But they don't pretend to be doctors and I don't pretend to be a respiratory therapist and we all just get along.

 

[deleted6669]

Too bad. I'm sure the situation in those countries is quite a lot different than in America, and the way in which they are being incorporated. Even if not, the last thing the world needs is more wannabes playing doctor. There is a place for midlevel providers, but it should definitely complement a physician's touch rather than replace it.

actually the pa's in england now are used as em "consultants" and essentially function at the level of permanent senior residents, including training junior residents. I have been offered positions over there and may take one when the kids are a bit older.

for your consideration:
Role of Physician Assistants in the accident and emergency departments in the UK
Ansari U, Ansari M, Gipson K. Accident and Emergency Department; Warwick Hospital, UK
Published in 11th International Conference on Emergency Medicine, Halifax, Nova SCotia, Canada, June 3-7 2006 and Journal of Canadian Emergency Medicine, May 2006, Vol 8 No 3 (Suppl) P583

Introduction: The Accident and Emergency departments in the UK are under severe pressure to expand their staffing levels in a bid to try and comply with the 98% target for 4-hour waiting times set by the government. Increasing staffing levels is proving to be very difficult when a majority of Staff Grades have already left or are leaving to become General Practitioners for financial gains and better working hours. This combined with a limited number of FY2 doctors being allowed to work in Accident and Emergency departments poses new challenges to staffing within Accident and Emergency. The objective of this study was to evaluate the training requirements, GMC regulations and supervision required to perform a suitable role in Accident and EMergency following the appointment of two Physician Assistants at City Hospital, Birmingham. Methods: The activities of two Physician Assistants at City Hospital were monitored for two months. All case records were reviewed and the number and type of patients seen by the assistants recorded. These were then compared with the records of those patients seen by Senior House Officers. Monitored information included number of patients seen, type of patients seen as well as the quality of the notes. Results: On average, Physician Assistants at City Hospital treated 3-5 patients/hour compared to 1.5-2.5/hour seen by Senior House Officers. Physician Assistants were able to deal with most medical, surgical, orthopaedic and gynaecological problems with minimal supervision. The medical records revealed that documentation was better by Physician Assistants. Conclusion: Senior Physician Assistants from the USA are an effective way to improve staffing within Accident and Emergency Departments with the UK. Physician Assistants saw more patients and required less supervision than Senior House Officers. Physician Assistants proved to be a cost effective method of supporting Accident and Emergency doctors at City Hospital, Birmingham.

 

[OHMAN0125]

Too bad. I'm sure the situation in those countries is quite a lot different than in America, and the way in which they are being incorporated. Even if not, the last thing the world needs is more wannabes playing doctor. There is a place for midlevel providers, but it should definitely complement a physician's touch rather than replace it.

What's sad is that the government likes to cut costs, so unless the primary care docs especially family med really lobby hard, they may lose this battle. Unfortunately it almost seems like an inevitability in my opinion.

 

[mjl1717]

or in my case....hi my name is emedpa. I am the only clinician here tonight in the emergency dept.
if you want someone else you can leave because I'm it....the doc on day shift will be here in 12 hrs...feel free to sit in the waiting room with chest pain, etc until then. have a nice day.....

Oh baby! That was deep! Probably too deep for many on this forum. So deep that many on this forum dont know they cant touch that especially a 1st and probably a 2nd year resident. Well said with your 20 year experience.
That was kind of like the KNOCK OUT punch. And seriously, in the medical heirachy- pond scum, algae, one celled organisms etc.-the med student is barely pond scum or barely hot air.

 

[Taurus]

Keep climbing the foodchain.

Keep climbing the foodchain.

....

 

[ForbiddenComma]

Amateurs, which is what most medical students are,

WHAT! How dare you denigrate my vast well of experience as a medical student!


...


ok, never mind.

 

[mjl1717]

WHAT! How dare you denigrate my vast well of experience as a medical student!


...


ok, never mind.

Let me make this perfectly clear, its not an ego or self esteem thing. Either one is nothing, pond scum, algae, one celled organism, somewhere in between, or the ultimate which Id say is being Osler-like. Unfortunately many M.D.s will not attain ANYTHING near Osler like accumen/clinical index of suspician (spelling). Very early in this medical saga
I was told by an intern that the most important thing is the "hands on" I repeat "hands on" experience. And thats basically the whole story.

