Working with MLPs

[The White Coat Investor]

---

Members do not see this ad.

I'm glad I don't have to work in an ED so overloaded that the PAs are doing the intubations and critical care. Seriously, time to hire some more docs.

 

[SeekerOfTheTree]

that's not what I said or what I mean. PAs are mostly being used internationally in primary care where we CAN do 80-90% of what a doc can do in an outpt setting right out of school. In specialty fields we are not replacing docs but taking some of the work load(yes, mostly the "easier cases") but also have a role in seeing sicker folks under some circumstances. you will always have a job. I will too. it's likely that your job at some point will require that you work with PAs to some extent. I only ask that you make choices based on the individual pa, not just based on the initials after someone's name. we both know docs we wouldn't let care for our worst enemy and those who are rock stars. there are similar folks in the pa world as well.

The only counterpoint I have is when there is a terrible doc, his license is on the line. When there is a terrible PA, his attending is on the line. When a malpractice case comes up and a PA takes full responsibility I will be impressed. When I am in court and a PA misses a pulseless LE and I go to court and he says no my fault don't list him, I will bow down to you and might even go to fourth base with you.

 

[deleted6669]

When there is a terrible PA, his attending is on the line. When a malpractice case comes up and a PA takes full responsibility I will be impressed. When I am in court and a PA misses a pulseless LE and I go to court and he says no my fault don't list him, I will bow down to you and might even go to fourth base with you.

I will pass on the 4th base offer but think you might find the following recent case interesting in which an sp was found not responsible for work done by a pa he was supervising at the time:
http://www.beckershospitalreview.co...oper-conduct-rules-vermont-supreme-court.html
I agree with you that if a pa makes a mistake and the physician was not involved in the case the physician should not be named in a suit. I think this decision in vermont will catch on as a precedent as it should. I believe the doc should only be named if they were asked to see the pt and either refused or were involved and fully agreed with the assessment and plan. Just cosigning a note without seeing the pt should not result in liability. Some of my SPs actually have a stamp that says "care reviewed, pt neither discussed nor seen" which they use as appropriate.
many states have gone to minimal chart review. I work in 2 states, one requires zero chart review(sp must have an "ongoing awarenewss of practice patterns") and 1 requires 10%. The larger hmo type organizations follow state law regarding minimums. independent hospitals tend to require 100% chart review for PA/NP which supercedes state law.

 

[deleted128562]

Have thought about this before and was thinking about it again this morning, and I'd be interested to get input from people like emedpa among others --

It seems like there's more and more focus being placed on letting "midlevels" work to the full scope of their license, but there is also a school of thought which says that the PA's and NP's coming out of school these days are not nearly at the level of their predecessors. I don't know emedpa's story, but I'm guessing he/she was a paramedic/ combat medic/ something similar for several years, got very good at stabilizing some pretty sick people, then went to PA school to add some medical knowledge on top of those already developed skills and experience. Used to be that the people who went to PA school were people with significant medical experience already. Used to be that people who went to NP school were nurses who had been working for many years already, often in critical care. Makes sense then that these people could gain a little more book knowledge and do quite well stepping into a provider role.

However, now days this is becoming less and less the norm. It is not at all unusual at my facility to see 24 year-old PA/NP students with no real previous clinical experience to speak of, doing their rotations. I personally know a guy who went, quite literally, from nursing school to NP school without so much as working a week full-time in nursing. I've talked to a couple PA students who did something like 500 hours as a tech or CNA prior to school (the equivalent of a few months work), and my understanding is that PA schools aren't requiring nearly the previous clinical experience they used to. Some of these students really freak the attendings out, and I've actually heard one battle-hardened PA say that he wouldn't let many of these nearly graduated PA students anywhere near him.

So what do you guys think? Does what I'm discussing reflect reality, and is this going to have a large impact on things as this inexperienced young bunch starts replacing the group of PA's/NP's that came from a time when a lot more was expected of them before they were even allowed to train?

 

[deleted547339]

There is an interesting point of discussion that I'd like to hear from the current docs:

When I read virtually anything anymore about the future of medicine, mid-levels are typically at the forefront of the discussion. Some of the points made in the popular media are valid, and certainly there is a prominent place for mid-level providers in the future of medicine, but can anyone articulate to me how it became a near colloquialism in this country to assume that mid-levels are the only way to solve our healthcare shortages?

