Whats your view on Physician Assistants?

[TurnYourHeadAnd]

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[Golfing_Doc]

It seems that their responsibilities depend on what state the PA resides in. Sometimes they have much reign alongside docs including in ERs, doing pretty much everything except major surgery and prescribing certain medications. Some liken their freedom to that of an NP, which in some cases can run their own clinics. Both have very vital roles in small towns which are in dire need of general practitioner type health care. In larger towns, they do not get to do as much.

just my 2 cents.

 

[brianmartin]

PA's in the ED where I work see patients on their own and write their own notes. Then the attending looks it over and says "OK". They see a lot of patients.

 

[DropkickMurphy]

PA's in the ED where I work see patients on their own and write their own notes. Then the attending looks it over and says "OK". They see a lot of patients.

Personally I think they are a great addition to the healthcare team. I would much rather have one of them treat me than a nurse practitioner, because they are far better trained as a group. However, I do think the numbers of them in non-primary care fields (read as other than: IM, FP, OB/GYN, peds, EM) should be limited to assure quality is maintained and to see them put where they will do the most good.

 

[Captain Fantastic]

I think they can be great additions to the team.

I'd never want to be one, though. In some regards it seems like it's a permanent residency -- always having to check out with the attending, etc. I want more autonomy than that.

But I've worked with a number, mostly in the ED, and I think they're top notch providers.

 

[Law2Doc]

?

They are a cost effective addition to the healthcare team, and an experienced one can teach you a lot. However medicine as an organization has done a poor job of protecting its turf from ancillary professionals (PA, CRNA, NPs), and these professionals have done a great job at getting the state to allow them additional autonomy, so I worry that, sometime down the road it could potentially cost jobs. But I'm coming from law, a profession which has fought tooth and nail to prevent any semblance of "the unauthorized practice of law" -- ie. paralegals from opening their own shops to handle simple paperwork/divorces/wills, realtors from doing their own contracts, accountants from advising clients on legal implications, etc. Different world outlook I guess.

 

[dancinRN1022]

hey...

there will never be a shortage of doctor's... i think we will have "job security"... i don't thnk the PA'a NP's or CRNA's will take people's jobs away...its not fair to the public to "protect our profession" at the expense of them...if medical schools started accepting more people.., if there was more faculty to train new qualified doctor's then we wouldn't need these professions to fill in the gaps...if there wasn't such a disparity in healthcare and if doctor's were evenly distributed everywhere then the public wouldn't need these people to fill in the wholes...but with that being said...being a PA seems like a great job...if you can't committ to 4 years of med school, 3 yrs of residency, and who knows how many years of a possible fellowship then its a great alternative... it seems like they have a certain amount of autonomy depending on the state and hospital they practice...in the er they do alot on their own...and i don't mind working with them...the public doesn't know who is who anymore so they dont care... for me... i am pretty much mid level right now as a nurse..atleast in the er... and money wise it didn't make sense to pay money for a different degree to make about as much as I make right now... in NYC i actually made more money as a nurse...

 

[Law2Doc]

hey...

there will never be a shortage of doctor's...

Not in the next few years, but never is a very long time. The generations behind the baby boomers are not quite as large.

 

[dancinRN1022]

Not in the next few years, but never is a very long time. The generations behind the baby boomers are not quite as large.

hey...
oh wait I didn't mean it like that... I meant...there will never be a shortage of jobs for doctors because of the other professions... i think there is already a shortage of doctor's especially in low income neighborhoods, rural areas, and primary care fields and that is why we need PA's, NP's and CRNA's...

 

[Law2Doc]

its not fair to the public to "protect our profession" at the expense of them.

And having a monopoly is not about playing fair. It's about maintaining a competitive advantage. I suspect in the long run the public benefits from folks who have gone to med school being their primary care giver, even if in the short run the looming shortage makes this seem impractical.

 

[Law2Doc]

I meant...there will never be a shortage of jobs for doctors because of the other professions... i think there is already a shortage of doctor's especially in low income neighborhoods, rural areas, and primary care fields and that is why we need PA's, NP's and CRNA's...

There is no rule that requires ancillary professionals to stay in the low income neighborhoods any more than the doctors. Once you open the floodgates and allow others to handle certain functions with more autonomy, you cede these functions to whomever can do it cheapest. That is what lawyers feared with paralegals, and that is what medicine should fear in terms of ancillary professionals. Sure it might not matter "now" -- the pie is huge and so giving away a slice still leaves you with a lot. But the pie may not always be so big and you can never get that slice back. And once you've given one slice away, you will find the recipient is still hungry and asking for another small slice, and another...

 

[dancinRN1022]

And having a monopoly is not about playing fair. It's about maintaining a competitive advantage. I suspect in the long run the public benefits from folks who have gone to med school being their primary care giver, even if in the short run the looming shortage makes this seem impractical.

i love a healthy debate now and then...

being a doctor is about "playing fair", its the nature of what we are all dedicating our life to, being fair and helping the public...you are not advocating for the public, you are advocating for yourself, your profession, and your pride of being the "doctor", most PA schools are affiliated with medical schools...so they receive the same quality education as doctor's just without the residency..and like the above poster said... their job is like having a permanent residency...there is always someone they have to answer to, so the public is getting safe care... i think sometimes the public is getting safer care...because atleast there is always someone to look at their work...have you ever seen a bad doctor?... i mean a really incompetent MD...its horrible! and there is no one to double check their diagnosis, or plan of care, and the public is un aware of this because all they see is a white coat...

there are tons of foreign trained doctor's here because of our inability to train a sufficient amount of doctor's in our own country...how do we know how competent they are, how do we regulate the quality of their education...yes they are all required to pass the boards...but learning how to master an exam doesn't make you a great doctor... (by the way before i start WWIII i have NOTHING against foreign trained doctor's i am just making a point because some foreign schools are better than ours)...my point is simply...its in the best interest of the public to give them access to trained healthcare professionals...and i do not agree with the notion of... I'd rather have a "doctor" or nothing at all...

