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Why do people recommend PA to medical students and premeds?

Discussion in 'Medical Students - MD' started by mr.applesauce, Nov 11, 2017.

  1. rg2o3

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    Yes. Also many of the clinics around here, seems that the PAs get stuck seeing colds or follow ups all day. Even worse are the PAs who get stuck working for surgeons that have them filtering patients all day to determine who is a surgical case (aka can get them money).
     
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  3. dillydilly2

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    Yes you were a neuroscience major so I get why you had to take those classes!

    Here is an example for the OP. UC Davis PA program class requirements. Granted, my friend is a second year PA student too and her requirements for her school had 2-3 more classes than this list.

    Screen Shot 2018-03-12 at 9.12.06 PM.png
     
  4. BorntobeDO?

    BorntobeDO? SDN Bronze Donor
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    +1000 to this. Number one reason I didn't go NP. Midlevels have no check mechanism at all on rapid for profit expansion. But I imagine they will soon. California BON is already not recognizing NP's from 'online' only programs. Won't be long before the mid-levels 12-18 month residencies start to become a defacto requirement at big hospitals. Not the same as ours, but definitely a step in the right direction.
    Dang MRSA spiders, they're everywhere!
     
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  5. These are extremely weak requirements. Between this and not taking the MCAT, how do they ever weed out the morons?
     
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  6. dillydilly2

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    :hungover:did you say spiders? *burn it all down*
     
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  7. Is that really true about the online programs? Link?
     
  8. BorntobeDO?

    BorntobeDO? SDN Bronze Donor
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    Nursing Programs
    enjoy
    Advanced Practice Programs
    notice what schools are on the approved list*
    *I know someone is going to see Phoenix and say its online, but it isn't, at least in California.
     
    #207 BorntobeDO?, Mar 12, 2018
    Last edited: Mar 12, 2018
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  9. BorntobeDO?

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    If you really want to feel like theres hope:
    "Allina Health does not hire new grads from all academic institutions. Many proprietary on-line schools do not meet Allina Health’s standards due to the minimal oversight of the student’s clinical experience, the high faculty/student ratio, and the lack of focus on national certification standards in the curriculum."
    New Graduate NP/PA Application - All Locations Description at Allina Health
     
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  10. BorntobeDO?

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    You should note that UC Davis is unique in that it combined its PA and NP programs several years ago, so the science requirements may look a little 'lax' compared to a normal PA, but it is actually quite a bit more difficult to get into without significant (multi-year) healthcare experience. Since it is headed by the nursing school, there is a bias towards nursing. Like most UC Davis programs I feel it is top notch.
     
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  11. People with lots of experience can still be morons...
     
  12. BorntobeDO?

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    No doubt, but my personal experience with this program leads me to believe that the graduates of this program are not. It is quite competitive to get into. They don't appear to have an average matriculate data set available, but when I was interacting with the school and other students who went there, it was either implied or understood that a 3.5 was considered competitive and that a good standardized exam would strongly assist your application.

    I don't want to act like I am a all-knowing resource on this topic as it has been a couple years, and I am not, but I did interact with that particular school, and have first person knowledge of it from my time as a nurse. UC Davis is not a degree mill with no standards.
     
  13. niko327

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    Having gone through training in PA school and in medical school, I feel that there's quite a bit of misinformation on this thread. To answer the OP's question:

    1. Why do people recommend physicians assistant to premeds who don't get into medical school or to medical students who fail out of medical school?

    Because they don't know what they are talking about. It is very silly to recommend PA school to someone who has failed out of medical school. Simply put, (with RARE exceptions) they will not be accepted. There are so many highly qualified applicants trying to get in to PA school as it is. Someone with a glaring red flag like failing out of medical school would have little chance of being accepted. Can it happen, sure, but it's extraordinarily rare. Sorry, that's just a cold, hard fact. Sadly, too may people have been offered this useless advice and all it does is foster false hope. As far as applying to PA school because you don't get in to medical school is concerned: Yes, plausible. So long as you have the pre-reqs, a competitive GPA, required experience and a good story as to why you want to be a PA, you have as good a shot as anyone. Just don't think that a 2.7 GPA and 40th percentile GRE is going to cut it, it won't.

