Why is the A in PA stand for assistant?

[50960]

Point taken, and I agree. The title doctor carries way too much clout in this society, but that is changing. As more so called "mid-level" practitioners carry the load of primary care things will change.

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[WMUPAS]

Now that it seems that the issue of "assistant" is over....let me put this on the table. I work in a "Big Ten" EM program. Although it isn't my primary job, I frequently teach EM residents (one-on-one and one-to-many as a paramedic).

My "bosses," EM profs, consider SOME EMPAs as their colleagues. Typically, the PAs are former EMS people with a long out-of-hospital clinical history. We EMS creatures are focused on critical care and stabilization. It seems that EM is a lot of it is primary care and a smaller portion of critical care.

My question is: How do you feel about experienced PAs working in EM?

I would really like to hear from the docs and PA/NPs.

If I need to repost to the EM forum, let me know.

Enjoy your weekend.

 

[FutureOrthoDoc]

This might sound bad and I know that PAs assist doctors, but it just irritates me that going to college for 4 years, then PA school for 2 - I would work so hard to be called assistant. It should be associate or something... any thoughts or other ideas for what 'A' can stand for?

Then why don't you go to medical school, and you don't have to
worry about it. This just seems trivial.

 

[deleted6669]

Now that it seems that the issue of "assistant" is over....let me put this on the table. I work in a "Big Ten" EM program. Although it isn't my primary job, I frequently teach EM residents (one-on-one and one-to-many as a paramedic).

My "bosses," EM profs, consider SOME EMPAs as their colleagues. Typically, the PAs are former EMS people with a long out-of-hospital clinical history. We EMS creatures are focused on critical care and stabilization. It seems that EM is a lot of it is primary care and a smaller portion of critical care.

My question is: How do you feel about experienced PAs working in EM?

I would really like to hear from the docs and PA/NPs.

If I need to repost to the EM forum, let me know.

Enjoy your weekend.

I have worked in emergency medicine for 18 yrs now, many of these as a pa. I currently work for a busy trauma ctr( >100k pts/yr)that uses a large contingent of pa's. we see almost anything that comes in the door with the exception of obvious mi's (they get screened by an em doc and go to cath lab), multisystem trauma(trauma team sees them), obvious new cva's( md screen and stroke team eval).we are well paid and appreciated by the md group. we are partners in the em group and receive production bonuses.The group uses over a dozen pa's most of whom had prior experience as military or civilain medics. we don't hire new grads. minimum qualification to get your interview: acls/atls/pals, 5 yrs experience as an em pa, great letters of rec from previous em job, and requirement to work on call for a yr before full time status so the group can check you out. it is a great gig.I also work solo a few times a month in a slower facility seeing whatever comes in the door
and that is a blast as well.
for more info on pa's in em see our professional society's webpage, www.sempa.org

 

[RAMPA]

i don't condone med students whining either. and pre-meds are probably the biggest bunch of whiners and most useless individuals of any one group.

my comments are in regard to the OP who thinks s/he "has worked so hard and is 'nobody's' assistant!"

in reality, many others work much harder to get where they are. 2 years post-bacc is childs play and in any other profession (i.e. MBA) it doesn't even guarantee you rights to a job or money. why the "Assistant" well, because you ARE there to ASSIST the doctor. You are not the primary care giver and as such you are called an ASSISTANT. I don't know why there is such grief over this. You do not know MORE than the doctors. Nothing is worse than a nurse/PA who believes their role is to run the show. Please do your job and ASSIST when WE need you to. And stop being such a baby... your job is very important and we'd likely go nuts without you. BUT please stop projecting your insecurities in the form of temper tantrums in my office or deliberately failing to work out the orders.

i kinda wanted to go against you with the first post, but i see your point. i thought oh man another God wanna be MD. as a pre-PA student i see that u hit the nail right on the head. if i wanna to be a PA its because I want to assist the doc and take some of the load off and not run the show. all of us have a different calling and we need to find our place in healthcare. and yes no more tantrums. I would be proud to be called a Physician Assistant or at least I play one on TV!

 

[iliketocut]

Thank you! For being honest and not trying to start an argument because your feelings are hurt over the truth in something someone says. Finally, an intelligent poster who took the time to actually read the posts.

 

[allendo]

Um, just in case you didn't notice, this is a FORUM for "ancillary staff" and the like, so if you are so sick of the whining you probably should not troll around and say inciteful things. You are only being mean and bragging about your *wondrous* education. I don't know what gave you your nasty attitude but you should not let one bad experience ruin your view of PA's. Just like I won't let my impression of you ruin the utmost respect I have for most M.D.'s.
P.S. I have read many threads on the pre-med and med forums most of which contain some "whining". Often that is what people need to do in order to let off steam and I do not fault them one bit.

I think the responce was right! If you want to be a doctor go to med school and quit trying to act like your a doctor. I was at starbuck and listened to a group of NP's talking about how they did'nt know what gram + and gram - bacteria are! Give me a freakin break

 

[WMUPAS]

EMEDPA:

Thanks for the info. I read your posts over at Phys.Assoc.com. Really admire your EM situation. I like the fact that your practice takes a year to eval a new PA. Pretty neat stuff. I also think that it is great that you are given partnership opportunity. This is the kind of group I want to be a part of. They take their obligation as supv docs seriously and will open the door to partnership.

I'm pretty envious. I am headed off to school this August and am worried about not finding a local or regional EM job post grad. Only a couple of the 15 hospitals in our nine county region use PAs in the ED. I don't need high volume ED to be happy. In fact, high volume wouldn't be the best choice because of the EM residency. On top of that, I will be fresh out of school...and worry about not getting hired in EM. I don't want to go to IM or FP to get experience and then up and leave the Supv. doc. Seems kind of unfair.

