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Whats your opinion on PAs?

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georgia_md

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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, 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.


thanks for the interesting read
 

Al2VCOM

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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.[/QUOTE]

Wow, sonic hedgehog is useless, embryo is useless (must not have done pediatric cardio), PA's have more clinical knowledge (cuz 3rd and 4th year dont really happen).

I've said my peace

But, I like PA's. I think they should prescribe medicine under the direct supervision of a doctor. That means in the same building.
 

mjl1717

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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.

Wow, sonic hedgehog is useless, embryo is useless (must not have done pediatric cardio), PA's have more clinical knowledge (cuz 3rd and 4th year dont really happen).

I've said my peace

But, I like PA's. I think they should prescribe medicine under the direct supervision of a doctor. That means in the same building.[/QUOTE]

Good post! I do not think anyone was arguing that P.A.s would easiy pass step1. We both know thats truly absurd. I also feel for a P.A. to immediately pass step 2 or 3 is a real long shot.. One thing for sure is that the P.A. is truly embedded in the nerve of the med student but a friend to the physician.
 

georgia_md

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Wow, sonic hedgehog is useless, embryo is useless (must not have done pediatric cardio), PA's have more clinical knowledge (cuz 3rd and 4th year dont really happen).

I've said my peace

But, I like PA's. I think they should prescribe medicine under the direct supervision of a doctor. That means in the same building.
Good post! I do not think anyone was arguing that P.A.s would easiy pass step1. We both know thats truly absurd. I also feel for a P.A. to immediately pass step 2 or 3 is a real long shot.. One thing for sure is that the P.A. is truly embedded in the nerve of the med student but a friend to the physician.


I think it is more than a long shot for a PA to pass step 2 or 3 , because they need to be a medical student to take the exams in the first place. But I know what you mean.

Personally, I think anyone can pass these exams. If they are prepared for them.
 
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....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...

Har har. So true. Can I use that?
 

DrMom

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I hope that everyone will get over themselves and realize that we all have a place in medicine.

I wish more people would realize this...not only in the MD/DO vs PA/NP arena, but also in the differences in medical specialties.
 

Bitsy3221

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My two cents, since I have attended both PA and allopathic medical school:

A new PA grad is as completely scared & clueless as the new intern fielding the "so-and-so's potassium is 3.2" call in July.

Residents work more hours, on average, than the PA. All that extra experience is inevitably going to allow them to see more patients/gain more experience/get more clinical acumen/advance in their training a bit quicker than the PA

On the other hand, a new PA who is given the same sort of academic interest as the resident is just as capable--no more, no less--than an intern. There is nothing that happened in your MS1 histo class that will make you more qualified at working up the CP patient at the bedside.

ON AVERAGE (and there is always exceptions to the rule) PA students hit their clinical years better equipt to handle clinical problems. They have had more intensive training at H&Ps, EKGs, x-rays, lab interpretation, etc, than med students starting their clinical experiences. Will it all even out? Eventually, but at this point in their training, PAs on average have the upper hand. When it comes to basic science questions, yes the med students will know more than the average PA student.

Most PA students have also taken a dedicated EBM class so they are actually able to critically read medical journals. I don't know many PAs or MDs who haven't done extensive research who can pick up a Science basic science article and gain much useful info from it.

PA education is indoctrinated with being able to constantly critique yourself and assess your own limitations. While there are always exceptions to every rule, most PAs are able to ask for help when they need it. Maybe if they haven't asked for help, they are comfortable handling the situation. Do they make mistakes? Yes. Do residents and attendings? Yes--I go to M&M every week where medical outcomes are discussed. I can't think of the last time we discussed an error in care/judgement at M&M where the error was made by the PA--it was all the residents and attendings. Not that they don't happen, but being an MD does not mean you are error-proof. It is a shame that when a doc screws up, it is an isolated incident, where when a PA makes an error, the validity of the entire profession and everyone in it is called into question in forums such as this.

PAs take a very intensive pharmacology class, which includes instruction in the biochemistry and physiology needed to understand the mechanism of action. I found this class more intensive than the pharm class the med students get. It is the same info med students get, just presented in a different order. PAs are very capable of safely prescribing medications. Are you aware that physical therapists are garnering support to pass legislation so they may have prescriptive privledges? As long as they get the appropriate education--have at it. PAs HAVE the appropriate training.

