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sylvanthus

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I think the likert scale is a great tool.









kiddin, no frickin clue what it is, just trying to get ya riled up.
 
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AlmostAnMD

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About **** my pants until I scrolled down lol

I have a biostats degree as well as MD. Back when I thought, you know, I wanted to do academics. Basically, it's a cheap way of trying to quantify a qualitative phenomenon. If that sounds like nonsense, it is, and usually used in lieu of real research like "does a drug work."

Example:

Do you like me
1- no
2- sort of
3-maybe
4-yeah
5-omg lets bone

get enough of those together and people start throwing t-tests towards them like anyone cares

omg his plan worked, this topic is now about likert scales
 
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WilcoWorld

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Dude

it doesn't matter where it was published. It could have been published in the Syrian Journal of Medicine and Basket Weaving. It's just as alarming if it were published there or JAMA. I couldn't care less about where it was published. For West JEM specifically I know it's a worthless throwaway magazine because they let me publish in it.

It was clearly published as a first step towards an equivalency paper some white tower idiot will eventually publish to get tenure. We're all looking at a hole in the ground where the foundation goes for a massive skyscraper of nonsense and all you can see is the hole, not the skyscraper to fill it

This topic is not now, nor ever, a debate over likert scales and it should never be mentioned again. The more I think about how you're reacting to this........are you at Yale?????
Nope I'm not at Yale, and I'd like to refer you to my 1st sentence in this thread: "I'm not trying to defend an MLP takeover, please bear with me."

I can see why my academic persnikcetiness strikes you as tone deaf, and you have a point. But please understand that EVERYTHING I have posted in this thread has been critical of this article. It's just that I prefer to critique journal articles on their (lack of) merits. I'm choosing that path because I think the way to preserve/restore the stature of Physicians is for us to show that we're BETTER at science.

But you're probably right and I'm probably just tilting at windmills.
 
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omg his plan worked, this topic is now about likert scales
My plan? Naw man, my plan is to get us all to say this article is crap and to be able to articulate precisely why it's crap.

I am operating on the assumption that the public won't be convinced by arguments that amount to "Midlevels aren't as good as doctors because I'm a doctor and I say so."

To extend your skyscraper metaphor - I feel like you and I both would like to see that skyscraper not be built. We're standing at the foundation and you're telling everyone "Skyscrapers are terrible" while I'm looking at the hole and saying "do you all notice that they're building this on quicksand?"

Hopefully we can both continue to try and make sure it doesn't get built.
 
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namethatsmell

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No, not everyone.

a) This was published in West JEM. Certainly not our most respected journal.
b) The "gold standard" of resident evaluation is the ACGME Milestones, which are quite different from a Likert scale.
c) THIS WAS NOT A STUDY OF PA VS PHYSICIAN ABILITY. From the abstract: "This program serves as a pilot study to demonstrate the feasibility of collocating clinical and didactic programming for physicians and EM-PAs during their postgraduate training. This brief innovation report outlines the logistics of the clinical and didactic curriculum and provides a summary of outcomes evaluated."

I agree with you on a and b.

With regards to c, it seems the authors appear to be directly wading into the waters of PA vs physician ability when they state "We found comparable evaluations between first-year EM-PA and physician trainee cohorts." Is there an alternate way to interpret this statement? I know you're not specifically supporting the paper and I remain open to the prospect I could be missing something.
 

WilcoWorld

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I agree with you on a and b.

With regards to c, it seems the authors appear to be directly wading into the waters of PA vs physician ability when they state "We found comparable evaluations between first-year EM-PA and physician trainee cohorts." Is there an alternate way to interpret this statement? I know you're not specifically supporting the paper and I remain open to the prospect I could be missing something.
I think that the authors are pulling a fast one and the editor was asleep at the wheel.

From the paper, "Further, each year only consisted of two PA trainees, thus limiting the ability to draw statistically significant conclusions. However, a descriptive similarity in scores can be observed."

In other words: We didn't set out to measure a difference between PAs and Physicians, not did we collect enough data to power such a statistical comparison. And wouldn't you know it, we didn't find the difference we weren't looking for!
 
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I think that the authors are pulling a fast one and the editor was asleep at the wheel.

From the paper, "Further, each year only consisted of two PA trainees, thus limiting the ability to draw statistically significant conclusions. However, a descriptive similarity in scores can be observed."