 

[Wizard of Oz]

but the truth is that MD's are under attack from all other health professions. They are taking things away from us cause we are at the top of the totem pole. No matter how much you want to say that PA/NP are just as good, we must protect our own profession. Conceding that they can do anything we do is erroneous and detrimental to our profession, regardless if ur a specialist or PCP.

"Under attack?" Docs, if you don't want PA's, don't hire them! It's like Bush being under attack by Condie because she's a better leader. If you don't want them to have the same rights as docs, vote in like-minded politicians, convince the public through your superior service, or just bribe congressmen like drug companies. It's that simple! PA's were created to pad your pockets. They work for docs.

"I'm Doctor Smith. I want to make more money or serve a wider variety of constituents by hiring a midlevel. I don't have the time to see all of them myself. My PA's name is Jones."

Patient: You're a what?
Jones: I'm a PA. I work for Doctor Smith.
Patient: But I want to see THE DOCTOR.
Jones: She can't see you until next month.
Patient: Get me THE DOCTOR!

Smith: What seems to be the problem, ma'am?
Patient: Is this PA as good of a provider as you?
Smith: Um, well, no, you see he wasn't trained properly in the basic sciences. He can't possibly know how to prescribe meds as good as me. He's inferior.
Patient: So why would I want to come to your practice for treatment if PA's are so inferior?
Smith: That's a good question. I don't know. Since midlevels all suck compared to me, and I hired one, I must be an idiot. You're right, you shouldn't have come to see me.
Patient: So why have them?
Smith: Well they control costs and threaten real medical professionals. Of course, since they are inferior, they will all bring us a multitude of malpractice lawsuits in the near future and then die out on their own. It's just a shame that new American docs don't want to do primary care anymore. If they did, we could prevent this infection by midlevels who we hire.
Patient: Can you refer me to another doc?
Smith: No because all of them I know who can get you in quickly use midlevels. You've just cost me a minute of my time. Please pay the clerk on your way out. Have a nice day!

 

[1Path]

I'm gonna have to call BS on this one.

My post should have read that their basic science knowledge IS the same. And obviouly I'm not talking about ALL PA's schools, but a PA friend of mine just finished at the #1 ranked PA school and she said she took quite a few basic science courses WITH med students.

So maybe the "BS" is with the PA program YOU attend since they are definitely NOT the same.

 

[pristine21]

OK I am in Medical School, and my best friend is in PA school. Sometimes we study together, and this is what I have found out: I get taught everything, the most common stuff is given the same time, if not less, than the zebras. For example during lymph heme, we had ~30 seconds of one lecture talking about EBV, while she had a good ~15 min, describing the most to least common clinical presentations. However, she was never even exposed to all the variations in the thalasemias and different presentations and how to tell the difference, because they are so rare. So in short I think PA's are valuable because they know a lot about the most important stuff, but they will never replace MD's because the rare, and most difficult types of cases are exposed to us, in medical school. I think the MD curriculum expects you to see the common stuff on the floors, and thats why they dont spend much time teaching it, while the reason PA school was developed is to have a group of practicioners competent in the most common disease processes....

 

[dilated]

My post should have read that their basic science knowledge IS the same. And obviouly I'm not talking about ALL PA's schools, but a PA friend of mine just finished at the #1 ranked PA school and she said she took quite a few basic science courses WITH med students.

So maybe the "BS" is with the PA program YOU attend since they are definitely NOT the same.

So the #1 PA school in the country is, what, Duke? And the PAs there have an average percentile score _on the GRE_ of about 65th percentile to get admission to that program. At Duke med, on the other hand, the average MCAT- a far harder test- is above the 92nd percentile.

I can take classes on quantum physics with the physics grad students. Doesn't mean I'll know what the hell I'm doing. Somehow I doubt the PAs are on the curve with the med students.

 

[deleted6669]

"I can take classes on quantum physics with the physics grad students. Doesn't mean I'll know what the hell I'm doing. Somehow I doubt the PAs are on the curve with the med students."


guess again...some of us actually were even tutors......I taught many med students to understand their pharmacology.....

