Would you feel safe with a PA as your PCP?

[GadRads]

I scored well below both of you, probably had a much lower GPA as well, yet went to a top 20 school, on a full ride (+ an additional scholarship), trained at a premier program, and have been faculty at 2 top 10 medical schools working at world class specialty hospitals. And I'm most certainly not disadvantaged or a URM, unless New England WASPs are now all going into finance and have been granted URM status. Numbers are just a part of your application. If you picked physicians by MCAT and GPA you'd be in rough shape. Lots of high flyers crashed and burned, badly. They coasted, got lazy, gave up. Who knows, who cares. That's their problem. Everyone comes in full of hope and dreams, cocky with their heads held high, only to find they brought a knife to a gun fight.
Boom!
Lol.


--
Il Destriero

The MCAT, apart from some low-to-moderate statistical correlation to Step 1, is irrelevant once medical school starts. I studied 2 weeks for the MCAT, and that's because the level of detail one needs to know pales in great comparison to the level of detail, endurance, stamina, and time required in medical school. You need both big picture and lots of details in medicine. NimbleNavigator might have even scored a 45, but it will be irrelevant once medical school starts. I honestly have never seen a senior medical student or resident with this kind of thought, except premeds.

I predict that he/she will become more humble as the years go by, and that's even if he gets accepted. In the meantime he/she is free to assume that a high MCAT magically confers the status of Master Physician.

---

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[psychMDhopefully]

Interesting idea. I never thought of it that way. To be honest, I feel like the main reason why I would trust a physician more than a PA is just the fact that the admissions requirements for MD schools are much more stringent. It's also the reason why, after seeing some of the admission stats to med school for URMs, I wouldn't really trust a URM physician.

From the stats I've seen of most PA programs, the average matriculant is pretty much on par with your average DO student. I guess I could see a PA being on par with a DO after a while.

Honestly, I think the whole idea of PA's is pretty dumb though. If we're gonna have PA's and NP's, why not just do what the UK does with its 6-year bachelor med programs?

Wow , boy you can smell a pre-med from a mile away. I'll ask once again, why are premeds allowed to post here?

 

[psychMDhopefully]

The professors (a PharmD and an MD) who taught this section over a period of three lectures (2 hours each) went into significant depth about the epidemiology, etiology, workup, and treatment of HTN. We had to know all the medications and their mechanisms in addition to the treatment guidelines and side-effects. This culminated in a 100 question multiple choice exam.

Some topics we had had to know about were the treatment thresholds, first and second line antihypertensives, appropriate combinations, the place of ACEi/ARBs in African Americans, the differences between Dihydropyridine CCB and Non-Dihydropyridine CCBs and their uses, the different types of diuretics and their effects on electrolytes, how to manage HTN in patients with chronic kidney disease, the cause of the "-inipril cough"and what to do about it, the many different types of Beta-blockers and when to use them, etc. I can't do justice to all of the topics but I hope I've done a good enough job in showing the depth they went to.

This same exam was what the MD students took. We all take the same exam together in the same lecture hall. Like I said there is more in common than there is different in PA/MD education. The PA class doesn't take as many classes as the MD students do and we definitely don't claim to have the depth of knowledge as physicians.

Wow, see the thing is, most MD students around the country would have all this in a 1 hr lecture and would be expected to know it all.

 

[vendtex]

I had a PA as my GYN provider for most of my adult life. I was sometimes treated by a doctor for one abnormal lab, but it made sense to see her as I was the less complicated, typical patient. Now I would never let my mother with asthma see a PA or my grandfather who has multiple health issues.

Would you know for sure if the PA missed anything or followed ACOG guidelines?


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[GinnyWeasley]

Would you know for sure if the PA missed anything or followed ACOG guidelines?


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Midlevel providers are a godsend to areas of the country that don't have direct medical access. Sure, I think we can all agree that they don't know as much as physicians. But they help out a lot of individuals, especially in underserved areas.

 

[giantswing]

Midlevel providers are a godsend to areas of the country that don't have direct medical access. Sure, I think we can all agree that they don't know as much as physicians. But they help out a lot of individuals, especially in underserved areas.

Loooooool.
Not.

 

[Psai]

Midlevel providers are a godsend to areas of the country that don't have direct medical access. Sure, I think we can all agree that they don't know as much as physicians. But they help out a lot of individuals, especially in underserved areas.