In other words: We didn't set out to measure a difference between PAs and Physicians, not did we collect enough data to power such a statistical comparison. And wouldn't you know it, we didn't find the difference we weren't looking for!

But they just had to publish it. Because publishing.
 
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namethatsmell

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I think that the authors are pulling a fast one and the editor was asleep at the wheel.

From the paper, "Further, each year only consisted of two PA trainees, thus limiting the ability to draw statistically significant conclusions. However, a descriptive similarity in scores can be observed."

In other words: We didn't set out to measure a difference between PAs and Physicians, not did we collect enough data to power such a statistical comparison. And wouldn't you know it, we didn't find the difference we weren't looking for!

Yup, agreed.

Which is what makes them inserting their reported "finding" of similar evaluations between PA and MD trainees even more irresponsible. The authors might as well have told us about how much precipitation there was on the days the PA and MD learners did their shifts as a way to try to predict the weather.

This is pure GIGO. And, unfortunately, that doesn't make it any less likely of being happily imbibed by the masses.
 
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Yup, agreed.

Which is what makes them inserting their reported "finding" of similar evaluations between PA and MD trainees even more irresponsible. The authors might as well have told us about how much precipitation there was on the days the PA and MD learners did their shifts as a way to try to predict the weather.

This is pure GIGO. And, unfortunately, that doesn't make it any less likely of being happily imbibed by the masses.

I can hear the muggles: "Look! They did a STUDY on it! Must be true!"
 
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AlmostAnMD

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Pretty much.

They did guarantee a second study out of this. They should look at pre- and post-publishing application rates to their residency program.

Hey now, let's not libel. I'm sure their residency is top tier and every medical student should apply, this kind of statement is outing a program, you know.
 
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We should consider these EM grads and any attending there to be midlevels
 
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Emedpa

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Just a point to assure you are all aware that this is not a new thing. There have been EMPA residencies for over 30 years. I applied to one in 1995. From the article:
"The United States currently has 49 clinical postgraduate EM-PA training programs".....(and)..."a recent cross-sectional study of EM-PA residencies identified that 93% of programs were in institutions that also had an EM residency program".
A partial list can be found here: https://appap.org/wp-content/upload...m-Membership-Roster-by-Specialty-Nov-2020.pdf
There will be PAs/NPs working in EDs alongside physicians for a variety of reasons(and yes, many are related to $$$). It is in everyone's best interest to make sure they are as competent as possible. These programs help advance that goal. I understand that physicians do not like to feel responsible for the work of the PAs/NPs they work with. Current legislation is aimed at removing physician liability for actions performed by PAs/NPs unless the physician was directly involved in said care.
 

Emedpa

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Lol that’s quite a twist on the push for independent practice.
Actually, No. Look at the new PA laws in MI and several other states, which still require physician involvement and oversight , but specifically remove physician liability.
from the MI legislation: "Under the new law, physicians within PA-physician healthcare teams will be recognized as participating physicians instead of supervising physicians to better reflect the PA’s and physician’s role within the team. The new law also removes physician responsibility for PA practice, making each member of the healthcare team responsible for their own decisions."
 
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Matthew9Thirtyfive

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Actually, No. Look at the new PA laws in MI and N Dakota(among others), which still require physician involvement and oversight , but specifically remove physician liability.

Uh, you realize in ND, they removed all supervision requirements in hospitals and nursing homes and allow PAs to open and own their own clinics without a physician if they have 4,000 hours of experience (which is still less than a third of a new attending). So, actually...yes?

The only good thing that comes out of that is that PAs will be responsible for their mistakes instead of physicians.
 
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Emedpa

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In North Dakota PAs in hospitals and in nursing homes practice on teams led by physicians, so a PA working in an ED there would still work for a physician led group or under the direction of the chief of the ED.
In private practice, they are are still specifically supervised.
For years physicians have been screaming that they don't want to be responsible for the work of PAs. We listened. Now you guys are actually complaining about a loss of responsibility, despite still being in control? You can't have it both ways. PAs, unlike other non-physician clinicians, are committed to working with physicians. No one practices alone, despite the initials after their name.
 