As a medical student, I see this very organized culture among the physicians that lecture and teach all of us. No other profession I've encountered has such a storied and organized way of disseminating information, and perhaps more so, instilling a way of life to their future colleagues. How did a profession, one typically with at least decent incomes and population, allow this to occur politically? It just seems amazing that the idea of mid-levels as a solution has been allowed to walk past such a politically strong group of professionals. Perhaps I'm missing something. I see it getting talked about on here a lot, and it certainly has traction in our school, but where are the multi-million dollar ad campaigns, bus stop posters, and national discussion on the value of physician-lead patient care? Johnson and Johnson seems to have no problem plastering my TV with nursing commercials. Where is our corporate sponsor?

One thing is for certain, medical school can really grind you some days. It's incredibly intense and, let's be honest, parts of it are a real pain. All of you have done it. I can't imagine spending all of this money and devoting so much of my life to the definitive treatment of my patients only to have someone tell me in 10 years that it was a financial mistake. I am constantly amazed how much we learn and the intensity in which we learn it. I'd be super irritated if it was "unnecessary" and, given the little bit I know so far, I can't imagine it being so. Something tells me that physicians have a good argument to be made and that we're just not fighting dollars with dollars. There has to be some organization out there, some intermediary with our future in mind, asking for physicians to stroke a check, right?

One part of your argument is horribly flawed: we are not a politically strong group. We are exceedingly weak. Physicians as a whole are too busy (or at least see themselves as such) to be involved in politics beyond voting and donating. We have no representation. The AMA "represents" us, but you can look at the previous thread about this. Beyond that, there are 100s of small organizations with minimal power. We need to become more organized, oust the AMA and actually make a push for change in Washington. Unfortunately, nursing organizations/unions are strong. Another problem is that people in a crap economy have very little sympathy for those making six-figures, regardless of the validity of their arguments. Finally, people are dumb - everyone who has spent a couple hours in an ED knows this. People are really, really dumb. If you present the argument "you only need half the time and money to get the same results" regardless of facts to back you up, people will bite. There is a substantial portion of our population who never reaches the ability to think abstractly (see: a few hours in the ED), and we think we will be able to convince them that what we provide is different and better than an NP? Common.

We've got to go about this a different way.

 

[deleted6669]

It seems like there's more and more focus being placed on letting "midlevels" work to the full scope of their license, but there is also a school of thought which says that the PA's and NP's coming out of school these days are not nearly at the level of their predecessors. I don't know emedpa's story, but I'm guessing he/she was a paramedic/ combat medic/ something similar for several years, got very good at stabilizing some pretty sick people, then went to PA school to add some medical knowledge on top of those already developed skills and experience. Used to be that the people who went to PA school were people with significant medical experience already. Used to be that people who went to NP school were nurses who had been working for many years already, often in critical care. Makes sense then that these people could gain a little more book knowledge and do quite well stepping into a provider role.
However, now days this is becoming less and less the norm. It is not at all unusual at my facility to see 24 year-old PA/NP students with no real previous clinical experience to speak of, doing their rotations. I personally know a guy who went, quite literally, from nursing school to NP school without so much as working a week full-time in nursing. I've talked to a couple PA students who did something like 500 hours as a tech or CNA prior to school (the equivalent of a few months work), and my understanding is that PA schools aren't requiring nearly the previous clinical experience they used to. Some of these students really freak the attendings out, and I've actually heard one battle-hardened PA say that he wouldn't let many of these nearly graduated PA students anywhere near him.
So what do you guys think? Does what I'm discussing reflect reality, and is this going to have a large impact on things as this inexperienced young bunch starts replacing the group of PA's/NP's that came from a time when a lot more was expected of them before they were even allowed to train?

as for me I had >10,000 hrs as an er tech and paramedic in 2 busy ems systems( LA county and Philadelphia) before becoming a pa. in school I did an em/trauma focus and took all my electives in em/peds em/trauma surgery. after graduation I launched headfirst into getting as much em exposure as I could working my way up from fast track to intermediate to covering main depts, leaving jobs every time I maxed out the scope of practice. money was never an issue. at several points I took pay cuts to have more autonomy and a better scope of practice. my favorite current job pays the least of any place I work. along the way I took atls/apls/also/fccs/abls/difficult airway classes, etc. and took every opportunity offered to intubate in the o.r. with anesthesia, get procedural sedation training, learn new procedures, etc
I do agree that the product being produced by most programs today is one of less experience than even 10 years ago although some programs like U.WA/Medex still require 4000 hrs of experience and most folks who matriculate have 8000+ hrs. I believe that new grads are not ready to work with minimal supervision. PA postgrad programs are starting to fill this experience void(see www.appap.org). there are now postgrad programs in most specialties. EM has 20, there are many in surgery, critical care, etc. I think at some point in the future pa school will go to 3 years and have a required 1 yr postgrad requirement. I don't know that it would be a bad thing. there are also now optional specialty board exams for PAs in many specialties, including em. eventually they won't be optional. also probably not a bad thing.