Most PAs could pass Step 2 CK & CS with minimal studying. The review books many PAs use to study for their boards are Step 2 books. Step 1? Probably not, but then again I doubt many MDs after their PGY-1 year could pass that exam without prep either. PAs do not have the basic science training that med students do, and unless they take the burden on themselves of learning that basic science, yes there will be gaps in the understanding of some disease processes.

PAs have their role, but most will not and DO not want the job of an MD, and if they do they go back to medical school like I and one of my other classmates did. They may not want to specialize, spend a decade in school and have to work weekends and holidays. What they do want is to learn, be challenged intellectually, care for and treat patients and consistantly drive themselves to be better--same as you. They are highly trained medical professionals, and I really hope that you all understand and celebrate that these will be the colleagues that can help make your life easier and improve care for the patient. They are not going to steal your job, and anyone who could even utter this sentiment has no understanding of the difference in medical and PA school training, and the medical-legal relationship of MDs. Although it is pretty fashionable for med students to bash PAs, try to learn about what they go through in school and in the workforce--trust me you will be a lot less threatened.
 
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...ON AVERAGE (and there is always exceptions to the rule) PA students hit their clinical years better equipt to handle clinical problems. They have had more intensive training at H&Ps, EKGs, x-rays, lab interpretation, etc, than med students starting their clinical experiences. Will it all even out? Eventually, but at this point in their training, PAs on average have the upper hand. When it comes to basic science questions, yes the med students will know more than the average PA student...

Whoa. Once again we're not comparing apples with apples. Medical school is four years, not two, and the first two years are basic sciences, not clinical skills. Therefore it is no wonder that a PA student starts her clinical year with more skills than a fresh third year medical student because, and I hope this isn't too obvious, medical students don't do any clinical medicine to speak of in their pre-clinical years. At my school, as an example, the first two years were pure basic science and medical knowledge with only a few standardized patient exercises (and empthy circle jerks) thrown in.

If a big part of a PA's first year is learning clinical skills, than something doesn't add up, even if we grant that the basic sciences are all unnecessary (which is not true at all). Where does all of this knowledge which is equal to or better than a medical student's come from and how does it fit into a year that is crammed with clinical wonder?

I don't know from where the assumption comes that medical students don't learn any clinical medicine in their two years of clinical training before graduation. My medical school ,while not "***-******" or "*****-****" has a reputation for turning out medical students who can start an IV, read an EKG, suture a laceration or two, and generally start out intern year with a good handle on the down-to-earth aspects practical medicine.

A typical intern, while as scared and confused as is possible for a functioning adult, generally knows a lot more than a PA one year into practice (unless that PA has prior medical experience). The intern is scared and confused more because of the burden of responsibilty than lack of skills or knowledge. Also because it takes a while to figure out where they keep the forms.
 
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...Most PAs could pass Step 2 CK & CS with minimal studying. The review books many PAs use to study for their boards are Step 2 books. Step 1? Probably not, but then again I doubt many MDs after their PGY-1 year could pass that exam without prep either. PAs do not have the basic science training that med students do, and unless they take the burden on themselves of learning that basic science, yes there will be gaps in the understanding of some disease processes...

Bull****. First of all, any reasonably intelligent person could pass any standardized test given sufficient time to study. What you are saying is that us dumb medical students have to kill ourselves studying for a test that the wiley PA can pass with minimal effort which is, again, animal dung.

This is an example of not knowing enough to know what you don't know. At my medical school, for example, we crammed all of the "useless" basic sciences into the first semester and spent the next year-and-a-half in an intensive "organ system based" curriculum which was in no way excessively esoteric or useless from a pratical point of view. And we still, most of us, had to study for Step 2 and not everybody got stellar scores either.

The idea that a bunch of medical students or PA students are competant to judge what is useful and what is useless knowledge is breathtaking in its arrogance. Your Uncle Panda is not the biggest fan of the medical profession and Lord knows I have had my tribulations but I have never looked back at anything we studied and said, "You know, on reflection I didn't want to know about embryology."

Do I need to know embryology on a daily basis? Of course not. But as someone pointed out it is all there as part of the deep background of knowledge, without which we may as well scrap medical school and PA school and let the motivated fry cooks memorize a few algorithms.
 
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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.