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In North Dakota PAs in hospitals and in nursing homes practice on teams led by physicians, so a PA working in an ED there would still work for a physician led group or under the direction of the chief of the ED.
In private practice, they are are still specifically supervised.
For years physicians have been screaming that they don't want to be responsible for the work of PAs. We listened. Now you guys are actually complaining about a loss of responsibility, despite still being in control? You can't have it both ways. PAs, unlike other non-physician clinicians, are committed to working with physicians. No one practices alone, despite the initials after their name.

So this article, written by the AAPA, that says that PAs in North Dakota can now own their own practice and not have a mandatory collaboration with a physician is wrong?

PAs Across America Celebrate First State with Key Components of Optimal Team Practice Following the Legislative Victory in North Dakota
 

Emedpa

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So this article, written by the AAPA, that says that PAs in North Dakota can now own their own practice and not have a mandatory collaboration with a physician is wrong?

PAs Across America Celebrate First State with Key Components of Optimal Team Practice Following the Legislative Victory in North Dakota
No, you are correct. An experienced PA may open their own primary care practice. Big surprise, most PAs in states that allow this(like NC) still work for and with physicians. Why? running a solo practice is a PITA.
Last time I checked, there was no huge push made by family med physicians to open clinics all over ND.
Would you rather have an experienced PA go through a board of medicine approval to open a clinic in an area of defined need or a new grad NP without any screening of any kind?
 
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No, you are correct. An experienced PA may open their own primary care practice. Big surprise, most PAs in states that allow this(like NC) still work for and with physicians. Why? running a solo practice is a PITA.
Last time I checked, there was no huge push made by family med physicians to open clinics all over ND.
Would you rather have an experienced PA go through a board of medicine approval to open a clinic in an area of defined need or a new grad NP without any screening of any kind?

I’d rather just have more physicians.
 
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Emedpa

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I’d rather just have more physicians.
There are plenty of physicians. They just don't want to work in primary care and/or rural and underserved areas for the most part. Most PAs/NPs don't want to work in these areas either, so while having a "town doc" would be ideal in jerkwater, usa population 700, a town PA or NP is much better than no care at all.
This is a systems problem more than anything else. Procedures pay, not keeping folks well through prevention. If medicare/medicaid compensated family medicine like they do dermatology or surgery, the "physician deficit" in rural and underserved areas would go away in a decade.
 
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Matthew9Thirtyfive

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There are plenty of physicians. They just don't want to work in primary care and/or rural and underserved areas for the most part. Most PAs/NPs don't want to work in these areas either, so while having a "town doc" would be ideal in jerkwater, usa population 700, a town PA or NP is much better than no care at all.
This is a systems problem more than anything else. Procedures pay, not keeping folks well through prevention. If medicare/medicaid compensated family medicine like they do dermatology or surgery, the "physician deficit" in rural and underserved areas would go away in a decade.

Is it though? Is inferior care better than no care? I dunno if that’s always true.

And if places were willing to put up the money, they’d get physicians there. They just aren’t.

But to that end, NPs don’t go to rural areas more than anyone else, and I doubt PAs will be any different.
 
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Emedpa

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As I understand it, a provider(regardless of training) is more likely to go into both primary care and rural medicine if they have very little debt or a way to pay off that debt(loan repayment programs, etc). I am all for loan repayment/forgiveness programs to get more providers of any type into underserved areas.
 

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Pretty much.

They did guarantee a second study out of this. They should look at pre- and post-publishing application rates to their residency program.
They know they will put asses in the seats. No skin off their back.
 

southerndoc

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This thread has derailed off-topic (what started as a discussion of training has now turned into a personal argument of PA vs MD). I have moved it to the off-topic forum. Feel free to continue this discussion there.

EDIT: I have selected the off-topic posts and moved them to the Off-Topic Forum. If you think that a post was moved that shouldn't have been, or if you think a post should've been moved to the Off-Topic Forum, then please contact me via private message.

Sorry I'm trying to do my best to keep things on topic and allow collegial discussion without allowing users to get into arguments or off-topic banter.
 
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southerndoc

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I have spent a significant amount of time to move the off-topic posts to the Off-Topic Threads Forum. If you think a post should've been moved (or if you thought a post should not have been moved), then please contact me via private messaging.

I agree with the OP. It's frustrating how things turned off-topic, but hopefully this will get us back to the original topic.

Thanks for your understanding.
 
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maxxor

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Job Description​

Overview

To be part of our organization, every employee should understand and share in the YNHHS Vision, support our Mission, and live our Values. These values - integrity, patient-centered, respect, accountability, and compassion - must guide what we do, as individuals and professionals, every day.

