Whats your opinion on PAs?

[8744]

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Hey, I don't want to get sucked into the anti-PA camp. I like PAs and if they can do the job, they should.

On the other hand, the idea that PAs could take and pass Step 1 and 2 right after PA school (or before it) is ludicrous. A lot of medical students barely pass the Step tests and some (seven percent of American students) fail it on the first attempt.

As for PAs doing heart caths, why have PAs do it all? Why not train a few reasonably motivated, intelligent high-school students to do it? It's not that conceptually difficult after all. You shoot some dye and visualize the arterial flow of a relatively simple organ. Why stop at that? I bet you can train cosmotology majors at the local community college to do simple abdominal operations. Maybe we could have a few PAs on home call in case of complications. The scrub nurses could help because they've seen the operation hundreds of times.

I guess PAs are just super doctors and we need to eliminate the medical degree as it is obvioulsly largely unnecessary.

Serioulsy. It's pretty much only medical students who feel threatened by PAs. Once you get some training you'll understand.

 

[anon-y-mouse]

So , are you saying, we can bomb step 3 with no significant consequences?

I am MS1. Do people usually take step 2 right after the 1st year? I am just a little worried, cause I haven't started studying for it yet.

???????

Step 1 after you finish your classroom training, after 2nd year in most cases. Step 2 CK + CS usually after your core rotations, around 4 year ish. Step 3 during intern year.

 

[anon-y-mouse]

MD's refer patients to midlevels? I thought you hadn't had any medical training at all, why don't you give examples? That's absolutely unheard of. Perhaps pandabear can shed some light on this since he's been out there. Also, it's not really an issue of "wouldn't dare treat" -- I mean, once psychiatrists get their unrestricted license, I don't think they'd feel totally comfortable managing some complicated heart condition, but technically the law says that they can do it. For basic acute conditions, psychs usually feel comfortable giving the appropriate antibiotics or whatever.

Of course we all have things to learn. If you looked at a first year midlevel student and a first level med student, I'm sure the midlevel student knows a lot more of practical knowledge of how to go in and see the patient and get the job done... the rate of learning is totally different -- students of medicine do a thorough job, and I'm sure during rotations, nurses teach students quite a lot, but at the end of residency, the picture completely changes. It's two totally different growth curves.

On the other hand, the idea that PAs could take and pass Step 1 and 2 right after PA school (or before it) is ludicrous. A lot of medical students barely pass the Step tests and some (seven percent of American students) fail it on the first attempt.

👍 👍

 

[OHMAN0125]

Serioulsy. It's pretty much only medical students who feel threatened by PAs. Once you get some training you'll understand.

Thank god for Panda Bear. No disrespect for PAs at all, but I'll pose a scenario (totally fictional for the anal out there), say there is an emergency trauma where ur the attending physician in the ER and you only have time to do one thing to stabilize the patient and you feel you know what to do. However, a PA that is with you says something totally different (you don't have time to look this **** up). Are you going to go with your expereince or go with the PAs decision. And if you ignore his input do you call this arrogance?? There is a reason for the hierarchy I believe.
Not taking anything away from PAs either, they're amazing but as Panda Bear says, it's a huge difference.
Now I bet someone is going to say that the attending doc may be wrong...blahblahblah. THat may be true, but are humans perfect?? Do PAs not make critical mistakes?

 

[OHMAN0125]

MD's refer patients to midlevels? I thought you hadn't had any medical training at all, why don't you give examples? That's absolutely unheard of. Perhaps pandabear can shed some light on this since he's been out there. Also, it's not really an issue of "wouldn't dare treat" -- I mean, once psychiatrists get their unrestricted license, I don't think they'd feel totally comfortable managing some complicated heart condition, but technically the law says that they can do it. For basic acute conditions, psychs usually feel comfortable giving the appropriate antibiotics or whatever.

Of course we all have things to learn. If you looked at a first year midlevel student and a first level med student, I'm sure the midlevel student knows a lot more of practical knowledge of how to go in and see the patient and get the job done... the rate of learning is totally different -- students of medicine do a thorough job, and I'm sure during rotations, nurses teach students quite a lot, but at the end of residency, the picture completely changes. It's two totally different growth curves.



👍 👍

You know what ticks me off. I dont know if its true yet, but I'll find it next year when I start clinicals. I hear that a lot of midlevels and nurses are always pimping medical students and making us look ******ed. No crap they have more clinical experience at that time. Dam humans and their insecurity. AUGH.

 

[deleted6669]

"MD's refer patients to midlevels? why don't you give examples? "

ok-
1.the headache specialist at a large neurology group in washingon is a pa. other neurologists refer their difficult h/a pts to him.
the other neuro guys need to stay sharp regarding everything in neurology( parkinsons, seizure d/o's, new tx of cva, etc) while he has just done h/a medicine exclusively for 23 yrs including a h/a fellowship at the mayo clinic.
he has presented numerous topics at md neurology conferences and written a book on understanding h/a's for clinicians and laypeople.
his book:
http://www.amazon.com/Why-Your-Head...ef=sr_1_1/103-5482982-5723028?ie=UTF8&s=books

2. the local gi group has most of their hep c pts managed by pa's. when a doc in the community refers a pt to this group for management of hep c they see the pa exclusively

3. the local infectious dz clinic resident HIV expert is an np. he manages many of the difficult HIV pts in the community.

4. a local urology group uses a pa as their " male sexual dysfunction clinician". not a glorious job, but he's it.

5. all the treadmills in my community are done by a pa or an np. community docs refer pts for treadmills, the midlevels do them and provide a preliminary interpretation. the pt goes home and eventually the studies are overread by a cardiologist.

6. all the sleep studies in my community are done by pa's.

7. when the er calls the local ortho group for a consult the 1st consultant to arrive is a pa. they eval the pt and either tx and send home or call in the ortho doc if THEY feel surgery is indicated.