Yes the midlevels in the ivory tower hospitals in specialty fields are there to help out individuals in the underserved areas that don't have direct medical access.

 

[W19]

Yes the midlevels in the ivory tower hospitals in specialty fields are there to help out individuals in the underserved areas that don't have direct medical access.

Their propaganda has worked I guess. Even med students/physicians are reciting their BS.

 

[Tenk]

Loooooool.
Not.

As an attending provider who works in an underserved ER, I can tell you that the person you quoted is absolutely correct. Some of my patients have to wait 2 months just to see a PCP. As a result I have to do a lot more primary care. I suck a lot more at primary care than someone who works in primary care. Most ER doctors do. I will over order and find more incedentalomas than someone just going to their PCP.

PAs and NPs are just like doctors. Some are good, some are not so good. You can't make broad generalized statements about such a heterogeneous group, because there will always be plenty of exceptions to your rule.

On point: I wouldn't care but usually when I go to my PCP it will be for a referral anyways.

 

[Moose A Moose]

Would you feel safe with a PA as your PCP?

Safe, sure... but a PA wouldn't be my first choice.

 

[GinnyWeasley]

Yes the midlevels in the ivory tower hospitals in specialty fields are there to help out individuals in the underserved areas that don't have direct medical access.

I'm referring to nurse practitioners who are the only health care provider for rural towns for miles. These people don't have the luxury of going to a doctor every time they need something. I'm confused as to why you're upset that people are getting medical care. Would you prefer them to get no medical care rather than decent medical care from a mid-level?

 

[GinnyWeasley]

Loooooool.
Not.

Would you mind explaining/giving examples of why this isn't true? Do nurse practitioners not provide rural/country towns with medical care when there are no physician present?

 

[chipwhitley]

I have an MD and I don't feel safe with myself as my PCP. Do you think I'm gonna feel safe with someone with even less education??

 

[Snoopy2006]

I've attempted to engage in completely respectful discourse but the amount of nastiness on this thread is both a violation of the SDN rules and also unprofessional. I'm unsubscribing and won't revisit.

I don't think there's as much nastiness here as you're perceiving. Each forum tends to have its own tenor, and SDN can often have a snarky atmosphere that seems harsh to people visiting the boards for the first time, but no one here is intending to be nasty.

I've got a lot of respect for PAs. I generally dislike when people equate all midlevels because it undermines the basic science training that PAs undergo, whereas NPs are trained under a much softer nursing-based curriculum. I also agree that a substantial amount of PAs (that I've met at least) seem to understand their limits and when to bring in a colleague, much more so than NPs.

People have also made some points in this thread that I think are solid ones:

-I trained at a medical school where PAs often sat in the same classes as us, and there's many in the country like this. A common misconception, therefore, is that PAs undergo the same foundational training as MDs. Schools vary and I can only speak to mine, but even when PAs sat through the same lectures, their tests often had different slants and different grading curves. Simply being exposed to a topic doesn't ensure the same level of mastery.

More importantly - and this is something that I heavily underestimated as a medical student - medical school is a small portion in the training of an MD. It is foundational, to be sure, but the rigorous training received in residency is incomparable. For most PAs, PA school represents the majority of their education prior to practice. For most MDs, medical school represents a small fraction of their overall knowledge base. 3 months on the floors as an intern helped me solidify concepts I had learned in medical school, but never truly mastered (relatively speaking) until I had a census of 10 patients and was running codes and making calls. My growth in 1 year of residency was greater than in 4 years of medical school, IMO.

Then just one year into my advanced residency, I noticed that the knowledge gap between our two PAs (>45 years combined experience) and myself was substantial, which echoes what a posterior earlier had noticed.

Re: JNC8
I think the point you were trying to make was that your classes focus on pathophysiology, which is something to respect. Certainly the focus on the basic sciences in PA school is on a different level than in an NP program. With that said, what you were describing (multiple lectures, an exam essentially focusing on updates in HTN) was very odd to MDs, who are used to covering vast swaths of material in the span of 2-3 hours and taking exams that span many different topics. My first reaction - without having read the rest of the posts, and with no snark at all - was that the JNC8 is something that it took me 10-15 minutes to master during my M3 year. It certainly is a topic that most medical students would learn in 10-20 minutes and move on. The two groups are coming from vastly different POVs, which is why I think you found their posts hard to believe, but they're not trying to put you down, and they're correct.