I guess I have 24 mos to think about it and figure out a plan. By the way, mentioning the certs for hire...I am an instructor for all but ATLS. ACLS, PHTLS, not PALS but PEPP, etc...

Thanks for the response

 

[deleted6669]

Seriously consider an em residency like the 1 at ucg and you would go a long way towards getting an awesome em job:
see www.apap.org for links to all the pa residencies

 

[Monika]

I think EMED meant to give you this link: Association of Postgraduate Physician Assistant Programs



Best wishes in your endeavors!

 

[pushinepi2]

....I made the decision to apply to PA school not because I could not go the "extra mile," but because I chose not to. I am OK with that. Maybe before applying to PA school, we all need to ask ourselves if we are OK with the “assistant” role and ask ourselves why we want to do this.

If I was so caught up in titles and names, I would want people to call me "Master Smith" like physicians are called "doctor." After all, my degree will be a Master of Science in Medicine.....In the end we just have to show mutual respect and understand our limitations, whether they be clinical, intellectual, or social.

Sooo interesting. It seems (from my own non randomized sampling of posters) that individuals with a healthy amount of experience enjoy a critical and yet well rounded perspective on the whole PA debate.

The practice of medicine depends upon an entire team of individuals dedicated to patient care. Without paramedics, the poor slob referenced in WMUPA's post would most certainly have expired in the waiting room. Without deciated ER nurses, that patient would never have been properly monitored and stabilized. Subsequent efforts at resuscitation presumably continued in the emergency department. Extrapolating the preceding example, the presence of a pulse s/p cardiac arrest does not a stable patient make! The post arrest patient depends on radiologists, radiologic technicians, critical care nurses, and an entire BATALLION of ANCILLARY providers to ensure health. Medicine is a collegiate effort, and it IS understandable that physician assistants/associates want credit for the important role played in the diagnosis, treatment, and managment of illness and injury.

As a paramedic, I trained with PAs / ARNPs / RNs / MDs and DOs throughout school. I too marvelled at the apparent incompetence of interns and medical students with regard to intubation or other resuscitative procedures. I worked long hours for little pay and respect. It was not uncommon, for example, to have your protocols ridiculed and pre-hospital blood draws discarded. It was clear that I wanted to do more for patients and needed to pursue further education.

Like WMUPAS, the quest involved admittedly selfish motives. I knew I had some talent at putting tubes into various orafices and wanted more recognition. PAs and MD/DOs simply could not understand nor appreciate the rigors of paramedic education.... Sound familiar ?

Looking back upon four years of medical school, it is clear that disrespect, lack of understanding, long hours, little appreciation, debt, and a whole host of trials and tribulations is to be expected. Interns are bottom feeders, scut monkeys, and basically cheap labor. Fortunately, I knew a little bit about the medical community prior to my acceptance. I am therefore not as disappointed as some of my colleagues at the troubled state of healthcare in these United States. I fully accept (and am grateful for) my lot.

These discussions about expanded practice scope and a generalized lack of appreciation can be applied to nearly every rung on the medical career ladder. Nurses lament low salaries and bed-making duties... PA students say their education is four years of medical school condensed into 24-27 months... med students counter that their courses require a more intimate understanding of pathology... And on and on.

When considering a medical career, "satisfaction" emerges as an entirely INTERNAL concept. Put more succintly, fulfilment does not result from other people telling you how valuable your contributions are. This idea has consequences for every level of health care provider. Physician Assistants who feel underutilized or disrespected by their physician colleagues might eventually pursue additional post graduate training. Physicians who are similarly abused may contemplate the option of fellowship training or a tenure-tracked career. Nurses not wanting to spend the rest of their lives taking orders from green-around-the-gills interns can apply to ARNP/CNM/DrNP programs. Of course, self-discovery is an ongoing concept. The more education that you receive, the more hungry you become. That is why my graduating class consists of former medics, nurses, PAs, and chiropractors.

What cannot be disputed, however, is the role that each type of care provider plays in medical decision making. I hope we can all agree on the following:

-Despite their knowledge and training, PAs and ARNPs will always maintain at least some level of physician interaction or oversight. Though ARNPs can 'hang their own shingle,' there often exists a mutually agreed upon protocol for physician referral. This necessity will not vanish just because the ARNP programs move towards a doctorate level degree.

-Physicians will, in most cases, have the most flexibility in patient managment decisions.

-Physicians undergo the most extensive pre-practice training of any health care provider. No other discipline (ARNP/PA-C/CNM/CRNA) mandates a minimum of three POST graduate years. PA residencies exist in many specialties, but none of them involve 36 months of investment. Furthermore, they are not a pre-requisite for board / license eligibility.

Since most people on this forum agree that the health professions draw upon many able bodied and intelligent individuals, it stands to reason that medical school is a viable option for anyone seeking to expand their clinical horizons. Those students who are never fulfilled and want the most amount of autonomy should seriously consider applying to or eventually completing an MD/DO program.

On a more amusing note, I recently ran into one of NSUCOM's physician asst/assoc/colleage students while on call for trauma surgery. I asked her why the PA students didn't complete more rotations with the medical school. She looked at me quizzically and replied, "Dude... we're not osteopathic physician assistants!" Crap. I knew I should have gone to MD school.

 

[WMUPAS]

pushinepi2:

Good post! The whole PA debate sickens me. I don't have a "respect" issue. If I want to feel respected, my kids will hug me or I can help someone when their house catches fire. Hell, strapping on a badge and a bugle gets a load of attention by itself. I feel bad for those who enter the med profession looking for respect...

People like me just want to have a greater effect on their patients' outcome. PA school is a good alternative (for me) to 4+3 minimum to do this. I am more concerned about how my kids turn out than my becoming a DO/MD.

Bottom line is that no one will judge me when I'm gone, by my "letters." They are going to judge me by contributions to this world, especially my kids. I can't afford to jeopardize my kids' childhood (ages 7,9,11) by going to MS. I can however, go to PA school and achieve my goal.