    2. Isn't PA school just as hard to get accepted into?
    PA school is getting tougher to gain admittance to all the time. It's such a popular profession for so many people looking to operate at a pretty high level in the medical world with fewer of the demands of medical school and residency. Overall, I feel that getting admitted to MD or DO school is probably more difficult in terms of the required coursework, research and MCAT. However, PA school has very significant barriers to entry that don't lag quite as far behind as many of the advice givers on this site seem to believe, especially with respect to GPA.

    3. Is PA just as difficult as medical school?
    No it is not. PA school is academically rigorous, without a doubt, and excellent preparation for the creation of mid-level clinicians. There are large volumes of information that you must assimilate in PA school delivered by a curriculum with a similar layout to medical school. You are prepared well. So well that Physician Assistant is a poor descriptor for the training, I feel that Physician Associate is a better term for what you are trained to do. Medical school, however, is a whole new level of pain. I found it to be significantly more detailed, more voluminous and more demanding in terms of what you are responsible for knowing. There is a much deeper level of understanding and integration of the basic sciences with the clinical subjects you learn. Perhaps the greatest difference I appreciated was the focus on Pathology. Also, the board exams in medical school are significantly more detailed and difficult compared to the PANCE or PACKRAT.

    3. I figured physician assistant schools are just filled with medical school quality students who didn't want to invest 7+ years of their lives and crazy student loans to train for a job.
    You may be right here to some extent. I feel that the majority of students in PA school have the ability to do fine in medical school if that is where they ended up. At the same time, there are also PA students who are struggling in their respective programs who would be absolutely eaten alive in medical school before the end of the first semester. Overall, I think that you just adjust to whatever your environment happens to be. It's like being in a surgical rotation versus a tough outpatient clinic rotation. If you are subjected to waking up at 3 am to be in the hospital by 4:30am, work for 16 hours a day for 8 weeks, with night calls and weekends, after a while you get used to the new normal. It sucks and you know it, but you're kind of used to it and you do it (that's kind of like medical school). You also realize that your outpatient medicine rotation of 10 hour shifts, 5 days a week with 2 weekends over 4 weeks wasn't really as tough as you thought. It certainly was no cake walk at the time you were going through it, but you never fully appreciated how much worse it could be (kind of like PA school). I think this is a reasonable analogy however imprecise it may be.

    In response to some other posters who were suggesting that PAs only see low acuity cases, please know that is only your experience. The fact remains that many PAs work in the ICU, as solo night house officers, in main ERs, etc, handling high acuity cases with physician oversight appropriate to their personal level of experience. Sometimes that means they're glued to the attending physician and sometimes that means they're working nearly independently. It all depends on their experience, what they know and where they work.
     
    #212 niko327, Mar 12, 2018
    Last edited: Mar 12, 2018
  14. rlbk

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    Well said, focused, and interesting perspective. I do agree I found that some students in my class were struggle-busing to the extreme where I could see them being eaten alive in med school. But also a vast majority like myself who found it very do-able and could be able to handle a heavier load. The coursework was hard and there was still a lot of material. I think the point is getting missed here because many people on here are really quick to the defense. Yes, med school is more intensive, clearly, in comparison to PA school. I don't think that's something that needs to be argued because obviously, med school is longer and you're the primary decision maker and don't need anyone's cosign. That's going to require more training.

    The point is, when we are talking about professions in health care, PA and MD/DO are comparable. Not the same, but comparable. That's why so many people find themselves deciding between going the PA route or the med school route, because it's a health care career based on the medical model that involves seeing patients, diagnosing them, determining treatment, etc etc. Now of course the extent of which you can do these things or how competent you are at them is different between PA and MD/DO. There are many students who very well have the capacity to become doctors, but choose PA because their priorities are are more focused on lifestyle. Many with children find that they can't commit to the rigorous, lengthy commitment of medical school. Those who choose MD/DO have a higher commitment to practicing medicine and want to be able to practice with full flexibility and autonomy. That's what it comes down to. No one is saying that a PA is just as medically educated as a doctor, I'm certainly not. But that does not mean that its not very hard to get into PA school or that PAs aren't capable of doing many things that a doctor does. There are lots of things PAs can't do, but we're okay with that. Those who choose PA and those who choose MD/DO are just two different types of people.
     