8. the coroner for pueblo county, colorado is a pa.
his website:
http://www.jameslkramer.com/

9. this guy is quite the stud too. chief researcher in cardiac electrophysiology at the u. of wa
Lyle W. Larson, PhD, PA-C
Chief Physician Assistant
and Teaching Associate
Division of Cardiothoracic Surgery
and Division of Cardiac Electrophysiology
University of Washington, Seattle

10. this guy is a partner in a derm practice. does his own mohs, transflaps, etc. he is the grandaddy of dermatology pa's. he practices the full scope of dermatology and has done so for over 20 years.
Joe R. Monroe, PA-C, MPAS practices at The Dermatology Clinic, Oklahoma City, Okla, and is the founder and President of the Society of Dermatology Physician Assistants.he has written numerous articles in peer reviewed dermatology journals and is a frequent lecturer on dermatology topics around the country.

11. norwalk hospital, ct.
the entire surgical house staff is pa's. they cover the floor, the surgical icu, do all the er consults and staff all the surgical clinics. they 1st assist all procedures with community md surgeons.
http://www.norwalkhosp.org/website/nhssite.nsf/MainPageKey/Residency-Surgical-Frameset

12. this lady is no slouch either:
Freddi Segal-Giddan, PhD, PA
Keck School of Medicine, USC
Director, Rancho Los Amigos National Rehabilitation Center






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

when you stop trolling EVERY SINGLE PA RELATED THREAD in the CLINICIANS(NOT MEDSTUDENTS) forum I may stop posting here.....
the whole comcept of this thread is *****ic. you might as well ask preschoolers about physics. medstudents for the most part KNOW NOTHING about midlevels. if this was posted in an area for working docs(say the family medicine forum) I might actually respect some of the responses but most of the ms1/ms2 folks responding to this thread have probably never worked with a midlevel of any kind.

 

[georgia_md]

???????

Step 1 after you finish your classroom training, after 2nd year in most cases. Step 2 CK + CS usually after your core rotations, around 4 year ish. Step 3 during intern year.

thank you

 

[Taurus]

Keep climbing the foodchain.

Keep climbing the foodchain.

...

 

[deleted6669]

Keep climbing the foodchain.

Keep climbing the foodchain.

...

working on it......

 

[QofQuimica]

Folks, please lay off with the personal attacks. Whoever makes the ad hominem argument automatically loses. 🙂

 

[8744]

Thank god for Panda Bear. No disrespect for PAs at all, but I'll pose a scenario (totally fictional for the anal out there), say there is an emergency trauma where ur the attending physician in the ER and you only have time to do one thing to stabilize the patient and you feel you know what to do. However, a PA that is with you says something totally different (you don't have time to look this **** up). Are you going to go with your expereince or go with the PAs decision. And if you ignore his input do you call this arrogance?? There is a reason for the hierarchy I believe.
Not taking anything away from PAs either, they're amazing but as Panda Bear says, it's a huge difference.
Now I bet someone is going to say that the attending doc may be wrong...blahblahblah. THat may be true, but are humans perfect?? Do PAs not make critical mistakes?

This thread is ridiculous on several levels (which is my favorite kind of SDN thread).

First of all, everyone is jumping on Emedpa for just stating the obvious, namely that anybody who works for a long time in a certain field is going to learn a lot and know enough to function at a reasonable level of competance. Again, we're not comparing apples with apples here. An emergency medicine resident with three or four years of training knows a lot and can do a lot, usually (because every profession has its naturals) a lot more than a PA with the same amount of time time after his graduation. I don't know every friggin' PA in the world but from my experience, my attendings, even the new ones, can run circles around their PAs who, in our program staff the urgent care ("Fast Track") where they do a fantastic job on the non-acute cases allowing the residents to concentrate on treating (as much as realistically possible) the sicker patients.

I'm serious about this. If you think PAs are qualified to do interventional radiology, general surgery, and complicated, non-primary care type medcine then we may as well beef up the curriculum a little at the community colleges and get some really cheap medical help for the rest of it.

I know plenty of PAs, nurses, and paramedics who can stabilize traumas. ATLS is not a closely guarded secret divulged only to MDs. But there is a lot more to medicine than that. You've got him stabilized, now what do you do? What about the ones from left field who refuse to follow the algorithm?

And I got to tell you, the fact that PAs and NPs are doing primary care should alert you to the fact that primary care is not all that complicated. If you're going to manage a dozen common chronic conditions and do a few simple procedures than maybe seven years of medical training is not required. I've done a little bit of family practice and nobody has made a good case why mid-levels can't handle it. Hell, that's why Family Medicine is desperately seeking a new paradigm, something to give them relevance. Unfortunately they have decided to differentiate themselves by getting all weepy and empathetic but that's for a different thread.

Is medical school necessary at all? Well, surely the first two year are largely self-study. I suppose anybody could get the sylabus, hit the books, and do pretty well on Step 1 and Step 2. But they don't. PA school is not medical school and vice versa. The majority of people study what they have to and nothing more. Clinical years are what you make out of them. But medical students have twice as much as well as call, longer hours, and higher expectations. Then there is residency training where you really learn how to be a physican.

The assumption on this thread is that every PA is some kind of marvel of medical knowledge who would be in charge of the medical team except for the technicality of not having a medical degree. This is also not the case. I was the Dumbest Resident at Duke (TM-2006 Panda Bear, MD) but I was a paragon of medical ability compared to the PAs at the bottom of their class. The only thing worse than an arrogant doctor is an arrogant mid-level who doesn't kow enough to know what he doesn't know. I used to hear this all the time from PAs: "We can do everything you can do."

"All right mother-****er, grab the speculum and have at it."

Finally, the difficulty of many jobs is directly proportional to your level of responsibility. This is the phenomenon of the "armchair quarterback." It's easy to call the plays when you're not responsible for the outcome. A lot of time you are going to be paid for your clinical judgement and your willingness to accept complete responsibilty for your patient.