From a purely financial standpoint, I can't afford to go to MS at 36 y/o. I would still be paying back MS debt when I should be retired. For something less than 40K and 24 mos, I can be practicing med under the supv of a doc, all while achieving my goal. Good fit for a medic already used to practicing under a doc.

Maybe more folks (like the poor person who started this thread) should consider my twisted logic. BTW, the "poor slob" is walking around his room asking when he can get the "hell out of here?" The whole team did a great job.

Glad you went to DO school. Congrats.....

 

[goooooober]

Here is the deal. WHether we like it or not, whether it is right or wrong, medicine has a very well established hierarchy, even for doctors. Medical students are looked down at by residents who are looked down at by attendings who are looked down at by chiefs etc. What keeps this system from collapsing altogether is one thing, RESPECT. The vast majority of medical students, residents, attendings, etc. ect. are very nice people who have lots of respect for nurses, PAs, janitors (sanitation engineers) etc., until one tries to disturb the hierarchy. That is when things get really ugly.

 

[EMDream]

Here is the deal. WHether we like it or not, whether it is right or wrong, medicine has a very well established hierarchy, even for doctors. Medical students are looked down at by residents who are looked down at by attendings who are looked down at by chiefs etc. What keeps this system from collapsing altogether is one thing, RESPECT. The vast majority of medical students, residents, attendings, etc. ect. are very nice people who have lots of respect for nurses, PAs, janitors (sanitation engineers) etc., until one tries to disturb the hierarchy. That is when things get really ugly.

I'd say a PA falls somewhere along the lines of a 3rd year resident. I'd laugh if a med student or an intern tried to get all "hierarchy" on a PA, and the PA would probably laugh too, in their face.

 

[sunnyjohn]

pushinepi2:

Good post! The whole PA debate sickens me. I don't have a "respect" issue. If I want to feel respected, my kids will hug me or I can help someone when their house catches fire. Hell, strapping on a badge and a bugle gets a load of attention by itself. I feel bad for those who enter the med profession looking for respect...

People like me just want to have a greater effect on their patients' outcome. PA school is a good alternative (for me) to 4+3 minimum to do this. I am more concerned about how my kids turn out than my becoming a DO/MD.

Bottom line is that no one will judge me when I'm gone, by my "letters." They are going to judge me by contributions to this world, especially my kids. I can't afford to jeopardize my kids' childhood (ages 7,9,11) by going to MS. I can however, go to PA school and achieve my goal.

From a purely financial standpoint, I can't afford to go to MS at 36 y/o. I would still be paying back MS debt when I should be retired. For something less than 40K and 24 mos, I can be practicing med under the supv of a doc, all while achieving my goal. Good fit for a medic already used to practicing under a doc.

Maybe more folks (like the poor person who started this thread) should consider my twisted logic. BTW, the "poor slob" is walking around his room asking when he can get the "hell out of here?" The whole team did a great job.

Glad you went to DO school. Congrats.....

good post

 

[pushinepi2]

I'd say a PA falls somewhere along the lines of a 3rd year resident. I'd laugh if a med student or an intern tried to get all "hierarchy" on a PA, and the PA would probably laugh too, in their face.

That's just great. A modicum of ignorance is all it takes to deconstruct several messages worth of progress. That is absolutely ridiculous. Second year residents manage emergency rooms throughout the United States. There's virtually no comparison. Talk about apples and oranges ? You're seriously suggesting that a physician assistant, with one year of clinical background, can compete with a senior level resident physician ? Ah, the train of thought gets derailed once again.

Though the previous post matters little in the scheme of things, it is attitudes like that which render medical students both incredulous and hostile. The likening of a newly graduated PA to a third year resident (if that is indeed your contention) indicates that you have virtually no understanding of a physician's training. In most cases, senior level residents (at least in EM) have completed more critical care, trauma anesthesia, radiology, neuro and pedi EM that a recently graduated PA can even dream about. Physician assistants who complete even ONE year of post grad EM training often tell me (granted, anecdotal evidence at best) that they are far more prepared from an additional year of post graduate schooling. Residency is designed to temper the knowledge base of the graduated physician with some much needed experience... A resident completing two years of 80 hour average work weeks has more than doubled the time that an average PA student spends in clinical rotations.

Interns and students frequently don't possess the experience necessary to formulate mature clinical judgements. The difference that a year of physician level responsibility makes, however, is hard to underestimate. I apologize if I have taken your remarks out of context. As you've seen, there are many PAs on this forum who have spent 18+ years in emergency medicine.. (no naming names). These individuals have seen it, done it, intubated it, and resuscitated it. Their experience gives them a rather unique and informed perspective on patient care and medical decision making. Judging from your post, it does not seem that you're one of these seasoned providers. My comments are in response to your apparent comparison between a PA (recent grad) and a third year resident.

 

[iliketocut]

Look, this is exactly why PA's will never completely be taken seriously-likening themselves to someone who went through 4 years of school and three years of residency is disrespectful and, well, plain stupid. As a third year resident, I was operating on patients independently. I'd like to see just one of them walk into an OR by themselves, ask for a scalpel and not get laughed out of the room. Then try to manage that patient independently post-op. Let's get serious, by the end of third year of medical school, we're all qualified to be primary care providers. We can take a history, perform a physical and write a prescription. Let's talk about REAL medicine, where the patient is critically ill and decisions must be made in a split second. No PA in the country could handle that independently and they know it. But third year residents do it ALL THE TIME. That is why phyisicans are smart and humble enough to know that they NEED the four years of school and extensive residency training. We owe it to our patients to know as much as we can and act accordingly. Not run around like a bunch of cowboys claiming we can handle situations that are completely beyond the scope of our training.

 

[WMUPAS]

pushinepi2 is right about the apples and oranges thing.