I may stop posting on this ridiculous thread because I don't want to get sucked into either denigrating PAs or trying to portray doctors as super-beings.

It is not one thing in particular that an EM attending does better. As I pointed out, lots of midlevels can do things better than most doctors. The IV nurse at our hospital can probably, in her sleep, hit a vein that would have me calling for...well...her. And the respiratory therapists are teaching me how to intubate and manage the vents.

If Emedpa can do the job, on the other hand, he should do it. But I tell you he's not typical. Most PAs, including here, manage the non-acute side of the ED. At a residency program this takes some of the primary care heat off of the residents which is a good thing. Since I work with both PAs and attendings I can say from my perspective that the attending knows a lot more about medicine and can integrate this knowledge into a plan, especially for the patients that don't fit into the nice little boxes that we try to force them into. It's the sum total, not a few individual things.

It is your background knowledge, your skills, and more importantly your ability to lead and accept total responsibilty that seperates the physician from the mid-level and what we are being trained to do. But who knows if our cost concious society will decide that having somebody to blame is not important.

Medicine is just a job. But it requires a lot more skill and knowledge than most of you realize, especially while you're slogging through the basic sicences wondering what it all means. If you think it's easy and rigorous training is not required then I'm serious, screw having doctors or PAs. Let the community colleges provide the medical muscle, training hordes of hyper-specialists who can all work like some communal entity without all the wasted time acquiring useless knowledge.

And now I'm done.
 

mjl1717

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The above post is correct. From what I see in all honesty emedpa IS NOT typical. In being head and shoulders ahead of the field.
 

Bitsy3221

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I am going to call you on this one, since I have taken both the PA boards and the USMLE, which I daresay you have not. I have been to PA school, and I have been to medical school, so I speak from an insider perspective that you--no matter how many "wiley" PAs you see come through your hospital--do not have. I never called medical students stupid, nor did I call PAs uber-brilliant.

I stand by everything in my prior post. I find it interesting that you pick and choose quoting my post and call what I say as "bull$hit". When I was a PA, I was at a different level than the interns I worked with--I knew significantly more about some things, just like they knew significantly more than I did about other things. You know what happened? We RESPECTED each other and WORKED TOGETHER as a TEAM and it ended up is pretty damn good patient care.

Why so much animosity? What exactly do you think PAs do in their 24 months of training? Feel free to PM me and I would be happy to give you some facts and comparisons, since again--I have done both.
 

soonereng

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I am going to call you on this one, since I have taken both the PA boards and the USMLE, which I daresay you have not. I have been to PA school, and I have been to medical school, so I speak from an insider perspective that you--no matter how many "wiley" PAs you see come through your hospital--do not have. I never called medical students stupid, nor did I call PAs uber-brilliant.

I stand by everything in my prior post. I find it interesting that you pick and choose quoting my post and call what I say as "bull$hit". When I was a PA, I was at a different level than the interns I worked with--I knew significantly more about some things, just like they knew significantly more than I did about other things. You know what happened? We RESPECTED each other and WORKED TOGETHER as a TEAM and it ended up is pretty damn good patient care.

Why so much animosity? What exactly do you think PAs do in their 24 months of training? Feel free to PM me and I would be happy to give you some facts and comparisons, since again--I have done both.

This is exactly what this thread needed. Someone who has done both to speak up. :thumbup:
 

primadonna22274

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Thanks Bitsy for your input. As a PA planning to return to med school, I really appreciate your clout on this issue.
;) Lisa
 

Flopotomist

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I would love to see some rational studies on this issue, but the one time I have seen it proposed, it was shot down by the IRB. I think there have been some great comments (and not so great comments on here) on here. It sounds like the most rational approach would be:

1. Respect that midlevel providers (yeah, sorry if that term offends, but it is the best term I know of right now) are capable of providing a certain level of care. In certain areas where an MD is not available, like a rural ED, or an impoverished area where no MDs will come, they may be an imperfect solution to the problem of physician shortages.

2. Respect that physicians DO have a higher level of training, and that that training MAY be needed in a small subset of patients. Because the midlevel providers may not be able to deal with this small subset, the IDEAL situation is to insure that a physician be available to supervise midlevels. The degree of supervision may vary.