 

[Arcan57]

I wish, every day, I had done PA or NP instead. Not kidding. What is the point of all this if I'm just going to be viewed as an interchangable cog (who, by the way, also gets to assume all the liability)?

Seems to me that either the midlevels are really overestimating their abilities, or I am getting really ripped off by the medical training establishment who are requiring 7 years of my sweat to do what I could have done in 2.

How on earth should it require 5 extra years of training to learn how to handle the extra "0.5 percent" of patients that need an MD instead of a PA or NP?

To be fair to docs, the number of patients that we work up differently from an MLP is significantly higher than 1/200. The issue is how much testing did it take to get to "this patient can safely go home". Did the 2yo with 1 day of cough, rhinorrhea, and fever get a rapid strep, flu swab, and CXR before being sent home? Did the patient with nausea ,vomiting , diarrhea, and mild epigastric tenderness get a CT ordered after the labs were negative? While the outcome for these patients is the same (self-limited diseases are self limited), you've just tacked on $500-2000 in unnecessary work-up and added about 90-120 minutes to length of stay.

 

[deleted128562]

as for me I had >10,000 hrs as an er tech and paramedic in 2 busy ems systems( LA county and Philadelphia) before going to pa school. in school I did an em/trauma focus and took all my electives in em/peds em/trauma surgery. after graduation I launched headfirst into getting as much em exposure as I could working my way up from fast track to intermediate to covering main depts, leaving jobs every time I maxed out the scope of practice. money was never an issue. at several points I took pay cuts to have more autonomy and a better scope of practice. my favorite current job pays the least of any place I work. along the way I took atls/apls/also/fccs/abls/difficult airway classes, etc. and took every opportunity offered to intubate in the o.r. with anesthesia, get procedural sedation training, learn new procedures, etc
I do agree that the product being produced by most programs today is one of less experience than even 10 years ago although some programs like U.WA/Medex still require 4000 hrs of experience and most folks who matriculate have 8000+ hrs. I believe that new grads are not ready to work with minimal supervision. PA postgrad programs are starting to fill this experience void(see www.appap.org). there are now postgrad programs in most specialties. EM has 20, there are many in surgery, critical care, etc. I think at some point in the future pa school will go to 3 years and have a required 1 yr postgrad requirement. I don't know that it would be a bad thing. there are also now optional specialty board exams for PAs in many specialties, including em. eventually they won't be optional. also probably not a bad thing.

Good info, thanks. Definitely sounds like you had significant experience before school and have been very motivated since finishing.

 

[deleted128562]

To be fair to docs, the number of patients that we work up differently from an MLP is significantly higher than 1/200. The issue is how much testing did it take to get to "this patient can safely go home". Did the 2yo with 1 day of cough, rhinorrhea, and fever get a rapid strep, flu swab, and CXR before being sent home? Did the patient with nausea ,vomiting , diarrhea, and mild epigastric tenderness get a CT ordered after the labs were negative? While the outcome for these patients is the same (self-limited diseases are self limited), you've just tacked on $500-2000 in unnecessary work-up and added about 90-120 minutes to length of stay.

Good point. Although perhaps this is where our utility as physicians is becoming less useful due to the current litigation and "satisfaction" environments - how often, even when you're "comfortable" with your diagnosis, do you order stuff just to avoid litigation and make the patient happy anyway? For instance, I've seen plenty of attendings go ahead and order the XR on the guy who rolled his ankle and doesn't even have any swelling or point tenderness, and walked into the exam room, because the guy came in expecting the XR, and hey you don't want to be the person who misses the tiny chance that there is a fracture. In fact, I'm not sure I've ever seen an xray NOT ordered on an ankle pain patient. And there are many other examples like this.

 

[styphon]

Even ACEP admits that only 5% of pts presenting to emergency departments across the united states have true life threatening emergencies.