 

[Snoopy2006]

And to answer the original question, I'd prefer the clinician with the most training - so the physician. I wouldn't necessarily feel unsafe with a PA as my provider (I would with an NP) but having seen the difference in training, I believe it matters. Significantly.

 

[vendtex]

And to answer the original question, I'd prefer the clinician with the most training - so the physician. I wouldn't necessarily feel unsafe with a PA as my provider (I would with an NP) but having seen the difference in training, I believe it matters. Significantly.

I believe much of the University of North Dakota's PA program is online according to their website......that make you feel safe?

 

[giantswing]

Would you mind explaining/giving examples of why this isn't true? Do nurse practitioners not provide rural/country towns with medical care when there are no physician present?

It's been discussed ad nauseam but the gist is that mlps generally gravitate toward the more populated areas and aren't the saints and saviors making up for the rural physician gap, which is why they were given such autonomy in the first place.

 

[UFAPFAPFAP]

I believe much of the University of North Dakota's PA program is online according to their website......that make you feel safe?

Throw away account for anonymity. The first 6 months (out of 24 months total) are solely online and consist of recorded lectures - not sure how that's much different than med students watching lecture at home on 2x speed during the first 2 years. After that there are occasional online "courses"/activities that are done along with courses which occur in physical classrooms.

 

[GinnyWeasley]

It's been discussed ad nauseam but the gist is that mlps generally gravitate toward the more populated areas and aren't the saints and saviors making up for the rural physician gap, which is why they were given such autonomy in the first place.

Hmm well I'm referring to the ones that stay in rural areas. It seemed like there was a problem discussing ones that provide very needed services when there are few doctors.

 

[chipwhitley]

The question that still puzzles me and that @Mad Jack posed earlier is why we even consider the prospect of a midlevel being someone's PCP. This is not something that would fly in almost any other country on the planet. Yet here we are, supposedly the country with the best medical care in the world, and we allow this to happen.

We don't let paralegals be someone's sole lawyer. We don't let someone with half of the required flight time of a commercial pilot fly a plane - no matter how good at it they may seem. But we let people with a fraction of the training loose in arguably the most critical job there is?

 

[giantswing]

Hmm well I'm referring to the ones that stay in rural areas. It seemed like there was a problem discussing ones that provide very needed services when there are few doctors.

I'm sure many of them are fine, but not necessarily or supervised adequately.

 

[GinnyWeasley]

I'm sure many of them are fine, but not necessarily or supervised adequately.

I agree. But they are necessary to give medical care to people that are unable to access doctors on a regular basis.

 

[Stagg737]

The question that still puzzles me and that @Mad Jack posed earlier is why we even consider the prospect of a midlevel being someone's PCP. This is not something that would fly in almost any other country on the planet. Yet here we are, supposedly the country with the best medical care in the world, and we allow this to happen.

I have no problem with NPs or PAs acting as PCPs in areas without access to a physician or if they cannot get an appointment in a reasonable time (aka the previous poster that said it would take 2+ months to see a PCP). In general though, I agree. Idk why anyone would choose to see a mid-level provider over a physician unless cost and convenience is really that much of a priority to them.

 

[vendtex]

I have no problem with NPs or PAs acting as PCPs in areas without access to a physician or if they cannot get an appointment in a reasonable time (aka the previous poster that said it would take 2+ months to see a PCP). In general though, I agree. Idk why anyone would choose to see a mid-level provider over a physician unless cost and convenience is really that much of a priority to them.

Sometimes it's ignorance of the fact that the provider is not a physician as it isn't unusual for patients to call them Dr. Whatever. How that starts one can only imagine.


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[giantswing]

Totally crap that rural people get sub par medical care but...

 

[chipwhitley]

Sometimes it's ignorance of the fact that the provider is not a physician as it isn't unusual for patients to call them Dr. Whatever. How that starts one can only imagine.


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At the clinic here, I've often overheard the secretaries call the NPs and PAs "Dr." when setting up appointments and they even document that the patient has an appointment with "Dr. so and so" who happens to be a PA. When I see patients, they also state that they saw "Dr. so and so" last time, unaware the person is a PA. I've never heard a patient in our clinic refer to a PA or NP as anything other than Dr. or "the doctor". I bet the secretaries don't even know that a PA is not a doctor. They think PA or NP is another medical degree, like DO. How would the patients know the difference when everyone is calling everyone Dr. in the clinic and everybody is walking around in a white coat?

