WTF...PA students = Medical students?!?!

[uclacrewdude]

the only time i ever met a PA student she had the audacity to look at me! SO I KILLED HER! I ATE HER ALL UP! RAWR! thatll learn her!

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[OB Defender]

After reading through this thread and spending > 20 years in L&D, I'd just like to offer some perspectives that might just help some of you.

First off - those of you who have been tossed out of the delivery room when you jumped in at the last minute to participate need to understand a few things. First off - nothing frosts a labor room nurse more than a stranger popping in at the 11th hour. Please understand that the "delivery", or "procedure" as some of you have called it, is not what OB is all about.
Introduce yourself to the patient and her partner, ask if you can participate in her LABOR and perhaps her delivery, and park you butt in that woman's labor room & watch what goes on.

This will give you the opportunity to learn about fetal monitoring from the people who actually understand it. You'll also gain some insight into just what labor is and what giving birth means to the patient. You'll discover some pain management techniques that will be invaluable in any area of medicine, and you just might earn some respect for the specialty. I guarantee you that if you treat the process with the respect it deserves, you'll have every labor nurse on the floor inviting you in, sharing some wisdom, and providing you with unlimited learning opportunities.

Show up to "do the delivery" and you'll be shown the door. And rightly so.

 

[mtnlion44]

I'm shooting from the hip here....Most PA's could be docs..but first there's not enough med schools in the US, so good candidates get put aside. The trusted old white guys who have been running allopathic med (AMA, AAMC, LCME, etc..) circled the wagons on doc salaries, but gave in to one trojan hourse after another,( CRNA, PA, NP's )who consistently take a larger and larger piece of the patient care pie. Maybe a 100 years from now, there'll be no docs left!! I'm a US citizen IMG in Europe. Thankfully our country deliberately graduates only 60-70% of the docs we need so people like me can come back and STILL get multiple job offers. Life is sweet. Guess who RUNS the hospitals folks..nurses! They saturate the administration. One hospital I rotated in last year..all staff had their "job title" (RN, RT, etc...except the docs..they wanted no sign of a MD anywhere in that hospital. As I hear, nurse as taught to be the patient advocate, to protect the patient from....guess?? ..the MD's!!! Anyway, at least in Europe the MD's run the show..nurses are..nurses, NO PA's, NO NP, NO DO's but even here..there are organizations probing for a weakness to get in the door. Sorry for the rant, DO's and PA's should be MD's. We put them on that pathway...We in allopathic medicine have watered down our own constituency and voting power, by allowing patient care to be taken by others. And these others make a bigger constituency than MD's..so guess who gets listened to more on Capitol Hill?? We lost this battle long ago...what hold in the future is anyones guess. I must end that I do support the nurses and PA's and DO's. I just don't embrace that patient care should be that fragmented with different professionals and had the AMA, AAMC etc done their job 20 years ago, most PA's and every DO would be an MD. (Hence, no PA students to take your procedure away )

I know this is an old thread but I have to respond to this bc. I hear this said a lot still. Medical training in other Western countries is no where near as rigorous or long or expensive as it is in the US. Therefore, automatically saying docs there are the same as docs here is essentially validating the argument that midlevels are qualified to have full autonomy. I'm not saying that is always the case, but that is a corollary of that argument. But anyways, talk about a train that has left the station; its way farther down the track than it was in 2005 and its not coming back. Patients have really suffered very little if at all for this. And doubling the number of MDs and DOs in hospitals is just not practicable from a cost standpoint, nor is necessary (maybe you don't consider a midlevel as equal but they can do suture and see people coming in with colds). This argument basically seems to be about protecting turf which is normal self interest but is not a moral or practical argument of any real weight. Wouldn't a better way of looking at this be that midlevels help physicians to remain as a "scarce good" and demand top dollar for their services? It essentially allows the hospital to absorb the very high marginal cost of the extra expertise/clinical reasoning/competence/qualifications that the physician may have (and they are paying a lot for it--$225-250/hr vs. $75) by unloading some of the work on someone who is equally capable of doing it.