3. Respect that patients have a right to be informed of the level of training of their provider. If I were in charge of the world, only physicians would wear the white lab coat (another story) but EVERYBODY interacting with patients should identify themselves and their role. I know that I personally choose a midlevel as my primary care provider because they tend to have more time to spend with me, and frankly I find them less intimidating than some old doc. I also don't have any major complicated medical problems though. Interestingly, my 90 year old grandmother will NOT see a physician, but will see her midlevel provider - her reasoning is that sick people see doctors, so as long as she is healthy she will only see her NP for her annual physical.

4. Respect the team oriented nature of healthcare. We must not devolve into an "us" versus "them" mentality. At some point, most of us entered the healthcare field for some type of altruistic reason - patient care. We must remember that we all share the same goal.

OK.. that is all...
 

mjl1717

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I am going to call you on this one, since I have taken both the PA boards and the USMLE, which I daresay you have not. I have been to PA school, and I have been to medical school, so I speak from an insider perspective that you--no matter how many "wiley" PAs you see come through your hospital--do not have. I never called medical students stupid, nor did I call PAs uber-brilliant.

I stand by everything in my prior post. I find it interesting that you pick and choose quoting my post and call what I say as "bull$hit". When I was a PA, I was at a different level than the interns I worked with--I knew significantly more about some things, just like they knew significantly more than I did about other things. You know what happened? We RESPECTED each other and WORKED TOGETHER as a TEAM and it ended up is pretty damn good patient care.

Why so much animosity? What exactly do you think PAs do in their 24 months of training? Feel free to PM me and I would be happy to give you some facts and comparisons, since again--I have done both.

This is probably one of the strongest comments to date!! Not to bring up negative info but O.J. Simpson once said "I didnt like everyone on my football team (Buffalo Bills). But we had to work together as a team".. Whether football, medicine, etc is this team concept too difficult to understand??
 

mjl1717

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I would love to see some rational studies on this issue, but the one time I have seen it proposed, it was shot down by the IRB. I think there have been some great comments (and not so great comments on here) on here. It sounds like the most rational approach would be:

1. Respect that midlevel providers (yeah, sorry if that term offends, but it is the best term I know of right now) are capable of providing a certain level of care. In certain areas where an MD is not available, like a rural ED, or an impoverished area where no MDs will come, they may be an imperfect solution to the problem of physician shortages.

2. Respect that physicians DO have a higher level of training, and that that training MAY be needed in a small subset of patients. Because the midlevel providers may not be able to deal with this small subset, the IDEAL situation is to insure that a physician be available to supervise midlevels. The degree of supervision may vary.

3. Respect that patients have a right to be informed of the level of training of their provider. If I were in charge of the world, only physicians would wear the white lab coat (another story) but EVERYBODY interacting with patients should identify themselves and their role. I know that I personally choose a midlevel as my primary care provider because they tend to have more time to spend with me, and frankly I find them less intimidating than some old doc. I also don't have any major complicated medical problems though. Interestingly, my 90 year old grandmother will NOT see a physician, but will see her midlevel provider - her reasoning is that sick people see doctors, so as long as she is healthy she will only see her NP for her annual physical.

4. Respect the team oriented nature of healthcare. We must not devolve into an "us" versus "them" mentality. At some point, most of us entered the healthcare field for some type of altruistic reason - patient care. We must remember that we all share the same goal.

OK.. that is all...

And this is reasonable thought..
 
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I am going to call you on this one, since I have taken both the PA boards and the USMLE, which I daresay you have not. I have been to PA school, and I have been to medical school, so I speak from an insider perspective that you--no matter how many "wiley" PAs you see come through your hospital--do not have. I never called medical students stupid, nor did I call PAs uber-brilliant.

I stand by everything in my prior post. I find it interesting that you pick and choose quoting my post and call what I say as "bull$hit". When I was a PA, I was at a different level than the interns I worked with--I knew significantly more about some things, just like they knew significantly more than I did about other things. You know what happened? We RESPECTED each other and WORKED TOGETHER as a TEAM and it ended up is pretty damn good patient care.

Why so much animosity? What exactly do you think PAs do in their 24 months of training? Feel free to PM me and I would be happy to give you some facts and comparisons, since again--I have done both.

There is no animosity. I like PAs. I'm more perplexed at why medical students feel threatened by mid-levels than anything else. As you know, I am the last person to try to convince anybody that that physicians are perfect and know and can do everything. I am also the last person to stand on credentials and trust in the absolute power of formal education but two additional years of education and four to eleven years of additional training that physicians must have before they can practice does count for something.