I have worked in Urgent Cares with ER/FM PA's who have more experience than me but yet I can feel the difference in education that is not totally overcome with experience, between me and PA's with even 10 years experience. I feel like when it comes to differential diagnosis, and anything out of specific defined "pathways"/comfort zone - they struggle.

I do respect the PA's I work with. I realize their strengths (procedures and who/what/how good are specialists), and I think most of the older ones realize their own weaknesses and ask me when they have questions or are uncertain.

I am not so sure about new PA's. Some of them do not ask questions even when they are uncertain (Unsure why: confidence?fear?shyness?). They appear to overestimate their strengths and think they have no weakness.

 

[deleted6669]

I am not so sure about new PA's. Some of them do not ask questions even when they are uncertain (Unsure why: confidence?fear?shyness?). They appear to overestimate their strengths and think they have no weakness.

agree. many new pas today started their programs either right out of high school(5 yr program) or college and lack health care and life experience.
every place I now work looks for folks with 5+ yrs of pa experience and gives preference to prior medics/nurses/RTs.

 

[Arcan57]

Good point. Although perhaps this is where our utility as physicians is becoming less useful due to the current litigation and "satisfaction" environments - how often, even when you're "comfortable" with your diagnosis, do you order stuff just to avoid litigation and make the patient happy anyway? For instance, I've seen plenty of attendings go ahead and order the XR on the guy who rolled his ankle and doesn't even have any swelling or point tenderness, and walked into the exam room, because the guy came in expecting the XR, and hey you don't want to be the person who misses the tiny chance that there is a fracture. In fact, I'm not sure I've ever seen an xray NOT ordered on an ankle pain patient. And there are many other examples like this.

Again, where we add value to the system we will be secure and where we don't we are vulnerable. If you know it's just a sprain (Ottawa ankle rules, clinical gestalt, etc) and you can't communicate that to a patient in a way that they trust and believe in you, then maybe the problem isn't with the patient. But you do have to communicate what a sprain means (pain, instability, possible PT if instability persists) because most people figure a sprain should be healed in a couple of days and they're pissed when it's still painful to put weight on it the next week (which is usually when the PG survey drops). There are going to be some patients that you need to get the x-ray on for non-medical reasons, but they should be the rare exception not the usual routine.

Medicine has plenty of people that can click on check boxes, but you exist in the system because of your critical thinking skills. If you cede that part of your job to others (unnecessary CYA consults, providing inadequate supervision) or just become a box checker because of (time, medicolegal, convenience) issues then you'll be replaced by something cheaper.

 

[Birdstrike]

I will pass on the 4th base offer but think you might find the following recent case interesting in which an sp was found not responsible for work done by a pa he was supervising at the time:
http://www.beckershospitalreview.co...oper-conduct-rules-vermont-supreme-court.html
I agree with you that if a pa makes a mistake and the physician was not involved in the case the physician should not be named in a suit. I think this decision in vermont will catch on as a precedent as it should. I believe the doc should only be named if they were asked to see the pt and either refused or were involved and fully agreed with the assessment and plan. Just cosigning a note without seeing the pt should not result in liability. Some of my SPs actually have a stamp that says "care reviewed, pt neither discussed nor seen" which they use as appropriate.
many states have gone to minimal chart review. I work in 2 states, one requires zero chart review(sp must have an "ongoing awarenewss of practice patterns") and 1 requires 10%. The larger hmo type organizations follow state law regarding minimums. independent hospitals tend to require 100% chart review for PA/NP which supercedes state law.

That looks like a board action which is completely different than med mal.

 

[Boatswain2PA]

Have thought about this before and was thinking about it again this morning, and I'd be interested to get input from people like emedpa among others --

It seems like there's more and more focus being placed on letting "midlevels" work to the full scope of their license, but there is also a school of thought which says that the PA's and NP's coming out of school these days are not nearly at the level of their predecessors. I don't know emedpa's story, but I'm guessing he/she was a paramedic/ combat medic/ something similar for several years, got very good at stabilizing some pretty sick people, then went to PA school to add some medical knowledge on top of those already developed skills and experience. Used to be that the people who went to PA school were people with significant medical experience already. Used to be that people who went to NP school were nurses who had been working for many years already, often in critical care. Makes sense then that these people could gain a little more book knowledge and do quite well stepping into a provider role.