 

[vendtex]

Throw away account for anonymity. The first 6 months (out of 24 months total) are solely online and consist of recorded lectures - not sure how that's much different than med students watching lecture at home on 2x speed during the first 2 years. After that there are occasional online "courses"/activities that are done along with courses which occur in physical classrooms.

That's fine. I was just pointing it out as a contrast to the situation in which supposedly PA students are in the same classes as medical students.


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[KnuxNole]

Totally crap that rural people get sub par medical care but...

For some people, a midlevel provider is the only access of care for them, cheaper, and the closest they can get to see a primary doc. Also depends on the person, I've heard people say that for basic acne medication or for the sniffles, it doesn't matter who they see. Some hear good things about how kind the NP was and how they listened the whole time, and recommend all their family and kids to go see Dr. NP, and how some got turned off by seeing so-and-so MD, how he/she was rushing, doesn't listen to their needs, and switches to Dr. NP. Of course, the reverse can easily be true(MD's who are kind and listen and PA/NP's who shove them Abx and peace out). Just a little food for thought...personally if I was to get a PCP, I would prefer a MD. I wouldn't mind seeing a NP for a quick routine follow up or two if the MD is swamped and all I need is refills, but would rather establish with a physician.

The ones that are good are the ones that know what they know and know what they don't know. PAs and NPs do have a role. When they work together with the physicians, that's when things are good. However, some that think they know beyond the scope of their training makes me worry. The NPs in the ED I work in, has optional supervision. For the hard cases, they have a choice to staff it with the MDs, but otherwise they do it all on their own. To be fair, it is mainly "fast track" patients, but patient's get mistriaged all the time...

 

[Denatured]

2000 people in my patient panel are comfortable seeing me, a PA, as their sole primary care manager. Some love me for making catches someone else missed, some have left my panel because they didn't like something I said or did, like not giving them opioids or benzodiazepines. None have left because they didn't think I had the clinical acumen. I handle everything from their sniffles to COPD exacerbation to managing their benign prolactinoma. Not that I don't discuss cases with colleagues or never have to look something up, but I would be more worried by the person who says they never get a curbside consult or needed to refresh their memory on the patho of zebra diagnoses you may make once in a decade. We rotate chart reviews amongst the staff, so I could review an MD or PA, and either could review mine. I can see the heads exploding.

For my family, I have them see another PA in the clinic. Is she as knowledgable as my collaborating physician? No, but she's better than the other physician.

Essentially, I wouldn't make my choice of provider based on a single characteristic such as degree. There are so many factors like years of experience, personality, how devoted they are to continuous learning, how do they view their relationship with the patient, people pleaser that will give you what you want or will tell you no when they believe you want inappropriate treatment/referral, do they refer everything or actually do the work up themselves, and how quickly can I see them for my acute issue (because I want continuity between who sees my chronic and acute issues otherwise things may be missed)?

 

[Psai]

2000 people in my patient panel are comfortable seeing me, a PA, as their sole primary care manager. Some love me for making catches someone else missed, some have left my panel because they didn't like something I said or did, like not giving them opioids or benzodiazepines. None have left because they didn't think I had the clinical acumen. I handle everything from their sniffles to COPD exacerbation to managing their benign prolactinoma. Not that I don't discuss cases with colleagues or never have to look something up, but I would be more worried by the person who says they never get a curbside consult or needed to refresh their memory on the patho of zebra diagnoses you may make once in a decade. We rotate chart reviews amongst the staff, so I could review an MD or PA, and either could review mine. I can see the heads exploding.

For my family, I have them see another PA in the clinic. Is she as knowledgable as my collaborating physician? No, but she's better than the other physician.

Essentially, I wouldn't make my choice of provider based on a single characteristic such as degree. There are so many factors like years of experience, personality, how devoted they are to continuous learning, how do they view their relationship with the patient, people pleaser that will give you what you want or will tell you no when they believe you want inappropriate treatment/referral, do they refer everything or actually do the work up themselves, and how quickly can I see them for my acute issue (because I want continuity between who sees my chronic and acute issues otherwise things may be missed)?