 

[Law2Doc]

there are tons of foreign trained doctor's here because of our inability to train a sufficient amount of doctor's in our own country...how do we know how competent they are, how do we regulate the quality of their education...yes they are all required to pass the boards...but learning how to master an exam doesn't make you a great doctor...

The previous head of AAMC (in a speech in 2005, See (toward the end) http://www.aamc.org/newsroom/pressrel/2005/051106.htm) agreed with you in the above statement (particularly in terms of US students trained offshore in the caribbean), and it is suggested that the ongoing increase in number of students in allo schools is in part meant to address this by increasing domestic attendance enough, thereby boxing the non LCME credentialed folks out.

I'm not sure what that has to do with ancillary professionals though -- it is really sidestepping the argument by pointing at another source of potential conflict. The goal of the profession should be to protect the members of that profession from encroachment, whether it be losing turf to local ancillary professionals, or losing turf to offshore educated folks. That is in part what you pay all your professional dues for.
Bear in mind that I am not saying that the ancillary professionals are not very capable -- if they weren't there wouldn't be so much cause for concern.

Medicine is full of examples where one field gave away procedures to another because it did not foresee the future value in it, or felt that what they had carved out as their signature procedure would always be the state of the art. It's even more problematic when you cede this kind of stuff outside the profession altogether. So sure, it might seem like no big deal to allow others to see the underserved, write prescriptions etc. But a dozen years from now when everyone has the same insurance and none of it pays for a lot of specialist procedures without the primary caregiver's say so you may see that doctors have given away the farm.

 

[imamom]

i love a healthy debate now and then...

being a doctor is about "playing fair", its the nature of what we are all dedicating our life to, being fair and helping the public...you are not advocating for the public, you are advocating for yourself, your profession, and your pride of being the "doctor", most PA schools are affiliated with medical schools...so they receive the same quality education as doctor's just without the residency..and like the above poster said... their job is like having a permanent residency...there is always someone they have to answer to, so the public is getting safe care... i think sometimes the public is getting safer care...because atleast there is always someone to look at their work...have you ever seen a bad doctor?... i mean a really incompetent MD...its horrible! and there is no one to double check their diagnosis, or plan of care, and the public is un aware of this because all they see is a white coat...

there are tons of foreign trained doctor's here because of our inability to train a sufficient amount of doctor's in our own country...how do we know how competent they are, how do we regulate the quality of their education...yes they are all required to pass the boards...but learning how to master an exam doesn't make you a great doctor... (by the way before i start WWIII i have NOTHING against foreign trained doctor's i am just making a point because some foreign schools are better than ours)...my point is simply...its in the best interest of the public to give them access to trained healthcare professionals...and i do not agree with the notion of... I'd rather have a "doctor" or nothing at all...

Not to be mean, but please be careful with your use of apostrophe -s, especially doing your secondary essays. 's means possession or contraction not plural as in: doctor's stethoscope (stethoscope of the doctor); The doctor's always right. (The doctor is always right). Get it?

Just trying to be helpful.

 

[dancinRN1022]

Not to be mean, but please be careful with your use of apostrophe -s, especially doing your secondary essays. 's means possession or contraction not plural as in: doctor's stethoscope (stethoscope of the doctor); The doctor's always right. (The doctor is always right). Get it?

Just trying to be helpful.

hahahah I am not taking it as being mean.... thanks for the advice..but this was not a secondary...simply a trivial debate on SDN at 8:00 am... i also use periods and capital letters in secondaries and not ... after every thought either...

 

[dancinRN1022]

I'm not sure what that has to do with ancillary professionals though -- it is really sidestepping the argument by pointing at another source of potential conflict. The goal of the profession should be to protect the members of that profession from encroachment, whether it be losing turf to local ancillary professionals, or losing turf to offshore educated folks. That is in part what you pay all your professional dues for.
Bear in mind that I am not saying that the ancillary professionals are not very capable -- if they weren't there wouldn't be so much cause for concern.

Medicine is full of examples where one field gave away procedures to another because it did not foresee the future value in it, or felt that what they had carved out as their signature procedure would always be the state of the art. It's even more problematic when you cede this kind of stuff outside the profession altogether. So sure, it might seem like no big deal to allow others to see the underserved, write prescriptions etc. But a dozen years from now when everyone has the same insurance and none of it pays for a lot of specialist procedures without the primary caregiver's say so you may see that doctors have given away the farm.

okay but what do you suppose we do about this?... i wrote my initial post because of your response to the questions, stating that we are going to lose jobs because of the ancillary professions... and I can not argue with you about the monetary consequence of having these professions in the future... whether or not we are going to lose money in the future.... and I can not argue with you about whether or not insurance companies will pay for procedures in a dozen years... my argument has been and will continue to be that the public is better off right now with the ancillary professions being in place playing their current roles within healthcare... and in order to "protect our profession" we should not attack or limit the scope of practice of these professionals (which is what you said lawyers did by prohibiting the paralegals and accountants)..we need to look at why they have become so successful in the first place and why we need them...and this is because of the disparity in healthcare...we need to increase the amount of qualified, domestically educated physicans and then the public will decide... if they want to receive their care from physicians or the rest... and if they decide on the others because they are cheaper...then that is a separate debate about does medicine have to be so expensive...

i bet you were a good lawyer by the way...