 

[OHMAN0125]

The thread lives on.

 

[1Path]

So the #1 PA school in the country is, what, Duke? And the PAs there have an average percentile score _on the GRE_ of about 65th percentile to get admission to that program. At Duke med, on the other hand, the average MCAT- a far harder test- is above the 92nd percentile..

And we all know that test scores mean EVERYTHING!

This entire thread reeks of insecurity and I'm sure that somewhere in cyberspace, PA students and PA's are laughing their a$$E$ off and I for one, am laughing right along with them!!

 

[SecretDove]

The fact that a patient can see a PA and not ever know they are not an MD is dangerous. Seems like deception to me.

If the patient doesn't know that, it's their own fault. Any PA or NP I've ever dealt with has their credentials clearly marked on a nametag or embroidery on a labcoat. The signage in the doctor's office also introduces the clinicians and says "so and so MD", "so and so, DO", "so and so PA", "so and so NP".

You make it sound like patients brave enough to see a PA and not an MD should sign a waiver or something.

 

[Wizard of Oz]

The thread lives on.

Yes, unfortunately so. Normally I just let these flame wars die, but not only do I have well-trained friends who are PA's, but I was rejected to PA school; and our most knowledgable neuroanatomy professors in med school are PA's. Furthermore, I prefer going to them as a patient.

This entire thread reeks of insecurity and I'm sure that somewhere in cyberspace, PA students and PA's are laughing their a$$E$ off and I for one, am laughing right along with them!!

You smell that too, do ya?

Everybody makes choices that suit them best. Some of my smartest students when I was teaching at the undergrad level went on to become PA's because of the nature of the training and lifestyle. Since my college's PA school is much more heavily respected (substitute USN/WR ranked if you wish) than it's med school, the PA career path gets a lot of publicity here. It should--I live in a rural state starving for them. It is not uncommon for students to desire the PA path over medicine. It's a personal choice. It's not about being any better or more qualified, it's about doing what you want to do in life (or having choices to work in many different specialties).

 

[dilated]

And we all know that test scores mean EVERYTHING!

Yes, someone who scores in the 92nd %ile on the MCAT is LIKELY to be smarter than someone who scores in the 65th %ile on the GRE. Sorry.

And considering I'm planning on surgery I'm not too skerrd by the onslaught of PAs. When they start doing their own CABGs I'll start to care.

 

[OHMAN0125]

Yes, someone who scores in the 92nd %ile on the MCAT is LIKELY to be smarter than someone who scores in the 65th %ile on the GRE. Sorry.

And considering I'm planning on surgery I'm not too skerrd by the onslaught of PAs. When they start doing their own CABGs I'll start to care.

I agree with you for the most part that most PA students did it because they could not compete for MD schools. But I know of some exceptions where it was the lifestyle, etc. In other words, generalizations = Bad. With that said, i'm guessing ur going into CardioThoracic surgery? Shouldn't u be scared of the cardiologists? Lol. J/K

 

[deleted6669]

FROM THE DUKE MEDICAL CENTER WEBSITE:
ORLANDO, Fla. -- A study by Duke University Medical Center researchers has shown that
physician assistants, with proper training can successfully perform cardiac catheterizations.

"Under the careful supervision of experienced attending cardiologists, trained physician
assistants can perform diagnostic cardiac catheterization, including coronary angiography, with
procedural times and complication rates similar to those of cardiology fellows. This is the first
large study that demonstrates that this is a safe practice," said Dr. Richard Krasuski, a Duke
cardiology fellow who led the study which was presented Wednesday at the 50th Annual
Scientific Session of the American College of Cardiology.

Physician assistants (PAs), who originated at Duke in the 1960s, work with physicians to provide
diagnostic and therapeutic patient care in virtually all medical specialties and settings. Cardiac
catheterization involves threading a thin catheter through a patient's arteries until it reaches the
heart. X-ray dye is then injected to determine if the arteries are blocked.

"With cardiac catheterizations increasing more than 300 percent during the last 10 years,
physician assistants have begun performing more of these procedures under the supervision of
cardiologists. However, there was insufficient evidence before this to support whether this was a
safe practice," Krasuski said.