  15. sb247

    sb247 Doer of things
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    I’d disagree that PAs are “ok with” supervision. You all would go independent in a heartbeat if it was legal and are already pushing for it
     
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  16. rlbk

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    If I really wasn't okay with that I wouldn't have decided to become a PA, I would have gone the med school route. There may be some areas where I would like to have a little more independence, but overall I feel comfortable and satisfied with what I'm allowed to do. Sacrificing independence is the price you pay for having a faster route and more flexibility in switching specialities. I can only speak for myself though, I'm sure there are PAs out there who are pushing for more. Don't say "you all would go independent in a heartbeat" because you do not know that and it is not true. If you threw it at us, sure we'd take it. But we know what we sign up for, we know we don't get that.
     
  17. sb247

    sb247 Doer of things
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    You are either dishonest or not paying attention

    http://news-center.aapa.org/wp-content/uploads/sites/2/2017/01/What-PAs-are-Saying-January-1.pdf
     
  18. rlbk

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    Also, since the PA profession is increasing in popularity, don't go thinking that if you're a med school drop out or flunkie that PA school is going to take you..... lol they probably won't. Maybe that was a thing in the past, I don't know, but PA schools now primarily want people who want to be PAs, not doctors. If they pick that up in an interview, you're probably not looking like a good candidate to them. Many PA schools have high standards, if you flunk out of med school, the PA school will likely assume there's a chance you'll flunk out of their program too. PA school focuses a lot on academics, many schools won't even accept your application if you have less than a 3.5 gpa. While that is referring to undergrad gpa and not med school gpa, the point is they want people who excel in classes and that's a main point for them. Those of you on the med school route don't know enough about PA, and PA as a profession is growing and changing as we speak. It's becoming more competitive because it's such a desirable thing to go into.
    I also agree that if you flunk out or get denied by PA school, you probably won't get into med school either. You need a strong application for both. I'm sure med school is still more competitive, though. If you don't get accepted into med school despite having a stellar application, you could potentially get into PA school, sure. But you'd need to have a very good application.
     
  19. rlbk

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    Like I said, I can really only speak for myself. I don't think PAs have enough training to have all the responsibilities that a doctor does, and neither do many of my peers. There are always going to be people who want more power though. If the physician I work with feels I'm competent enough and am capable of doing more, I'd take it on. I realize I am working under their license and respect that. It's up to what they're comfortable with.
     
  20. W19

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    I rotated with a few PA students and I found them quite knowledgeable. OTOH, the one NP student I rotated with was terrible.
     
  21. sb247

    sb247 Doer of things
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    A more appropriate response would be, “my bad, I was wrong to imply that my professional organization isn’t fully gunning for Independance “
     
  22. rlbk

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    I think you need to relax...lol. I've never encountered ANYONE in the clinical setting thus far who has been so aggressive regarding their superiority. Mostly because it's just not necessary. Everyone who works in the hospital knows their role (or at least should) and knows that physicians always have the final say and their opinions will always be held to a higher regard than that of the PA (however, with 90% of encounters I've seen, the physician and PA grow to be so close that they usually draw the same conclusions and agree with each other and the PA starts to know how the physician typically thinks or acts regarding many situations). I don't think what you're doing here is productive to providing better care in the slightest. For you to base your stance on an entire profession based off of what you "think" you know, is very presumptuous.