 

[deleted6669]

I know this is an old thread but I have to respond to this bc. I hear this said a lot still. Medical training in other Western countries is no where near as rigorous or long or expensive as it is in the US. Therefore, automatically saying docs there are the same as docs here is essentially validating the argument that midlevels are qualified to have full autonomy. I'm not saying that is always the case, but that is a corollary of that argument. But anyways, talk about a train that has left the station; its way farther down the track than it was in 2005 and its not coming back. Patients have really suffered very little if at all for this. And doubling the number of MDs and DOs in hospitals is just not practicable from a cost standpoint, nor is necessary (maybe you don't consider a midlevel as equal but they can do suture and see people coming in with colds). This argument basically seems to be about protecting turf which is normal self interest but is not a moral or practical argument of any real weight. Wouldn't a better way of looking at this be that midlevels help physicians to remain as a "scarce good" and demand top dollar for their services? It essentially allows the hospital to absorb the very high marginal cost of the extra expertise/clinical reasoning/competence/qualifications that the physician may have (and they are paying a lot for it--$225-250/hr vs. $75) by unloading some of the work on someone who is equally capable of doing it.

Thanks. we do more than suture and treat colds, but there is definitely a need for every healthcare worker in 2016. There are MANY facilities that can not attract physicians that would close were it not for the PAs and NPs that staff them 24/7/365, often without any physicians on site.

 

[Winged Scapula]

I know this is an old thread but I have to respond to this bc. I hear this said a lot still. Medical training in other Western countries is no where near as rigorous or long or expensive as it is in the US. Therefore, automatically saying docs there are the same as docs here is essentially validating the argument that midlevels are qualified to have full autonomy. I'm not saying that is always the case, but that is a corollary of that argument. But anyways, talk about a train that has left the station; its way farther down the track than it was in 2005 and its not coming back. Patients have really suffered very little if at all for this. And doubling the number of MDs and DOs in hospitals is just not practicable from a cost standpoint, nor is necessary (maybe you don't consider a midlevel as equal but they can do suture and see people coming in with colds). This argument basically seems to be about protecting turf which is normal self interest but is not a moral or practical argument of any real weight. Wouldn't a better way of looking at this be that midlevels help physicians to remain as a "scarce good" and demand top dollar for their services? It essentially allows the hospital to absorb the very high marginal cost of the extra expertise/clinical reasoning/competence/qualifications that the physician may have (and they are paying a lot for it--$225-250/hr vs. $75) by unloading some of the work on someone who is equally capable of doing it.

Off topic but would you care to elaborate?

I'm unaware of any Western countries with shorter or less rigorous medical training than the US.

 

[deleted6669]

Off topic but would you care to elaborate?

I'm unaware of any Western countries with shorter or less rigorous medical training than the US.

If I'm not mistaken, don't many European countries combine undergrad and medschool into a 5-6 yr program vs the 8 required here? I remember rotating with 5th yr students from the UK, who were basically MS3s.

 

[Winged Scapula]

If I'm not mistaken, don't many European countries combine undergrad and medschool into a 5-6 yr program vs the 8 required here? I remember rotating with 5th yr students from the UK, who were basically MS3s.

1) The combining of undergrad and medical school is not "medical training", the entire 6 years are not medical school and therefore, don't qualify, IMHO as medical training. The first two years are spent taking basic science preparatory courses.

If anything, they spend less time in medical school studies than US students do.

2) Many countries, especially the Commonwealth ones, have gone to the US style of a 4 year post graduate program.

3) Most other Western countries have longer specialty training programs, e.g., residencies, than in the US. While the GP track exists, it still requires Foundation Years (or the equivalent) before further training.

Thus to claim that other countries have shorter training than the US is a farce. The user I was responding to conveniently neglects to note that medical training doesn't stop with medical school graduation.

 

[deleted6669]

1) The combining of undergrad and medical school is not "medical training", the entire 6 years are not medical school and therefore, don't qualify, IMHO as medical training. The first two years are spent taking basic science preparatory courses.

If anything, they spend less time in medical school studies than US students do.

2) Many countries, especially the Commonwealth ones, have gone to the US style of a 4 year post graduate program.

3) Most other Western countries have longer specialty training programs, e.g., residencies, than in the US. While the GP track exists, it still requires Foundation Years (or the equivalent) before further training.

Thus to claim that other countries have shorter training than the US is a farce. The user I was responding to conveniently neglects to note that medical training doesn't stop with medical school graduation.

do you happen to know the lengths of various residencies in the UK for example? They would have to be > 2 yrs longer than in the US to spend the same amt of total time in school. asked another way, how old is the typical new attending in several fields like family medicine or surgery?

 

[Winged Scapula]

do you happen to know the lengths of various residencies in the UK for example? They would have to be > 2 yrs longer than in the US to spend the same amt of total time in school. asked another way, how old is the typical new attending in several fields like family medicine or surgery?

Its hard to give an exact answer because the length of residencies outside of the US tend to be less time based and more skill based. In the UK, it typically takes 10-12 yrs to become a consultant (attending) surgeon, so most are in their mid to late 30s by the time they become a consultant (if they even do).