 

[deleted6669]

panda- appreciate your input as always(honestly).
my point is NOT that every pa is a super stud and better than every md. far from it. there are lots of stupid/lazy pa's out there just like there are lots of stupid/lazy docs. my point is that pa's who apply themselves in school can learn about specialty medicine and perform it well. it is the very rare pa working in a specialty who knows more about that specialty than an md in the same specialty. that same pa however knows a lot more than a physician who does not practice that specialty. that is why it is reasonable for them to see consults sent to a specialty group. for instance the h/a clinic pa that I mentioned above has done nothing but h/a medicine for the last 23 yrs. he did a h/a fellowship at a well respected h/a center, reads all the journals and texts, goes to all of the conferences( and gives lectures at many of them). to think that an fp md right out of residency knows 10% of what he does about h/a's is idiotic.
ditto gi pa's who just do hep c. they know it cold, sometimes better than the gi docs because that is all they do.
as an em pa I have no illusions that I am a better clinician than the vast majority of residency trained/board certified em docs. however after doing nothing but em for 20 yrs I can handle 80- 90%+ of what they can with no difference in outcome. I run circles around the fp and im residents who moonlight in the dept. I still ask questions of the docs in my group when I don't know something. they often ask me as well. for the most part when it reaches that point the answer usually from me or them is" don't know, call the xyz specialist".
I'm just looking for a min amt of acknowledgement here that
1. not all pa's are idiots
2. most of us do a good job the majority of the time
3. we have a place in medicine, including specialty fields

 

[OHMAN0125]

I'm just looking for a min amt of acknowledgement here that
1. not all pa's are idiots
2. most of us do a good job the majority of the time
3. we have a place in medicine, including specialty fields

I think that PAs already get that respect and more. I feel they are crucial in medicine. However, I think that others as well as myself feel as if you're suggesting that PA = MD, and that is rubbing the wrong way. Yes specialist PA > MD who is not in the specialty probably. But no way is a derm PA > derm MD.

Ok, MUST RESIST POSTING THIS THREAD......

 

[deleted6669]

"I think that PAs already get that respect and more."

in the community, yes.
at sdn, hell no.

"But no way is a derm PA > derm MD. "
I didn't say that. what I am saying in this particular case(joe monroe, pa-c derm stud) is that HIS derm pa skills= derm md skills.he does EVERYTHING that the derm docs in his group do, including mohs, transflaps, all types of biopsies and skin grafts, etc
seriously, the guy writes 3-4 derm articles/month, goes on the derm lecture circuit several times/yr and teaches dermatology rotations for a medschool. he is not typical. but he knows his stuff cold.
he is not a typical pa. he is the guru of derm pa's.
lyle larson is the guru of cardiology pa's.
and no, I am not the guru of em pa's. in my group of 12 em pa's I am in the middle experience wise. I work with many of the original em pa's. guys who came back from vietnam and went right to pa school then did em residencies. some of these guys have been doing em for 30 years.
I hope to be as good as they are someday.

 

[DropkickMurphy]

"All right mother-****er, grab the speculum and have at it."

Just when I thought I'd heard the most humorous thing possible from Panda.....I'm surprised yet again.

 

[Wizard of Oz]

Ok, MUST RESIST POSTING THIS THREAD......

Yeah a couple of days ago I thought the thread would drift off into the sunset. No luck. I saw it from the first day it went up, and whenever somebody titles a thread "What's your opinion of X" where X = anything but MD's, it is an invitation for flames.

If you eliminated all of the posts in which someone applies a gross over-generalization to a type of practioner/applicant/specialist (e.g. "PA's would fail USMLE because they can't possibly know as much as MD's") and all of the posts in which somebody objects to a well-agreed-upon generalization with some rare exception (e.g. "Hey I know somebody who got into Harvard with a 21 MCAT), I suppose that the allo posters would have very little to say on SDN.

Keep climbing the foodchain.

"Foodchain," "threat to MD's," "stealing our business," etc.--all signs of problems with American healthcare. Too much emphasis on physician ego and not enough on the patient. We are threatened by foodchain bottom-dwellers; all the while WE ARE THE ONES WHO DON'T WANT to do primary care! Furthermore, WE have the power to elect our congressmen (or bribe them), and WE are the ones who hire the PA's.

"I think that PAs already get that respect and more."
in the community, yes.
at sdn, hell no.

emedpa and Panda, if anyone is reading this threads for the first time, it is quite clear that your posts are the most intelligent and credible. Thanks for behaving maturely.

 

[ANCAdoc]

I disagree. I do not think emedpa's posts were all that intelligent or credible. It sounded like many of his arguments were founded on questionable data, reports of his 20 yr work experience, and the arrogance of physicians. He made some comments in left-field, one of my favorite being how PAs could do well on the USMLE exams. I'm sorry but the training gap between MD's and PA's is sizeable.

Most of us believe that PAs have a place in medicine, and this should have been a short thread had people like emedpa stopped trying to take it further.

 

[deleted6669]

"Most of us believe that PAs have a place in medicine, and this should have been a short thread had people like emedpa stopped trying to take it further."

if you will review the thread you will see I did not enter until after the pa bashing had begun.my 1st post here was #82 in the thread. as the resident "pa defender" here at sdn it is my burden to show both sides of the coin. I am happy to let the thread die as soon as the bashing stops, until then I will refute every anti-pa sentiment posted here by clueless medstudents.

 

[Wizard of Oz]

I disagree. I do not think emedpa's posts were all that intelligent or credible. It sounded like many of his arguments were founded on questionable data, reports of his 20 yr work experience, and the arrogance of physicians. He made some comments in left-field, one of my favorite being how PAs could do well on the USMLE exams. I'm sorry but the training gap between MD's and PA's is sizeable.

Most of us believe that PAs have a place in medicine, and this should have been a short thread had people like emedpa stopped trying to take it further.