    The statement above that you just made makes it seem like you're threatened by PAs lol which you shouldn't be. We'll never have full autonomy, which personally I don't mind. Sometimes making stressful decisions is difficult for me and I need to be able to consult with someone, so I like discussing with a physician if I need to and having their approval, it makes me feel more comfortable. Utilize your PAs in the future because they'll make your life a lot easier (if they're good, which is more likely than not). I understand that most everyone here is probably MD so you're all gonna have your MD pride and that's cool, but don't take it to the point where you just look arrogant and intolerant. I'm not here for beef, I'm here to offer a PA perspective because sadly there's sometimes misconceptions. The attendings that I work with on rotations have not once belittled me or suggested I don't actually know medicine, they expect me to know a lot of it, and are often impressed by the extent of what we are taught. For some reason, those still in med school often tend to sit on a much higher horse than actual attending physicians. Just something to think about.
     
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  23. Matthew9Thirtyfive

    Matthew9Thirtyfive Kind of fantastic.
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    You clearly don’t have much experience with NPs. I have worked with several who actively try to discredit physician training and assert themselves as being just as good as a physician in a clinical setting, to the extent that they introduce themselves as “Dr. Last name” to patients (against hospital policy, btw).

    Tbf, the only people in the PA world who are remotely like that are PA students, and they seem to lose it pretty fast after they realize what a gap there is in their knowledge compared to a physician.
     
  24. rlbk

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    I think it's like that for all students, med students too, going out on rotations is always a wake-up call because there's a difference between what you read and study and then how to apply that clinically. Being aware of your knowledge gap is essential and motivates you to absorb everything you can from the physicians. As a student, I always feel like I'm useless to my preceptors because I basically am at this point lol. I often feel incompetent and kick myself for not remembering certain things and the attending always reminds me: 'that's why you're here, to learn. If you knew everything already you wouldn't be here'. I take advantage of being able to pick their brains because I'm fully aware they are the ultimate resource of knowledge.

    I've actually never really encountered NPs, they really don't have a presence at all in the hospitals where I'm at. The only mid-levels I see are the PAs. But that's so horrid that they introduce themselves as doctor?? Any PA I've been with will pretty much always get called "doctor" by the patient and the PA ALWAYS corrects them and makes sure they know they are the PA, not the doctor. That's just disrespectful.
     
  25. niko327

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    Hey sb247, again, I feel I may have something to add here. The "whole independent push" is not as clear cut as it may seem. The "independent practice push" so far as I've seen is unpopular among many in the PA Profession. It's been tolerated thus far only because PA's feel they are getting squeezed out of employment opportunities due to the independent practice push by other mid-level providers. Many of the decision regarding whether or not someone gets hired has is shifting towards financial considerations. For example: Why would I hire this PA and need to pay my physicians more to supervise her. Why wouldn't I just hire someone else with full practice authority who can operate independently without all the extra financial and administrative hassle. All of this is really being driven by an instinct for self preservation. I can see how you may feel the way that you do about someone less trained than you pushing for independence. At the same time, here are some of the politics involved. What do you think?
     
    #224 niko327, Mar 13, 2018
    Last edited: Mar 13, 2018
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  26. Matthew9Thirtyfive

    Matthew9Thirtyfive Kind of fantastic.
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    I agree sort of. But the difference is that by the time physicians hit independent practice, they have closed that knowledge gap. When PAs and NPs graduate and go out into practice, they haven’t even come close.

    I have noticed this trend as well. I have not met a PA irl who wants independent practice. I know some who want autonomy, but they like having the safety net. I also am not so naive as to think there aren’t PAs who want it.
     
  27. niko327

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    Hi rlbk, Yes you are only really speaking for yourself here. If independent practice gains any significant traction, I think there will be quite a bit of push-back from many within the PA profession. Many didn't sign up for independent anything and all of the liability that goes with it. Lots of PAs think they'll survive based on our historic ability to provide a high level of care in a supervised setting, making us as desirable as any other mid-level. Keep in mind that being independent means you are fully responsible for outcomes, couple this with the fact that compensation will surely lag behind for a good long time and....well I think you get my drift. When you enter practice, you'll find that you're thinking about your liability all the time. Liability is a big deal that so many students (medical, PA, nursing, NP) on this site fail to duly appreciate.
     