Feel free to be a provider by yourself. I'm a doctor.

 

[Denatured]

Feel free to be a provider by yourself. I'm a doctor.

You're welcome to call yourself whatever you like. No concern to me, friend.

 

[NimbleNavigator]

None have left because they didn't think I had the clinical acumen.

Umm... what? How would they even know? I mean, obviously you know way less than most physicians, but you still know way more than the average person.

 

[Denatured]

Umm... what? How would they even know? I mean, obviously you know way less than most physicians, but you still know way more than the average person.

I'll clarify, no one has left my panel because I've missed something.

If that's what you want to measure, I do have a couple family members of different physicians on my panel.

ETA: thanks for saying most and not all. Considering you have no idea who I am, I'll take that as a compliment to the PA profession.

 

[vendtex]

I'll clarify, no one has left my panel because I've missed something.

If that's what you want to measure, I do have a couple family members of different physicians on my panel.

ETA: thanks for saying most and not all. Considering you have no idea who I am, I'll take that as a compliment to the PA profession.

I'm not sure how you think you would know why someone left your panel? I'm not saying you aren't a competent provider but that statement is unrealistic unless you interrogate those who leave. But even then the reasons given aren't necessarily reliable if they are confronted in that manner.

I've met a couple excellent PAs and some horrible MDs and DOs but if I were to advise someone who has no medical knowledge whom they should see it would be the MD because at least I can be confident that they have had similar training. PA training seems much more variable in quality. You are right that other qualities influence the quality of a provider but if the only thing I know is the training I would always chose the MD first until more information and specific knowledge about the other providers became clear.


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[Denatured]

I'm not sure how you think you would know why someone left your panel? I'm not saying you aren't a competent provider but that statement is unrealistic unless you interrogate those who leave. But even then the reasons given aren't necessarily reliable if they are confronted in that manner.

I've met a couple excellent PAs and some horrible MDs and DOs but if I were to advise someone who has know medical knowledge whom they should see it would be the MD because at least I can be confident that they have had similar training. PA training seems much more variable in quality. You are right that other qualities influence the quality of a provider but if the only thing I know is the training I would always chose the MD first until more information and specific knowledge about the other providers became clear.


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I suppose your right that someone may have left that just waltzed out and said nothing. I work in a military system seeing dependents and retirees, sprinkle in a few active duty. So if they chose to leave my panel they will go to a colleague. If they change, the clinic manager gives me an anonymous, though I admit I can usually figure it out, satisfaction report describing why they chose to be with someone else so we can improve. Like any reporting system, it isn't without flaw. I'll qualify my statement with "that I know of." I would hope that if I missed something that my colleagues would respect me enough to come tell me. So far no one has told me this and I've only talked with someone else over a major miss once, and it turned out it was because of incorrect data input by a CNA.

I agree and would never dispute that logical decision. If given only one characteristic, education level, without anymore information in perpetuity, I'd pick the MD/DO every time as well.

I don't believe it's quite as variable as you think. At least no more variable medical student training. We have a standard didactic format and clinical hours that must be met in specific areas of medicine. Clinical rotation experience can be variable, of course, but I see that is the same with medical students.

However, I suppose I'm trying to explain why I wouldn't dismiss a PA outright until I experienced them for myself because of the many nuances.

 

[NimbleNavigator]

I work in a military system seeing dependents and retirees, sprinkle in a few active duty.

That explains it tbh. The VA is such trash that they've probably just resigned themselves to taking what they can get.

 

[Denatured]

That explains it tbh. The VA is such trash that they've probably just resigned themselves to taking what they can get.

I figured someone would use the military info as a slight. However, I do not work for the VA. Wouldn't know what it's like there except for news articles, personally.

 

[NimbleNavigator]

I figured someone would use the military info as a slight. However, I do not work for the VA. Wouldn't know what it's like there except for news articles, personally.

Look dude, I'm sure you're a great PA. At the end of the day, though, I think it's dangerous that you seem to think of yourself as equal to physicians. You aren't equal to a physician. You're a physician's assistant. I'm not trying to belittle you or anything, but I just think that everyone has to know their limits - even physicians. It doesn't seem like you do, and I think that's unfortunate.