The Duke study compared 929 diagnostic cardiac catheterizations performed by PAs with
supervision by a cardiologist to 4,521 catheterizations performed by cardiology fellows.
Cardiology fellows are physicians receiving three to four years of advanced training in cardiology
after completing an internal medicine residency. The procedures were performed at Duke
between July 1998, when PAs were first given approval by the institution to perform the
procedure, and April
2000. The patients in the two groups were of similar demographics.

The study showed that the incidence of major complications, such as myocardial infarction (heart
attack), stroke, arrhythmia requiring defibrillation or pacemaker placement, pulmonary edema
requiring mechanical ventilation and vascular complications requiring surgical intervention, were
nearly identical in both groups. For PAs, the complication rate was
0.54 percent as compared to a
0.58 percent complication rate for cardiology fellows.

Additionally, the cases performed by the PAs were done more quickly (
70.2 minutes versus
72.6 minutes by the cardiology fellows), and used less fluoroscopic time (
10.2 minutes as compared to
12.2 minutes).
"We are not saying that PAs should replace doctors in performing cardiac catheterizations. What this study shows is that this is a skill that can be learned
and successfully performed by PAs, thus permitting cardiologists to become more efficient in the
cath lab while maintaining excellent patient care," Krasuski said.

Krasuski added that with the involvement of PAs, cardiologists are freed up to interpret data
generated by the catheterization, plan the patient's follow-up care and even consult with
referring physicians while the case is still going on.

PAs must receive approximately one year of specialized training to properly perform the
procedure. Additionally, they must have advanced life support training, remain up-to-date on the
latest techniques and information on catheterization and be approved by cath lab directors and
faculty to perform catheterizations.
Joining Krasuski in the study were Dr. John Warner, Dr. Andrew Wang, Dr. J. Kevin Harrison,
John Bolles, Erica Moloney, Carole Ross, Dr. Thomas Bashore and Dr. Michael Sketch Jr.

 

[ANCAdoc]

It is unfortuante that the sample sizes do not match. There is a reason why sample sizes as close as possible are usually the gold standard in research. The authors could have pulled 900 random samples of the 4000. Then, let's see how the results turn out (note, i do not presume they would be different, just a better way to compare).

Also, they compared PA with cardiology supervision vs. cardio fellow. Were these fellows under cardiologist supervision? If not, sounds like an unfair comparison. My guess is that it is likely they flew solo or were teaching a resident. If this isn't mentioned in the study, shame on the reviewers (and authors).

 

[Chronic Student]

My post should have read that their basic science knowledge IS the same. And obviouly I'm not talking about ALL PA's schools, but a PA friend of mine just finished at the #1 ranked PA school and she said she took quite a few basic science courses WITH med students.

So maybe the "BS" is with the PA program YOU attend since they are definitely NOT the same.

I did attend the #7 ranked program (tied with another program) and it has a very good reputation.

The basic science knowledge IS NOT THE SAME. PERIOD. There is no question about it.

I don't care what PA school they attend, there is simply not enough time in PA school to cover the depth and breadth of basic science material that is covered in med school.

-Mike

 

[Wizard of Oz]

Yes, someone who scores in the 92nd %ile on the MCAT is LIKELY to be smarter than someone who scores in the 65th %ile on the GRE. Sorry.

Tough to compare GRE vs. MCAT. My MCAT actually was in the 90th percentile. GRE, 60th. Sorry

 

[deleted6669]

I did attend the #7 ranked program (tied with another program) and it has a very good reputation.

The basic science knowledge IS NOT THE SAME. PERIOD. There is no question about it.

I don't care what PA school they attend, there is simply not enough time in PA school to cover the depth and breadth of basic science material that is covered in med school.