    #226 niko327, Mar 13, 2018
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  28. rlbk

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    Oh for sure, agreed. I don't have the desire to be fully independent. I'm saying a little bit more autonomy here and there would be okay, but I wouldn't even push for that. If I wanted to have the full responsibilities of a doctor I would have gone to medical school lol.
     
  29. sab3156

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    I know an oculoplastics guy who is pretty young, and always recommended pre-meds working with him to go PA. I don't understand it, but I think he reasons that it is far less investment of time. That's about it.
     
  30. rlbk

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    This depends on the time frame you're speaking of. When you compare a physician who has just completed all their education with a PA who has just completed their education, you're correct in saying that PAs haven't come close to closing that knowledge gap. But once a PA gains enough experience practicing in a certain field, that gap narrows. On one rotation I had, my preceptor was the attending. He had a PA he'd been working with for a couple years. The attending would send his PA off to go see patients and do consults, follow ups, carry out their own plans, and discharge etc without ever seeing any of these patients himself. He'd barely skim over the PAs notes and hit cosign.
    The PA will not reach the expertise as that of a physician, but very experienced PAs will have a narrower knowledge gap. The physician you work with is really important because it seems the better relationship you have with the physician, the better of a PA you become.
     
  31. W19

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    I never understand that nonsense... When you are consulting an attending, you want the opinion of an expert and the last time I checked, PA aren't expert in anything. Why would an attending send a PA to take care of consults?
     
  32. rlbk

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    In some specialties PAs can handle it. Not right away, but with time and showing that you're competent enough. And a good physician who's effective in teaching their PA how they like certain situations handled. And if I were you, I wouldn't suggest holding stiff prejudices. If you trust the opinion of said attending, then trust his/her judgement in their PAs abilities. They won't send them to do consults on things they don't think they can handle. Ones that they feel needs their opinion, they'll go to them. Simple as that. If you're a hospitalist per say, and you consult nephrology, the nephrologist may not deem your consult as one that requires an 'expert' opinion. Stupid consults happen allll theee timeeee. That nephrology PA will know more about nephrology than you do as a hospitalist, even though you're a doctor. You don't retain the information that you don't use. I am AMAZED at how little some doctors know about areas that are outside of their specialty. I've witnessed doctors blast their patients with benzos, multiple antipsychotics, adderall (which wtf are you doing giving an upper with a downer) and then consult psychiatry asking why their patients have an altered mental status ............
     
  33. smurfeyD

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    The only problem is, whether the gap of knowledge becomes more narrow or not, the difference in pay doesn't. PA's reach their ceiling in terms of career advancement pretty quickly.
     
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  34. DO2015CA

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    Although weak requirements. UCD has a pretty competitive PA program to get into.
     
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  35. Medicine016

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    For the record, this is not "objective" data as you claim.
     
  36. libertyyne

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    The DO data is objective. The median GPA is in all likelihood higher for PAs. The DO MCAT data paints a fairly clear picture though, so you can believe what you want, but with a mean or median close to 500 that is hardly anything to write home about.

    Why don't you provide some more "objective" data for comparison.
     
    #235 libertyyne, Mar 13, 2018
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  37. smurfeyD

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    Not to mention, some of the classes required that determine the GPA's are different between most PA and DO programs
     
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  38. Deecee2DO

    Deecee2DO Medical Student (MS-1)
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    I agree @Medicine016 . To add some objective data here, I just checked up on Top 20 PA programs from last year (Duke and Emory which are in the top 5) and their incoming class GPA avg is 3.4-3.5, which is still lower than the overall DO matriculant average GPA (3.5-3.6). On top of that, you can't compare the GRE to the MCAT either which is the other admission's metric, as the MCAT is just grossly more difficult and the two tests are worlds apart both in content volume and critical thinking. Also, the pre-reqs are less for PA than MD/DO.
     
    #237 Deecee2DO, Mar 13, 2018
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  39. W19

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    I understand that for instance a nephro PA that has been working in the field for years will probably know more than a non nephro doc, but that does not mean that PA is an expert. I am sorry, I will not consult any doc who uses PA/NP to see their consult the first time.
     