Residents in our system can't even moonlight until PGY-III. And even then, they have to acheive a certain score on inservice exams.

Although there are many EDs in the US (or at least Michigan) that are managed by PAs, there needs to be a lot of experience on the part of the PA and good oversight by supv docs for success. Even as a medic and instructor for a long time, I would be scared as hell to work in an ED without post PA grad experience.

Comparing residents with PAs has to be done with an extreme amount of caution. A lot of EM attendings will equate a PA post-grad EM residency with 5 yrs of clinical experience. However, this residency doesn't make you as proficient as a PGY-III. Even some of our new residency grads leave with a tiny bit of apprehension about being on their own as an attending.

I would like to hear emedpa's comments on the above posts. BTW iliketocut, I think it was this forum or another were CT PA's were doing entire cabg procedures with the attending assisting as necessary. Also, heard something in one of the md/do/pa forums that Duke has PCTA program for PAs. If you have read my above posts, you know my take on my role as a future PA. I don't know what to think about any of this. I guess the supervising doc has to be the one to determine if the PA has the requisite knowledge and clinical ability.

 

[iliketocut]

BTW iliketocut, I think it was this forum or another were CT PA's were doing entire cabg procedures with the attending assisting as necessary. Also, heard something in one of the md/do/pa forums that Duke has PCTA program for PAs. If you have read my above posts, you know my take on my role as a future PA. I don't know what to think about any of this. I guess the supervising doc has to be the one to determine if the PA has the requisite knowledge and clinical ability.[/QUOTE]

Good post-as I have commented on the forum you mention in particular, at my institution, we do not allow PA's in the OR for any reason. I have actually seen attendings refuse to let a PA student in even to observe, which I do not necessarily agree with. Our surgical program is very much a hierarchy and it is not that PA's are considered "lower" than anyone, they are not considered part of the hierarchy period. They are ancillary staff members, which all of them seem satisfied with. That is why these posts are so interesting to me. As residents, we get along with the PAs well, probably because they don't walk around claiming they are equivalent to our 3rd year residents. They help us out, do the floor work when we're in the OR and generally make life a lot easier. As far as PA's in the OR, my understading is that at some institutions, they do have the opportunity to train to do minor procedures (i.e. vein harvesting). They are ALWAYS under the supervision, discretion of a surgeon. They are not performing major surgery, these are minor, routine procedures that some places don't have enough residents to cover. Believe me, after my third breast biopsy or so, I would've been more than happy to turn any more over to a PA or someone trained to assist in this type of case.

 

[EMDream]

That's just great. A modicum of ignorance is all it takes to deconstruct several messages worth of progress. That is absolutely ridiculous. Second year residents manage emergency rooms throughout the United States. There's virtually no comparison. Talk about apples and oranges ? You're seriously suggesting that a physician assistant, with one year of clinical background, can compete with a senior level resident physician ? Ah, the train of thought gets derailed once again.

Though the previous post matters little in the scheme of things, it is attitudes like that which render medical students both incredulous and hostile. The likening of a newly graduated PA to a third year resident (if that is indeed your contention) indicates that you have virtually no understanding of a physician's training. In most cases, senior level residents (at least in EM) have completed more critical care, trauma anesthesia, radiology, neuro and pedi EM that a recently graduated PA can even dream about. Physician assistants who complete even ONE year of post grad EM training often tell me (granted, anecdotal evidence at best) that they are far more prepared from an additional year of post graduate schooling. Residency is designed to temper the knowledge base of the graduated physician with some much needed experience... A resident completing two years of 80 hour average work weeks has more than doubled the time that an average PA student spends in clinical rotations.

Interns and students frequently don't possess the experience necessary to formulate mature clinical judgements. The difference that a year of physician level responsibility makes, however, is hard to underestimate. I apologize if I have taken your remarks out of context. As you've seen, there are many PAs on this forum who have spent 18+ years in emergency medicine.. (no naming names). These individuals have seen it, done it, intubated it, and resuscitated it. Their experience gives them a rather unique and informed perspective on patient care and medical decision making. Judging from your post, it does not seem that you're one of these seasoned providers. My comments are in response to your apparent comparison between a PA (recent grad) and a third year resident.

I wasn't talking about a newly graduated PA at ALL, I was talking about an experienced PA well into their career, and one with a fair bit of autonomy.

 

[EMDream]

Let's talk about REAL medicine, where the patient is critically ill and decisions must be made in a split second. No PA in the country could handle that independently and they know it.

I think that is total BS. And I'm sure that experienced ER PA's especially, would call you on it.

 

[iliketocut]

Stay in the ER. That's not what I'm referring to. The ER is not where critically ill patients STAY, it is where they originate. I'm talking about the ICUs or the post-op holding area or the trauma bays, which is where most of these types of patients are. I am talking about the minute to minute care of these patients, which requires knowledge more in depth than your PA classes or an ATLS course or even pure experience. This is simply a fact. You set yourself up by trying to compare yourself to someone in a position you have never been in. When you reach the level of a third year resident, feel free to comment on what a third year resident knows. But until then, you don't have a leg to stand on.

 

[WMUPAS]

My post is not intended to pick a fight, just some honest questions/observations:

I know where you are coming from, but as a medic I have seen some pretty attrocious screw-ups by ED docs. Screw-ups that I had to fix when no one was looking. No one is immune from mistakes. More over, some docs just can't deal with crit pts.

Why is that no one has a problem with a paramedic making "split-second life and death decisions" in the field, but a PA is in question? What does a medic do? Stabilize and transfer to definitive care. What do ED docs do with unstable pts? Stabilize and refer to approp svc or center (I realize there is more to it). If you think PAs don't have enough training, look at the national curriculum for paramedics. PAs have much more in-depth training than medics.

Why the issue with PAs? I know I won't graduate with the same amount of info as a doc. I know I can't replace a BC EM doc (when I graduate), but not many BCEM folks want to work for 60K in a <5K ED in Deadtoad, West Virginia.