But the point is that you took the Step 2 after completing two years of medical school, not after the first year of PA school. This is a case of hindight.
 

Bitsy3221

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Just to clarify.....I took Step 1 after two years of med school. I took Step 2 after three years (and a few months) of medical school. I took the NCCPA boards after 2 years of PA school. I would have heinously bombed Step 2 (and the NCCPA exam and Step 1, for that matter) after one year of PA school. I still would have heinously bombed Step 1 even after graduating from PA school, and after working as a PA for a few years.

Speaking solely for my own experience and ignoring the "month, week, pencil" analogy, I did not need to study nearly as hard for Step 2 as Step 1, and if I had to go back and take all three exams again (ignoring CS for obvious reasons) I would have to study my arse off to do decent on Step 1, but could probably do reasonably well on Step 2 and the NCCPA with a few evenings of study (not dedicated years of study), since that is all I did to prepare for Step 2 the first time I took it. I would bet that would probably be the case for you as and most people in practice as well, and the studying would primarily be to review the info that you don't use on a daily basis (for example, for me that was peds immunization schedule, latest report from the JNC, and other assorted tidbits from outpt/family medicine)

Isn't hindsight supposed to be 20/20, anyway? :)
 

SecretDove

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I wish more people would realize this...not only in the MD/DO vs PA/NP arena, but also in the differences in medical specialties.

Agreed. No one can provide A+ patient care BY THEMSELVES. We're all part of a healthcare TEAM. Everyone contributes.......patients appreciate.
 

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Agreed. No one can provide A+ patient care BY THEMSELVES. We're all part of a healthcare TEAM. Everyone contributes.......patients appreciate.

The whole "team" concept sounds really nice, but the reality is that difficulties arise when there are questions about leadership and hierarchy. Anyone who truly believes that all members of the "team" are equal in their ability (and right) to make decisions regarding diagnosis and treatment is just fooling themselves.

Techs, nurses, PAs, and everyone else in Allied Health needs to acknowledge the primacy of the physician's judgement. Physicians need to be the acknowledged leaders of the "team" because they have the most education, and they take responsibility for all decisions in the form of exposure to lawsuits. All other staff members, regardless of their level of experience, have both the responsibility to make their opinions know and to defer to the physician when they are over-ruled.

There are some RNs, techs, NPs, and PAs out there who have difficulty with these concepts. They end up sabotaging cases by making their disagreement with the doctor known to the patient, offering counter diagnoses, or withholding important information from the physician. This is a fundamental violation of their professional ethics, and they should be (but rarely are) disciplined for this type of behavior.

So before everyone jumps on the love train (Go Team!), keep in mind that it is ultimately our responsibility to assume leadership, and to keep the "team" functioning appropriately.

In the words of one of my old Nurse Managers (from my days as a tech), "I'm not a doctor and neither are you. You want to be a doctor? Go to med school. Until then, report what you see and do what you're told!"
 

Bitsy3221

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Techs, nurses, PAs, and everyone else in Allied Health needs to acknowledge the primacy of the physician's judgement. Physicians need to be the acknowledged leaders of the "team" because they have the most education, and they take responsibility for all decisions in the form of exposure to lawsuits

Agree wholeheartedly

There are some RNs, techs, NPs, and PAs out there who have difficulty with these concepts. They end up sabotaging cases by making their disagreement with the doctor known to the patient, offering counter diagnoses, or withholding important information from the physician. This is a fundamental violation of their professional ethics, and they should be (but rarely are) disciplined for this type of behavior.

I also agree that this happens, just take issue with the person that is doing this, not the letters after their name (and then begrudge everyone else with the same letters after their name)

How did you feel as a med student or an intern when some veteran nurse or attending that you never met before lays into you for nothing other than for the sole reason that you are a med student/intern and they had a bad experience with a med student/intern in the past? Or how about when you see a new patient and they jump all over and disrespect you because of a previous bad experience with a doctor? You don't like being held accountable or punished for your predecessors' errant behaviours and attitudes, so don't do it to other people either.
 

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You don't like being held accountable or punished for your predecessors' errant behaviours and attitudes, so don't do it to other people either.

You're absolutely right and make an important point.
 
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