Questionable data is better than no data, and I'm afraid that anecdotal evidence is all we really have in this case because PA's don't take the USMLE. If I have to pick between a Caribbean-trained MD and a PA for primary care, I choose the PA every day of the week and twice on Sunday. emedpa's anecdotal extensive evidence coincides with mine, and I am not a PA nor have I ever been one. What he is saying is that you may need to know how a steroid hormone activates transcription for the USMLE, but just because you don't doesn't mean that you can't do primary care. As such, his emphasis was that the later USMLE steps would not be oh so challenging for a PA. The first step may be a stretch with their limited basic science background, but at the end of the day, M1 and M2 are just facts to memorize. I paid for what I consider to be a quite expensive first year of med school, and all I get to do clinically is an H&P? Come on! I could have memorized these tedious facts as an undergrad at a quarter of the tuition cost and had this crap on the MCAT. M1 and M2 are actually what lay people think "pre-med" is anyway. It's ridiculous. Less than 5% of my contact hours are in clinic which is in staunch contrast to my PA student colleagues who start learning procedures right away.

The sizeable training gap is unnecessary for most of the cases that a primary care provider will see, and the difference in training is one cause of physician arrogance.

I spent four years teaching at a division one undergrad school before switching to medicine. I am very well familiar with the academic potential of a student capable of a 26 MCAT (good enough for the bottom end of the allo entering class in my state), a 24 (good enough for the bottom end of the osteo entering class in my state), and the typical student who goes to PA school. Again, my state is a little bit different, but the PA path is both more popular and more competative because of lifestyle, cost of education, and specialty flexibility. Maybe it's not true where PA's can't prescribe or it is still Bachelor's level, but it is true where I am, and it is true that we need PA's badly. To say that our PA class is incapable of memorizing USMLE step I content would be fallacious because I actually taught some of our PA students before they got here, AND THEY BEAT ME OUT OF ADMISSION TO THEIR PA CLASS!

As for clinical skills, they are tested more rigorously than we are and are generally better prepared when they start their rotations partially because their program director teaches neuroanatomy to medical students and is intent on proving what I already know to be true, namely that a PA is every bit as qualified to handle acute health problems as an MD.

 

[deleted6669]

thanks-by the way the only state where pa's can't prescribe is indiana.
the other 49 states are a-ok with pa's prescribing and having dea #s in their own name.
indiana is the last holdout and will probably come around in the next 5 yrs.

"a PA is every bit as qualified to handle acute health problems as an MD."
this is a stretch....I would say a new grad pa is as qualified as most interns. someone who has completed an md residency knows a lot more than a new grad pa. clinically however the pa's have it over the medstudents and interns up front.
as a second yr pa student on my IM rotation I taught the intern on the service how to start an iv, do a blood gas, suture, and dictate an h+p. granted this was august so the guy had been an intern for 3 weeks at that point but still, he had graduated from a US medschool and in theory should have known this stuff already( I would hope).

 

[ANCAdoc]

The sizeable training gap is unnecessary for most of the cases that a primary care provider will see, and the difference in training is one cause of physician arrogance.

I disagree with this somewhat. Having started to read medical journals on a regular basis, I am grateful for my first two years of studies (though I do think we go overboard in some disciplines). Without a rigorous background in cell bio, biochem, micro, I would be lost reading many of the articles in JAMA, NEJM, etc. I guess what I am trying to say is that PA's might not necessarily have as deep a background in objectively evaluating a research article. I view them as stuck with practice guidelines they learned in school or on rotation, and do not change unless informed by a higher up (or during their CME). The PA's in primary care I know do not spend time reading AFP while the family practice docs I know at least skim the issues.

Bottom line - If I give a PA and an MD a urology research paper, will they take the same thing out of it? The training gap is not the cause of physician arrogance, it serves a purpose.

 

[ForbiddenComma]

PA is every bit as qualified to handle acute health problems as an MD.

Just when the thread is about done... someone goes and writes something like that.

Hell, why stop there? How about an RN is just as qualified to handle acute health problems as a PA? After all, I'm sure somebody knows a nurse somewhere who is brilliant and is on the lecture circuit -- and what more proof do we need? Why is it that RNs cannot write prescriptions? Or are you one of those PA elitists trying to defend your "turf" at the expense of the patient?

And hell, what makes an RN better than an LPN? It sounds like RN elitism to me! Maybe it's time we stop coddling the RNs, worry only about patient care, and consider LPNs their equals. Hell, let's poll some of the RNs at your hospital and see what they think about that!

You see my point. I am not trying to denigrate midlevels any more than I would ever denigrate nurses. But the training is more limited than med school -- simple as that. If it were the same, then it would not be called "PA school." It would be called "med school."

Also, your Caribbean MD school example cuts both ways. You state that you would never go to a Caribbean MD if you had a choice. Why? Presumably, because they had inferior training, right? So maybe training does matter after all? In addition, the entrance standards are much more lax for a Caribbean school than an American school. You probably figure that there's a much greater chance of a Caribbean doctor being a grade-A ***** because of that, right?

Finally, yes, of course people are going to be pissed off on the allo forum with posts like yours. If you went to a PA student forum and and said PAs were no better at handling cases than nurses, you would receive a similar reception. I busted my ass off and beat stiff odds to make my way into med school instead of settling for PA/NP school, and so did a lot of other posters here. We also did so incuring massive debt and a future of 3+ years of residency. Saying that what we signed up for is no more intensive than PA school means that we are world class *suckers* and is a direct slap in the face.

 

[deleted6669]

you finally figured it out. pa's can't read. not one of us. we only regurgitate back what we hear in lectures. we are too stupid to learn anything unless an md tells us we are not doing something correctly.
the pa's I work with read LOTS of em/trauma/critical care journals every month.we go to the same conferences that docs do. I usually go to the american college of emergency physicians conference every yr for example. they don't dumb down the lectures because they know I am there.
every pa is required to do 100 hrs of cme every 2 yrs to remain licensed and we all have to retake boards every 6 yrs to remain certified. I read many em and primary care journals every month and have published articles in several of them, including one in which my article was the em cme of the month topic.

by the way here are the results of the last em pa survey done by an emergency physican on behalf of ACEP in 1999 as summarized in the pa journal. interesting reading:
http://www.aapa.org/gandp/issuebrief/emergency.pdf

 

[ANCAdoc]

Emedpa, you took my post way to personally.