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  40. W19

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    One classmate who took both told me the GRE is a joke compared to the MCAT (old version)... He scored 95+ percentile in the GRE with minimal effort and 27 MCAT studying for almost 3 months.
     
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  41. libertyyne

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    upload_2018-3-13_18-1-13.png
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    Lets not make up facts.
     
  42. growacet

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    The morons fail out. Usually in the first semester.
     
  43. W19

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  44. libertyyne

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    I am just pointing out that the poster I quoted was incorrect. Those are not bottom stats, those are averages.
     
  45. Deecee2DO

    Deecee2DO Medical Student (MS-1)
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    Makes sense
     
  46. W19

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    Well, I had an idea what subjects are tested in the GRE but I did know the content... However, that classmate told the content is pretty weak compared to the MCAT...
     
  47. Matthew9Thirtyfive

    Matthew9Thirtyfive Kind of fantastic.
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    The GRE is basic college math and critical reasoning. It is not difficult.
     
  48. Matthew9Thirtyfive

    Matthew9Thirtyfive Kind of fantastic.
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    @rlbk
    Okay, here's my response.

    This is said a lot, and it's misleading for a couple reasons. One, it is not necessarily that the knowledge gap between the attending and the PA narrows, it's that a PA with 10+ years of experience will be closer to a freshly minted attending. If you take a freshly minted attending and a freshly minted PA and follow them for 10 years, the PA will learn what to do in certain situations and maybe even some of the reasoning behind it, but the basic science knowledge gap will still be there. In 10 years, when something not quite right comes through the door, he will still be asking the MD for help (or at least, he should be).

    And that's fine. That's what the physician/mid-level relationship should be like. Mid-levels are great at handling routine stuff, even in a subspecialty practice. When your PA does nothing but that specialty all day, of course he's going to be able to handle a lot of consults on his own. That just makes sense. But you better believe that the physician is handling anything that isn't straightforward (or, again, she should be).

    I have practiced as a mid-level. Following protocols and guidelines is not difficult. Looking at the guidelines to see which ones make sense to you for a given patient is also really not that difficult if you put a little thought into your practice. But when someone presents atypically or with something complex, even if I was pretty confident I knew what was going on, I still sent them to see an MD/DO.

    My point (sorry this post is so long winded) is that anyone can get good at doing the bread and butter. PAs are good because they have some basic science knowledge (versus an NP that has essentially none), but a lot of it is still just training. The gap between a PA and an MD/DO is in the depth of knowledge--most PAs will just never have the same level as an MD/DO.
     
    #247 Matthew9Thirtyfive, Mar 13, 2018
    Last edited: Mar 13, 2018
  49. rlbk

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    Again, like I said, you don't need an absolute expert for every consult because not every patient is going to be so complex that a PA can't handle it and if you think otherwise, that's just laughable. Mid-levels are certified to see their own patients and have been for a while. Most doctors I've encountered have no resistance to this because they trust their PAs and they help them feel less overloaded with patients. If you think that a physician sees every single patient that a PA sees, you must not have much experience with PAs. The medical field evolves and changes all the time, if you wanna be one of those stubborn physicians who are difficult to work with, by all means you do that. If you refuse to consult a doc who uses a PA/NP to see them, that only looks bad on you.
     
  50. rlbk

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    Yeah the GRE is absolute bull**** lol. Not even college math, it was a lot of geometry. And then a **** ton of vocabulary. Not medically relevant in the slightest. It's no where near what the MCAT is. The GRE is a total joke and needs to be scrapped, most schools don't even give a **** about your GRE score anyway because they know it isn't relevant, it's just a technicality.
     
  51. W19

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    Consult can appear mindless, but turn out to be challenging at time... PAs have their place in medicine, but they aren't supposed to be the first line for consult no matter how long they have been working in a specific field. It's just my opinion.

    I am ok with follow up though, but I believe a physician should see the patient first for any consult...
     
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