Why is it that EM groups that can't afford to hire another DO/MD go with PAs? Is there a double standard in the industry that I don't know about. I find it interesting that in a number of specialties, the use of a PA is directly linked to not being able to afford to hire another doc or not wanting to pay another doc. Are the groups hiring PAs jeopardizing pt outcomes to save $ or do they see something in their abilities that others don't?

Working in an ED (75k+/yr), Level I TC, has shown me that only a small part of EM is life & death crit care. PAs seem to integrate into this setting quite well since the better hunk of the pt pop is primary care stuff. Maybe just different demographics here.

I would be interested to see the med literature regarding the PAs ability to manage critically ill/injured patients successfully. Where is emedpa when we need him.

Again, not trying to pick a fight, just some honest questions based on the above posts.....

 

[WMUPAS]

iliketocut:

sorry. missed your follow-up on the ED thing. However, your gonna find PAs everywhere. SCCM even has info for crit care PAs.

It looks like they are infiltrating almost every specialty. What would you do if your group hired a PA? I am being serious when I ask. Would you reject or educate and train to address your concerns?

 

[adamdowannabe]

Hey Iliketocut,

a lot of PA programs, shuffle PA students through the same patho and other med classes as the med students......

Some PA's are very well educated, and know a LOT......a lot more then you are willing to give anyone credit for.....

there are some hosptals where surgeons turn residents down for a procedure, because the PA is better..........

for every example you state, there is the exact opposite. Thats why it takes a whole lot of people to make the world go round.

A good PA, who knows their skills, probably won't stick around at a job on a surgical floor when all they get to do is catch the "droppings" from residents who are scrubbed into cases......... hospitals that utilize PA's more greatly are plentiful.

Opinions are great..... but factual/statistical eveidence is better!

 

[adamdowannabe]

And I really want to know,

how do you justify your statement, that "REAL medicine" only occurs when a patient's life hangs on the line, minute to minute....

real medicine? you basically just took most physicians careers, and lumped it into "non-real medicine" even fellow surgeons! I dare ya to walk up to an Ortho surgeon, and tell them they don't practive "real surgery" because they are playing with hammers, drills, saws, plates and screws....

You have run a gammut of education, you are obvioulsy intelligent and hard working enough to be well on your way to being a surgeon, but you make a lot of personal attacks to state your opinions....... it probably doesn't speak well (accurately) of who you actually are as a physician.

Forums (anonymous ability to say whatever) often leads people to misrepresent themselves, statements are written post-haste, often times not thought out, the message might be clear to the poster, but might read entirely different to the audience, and often times seemingly benign comments aren't at all.

I have a feeling, that after your done with you're residency, you might meet/work with a awesome surgical PA, who impresses the hell out of you, and you the opinion that has been built up in your current situation might disolve.... (who knows, maybe not)

 

[pushinepi2]

I wasn't talking about a newly graduated PA at ALL, I was talking about an experienced PA well into their career, and one with a fair bit of autonomy.

I implied something similar in my previous post.The above scenario is entirely different and would at least attempt to compate different varieties of apples. There's little doubt that experienced PAs clearly enjoy a, "fair bit" of autonomy as you say.

... A lot of PA programs, shuffle PA students through the same patho and other med classes as the med students......

"Shuffle?" The only time I saw PA students shuffle through my gross class was when they viewed some of the specimens previously dissected by the medical students. Some pathology/system classes may be similar, but this statement makes little sense. Even if we agree that PAs take the same TYPE of classes, the time invested in each is considerably different. PAs in the NSUCOM program were already experiencing clinical rotations while I was sitting for the next path/systems based examination. The same held true for PAs in adjacent community college and university programs.

...Some PA's are very well educated, and know a LOT......a lot more then you are willing to give anyone credit for.....

there are some hosptals where surgeons turn residents down for a procedure, because the PA is better..........

for every example you state, there is the exact opposite. Thats why it takes a whole lot of people to make the world go round....Opinions are great..... but factual/statistical eveidence is better

I'd agree. Thanks for your opinions. Again, many posters on this forum agree that PA procedural competency is probably similar. PAs are without question well trained. PA's do KNOW a lot and other posters have not attempted to marginalize the value of on the job clinical experience. Its a bit of a shame to let these forums degenerate into PA vs MD/DO threads. Fortunately, we've already answered the OPs question... we all can tolerate a bit more of this inevitable diversion. Thanks for the discussion.

 

[EMDream]

"Shuffle?" The only time I saw PA students shuffle through my gross class was when they viewed some of the specimens previously dissected by the medical students. Some pathology/system classes may be similar, but this statement makes little sense. Even if we agree that PAs take the same TYPE of classes, the time invested in each is considerably different. PAs in the NSUCOM program were already experiencing clinical rotations while I was sitting for the next path/systems based examination. The same held true for PAs in adjacent community college and university programs.

Are you kidding me?
I am taking gross anatomy this summer for six credits and we do dissection EVERY day. I'm just finishing patho. My program will not even let me start didactic until I finish these courses. Our gross is definitely not viewing previously dissected cadvers! WE do it all! I'm shocked that not all PA's take gross anatomy like we do. We take biochem, gross, patho, micro, before we even start pharm, clin med, etc... and after we finish a year of didactic. pharm clin med, clin skills, behav med, blah blah, then we do rotations for a year and then back into the class room for another 7 mos for neuro, advanced micro, 2 additional rotations, research, epedemiology,. I'm apalled that not every PA does gross anatomy. I guess not all PA programs are alike, but i guess the same holds true of med schools (*cough* caribbean)

 