-Mike

agree- med school goes much more into depth with things like neuroscience, embryology, histology, etc
that being said you don't really need all of this stuff in most medical fields and most docs probably forget the stuff that does not apply to their specialty. the goal of medschool, however is to prepare the clinician to be able to work in all fields and there are some specialties in which knowledge of embryology for example might be crucial.
my dad was a specialty doc and one of his favorite statements about medschool was " you only need to know half of what they teach in medschool to be a competent doctor, unfortunately they haven't figured out which half yet".
pa school focuses on what is needed to practice clinical medicine with very little focus on preparing folks for research positions or work in fields requiring a strong basic science background. the thing pa programs do as well( if not better per a pa friend of mine in medschool now) is to teach pa's how to perform an excellent hx and physical exam. we spent A LOT more time on this than the medtudents at my school. in part this is because the medstudents will have more clinical time to figure this out. we need to know it cold. having seen pa students vs 3rd/4th yr med students perform a complete neuro exam( the 30 min variety) the pa does a more thorough exam hands down the majority of the time.

medschool trains folks to pass usmle steps 1-3.
pa school basically covers the material needed to pass steps 2 and 3 but not 1.

 

[ANCAdoc]

I'd love to see how PA's would perform on the Steps 2 and 3. Even on the interview portion of Step 2.

 

[deleted6669]

I'd love to see how PA's would perform on the Steps 2 and 3. Even on the interview portion of Step 2.

pa's I know who have gone to medschool have said that they could have passed step 2 and 3 right out of pa school.
until 1996 the pa board exam was a week long exam with 3 required practicals, a primary care exam, a core medical knowledge exam, and a surgical exam.
now it's just a sit down 3 hr test on the computer. it's a damn shame they changed it.
the rule of thumb I have heard for the usmle is this:
step 1 study for a month
step 2 study for a week
step 3 bring a #2 pencil.....

 

[1Path]

Tough to compare GRE vs. MCAT. My MCAT actually was in the 90th percentile. GRE, 60th. Sorry

Interestingly, 3 times in my life it was a DOCTOR that fcuked up and almost killed me. Thank goodness those other dumb a$$ health professionals were there to save me! Arrogance in medicne will always be deadly.

 

[georgia_md]

Interestingly, 3 times in my life it was a DOCTOR that fcuked up and almost killed me. Thank goodness those other dumb a$$ health professionals were there to save me! Arrogance in medicne will always be deadly.

No matter who treats who, Doc or PA or Pee Wee Herman, people are going to die. It's inevitable. It is just convenient for you to place the entire blame on the doc, because he is the boss.

The controversy continues...

 

[mjl1717]

Interestingly, 3 times in my life it was a DOCTOR that fcuked up and almost killed me. Thank goodness those other dumb a$$ health professionals were there to save me! Arrogance in medicne will always be deadly.

Interesting and strong comment.

1)Just an aside, paramedics and EMT probably dont get the respect they deserve since they by themselves in the inner city diffuse potentially deadly and volatile situations. And on their own triage, prevent and stabilze potentially fatal situations.

2)On the other hand the E.R. doc has an entire team around him possibly saying "well I wouldnt do that", kind of like a check and balance system.

3)Also emedpa I usually agree with you. But this time having studied for both P.A. and M.D. exams {by the way that last P.A. certification exam taken July/06 that I took was more like 7 or 8 hours} My point is that I disagree that most new or old PA grads would easily pass step2ck or step3 USMLE.
Even the interview part step2cs in the above scenario would probably be a total embarrasment!
.
4)In my opinion step 2 cs, {a relatively new exam} was created to make sure IMGs could understand a difficult language, overcome cultural gaps and give a patient at least a decent level of communication. Also in my opinion step 2 cs -for Americans grads was created to lower their ego/ self esteem and get off a high horse. But in addition to make absolutely certain they could communicate properly, concisely, with respect, at the right time in words that the patient can understand-{something that most born indigenously to this country feel they are automatically born with} Just my 2 cents.

 

[anon-y-mouse]

pa's I know who have gone to medschool have said that they could have passed step 2 and 3 right out of pa school.
until 1996 the pa board exam was a week long exam with 3 required practicals, a primary care exam, a core medical knowledge exam, and a surgical exam.
now it's just a sit down 3 hr test on the computer. it's a damn shame they changed it.
the rule of thumb I have heard for the usmle is this:
step 1 study for a month
step 2 study for a week
step 3 bring a #2 pencil.....

Emedpa, it sounds like you really want to be a physician and the way you've described, it seems quite trivial for you to go back and get that degree, so why don't you do it? You've totally trolled this thread, since it is about the opinion of MEDICAL STUDENTS.