 

[W19]

Would PA/NP trust a 4th med student to be their kids' 'provider'? A 4th year med student has more didactic/clinical training than most PA/NP, so I am not sure why these people come here and try to tell us they are as good as physicians... We are rotating with 2 PA students right now and our preceptor expect a lot more from us, but once rotation is over for them next year, they can go out and make 100k/year while people would label 4th year med students as crazy if they demand to have a midlevel license to practice 'medicine'. WTF is wrong with that system?

 

[NimbleNavigator]

Would PA/NP trust a 4th med student to be their kids' 'provider'? A 4th year med student has more didactic/clinical training than most PA/NP, so I am not sure why these people come here and try to tell us they are as good as physicians... We are rotating with 2 PA students right now and our preceptor expect a lot more from us, but once rotation is over for them next year, they can go out and make 100k/year while people would label med students as crazy if they demand to have a midlevel license to practice 'medicine' once they have completed 3rd year. WTF is wrong with that system?

IDK man. A lot of things in medicine just don't make sense to me

 

[Taddy Mason]

Look dude, I'm sure you're a great PA. At the end of the day, though, I think it's dangerous that you seem to think of yourself as equal to physicians. You aren't equal to a physician. You're a physician's assistant. I'm not trying to belittle you or anything, but I just think that everyone has to know their limits - even physicians. It doesn't seem like you do, and I think that's unfortunate.

The irony is too much. I also suggest you check the defenition of belittle.

 

[Denatured]

Look dude, I'm sure you're a great PA. At the end of the day, though, I think it's dangerous that you seem to think of yourself as equal to physicians. You aren't equal to a physician. You're a physician's assistant. I'm not trying to belittle you or anything, but I just think that everyone has to know their limits - even physicians. It doesn't seem like you do, and I think that's unfortunate.

I don't think of myself as equivalent to anything. I don't think I'm those terms. I do the best I can and work to better myself because I'm far from perfect. The only thing I'm implying is that I'm safe, competent, and dedicated to my patient population. Where did I say I was better or equivalent to anyone else? I simply stated what I did. I mentioned that I think one of my PA colleagues is better than another MD in the office, but that's her and not me.

I disagree, I think you are trying to belittle me. You wouldn't have put 's on physician assistant or said that I was a last resort of the VA. It's cool though because you are entitled to your opinion, which has no effect on my well being or practice. I do appreciate you helping me pass the time on this boring day.

 

[Denatured]

Would PA/NP trust a 4th med student to be their kids' 'provider'? A 4th year med student has more didactic/clinical training than most PA/NP, so I am not sure why these people come here and try to tell us they are as good as physicians... We are rotating with 2 PA students right now and our preceptor expect a lot more from us, but once rotation is over for them next year, they can go out and make 100k/year while people would label 4th year med students as crazy if they demand to have a midlevel license to practice 'medicine'. WTF is wrong with that system?

It is unfortunate when less is expected of a PA student. I agree too, that a tiered system would be better than having a separate profession. Too far down stream to change now, sadly.

 

[vendtex]

I suppose your right that someone may have left that just waltzed out and said nothing. I work in a military system seeing dependents and retirees, sprinkle in a few active duty. So if they chose to leave my panel they will go to a colleague. If they change, the clinic manager gives me an anonymous, though I admit I can usually figure it out, satisfaction report describing why they chose to be with someone else so we can improve. Like any reporting system, it isn't without flaw. I'll qualify my statement with "that I know of." I would hope that if I missed something that my colleagues would respect me enough to come tell me. So far no one has told me this and I've only talked with someone else over a major miss once, and it turned out it was because of incorrect data input by a CNA.

I agree and would never dispute that logical decision. If given only one characteristic, education level, without anymore information in perpetuity, I'd pick the MD/DO every time as well.

I don't believe it's quite as variable as you think. At least no more variable medical student training. We have a standard didactic format and clinical hours that must be met in specific areas of medicine. Clinical rotation experience can be variable, of course, but I see that is the same with medical students.

However, I suppose I'm trying to explain why I wouldn't dismiss a PA outright until I experienced them for myself because of the many nuances.

FWIW the excellent PAs I was referring to were ones that I encountered in the military. It's the ones out in rural areas that weren't military trained or experienced, that opened my eyes to the variability in training and competence. There also seems to be more nepotism in small towns which tends to protect the bad ones. Others may have different experiences.