[deleted6669]

not all med students/residents are created equal just as no 2 pa's are alike.....a pa with 5 yrs er experience who was a former paramedic for years knows a lot more emergency medicine than the vast majority of medstudents(unless they had prior careers in medicine) and most interns. a new grad pa without prior experience is basically a project for a doc or group to shape into a competent clinician, much like a brand new intern.
there are er's that are run solely by pa's without md's present. these ARE NOT new grad positions.
there are pa's doing cardiac caths (diagnostic, not interventional) without md's present at a # of major medical ctrs.
many major medical centers use pa's as 1st assists.this is not a new thing. are they doing major surgery by themselves? NO. when president clinton had his recent cabg, a pa harvested his veins, opened and closed his chest and assisted with the procedure.
regarding procedures: anyone can be taught how to do a procedure and the more often you do it the better you will get at doing it. at my facility the pa's do all the pediatric facial lac repair including ears, lips, etc because we do more of them than the docs and they feel more comfortable with us doing them.they see most of the crashing trainwrecks because that is where their skill lies(although we still see our share on a busy day)
All pa programs should have an a+p course with exhaustive dissection, some do not. I was fortunate in that I took a+p as an upper division bio course in college with full dissection and again in pa school.
can't we all just get along folks........

 

[WMUPAS]

Amen!

 

[LukeWhite]

As far as PA standing for Assistant or Associate, I dont think it really matters.
The defination of associate:
adj : having partial rights and privileges or subordinate status;
"an associate member"; "an associate professor"

The defination of assistant:
adj : of or relating to a person who is subordinate to another

They both mean the same thing if one sounds better so be it.

An associate is a member of the same group, of an implied lower rank. For example, all the professors are professors, but the associates are ranked lower than the fellows or full professors.

A physician associate would therefore be a physician. As that's not the case here, calling PA's physician associates would be inaccurate.

No reflection on the aptitudes of PA's, which are suberb. But they're not superb enough to Hurt Words. There are plenty more accurate synonyms, if synonyms you must have. I suspect the appeal of "associate" is less its very subtle inaccuracy of description than the fact that it would mean you don't have to order new business cards.

 

[PACtoDOC]

Are you kidding me?
I am taking gross anatomy this summer for six credits and we do dissection EVERY day. I'm just finishing patho. My program will not even let me start didactic until I finish these courses. Our gross is definitely not viewing previously dissected cadvers! WE do it all! I'm shocked that not all PA's take gross anatomy like we do. We take biochem, gross, patho, micro, before we even start pharm, clin med, etc... and after we finish a year of didactic. pharm clin med, clin skills, behav med, blah blah, then we do rotations for a year and then back into the class room for another 7 mos for neuro, advanced micro, 2 additional rotations, research, epedemiology,. I'm apalled that not every PA does gross anatomy. I guess not all PA programs are alike, but i guess the same holds true of med schools (*cough* caribbean)

Okay, I am tired of reading this BS. Iliketocut has some very valid points, as do many of you PA's. Truth be told, I don't think even a small percentage of residency trained physicians of any specialty outside critical care medicine would feel comfortable dealing with a seriously ill ICU patient. Thats why most facilities in the real world don't even give admission priviledges for FP's and some IM docs to ICU's. More and more the sick patients are being managed by these high speed ICU docs who do only that. So Cutter, I think you are losing that argument. On the other hand though, EMDream is seriously dreaming if he ever thinks he is going to convince anyone (other than himself) that his education is the same or even similar to medical school. PA school may encompass many if not most of the same subjects, but it does not offer the same LENGTH of courses, DIFFICULTY of courses, or ASSESSMENT of courses.

I have been through this discussion many times before, but let me spell it out again for you newbies. As a PA student, I was simply responsible for one solid year of didactic education. It included all the subjects that EMDream stated above, yet it still only lasted a year. And at the end of that year, I started clinicals. The only true barrier exam for a PA student was my board exam at graduation......count it.....one exam. In medical school, I had to pass Step one of boards, which included all the basic sciences from the first 2 years. I can firmly stand up and affirm that there is NO WAY ON EARTH that I could have ever passed the USMLE Step One as a PA, new grad or experienced. The depth of material was the difference between swimming in the shallow end of a pool versus swimming in the choppy San Francisco Bay. Sure on the surface it looks like we are swimming either way, but one fails to see how difficult the swim is, and how far one can sink if things get overwhelming. And in the final 2 years of medical school, we have to take a board exam (NBME SHELF) for each subject like surgery, IM, FM, Peds, OBGYN, Psych. Each one of these exams basically guarantees a minimal level of competence in that subject, and when you combine having to achieve a passing score on each of these, the difficulty level is exponentially greater. This does not even take into account having to study for step III, or residency internal exams and board certification.

EMDream, if you have not already figured it out yet, you are not going to EVER convince physicians that you have equivilant or near-such education. Nurses also take patho and their own version of micro and pharm, but don't think for a minute it is even on the level of your PA education. See the comparison?

Yes, PA's are valuable assets to the healthcare setting. No, a residency environment is not the real world and is not a place to judge what a PA does in the real world. Truth in fact; surgeons and physicians everywhere are hring PA's like there is no tomorrow, and normally the people who complain the most about PA's and their education are either residents or unfamiliar with them.

I would place my fate in the hands of a sharp EM trained PA any day over a moonlighting resident from virtually any specialty. I would also prefer that my family member in the ICU be taken care of by an ICU hospitalist. If my daughter in the future is ever sent to a pedi-ENT specialist and she sees the PA to get her in quicker, I will not readily assume that because I am a physician that I am just as capable as the PA. Training in any particular setting honestly begins the day any of us graduate from our respective professional schools, be it medicine, podiatry, dentistry, and even PA or NP school. Most procedures in medicine could be performed by a monkey with adequate practice time. Most diagnoses could be proven to be determined by a computer algorithm based on pattern recognition of common symptoms. I am convinced that the vast majority of information needed to practice safely in most fields of medicine can be gained through a PA level of education. Unfortunately for me though, I was simply not satisfied with knowing enough. Instead I wanted to know more than enough, but even now I realize that combining a PA and physician education still does not make me feel like I know enough. Will my practice of medicine really be all that different as a physician compared to my PA days? I truly doubt it, but I hope it does. I might pick up one or two extra zebras that ordinarily would have been missed, but I doubt it will change the statistical accuracy of my diagnostic abilities.