I don't even know where to begin with this "rule of thumb" thing: it is largely true, but NOT because the tests are trivial. The best way to perform well on step 1 is to do well in one's classes. Routine shelf exams in the basic science courses keep people on their toes and learning that material in the first place means that people don't have to spend 6 months preparing for the exam. As for step 2, people study every day and hardcore for 1-2 weeks before every NBME shelf exam of every core rotation -- if you add this all up, and then add the time spent preparing for step 2, it is a LOT more than 1 week. As for step 3, it is largely insignificant, since one will have already had residency.

Also, a lot of physicians do NOT forget the basic science material... it may not roll off the tongue, but it's still somewhere hazily in the cortex, and reading journal articles or seeing it in context usually rouses that material again. I had a 65 year old PSYCHIATRIST pimp me on the cause of cleft lip when we saw a mother whose child had it (medial + maxillary prominences fail to merge). My super old surgeon preceptor walked me through the clotting cascade and the biochemical cascades involved in the metabolism of heme (and which pathology was apparent in the patient), *while* performing surgery. Also, the embryology is NOT trivial and useless, it's really important in fields like pediatrics, where congenital defects are fairly common. It's a pretty common saying in medicine that things are way easy to learn (or at least recognize) the second time around after one's learned it in the first place. Of course midlevels are not paid to recognize these things and are instead glorified nurses. I am sure there are decent patient outcomes when midlevels treat patients. Of course that is largely because there are already established routines and guidelines for treating most common illnesses.

As I said earlier, of course there is a place for non-doctors, but these non-doctors should recognize and realize what they DO NOT KNOW. The attitude put forth by emedpa regarding the "uselessness" of biochem, embryology, histology, and so on is scary... these things ARE useful in some ways and do come up.

I'm glad pandabear's laughing about this... it seems clear to him as a physician the clear difference in knowledge base.

I encourage fellow med students to learn to recognize these overconfident attitudes and NOT sublet their medical license to allow someone free reign if they're just going to have a monthly lunch meeting and no other oversight.

 

[soonereng]

Of course midlevels are not paid to recognize these things and are instead glorified nurses.

I was going to stay out of this, but you have no idea... there are midlevels who MDs refer patients to because they are better than the MDs at treating certain things and the MDs know it. The same works in reverse. It is about getting the best care for your patient rather than some "I know more than you" ego contest. The psychiatrist you talked about might remember some embry, but they wouldn't dare try to treat the patient themselves, because they know that there are others more capable than themselves, even the "glorified nurses."

Also FYI, NPs in my state (and many others) practice under their own licenses and malpractice insurance, so maybe in the future when you want to make more money or see more patients than you can solo, you should hire an NP that way you won't have to worry about subletting your medical license. In the end it always comes down to time and money...

Also, the embryology is NOT trivial and useless, it's really important in fields like pediatrics

Very true, also very important in ENT...

You've totally trolled this thread, since it is about the opinion of MEDICAL STUDENTS.

Yes, and as a STUDENT you should realize that you may not know everything, otherwise, you have no reason to be a STUDENT and should be a teacher. I realize I don't know everything and have much to learn from MS1s, MS2s, MS3s, MS4s, PGY1s, PGY2s, PGY3s, PGY4s, MDs, DOs, PAs, NPs, CRNAs, CNMWs, and probably some more alphabet soup that I don't even know yet; but one thing I do know, arrogance will get you nowhere in medicine but a trip to court.

 

[1Path]

I realize I don't know everything and have much to learn from MS1s, MS2s, MS3s, MS4s, PGY1s, PGY2s, PGY3s, PGY4s, MDs, DOs, PAs, NPs, CRNAs, CNMWs, and probably some more alphabet soup that I don't even know yet; but one thing I do know, arrogance will get you nowhere in medicine but a trip to court.

I read somewhere that half of all medical malpractice suits would never have been taken to that level if the doctor at fault had simply apologized to the patient. And having noticed a trend where medical professionals have become increasingly arrogant over the 20 or so years I've worked around and with them, I'm starting to have little empthy for the poor physician who finds himself (yes, often a dude) in court.