However, now days this is becoming less and less the norm. It is not at all unusual at my facility to see 24 year-old PA/NP students with no real previous clinical experience to speak of, doing their rotations. I personally know a guy who went, quite literally, from nursing school to NP school without so much as working a week full-time in nursing. I've talked to a couple PA students who did something like 500 hours as a tech or CNA prior to school (the equivalent of a few months work), and my understanding is that PA schools aren't requiring nearly the previous clinical experience they used to. Some of these students really freak the attendings out, and I've actually heard one battle-hardened PA say that he wouldn't let many of these nearly graduated PA students anywhere near him.

So what do you guys think? Does what I'm discussing reflect reality, and is this going to have a large impact on things as this inexperienced young bunch starts replacing the group of PA's/NP's that came from a time when a lot more was expected of them before they were even allowed to train?

I'll throw in here as well. While I am a relatively new grad, I am more of a "throw back" PA because I spent 20 years in the military doing SAR. I was hired into a rural, approx 7500 visit a year, single coverage ER right out of school and, to date, have succeeded. I attribute my success primarily to a couple of thingsthings - I am "mature" enough to know how green I am, I have the experience to know "sick from not sick", and I have a great group of family practice doctors in town that I don't hesitate to call when I need help. Like I said I am rural, and I can't even tell you where the closest EM certified physician is, because even the local tertiary centers have IM or FP docs running the EDs.

You are absolutely right that the educational paradigm has shifted in both the PA and NP world. However, in your hiring and firing constructs, please remember that PA school far outperforms NP school in what matters - science and clinical hours.

My suggestion for you, and others, as the EM specialty continues to grow - like others have posted here, realize that part of being an EM specialist will mean that you will have to have mid-levels working for you. Help make them into EM mid-levels. Do this by first taking PA students and ensuring they get a great EM rotation. Second, help EM mid-levels specialize. ACEP is doing a great job of this by working with SEMPA to set the high standard for the EM CAQ for EM PAs. And third, work with your physician cohorts to stem the tide of mid-level independence practice as advocated by the nursing mafia (ie: NP independent practice).

 

[Boatswain2PA]

One part of your argument is horribly flawed: we are not a politically strong group. We are exceedingly weak. Physicians as a whole are too busy (or at least see themselves as such) to be involved in politics beyond voting and donating. We have no representation. The AMA "represents" us, but you can look at the previous thread about this. Beyond that, there are 100s of small organizations with minimal power. We need to become more organized, oust the AMA and actually make a push for change in Washington. Unfortunately, nursing organizations/unions are strong. Another problem is that people in a crap economy have very little sympathy for those making six-figures, regardless of the validity of their arguments. Finally, people are dumb - everyone who has spent a couple hours in an ED knows this. People are really, really dumb. If you present the argument "you only need half the time and money to get the same results" regardless of facts to back you up, people will bite. There is a substantial portion of our population who never reaches the ability to think abstractly (see: a few hours in the ED), and we think we will be able to convince them that what we provide is different and better than an NP? Common.

We've got to go about this a different way.

I agree. While some physician specialty organizations are working with mid-level specialty organizations very well (ACEP and SEMPA), there is a disconcerting lack of political power among physicians, especially in comparison to the nursing mafia.

In my opinion, physician organizations should work to strictly define what it means to practice medicine. It makes no sense that if you, or I, in a chest tube it is considered "practicing medicine", but if a NP does it considered "nursing". If physicians flexed their political muscle to define exactly what medicine was, then anyone who practiced medicine could then be (legislatively) forced to fall under your supervision, even if they have an academic "Doctorate" title.

 

[Boatswain2PA]

To be fair to docs, the number of patients that we work up differently from an MLP is significantly higher than 1/200. The issue is how much testing did it take to get to "this patient can safely go home". Did the 2yo with 1 day of cough, rhinorrhea, and fever get a rapid strep, flu swab, and CXR before being sent home? Did the patient with nausea ,vomiting , diarrhea, and mild epigastric tenderness get a CT ordered after the labs were negative? While the outcome for these patients is the same (self-limited diseases are self limited), you've just tacked on $500-2000 in unnecessary work-up and added about 90-120 minutes to length of stay.

Agree with you, but I would like to offer an possible explanation - it is often been said that PAs are like eternal Residents in that we must always be prepared to "present" our patients to our "attending". Like the resident's I worked with as a student, sometimes the tests I order depend on the attending on call, and I order the tests just so I can "prove" my case to the attending when I call them.