My point (read the bottom line again) is that the training gap between MD and PA counts for something. You seriously think a PA can read an article and take from it the same impt items an MD can? Hmm...I wonder how many PA's JAMA or NEJM or even UROLOGY asks to peer-review????

Remember, I am talking about the AVERAGE PA, not you. Our extra training years in the basic sciences has a purpose.

ForbiddenComa has some great points.

 

[deleted6669]

given your example- a urology paper-
I would agree that the avg md of any specialty would get more out of it because of their basic science background.
however a urology pa who has gone back and learned the basic science relevant to his job would get more out of it than the avg non-urology md.
say the pa had attended this postgrad program:

Northwest Metropolitan Urology Associates
Postgraduate Physician Assistant
Urology Residency Program
Gordon R. Gluckman, M.D., Program Director
Brian Hennig, Clinical Manager
1875 Dempster, Suite 506
Park Ridge, IL 60068
(847) 823-4700
Fax: (847) 823-4715
E-mail: [email protected]



--------------------------------------------------------------------------------
Length of Program 12 months
Class Size 2
Starting Date: July 1
Ending Date: July

PROGRAM DESCRIPTION AND PURPOSE:
The purpose of this program is to provide the graduate physician assistant with an opportunity to obtain advanced training in Urology.

Northwest Metropolitan Urology Associates is a tertiary care group providing adult and pediatric urologic surgery services to patients throughout the Chicago and northwest suburban area. Based at two large teaching hospitals, this group will provide resident PA's with the opportunity to participate in the care of patients with a wide variety of urologic disorders.

RESIDENCY OBJECTIVES:
The physician assistant resident will receive education and clinical experience in general urology as well as in the important urologic specialties. PA residents will learn to identify and care for patients with general urologic problems as well as problems within the sub-specialty fields of urologic oncology, erectile dysfunction, infertility, kidney stones, infectious disease and urologic trauma. PA residents will also participate in the care of pediatric patients under the direction of a pediatric urologist.

PROGRAM LENGTH:
12 months, beginning July 1 of each year (although a later starting date may be arranged for PA students who graduate in August or September).

INSTITUTIONAL AFFILIATIONS:
The residency program operates at two main institutions: Lutheran General Hospital in Park Ridge, and Resurrection Medical Center in Chicago. These institutions are only a few miles apart and the physician group has offices in the professional buildings of each center.

OPENINGS:
2 residency positions each year.

COMPENSATION: $40,000
BENEFITS:
Comprehensive Health/Dental Insurance; Malpractice Insurance; paid vacation

HOUSING:
Housing is arranged individually be each resident. The program is located in a clean residential area with many apartment complexes nearby.

APPLICATION CALENDAR:
Applications are accepted beginning in October of each year. Interviews are conducted in the early spring and the selection committee makes their final choices by April.

APPLICATION FEE: None
ADMISSION REQUIREMENTS:
Applicants must be a graduate of a CAAHEA approved physician assistant program and be eligible for, or have passed, the NCCPA exam. Applicants must also be eligible for an Illinois PA license, which they will apply for at the time of their acceptance.

SELECTION CRITERIA:
Applicants will be selected based upon their academic records, their letters of recommendation and their personal interview.

CREDENTIAL AWARDED:
At the completion of the program, the resident will be awarded a certificate of advanced training.

 

[ANCAdoc]

given your example- a urology paper-
I would agree that the avg md of any specialty would get more out of it because of their basic science background.
however a urology pa who has gone back and learned the basic science relevant to his job would get more out of it than the avg non-urology md.

I'll agree with that 100%.

 

[deleted6669]

I'll agree with that 100%.

thank you. most of your colleagues here assume that an ms3 knows more about every specialty than a pa who has worked in that specialty their entire career.
I'm willing to let the thread die here unless anyone needs to pa bash some more.....

 

[Wizard of Oz]

Just when the thread is about done... someone goes and writes something like that.

Hell, why stop there? How about an RN is just as qualified to handle acute health problems as a PA? After all, I'm sure somebody knows a nurse somewhere who is brilliant and is on the lecture circuit -- and what more proof do we need? Why is it that RNs cannot write prescriptions? Or are you one of those PA elitists trying to defend your "turf" at the expense of the patient?

And hell, what makes an RN better than an LPN? It sounds like RN elitism to me! Maybe it's time we stop coddling the RNs, worry only about patient care, and consider LPNs their equals. Hell, let's poll some of the RNs at your hospital and see what they think about that!

You see my point. I am not trying to denigrate midlevels any more than I would ever denigrate nurses. But the training is more limited than med school -- simple as that. If it were the same, then it would not be called "PA school." It would be called "med school."

Also, your Caribbean MD school example cuts both ways. You state that you would never go to a Caribbean MD if you had a choice. Why? Presumably, because they had inferior training, right? So maybe training does matter after all? In addition, the entrance standards are much more lax for a Caribbean school than an American school. You probably figure that there's a much greater chance of a Caribbean doctor being a grade-A ***** because of that, right?

Finally, yes, of course people are going to be pissed off on the allo forum with posts like yours. If you went to a PA student forum and and said PAs were no better at handling cases than nurses, you would receive a similar reception. I busted my ass off and beat stiff odds to make my way into med school instead of settling for PA/NP school, and so did a lot of other posters here. We also did so incuring massive debt and a future of 3+ years of residency. Saying that what we signed up for is no more intensive than PA school means that we are world class *suckers* and is a direct slap in the face.

If PA's couldn't handle acute health problems, then they wouldn't be licensed to see patients in the absence of physicians, and where I live, the doc reviews maybe a tenth of the charts of the patients that his/her PA sees. In my case for one specific Dx, ten derm appoints, ten PA prescriptions, couldn't pick the doc out of a police lineup if I had to.

Urology research paper--I'm not talking about specialties or research. I'm talking about fixing your strep throat, prescribing for your UTI, sewing your lac, telling your kid to drink fluids, etc. I'd even go chronic with hypertension or depression. To counter IUSM, and this is if you want to do garden variety primary care in a clinic, your extra training years in the basic sciences have NO purpose. Our government reflects this attitude with its laws. You CAN learn everything you need to know to handle ninety percent of what you will see in a family general clinic as a midlevel. For the other ten percent, the doc is just as likely to refer 'em out anyway.