Bottom line: Do that which makes you feel happiest, and for me that was all about NOT being a PA anymore. But I don't begrudge those who would become PA's, but I beg you to quit trying to convince people that you are somehow the equivilant to a physician. No one is ever going to buy it, and with that speech and the addition of 75 cents, you can perhaps get a soda from the pop machine!

 

[pushinepi2]

What PACtoDOC just said.

 

[Anubis84]

Um, what would prefer, Para-medical, like paralegal? A PA is not a primary health care professional, but a subservient, dependent health care professional that is regulated and controlled by MDs and DOs. You assist doctors. That's your job as a PA, not to practice medicine.

Also, not all PAs have 6 years of schooling -- most have 2 years at best. If you want to be independent health care professionals, go to medical school.

 

[Docgeorge]

An associate is a member of the same group, of an implied lower rank. For example, all the professors are professors, but the associates are ranked lower than the fellows or full professors.

A physician associate would therefore be a physician. As that's not the case here, calling PA's physician associates would be inaccurate.

No reflection on the aptitudes of PA's, which are suberb. But they're not superb enough to Hurt Words. There are plenty more accurate synonyms, if synonyms you must have. I suspect the appeal of "associate" is less its very subtle inaccuracy of description than the fact that it would mean you don't have to order new business cards.

You make a good point.

 

[niko327]

Um, what would prefer, Para-medical, like paralegal? A PA is not a primary health care professional, but a subservient, dependent health care professional that is regulated and controlled by MDs and DOs. You assist doctors. That's your job as a PA, not to practice medicine.

Also, not all PAs have 6 years of schooling -- most have 2 years at best. If you want to be independent health care professionals, go to medical school.

PAs have 2 years of schooling, don't practice medicine, and are subservient. Thanks for your contribution, that cleared everything up for everyone, you're a superstar, really.

 

[hospitalistpac]

Um, what would prefer, Para-medical, like paralegal? A PA is not a primary health care professional, but a subservient, dependent health care professional that is regulated and controlled by MDs and DOs. You assist doctors. That's your job as a PA, not to practice medicine.

Also, not all PAs have 6 years of schooling -- most have 2 years at best. If you want to be independent health care professionals, go to medical school.[/QUOTE

It sounds like you need to do some research on PA education.
All PAs go to "PA school" fot 2 years. This does not mean 2 years after highschool.
There are some PA schools that are being phased out that did not grant a degree but a certificate or even associates but even these were attended by persons with a medical background as in nurse or paramedic.

In 2004 50% of PAs held atleast at Bachelors and 30% a masters. Every year more and more PA programs are masters.
My program was 26 mos. I graduated with a post bacc certificate. The following year students at my program were awarded a well deserved masters. The program length or curriculum did not change.
This leave me with completing my masters now, which I am doing. But everything I have learned to be a better PA has been through practicing. I have worked in different settings with a variety of excellent physicians. Nothing in my masters program has made me a better PA but I enjoy the mental challenge and opportunity for future publishing.

We are usually referred to as interdependent as opposed to dependent, and the term subservient is just mean. I see you are pre-med. When you are an attending I am sure your feelings will change. I enjoy a remarkably collegial relationship with attenings and residents of all specialities.

And for the record, AGAIN, no PAs are trying to be independent health care providers. How many times will we hear this?

 

[50960]

Clearly a newbie whos daddy is making him go to med school.........

 

[WMUPAS]

Great job at articulating the most recent argument! Earlier, I posted that we all have our specialties. pactodoc seems to be the most enlightened on the subject because of his background. Thank you for seeing the argument from both sides...

 

[deleted6669]

check out my " 2 yrs of school":
emt program 6 months
(insert 5 yrs as er tech here)
bs degree from university of california(4 yrs)took more classes in bio than my wife who was a prevet-med bio major
paramedic school 1 yr
(insert 5 yrs as a paramedic in a busy 911 system here)
pa school( bs #2) 3 yrs
postgrad masters in em 1 yr

not counting work experience that's 9.5 yrs of school.....and I was a pretty typical member of my pa school class.....

just for the record pa's are trained and practice as primary care practitioners and health professionals. from the website of the nation's largest hmo which has been using pa's as pcp's since 1970:

Why select a primary care practitioner?
Whether you're a new or long-time member, we encourage you to take this vital step and select a primary care practitioner.
We find that if you have a long-term relationship with a primary care practitioner, you are more likely to work with him or her to make health decisions that are best for you.
Your primary care practitioner can coordinate all of your care at Kaiser Permanente, including referrals to specialists when needed.
You may choose a physician, physician assistant, or nurse practitioner as your primary care practitioner in these departments:

Family Practice for children and adults
Internal Medicine for members 18 years and older
Pediatrics for members under age 18

 

[WMUPAS]

Oh...This is getting good....

 

[pushinepi2]

Oh...This is getting good....

Absolutely. The PA profession does have its heavyweights. Who can argue with grandpa ? Love it.

Anyway, here's someone's 2 cents over on the pre-osteo forum:

Why not just take the path of least resistance and remain a CRNA / why med school?

For lack of a better word (and please forgive if this sounds conceited) I'm stagnant. I need further academic and professional challenge/stimulation, expanded scope of responsibility and practice....

EMEDPA, WMUPAS, myself, and others have eloquently tried couch this discussion in terms of personal decision making. Clearly, the PA school path is a rewarding one that involves medical decision making, responsibility, and intelligence. The back and forth garbage about what pathway has longer gross anatomy classes, who dissected what cadever, and 27 months of intensive training=medical school is far off of the mark. In the end, the PA vs doctor school decision is an entirely personal one, as I've previously argued.

