WMUPAS said:
....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.