What I am saying is that if you don't care about prestige or salary and want to do family med, yes, you are a sucker for wasting all of that time and money on an MD.

Also, PA school was not "settling" for any of the PA's I know. They just wanted a 100K salary and a good family life at the same time without the debt and time commitment associated with medical education.

 

[georgia_md]

thanks-by the way the only state where pa's can't prescribe is indiana.
the other 49 states are a-ok with pa's prescribing and having dea #s in their own name.
indiana is the last holdout and will probably come around in the next 5 yrs.

could that be the reason why there are less pharmaceutical related deaths/injuries in Indiana than the whole USA?

 

[deleted6669]

could that be the reason why there are less pharmaceutical related deaths/injuries in Indiana than the whole USA?

yup we are killing em left and right everywhere except indiana.
drug interactions? forget em- all my pts get erythromycin and diflucan with their statin rx. what's the chance of a fatal drug-drug interaction anyway. arrhythmias aren't all that common, right........and lots of prophylactic antibiotics for those with uri's on coumadin. gotta remember to do that too....
oh yeah, septra for all my dm pts with renal failure...will hop on that too.....

 

[ANCAdoc]

could that be the reason why there are less pharmaceutical related deaths/injuries in Indiana than the whole USA?

Here's Indiana's 2006 position on PA prescribing rights (from the Indiana State Medical Association):
(I'm not taking sides on this point by traintosave, just showing IN's position)
Emedpa, any insight into why IN is very conservative in these measures?

Resolution 06-26 Physician Assistant Prescribing

Introduced by: ISMA Board of Trustees

Action: Adopted as amended

RESOLVED, that the House of Delegates oppose physician-delegated physician assistant prescribing privileges; and be it further

RESOLVED, if physician-delegated physician assistant prescribing privilege legislation is proposed, in order to ensure the highest quality medical care to patients in Indiana, the ISMA believes legislative authorization of physician-delegated physician assistant prescribing privileges be conditioned on the following principles:

• Privileges for PA prescribing are delegated by the supervising physician.

• The current definition of supervision in IC 25-27.5-2-14 and of supervision requirements in IC 25-27.5-6 should be maintained.

• The PA being delegated prescribing privileges must have obtained an adequate number of contact hours in pharmacology at an ARC-PA accredited program.

• Pharmaceuticals that the physician may delegate to the PA for prescription are limited to a seven-day supply of a scheduled substance approved by the supervising physician; and be it further

Resolved , however should prescriptive privileges be granted to PAs the following conditions should be included:

• PAs may only prescribe while supervising physician is physically present.

• Privileges for PA prescribing are delegated by the supervising physician.

• The PA being delegated prescribing privileges must have obtained an adequate number of contact hours in pharmacology at an ARC-PA accredited program.

• Pharmaceuticals being dispensed by a PA should be limited to a seven-day supply of any scheduled drug with no refills.

 

[georgia_md]

I think a lot of times, confidence is mistaken as arrogance. If a person knows that he or she is right, he should stand up for what he or she believes and be confident in their decisions.

The doctor in any field should have a certain amount of authority because he has more education and training than any other health professional in that particular field. That authority should be respected. In the Bible, it says, you should respect those who has authority over you, or God will never promote you to a higher authority.

 

[deleted6669]

"I think a lot of times, confidence is mistaken as arrogance. If a person knows that he or she is right, he should stand up for what he or she believes and be confident in their decisions."

agree- that's what I'm doing.


"Emedpa, any insight into why IN is very conservative in these measures?"
most states started out with laws like this and over time expanded them as the pa's showed they were capable of safe prescribing. my state recently went from pa's writing only dea sch 3-5 to unrestricted 2-5 rights. when the pa field started no states allowed for pa's to prescribe. it has taken almost 40 yrs to get 49 states on board as well as guam, puerto rico, american samoa, etc
pa's can work in the us virgin islands but can't rx there(yet).

 

[georgia_md]

yup we are killing em left and right everywhere except indiana.
drug interactions? forget em- all my pts get erythromycin and diflucan with their statin rx. what's the chance of a fatal drug-drug interaction anyway. arrhythmias aren't all that common, right........and lots of prophylactic antibiotics for those with uri's on coumadin. gotta remember to do that too....
oh yeah, septra for all my dm pts with renal failure...will hop on that too.....

haha, . I apologize, but seriously, I was just joking about the Indiana thing

 

[deleted6669]

haha, . I apologize, but seriously, I was just joking about the Indiana thing

🙂
I know...just adding a bit of sarcasm for flavor.

 

[georgia_md]

Here's Indiana's 2006 position on PA prescribing rights (from the Indiana State Medical Association):
(I'm not taking sides on this point by traintosave, just showing IN's position)
Emedpa, any insight into why IN is very conservative in these measures?

Resolution 06-26 Physician Assistant Prescribing

Introduced by: ISMA Board of Trustees

Action: Adopted as amended

RESOLVED, that the House of Delegates oppose physician-delegated physician assistant prescribing privileges; and be it further

RESOLVED, if physician-delegated physician assistant prescribing privilege legislation is proposed, in order to ensure the highest quality medical care to patients in Indiana, the ISMA believes legislative authorization of physician-delegated physician assistant prescribing privileges be conditioned on the following principles:

• Privileges for PA prescribing are delegated by the supervising physician.

• The current definition of supervision in IC 25-27.5-2-14 and of supervision requirements in IC 25-27.5-6 should be maintained.

• The PA being delegated prescribing privileges must have obtained an adequate number of contact hours in pharmacology at an ARC-PA accredited program.

• Pharmaceuticals that the physician may delegate to the PA for prescription are limited to a seven-day supply of a scheduled substance approved by the supervising physician; and be it further

Resolved , however should prescriptive privileges be granted to PAs the following conditions should be included:

• PAs may only prescribe while supervising physician is physically present.