Personal fulfillment goes beyond the associate/assistant debate and post graduate training. People have a variety of reasons (personal, financial, familial) for pursuing one path vs. the other. Personally speaking, I've been on the receiving end of unjustified criticism during my years as a medic. I seriously considered the PA route because UF's program required 2,000 or so patient contact hours and placed a high premium on EMS experience. I talked to seasoned NPs, PAs, and docs about the career options and made a decision based upon where I thought I wanted to end up. I thought about medical direction of an EMS service. The physician route made more sense because most state statues stipulate that EMS directors must be trained to the physician level.

That's just my take on the matter. Other people want to open up doors via the nurse practitioner route. Healthcare, fortunately, is a large umbrella that welcomes people from all backgrounds and educational levels. Healthy respect for each other's choices is necessary for us to achieve the ultimate goal of delivering excellent medical care to our patients (and earning a living in the process.) Professional school is a large financial and intellectual investment. Deciding between the PA vs NP vs DO vs MD route should involve a serious discussion about the pros and cons of each profession. People matriculating at PA schools will always grapple with the following issues:

-The assistant/associate discussion
-Scope of practice debate
-Perceptions of inferiority
-Adequacy of clinical training
-The requirement of supervision

If a PA student thinks that these issues will go away once you've completed a master's level degree, think again. There will always be disrespectful medical students, incredulous interns, and doubtful patients. Despite an alphabet soup of certificates (ATLS/ACLS/NCCPA), some people will never be convinced that the PA's education prepares them for a role as an independent, comprehensive provider of medical care. If PA students are unwilling to contemplate these issues or face controversy, then perhaps an alternate career pathway should be considered. Each profession, of course, has its positives and negatives. No matter what intellectual epiphanies take place here on SDN, these issues will always face current and future physician associates.

 

[deleted6669]

"Who can argue with grandpa ? Love it. "

FIRST "WIZENED", NOW "GRANDPA"? - OUCH.....

All kidding aside pe2, excellent post above. thank you for bringing a balanced look at these issues as someone who has played in the field and is now taking the big step to md. your posts are always appreciated. knowing what I know now I would have probably gone that route as well and still may someday if the powers that be ever develop a reasonable pa to md/do bridge program. don't get me wrong, I love my job and make really good money. the pt care side of things is great but the issues that do not involve pt care can be frustrating at times.

 

[pushinepi2]

"Who can argue with grandpa ? Love it. "

FIRST "WIZENED", NOW "GRANDPA"? - OUCH.....

I figured it couldnt get much worse than you threatening to hit me with your most recent titanium clad replacement hip. Then, I'd really be in need of your independent, expert, critically competent, and comprehensive services.

 

[deleted6669]

"Then, I'd really be in need of your independent, expert, critically competent, and comprehensive services. "

wow...you mike me sound like midas...brakes, shocks, AND an oil change.....appreciate the props but independent I'm not, a doc still signs all my charts within 24 hrs when I do my solo er gig and 10% of them within 1 month when I work in a regular er setting......and comprehensive...does that mean I know who to write my referal to?
and the hip is just fine...no scars, no hardware, no procedure...I was just pulling your leg.....in fact I'm running a marathon in 2 months.....

 

[Anubis84]

It begs the issue, where do you draw the lines in terms of scope of practice? When does the PA venture over into MD/DO territory? IF PA isn't a good term, then what do you suggest? In law, there are paralegals and legal assistants, but I'm not sure if there is a difference. What options to PAs have?

 

[adamdowannabe]

Anyone get the number for that truck driving school off the TV commercial?

Damm............ so much hostility, everyone!

I think maybe I want to become a Shamen, a Medicine-Man

Give me some burning sage, an eagle feather, some red dirt and a few chicken bones............. and send me off to a thrid world country,

Better to be a considered godlike........

All the while, I will come back to LA to star in a TV show about doctors, because.... we all want to be like Dr.COX anyway! A TV show MD gets more recognition as a doctor, then a real one! So, as long as you get to do as much as you are trained to do, (work that out with your supervising physician) and you have fun doing it...... why not get called...... HEY YOU? The more one knows, and more confident one gets....the less important the recognition becomes. A name, an arguement....earning respect, being treated well...it all comes to those that earn it.......somehow, someway.... it does.

Let an MD, yell all they want about how a PA is a hand servent, as long as it makes him happy, and he pays you well to do it....... it's hurting no one but his relationship with people who observe and find him rude and tactless...and then his "respect" won't come.... regardless of the degree.

If you as a PA/MD/DO/Pest Control Man, help save someones health.... you have accomplished the "mission"..... It's not a contest to see who knows the most, it's really about who can apply what they know with the most proficency. What good is a know-it-all, if they can't apply it. right?

Can I get an Amen..??? A hallejuah? Allrighty... everyones hand in the center...on three.....go team, ready...... 1..2..3...GO TEAM

 

[LukeWhite]

It begs the issue, where do you draw the lines in terms of scope of practice? When does the PA venture over into MD/DO territory? IF PA isn't a good term, then what do you suggest? In law, there are paralegals and legal assistants, but I'm not sure if there is a difference. What options to PAs have?

para-dox?

 

[deleted6669]

para-dox?

or parawoctor from a recent discussion elsewhere on these forums....
or physician affiliate(keeps the pa) or affiliated clinician or associate medical practitioner( graduation ceremony would be "getting amped")

 

[adamdowannabe]

I want to get amp'd , that would be fun,

plus, then you could walk into a patient, and say

"Hey I am Amp. So'n'So..........

and people can now in a rush say..... are there any Doctors, nurses or Amps that can help me?

Ok then, it's decided.... Amp it is! Schweeet, im stoked !