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[Denatured]

FWIW the excellent PAs I was referring to were ones that I encountered in the military. It's the ones out in rural areas that weren't military trained or experienced, that opened my eyes to the variability in training and competence. There also seems to be more nepotism in small towns which tends to protect the bad ones. Others may have different experiences.


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We military PAs certainly have extra incentives to study and more opportunities to practice autonomously. Don't let a few bad apples leave a bad taste in your mouth for the rest.

 

[TedStark]

2000 people in my patient panel are comfortable seeing me, a PA, as their sole primary care manager. Some love me for making catches someone else missed, some have left my panel because they didn't like something I said or did, like not giving them opioids or benzodiazepines. None have left because they didn't think I had the clinical acumen. I handle everything from their sniffles to COPD exacerbation to managing their benign prolactinoma. Not that I don't discuss cases with colleagues or never have to look something up, but I would be more worried by the person who says they never get a curbside consult or needed to refresh their memory on the patho of zebra diagnoses you may make once in a decade. We rotate chart reviews amongst the staff, so I could review an MD or PA, and either could review mine. I can see the heads exploding.

For my family, I have them see another PA in the clinic. Is she as knowledgable as my collaborating physician? No, but she's better than the other physician.

Essentially, I wouldn't make my choice of provider based on a single characteristic such as degree. There are so many factors like years of experience, personality, how devoted they are to continuous learning, how do they view their relationship with the patient, people pleaser that will give you what you want or will tell you no when they believe you want inappropriate treatment/referral, do they refer everything or actually do the work up themselves, and how quickly can I see them for my acute issue (because I want continuity between who sees my chronic and acute issues otherwise things may be missed)?

This reeks of arrogance and naivety. Fortunately the safeguards in place were successful at keeping a medical license out of your hands.

 

[cbrons]

I don't mind PAs too much, but I really hate nurse practitioners (the degree and profession, not the person).

 

[Denatured]

This reeks of arrogance and naivety. Fortunately the safeguards in place were successful at keeping a medical license out of your hands.

I'm confused. Could you specifically point out the statements of arrogance? I don't believe others received that impression. I only stated what I do based on fact. Never said I was better or worse than anyone. Just competent.

I also have a state medical license. It's a requirement for me to practice.

 

[NimbleNavigator]

I'm confused. Could you specifically point out the statements of arrogance? I don't believe others received that impression. I only stated what I do based on fact. Never said I was better or worse than anyone. Just competent.

I also have a state medical license. It's a requirement for me to practice.

I have a toy Lamborghini but I don't go around telling people I have a Lambo.

 

[cbrons]

At the clinic here, I've often overheard the secretaries call the NPs and PAs "Dr." when setting up appointments and they even document that the patient has an appointment with "Dr. so and so" who happens to be a PA. When I see patients, they also state that they saw "Dr. so and so" last time, unaware the person is a PA. I've never heard a patient in our clinic refer to a PA or NP as anything other than Dr. or "the doctor". I bet the secretaries don't even know that a PA is not a doctor. They think PA or NP is another medical degree, like DO. How would the patients know the difference when everyone is calling everyone Dr. in the clinic and everybody is walking around in a white coat?

You can correct this real easily. When patients say, "YEah I see doctor so and so" I immediately say, "They're not a physician, they're an NP" or "Theyre a physician assistant, not an MD." They look at me puzzled and are like, "Oh wow I never knew that." Yeah it happens from time to time, you just have to enlighten them.

Why is that important? There have been several law suits related to non-physicians misrepresenting themselves in health care settings. This is why many hospitals have distinct ID badges with "RN" and "MD" or "PHYSICIAN" or "PA" or "NP" etc. Also why it is illegal in some states for non-physicians to call themselves "doctor" so-and-so in health care settings. As a 4th year med student, people very very frequently call me "doctor" so and so, and I say just call me cbrons, I'm not a doctor. Any NP (including DNP) or secretarial staff who calls non-physicians "Doctor" so and so in the hospital or clinic is misrepresenting themselves as a physician, and exposing the hospital/health care company/supervising physician/all of the above to liability.

You think a malpractice lawyer could not VERY easily show that a person passed themselves off as a physician or failed to correct previously established misrepresentations? It has happened several times and will continue to happen as patient and lawyers continue to realize how much PAs/NPs play a role in patient care.