• Privileges for PA prescribing are delegated by the supervising physician.

• The PA being delegated prescribing privileges must have obtained an adequate number of contact hours in pharmacology at an ARC-PA accredited program.

• Pharmaceuticals being dispensed by a PA should be limited to a seven-day supply of any scheduled drug with no refills.

Yes, you only cut-and-pasted what we already know: That PA's can't prescribe in Indiana.


What we don't know is why can't they. There doesn't seem to be a legitimate reason why not.

The only reason that comes to mind is that Indiana is a bit "backwards".

 

[deleted6669]

"a bit".....
folks can marry their sisters there. the definition of a virgin there is a girl faster than her daddy and brothers. if the tooth brush had been invented somewhere else it would be called the teeth brush.

 

[georgia_md]

"a bit".....
folks can marry their sisters there. the definition of a virgin there is a girl faster than her daddy and brothers. if the tooth brush had been invented somewhere else it would be called the teeth brush.

 

[georgia_md]

It's christmas eve. I guess most of us are with family and loved ones during this time. For those who aren't, I know how you feel. Anyways, happy holidays y'all. Take cares!

 

[Tired]

Yes, you only cut-and-pasted what we already know: That PA's can't prescribe in Indiana.


What we don't know is why can't they. There doesn't seem to be a legitimate reason why not.

The only reason that comes to mind is that Indiana is a bit "backwards".

The AMA has fought giving prescriptive powers to non-physicians for quite some time. In my own state, a bill that would have allowed psychologists to precribe a limited repertoire of psychiatric medications (after undergoing a six-month training and certification course) was recently successfully defeated.

My guess would be that the AMA and local medical association successfully fought of PAs being able to prescribe in Indiana as well. Gotta protect their business interests, right?

 

[deleted6669]

The AMA has fought giving prescriptive powers to non-physicians for quite some time. In my own state, a bill that would have allowed psychologists to precribe a limited repertoire of psychiatric medications (after undergoing a six-month training and certification course) was recently successfully defeated.

My guess would be that the AMA and local medical association successfully fought of PAs being able to prescribe in Indiana as well. Gotta protect their business interests, right?

are you sure it's 6 months? my understanding was that only phd psychologists were eligible and only after completing an additional masters degree in psychopharmacology.
http://psychopharm.mspp.edu/index.asp?action=10&what=10&type=0

 

[dilated]

My guess would be that the AMA and local medical association successfully fought of PAs being able to prescribe in Indiana as well. Gotta protect their business interests, right?

Good. I never see anyone bashing the nurses or the trial lawyers for lobbying on their behalfs, yet physicians are supposedly bad for doing the same thing. If the physician lobby was 1/10th as vicious as ATLA it'd be a whole different ballgame.

 

[georgia_md]

Gotta protect their business interests, right?

Yeah, protect that too, and some other thing called human life

 

[Taurus]

Big deal that PA's can't prescribe in Indiana.

You guys are missing the bigger threat. NP's have far more authority than PA's. They can prescribe in several states and it's only a matter of time before it's in all 50. At the end of the day, I see nurses such as NP's and DNP's eating our lunches, not PA's.

 

[MacGyver]

And I got to tell you, the fact that PAs and NPs are doing primary care should alert you to the fact that primary care is not all that complicated. If you're going to manage a dozen common chronic conditions and do a few simple procedures than maybe seven years of medical training is not required. I've done a little bit of family practice and nobody has made a good case why mid-levels can't handle it. Hell, that's why Family Medicine is desperately seeking a new paradigm, something to give them relevance.

Lets be fair to "primary care" here. According to emedpa, he is at the same level as an EM MD and does absolutely everything they do. Now whether you believe that or not is a separate discussion, but the bottom line is that this is NOT just about "primary care" and that there are many who feel exactly like emed that everything is up for grabs.

The tone of your post suggests that you believe that EM PAs CANNOT do the same job as an EM MD. I'd like to know why you feel that way, and what is it SPECIFICALLY that you can do that a EM PA is not competent to do.

 

[MacGyver]

Big deal that PA's can't prescribe in Indiana.

You guys are missing the bigger threat. NP's have far more authority than PA's. They can prescribe in several states and it's only a matter of time before it's in all 50. At the end of the day, I see nurses such as NP's and DNP's eating our lunches, not PA's.

True NPs are the bigger threat. But the gains of PAs have come DIRECTLY because MDs have advocated for them in order to make more $$$$. By definition, PAs practice medicine which means the state medical boards have full control over what they do.

Nurses are different because they dont practice "medicine" they practice "nursing" so the BOMs have zero control over what they do.

 

[Taurus]

PAs practice medicine which means the state medical boards have full control over what they do.

Nurses are different because they dont practice "medicine" they practice "nursing" so the BOMs have zero control over what they do.

Bingo!

 

[Elysium]

I keep going back and forth whether or not I should post in this absurd thread, what with all the usual paranoid - napoleon complexed SDNers that show up in these threads screaming doom about midlevels being the end of modern medicine as we know it, etc. When, of course, these people, of whom I would dare not mention, should probably head directly to the nearest psycholog...no, wait, psychaitrist and seek mental help at once to discern and investigate why one is so fixated and angry about a single aspect of health care when there are so very many things to be worked up about. Maybe an NP spurned an advance?

Anyway, in all honesty, I'll own up: I've done the first year of med school (DO) hated it, just really couldn't stand it (was it the school, which was a crap hole start up DO school - a bad idea? or just med school? who knows?). Decided that at my age (mid 30's) that finishing training at 40 just really didn't seem all that great, what with the $250,000 in debt all to go into primary care (hate surgery). My fiance is an MD (intern) and wants to do a 7 year residency, so it was going to be a juggling act to have kids and try to finish training and pay back our combined debt of $500,000. So, being that I literally hated every single minute of med school leaving was not that hard of a decision. I applied to PA school and got accepted to several great places. I have now finished 2 semesters (have one more didactic semester left) and so can comment with some intelligence about the level of difficulty of PA vs. med school.

here's the deal: it literally is apples and oranges.