In general the pathway is:

Foundation Years 1 and 2. These are essentially like our MS3 or 4 years or similar to a TY with various rotations amongst different specialties; these are done after medical school graduation. Everyone does these, regardless of specialty.

Apply for Core Surgical Training after completion of FY: you may or may not get in the first year. When you do, this last 2 years where you rotate amongst core surgical specialties.

Apply for Specialist Surgical Training after you complete Core Surgical Training: this is 6 years in length for general surgery, provided you are awarded the ability to advance to the next year. In other words, training can be extended at the discretion of your consultants.

A common complaint amongst NHS trainees is that they are not advanced appropriately and that they will "never" be a consultant. I once saw an orthopedic registrar have his training extended because he pissed off one of the consultants; its highly subjective but these guys are very well rounded, great surgeons when they are done.

You can read more about GS training here:
https://www.healthcareers.nhs.uk/explore-roles/surgery/general-surgery/training-and-development

For "Family Medicine" (called GP): you do your Foundation Years, apply for GP training track which is a minimum of 3 more years. There are reportedly not enough spots for everyone so many apply for several years, doing more registered medical officer years before they get into the specialist training.

 

[deleted6669]

Thanks. I was unaware of most of the above regarding residency in the UK.

 

[Winged Scapula]

Thanks. I was unaware of most of the above regarding residency in the UK.

No worries. Most are which is why I always smh at those that claim that the US has such long training. The RCS (Royal College of Surgeons) exam has a 30% pass rate (required to advance), compared to a 70% pass rate here (for the ABS). Its pretty intense.

I was done with surgical training in the US long before any of my Aussie colleagues.

 

[Redpancreas]

I wanted to scrub in on a C-section today and was snubbed by the OB resident in favor of a PA student (I almost hit her with "I didn't realize PA's were doing C-sections now," but thought better). A few days ago, I was reamed out for having the audacity of trying to observe a birth without introducing myself to the patient first. No problem, my bad -- I wasn't aware of L&D etiquette and now make it a point to establish some kind of relationship with everybody on the floor first thing in the morning. Anyways, one of the patients went into labor yesterday and I go in, ready to help push and hopefully catch, only to find the PA student and a throng of nursing students crowding the joint. Not to sound elitist, but does anybody else do their 3rd year rotations with PA students? Things like this don't usually bother me, but as of late I'm the one to take the back seat, unless there's scut to be done. I figured my "Y" chromosome had something to do with it until one of the other female med students echoed my sentiment.

Please tell me if I'm in the wrong, but wouldn't it make more sense for the PA students to keep to their own kind and let me get my $33,000 worth of education. The residents know I'm pissed and know that if the program director comes down on them, I was the one who complained; thus, making life 10x worse for the remainder of the rotation and risking an unfavorable eval. Any suggestions or like experiences?

OB is notorious for some reason for these things. Whether it's PAs, nursing students, or foreign grads, there are too many freaking learners and residents and attendings have no time to differentiate you all. I'm glad I didn't have to honor OB clinically.

Rest assured that this is less common in IM, surgery, Neuro, etc.


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[VA Hopeful Dr]

No worries. Most are which is why I always smh at those that claim that the US has such long training. The RCS (Royal College of Surgeons) exam has a 30% pass rate (required to advance), compared to a 70% pass rate here (for the ABS). Its pretty intense.

I was done with surgical training in the US long before any of my Aussie colleagues.

I don't claim to know much about Australian training, but doesn't the UK have much more stringent work hour rules than we do. Plus, didn't they until quite recently get overtime pay, possibly for weekends as well.

 

[Winged Scapula]

I don't claim to know much about Australian training, but doesn't the UK have much more stringent work hour rules than we do. Plus, didn't they until quite recently get overtime pay, possibly for weekends as well.

They do and they do. From my observation those work hours are pretty routinely violated and whether you get paid overtime depends on whether you claim the the hours. They face the same issues we do with a lot of work and not a lot of time to get it done.

However there's a pretty good data that shows most Americans would rather work less years in exchange for the longer hours.


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[VA Hopeful Dr]

They do and they do. From my observation those work hours are pretty routinely violated and whether you get paid overtime depends on whether you claim the the hours. They face the same issues we do with a lot of work and not a lot of time to get it done.

However there's a pretty good data that shows most Americans would rather work less years in exchange for the longer hours.


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I wonder if that data is collected from current residents or from current attendings? Cause I bet the answer varies quite a bit...