 

[Boatswain2PA]

I have worked in Urgent Cares with ER/FM PA's who have more experience than me but yet I can feel the difference in education that is not totally overcome with experience, between me and PA's with even 10 years experience. I feel like when it comes to differential diagnosis, and anything out of specific defined "pathways"/comfort zone - they struggle.

I do respect the PA's I work with. I realize their strengths (procedures and who/what/how good are specialists), and I think most of the older ones realize their own weaknesses and ask me when they have questions or are uncertain.

I am not so sure about new PA's. Some of them do not ask questions even when they are uncertain (Unsure why: confidence?fear?shyness?). They appear to overestimate their strengths and think they have no weakness.

This is how it should be with the "older" PAs. You have an extra 3-5 years of education which makes you the ultimate expert in EM, while withthey have the experience to realize that something isn't right with this patient. With newer PAs - I would suggest that you, and your cohorts, have a responsibility to work within the PA education system (formal and informal) to help fix this.

 

[deleted6669]

HEY BOAT- did you take the caq yet? they will offer it at sempa in new orleans this yr in addition to the regular once/yr test in sept.

 

[The White Coat Investor]

as for me I had >10,000 hrs as an er tech and paramedic in 2 busy ems systems( LA county and Philadelphia) before becoming a pa. in school I did an em/trauma focus and took all my electives in em/peds em/trauma surgery. after graduation I launched headfirst into getting as much em exposure as I could working my way up from fast track to intermediate to covering main depts, leaving jobs every time I maxed out the scope of practice. money was never an issue. at several points I took pay cuts to have more autonomy and a better scope of practice. my favorite current job pays the least of any place I work. along the way I took atls/apls/also/fccs/abls/difficult airway classes, etc. and took every opportunity offered to intubate in the o.r. with anesthesia, get procedural sedation training, learn new procedures, etc
I do agree that the product being produced by most programs today is one of less experience than even 10 years ago although some programs like U.WA/Medex still require 4000 hrs of experience and most folks who matriculate have 8000+ hrs. I believe that new grads are not ready to work with minimal supervision. PA postgrad programs are starting to fill this experience void(see www.appap.org). there are now postgrad programs in most specialties. EM has 20, there are many in surgery, critical care, etc. I think at some point in the future pa school will go to 3 years and have a required 1 yr postgrad requirement. I don't know that it would be a bad thing. there are also now optional specialty board exams for PAs in many specialties, including em. eventually they won't be optional. also probably not a bad thing.

This is not a pathway that PAs can routinely take. Is it an adequate path? Probably. Is it the most efficient way to get adequate training to do emergency medicine? No way.

It isn't about getting a few really great PAs, it's about making sure there is a level of competence that all meet. That level, at least just out of PA school without significant prior experience, is not adequate to evaluate undifferentiated patients in the ED, even in a fast track, without more supervision than most PAs in the ED routinely get. Patients deserve more than that. If we're going to use PAs, especially brand new ones, we need to have a very high level of supervision and carefully limit their scope of practice. It isn't about defending the turf, it's about our responsibility to patients.

 

[deleted6669]

agree with above.
for what it's worth, I was a fairly typical student in pa school in the early 90s. today I would not be except at a few programs like U.WA
it used to be that the typical pa student was a 30-35 yr old male paramedic/rn/rt with 10+ yrs of experience. today the typical student is a 23 yr old female bio major/ cna with 6 mo experience and some shadowing. not the same by any means. not even close.

 

[The White Coat Investor]

agree with above.
for what it's worth, I was a fairly typical student in pa school in the early 90s. today I would not be except at a few programs like U.WA
it used to be that the typical pa student was a 30-35 yr old male paramedic/rn/rt with 10+ yrs of experience. today the typical student is a 23 yr old female bio major/ cna with 6 mo experience and some shadowing. not the same by any means. not even close.

Absolutely. Nearly all the PAs we use once met your description. We're lucky in that we have a nice shop and can get experienced folks, even if 5 years before they were the prototypical 23 year old female with 6 months experience.

 

[deleted6669]

There are still a few traditional programs like stanford and U.WA that stress prior hce as an entry level requirement. if looking at new grads really look at what they did before pa school and what program they attended. I have done some hiring/firing PAs over the years as a lead PA and I always put "preference to those with > 5 yrs em experience, acls/atls/pals, and former medics/rns/rts" in the job announcements I post.