I wish I could tell you it was the same, but it's just not. It's not. Ity's not even close to the same. We take basically the same classes, but, thank god, they wipe out the first year except for anatomy and phys. And, let's all just be honest: embryo is a big bunch of bullsht. I don't care that they use it in ENT or whatever. The don't remember that crap from FIRST YEAR. They RE-learn it in residency or whatever. Sonic hedgehog is useful for esentially NOTHING and everyone knows it. Nothing in first year is useful, which is why you learn it in the first year, because obviously you're going to forget it. I mean, yes, anatomy is certainly necessary in surgery, but you RE-learn it in residency, the stuff you operate on. Most FPs probably don't remember all the innervations of the sacral plexus or whatever off the top of their heads. You get my point. Anyway, so in the second semester we get a watered down second year. Path, pharm, clinical skills, stuff like that. We spent A LOT of time doing physical exam and writing SOAP notes, a lot more than we did in med school. Everything is very clinically oriented, very nuts and bolts. The tests are big picture, the diseases are big picture, the complaints are the most common, they don't test on minuita crap because there isn't the time to learn that kind of detail. We don't use Robbins, we use the CMDT. There isn't time to read Robbins. We got through most systems in a semester. We'll do "primary care" (peds, ob/gyn, geriatrics), suturing, procedures, starting IVs, more SOAP notes, more behavioral medicine, more pharm (a year of pharm) next semester.

Bottom line: In med school you pull all nighters and study 30, 40+ hours for a test and feel like it isn't nearly enough. In PA school (me, personally) I would study 3-4 hours, maybe 5 hours the day or two before and I never made lower than an 85 on any test. I pulled a 3.5 GPA this semster and I pretty much never sweated it. Ever. Med school sucked ass. I made B's and C's and worked and worked and worked (and so did all my friends) in med school and it was crap. 7 people failed anatomy out of 76 my first year. The next year 8 people failed pharm in my med school class. I'm glad to be out from under that stress.
Do PAs know as much as doctors when they graduate? They do not. PAs could NOT pass Step I. To say that is patently absurd. Step II, maybe. Step III, I don't know. Step I is a test based in the basic sciences, of which PA school is decidedly light. There is no way you could pass it, based strictly on the PA school cirriculum. If you had a great science background or studied on your own, that would be different. Do PAs have more clinical knowledge? They probably do. Most PAs have experience coming into the program, are older and generally more seasoned. Plus, we're geared toward the clinical. Now, when a physician is done with residency all bets are off. At that point, a doctor knows decidedly more than a PA with a comprable number of years working under their belt.

A PA is not meant to usurp a physician, that was never to be the point. My dad is an MD internist and my fiance is an MD. I have a tremendous amount of respect for what doctors have to go through to complete their training. As I write this, my fiance has to go work in the ICU on Christmas morning at 6am and doesn't get off until 9pm. At the same token, I'm so glad I choose not to go down that road because life as a doc sucks in so many ways. I'm content not to have "the final say" or be an "assistant" or whatever because I realized that medicine is a job that wasn't ever going to love me back. At the end of the day, all that really matters is your family and it's hard to have one if you spend 100+ hours in the hospital.

I hope that everyone will get over themselves and realize that we all have a place in medicine. Docs stand to make money off of hiring PAs, which is why we're around and why docs have supported the growth of the profession. Without docs PAs couldn't exist. And I hope that med students and doctors realize that PAs aren't "glorified nurses" (like, **** you, dude. I was almost one of your collegues, dipsht). I'm getting a master's degree that will take 2.5 years to get with over 1000 clinical hours (plus the 4 years I've spent working in the health care field) and I know quite a bit about primary care and the management of basic complaints. As a specialize, I expect to know more, just as you all will. We'll all be life long learners, as ghey as that term is.

Anyway, whatev, I can't believe I just spent all this time writing this. I think I need to drink some more eggnog.

Peace out, ya'll.

 

[deleted6669]

Trixie-
nice post. best to you and your significant .
if you are at the program I think you are you will be doing over 2000 hrs of clinicals(that's also the avg for pa school):
PA 630 Family Medicine Rotation
Clinical rotation for 12 weeks in a family practice medical office setting preferably in a rural or community setting to include the care of adults, women and children. 12 hours; Phase II.

PA 631 Internal Medicine Rotation
Clinical rotation for 6 weeks in an internal medicine practice medical office setting. 6 hours; Phase II.

PA 633 In-Patient Medicine Rotation
Clinical rotation for 6 weeks in an in-patient setting including required readings in medicine practice. 6 hours; Phase II.

PA 634 Surgery Rotation
Clinical rotation for 6 weeks in a surgical setting with an emphasis on inpatient, outpatient, and the surgical arena. 6 hours; Phase II.

PA 636 Emergency Medicine Rotation
Clinical rotation for 6 weeks in an emergency department or trauma care setting. 6 hours; Phase II.

PA 637 Community Medicine Rotation
Clinical rotation for 6 weeks in a community medicine setting such as a prison, health department, family planning/STD clinic, international setting, community mental health or other community based locations. 6 hours; Phase II.

PA 638 Elective Rotation
Clinical rotation for 4 weeks in any specialty type practice setting of the student's choice. 4 hours; Phase II.

PA 639 Primary Care Rotation
Clinical rotation for 6 weeks in family medicine, pediatrics, geriatrics or women's healthcare as selected by the student. 6 hours; Phase II.

52 weeks x min 40 hrs/week= 2080 hrs...and lots of those rotation blocks are > 40 hrs/week...definitely em will be if you rotate with me. most of our students do 50 hrs/week( 5 x 10 hrs)
a lot of your colleagues also do added electives during the 3 months you are "supposed to" be finishing your thesis.I recently had a student who did almost 500 extra hrs of em during this time.


I will be working a 13 hr solo overnight shift tomorrow too so it's not just the docs holding the fort on the holidays.

 

[georgia_md]

Bingo!

and Bingo was his name-o!