PA residents will be held to the same clinical and academic standards as EM physician residents. The clinical didactic curriculum will be based upon the AGCME Requirements for Graduate Medical Education in Emergency Medicine, and the 2011 EM Model of the Clinical Practice of EM. PA residents will be expected to attend weekly didactic conference. Residents will also participate in a variety of didactic offerings, including journal club, grand rounds, procedure labs, and simulation training. PA residents will complete the program with certification in ACLS, PALS, and ATLS. The PA resident will take medical histories, performs physical examinations, perform specified procedures , and develop patient treatment plans in collaboration with the attending physician. The PA resident will work primarily in the Emergency Department, (York Street, Chapel Street, and Shoreline Medical Center Campuse)

EEO/AA/Disability/Veteran
Responsibilities

  • 1. Clinical Rotations Rotations will be primarily at Yale New Haven Hospital (York Street and Chapel Street campuses). The rotation schedule will include: a. Emergency Medicine Orientation b. Emergency Medicine (York Street/Chapel Street/Shoreline) c. Pediatric Emergency Department d. MICU e. Trauma/EGS f. Orthopedics g. Ultrasound/Anesthesia h. ED Radiology i. Ophthalmology j. EMS k.Electives Duty hour limitations for PA residents will follow the same ACGME guidelines utilized for physician residents
  • 2. PA residents will complete the program with certifications in ACLS, PALS, and ATLS.
  • 3. PA residents will be expected to attend weekly conference with the Emergency Medicine physician residents. Residents will also participate in a variety of didactic offerings, including journal club, grand rounds, procedure labs, and simulation training.
  • 4. Discusses each case with the supervising attending physicians who sign (s) the medical record. Consults with community medical staff physicians as appropriate and discusses each patient's evaluation and plan
  • 5. Provides a complete medical record on all patients provided care.
  • 6. Practices within the policies and procedures of the Emergency Department and the policies of departments for rotations. Performs procedures including (but not limited to) lumbar puncture, suturing and management of wounds, minor burn care, arterial blood gas sampling, incision and drainage of abscess, thoracentesis, advanced cardiac life support procedures, paracentesis, urinary bladder catheterization, gastric lavage, central venous catheter insertion, advanced airway management, and bedside ultrasound.
  • 7. Assignment is based on rotation schedule.
  • 8. Provides clinical instruction to Physician Associate students and residents, Emergency Medical Technician and Paramedic Students.
  • 9. PA residents in collaboration with physicians, take medical histories, perform physical examinations , and perform specified procedures. The PA resident will work in the Emergency Department, at the York Street, Chapel Street and Shoreline Medical Center Campuses.
Qualifications

EDUCATION


EDUCATION (number of years and type required to perform the position duties): 1) Bachelors Degree required. 2) Graduation from an ARC-PA approved Physician Assistant program 3) Additional criteria may be specified by the residency program.


EXPERIENCE


EXPERIENCE New graduates and experienced providers are encouraged to apply.


LICENSURE


LICENSURE/CERTIFICATION: PA Required (State of Connecticut licensed/eligible) Current and active certification by the National Committee for Certification of Physician Assistants.


SPECIAL SKILLS


SPECIAL SKILLS: Excellent interpersonal, communication and leadership skills are required. Demonstrates the knowledge and skills necessary to provide quality care appropriate to the Emergency Department.


PHYSICAL DEMAND


This intensive 18-month program will providethe opportunity to learn emergency medicine in a world-class teaching institution. Yale-New Haven Hospital is a 1,541 bed tertiary care medical center; our emergency services treat over 140,000 patients/year. Structured didactic education will be provided on a weekly basis in conjunction with Yales emergency medicine physician residents and faculty. Coursework will include weekly lectures, small group sessions, and simulation training. Residents will obtain ACLS, PALS and ATLS certification.


Additional Information

This is an 18 month training position for the APP residency. Train alongside the EM medical residents, striving to achieve an advanced educational and dedicated as an APP. Receive multiple rotations, Ortho, MICU, Peds. EMS, ED, Ophthalmology, Tox, and ED. Rotations in the sim lab and US as well. Mulitple residency positions available. You must have graduated your program by May 2021 and be eligible to start before the end of May 2021. License requirements vary for APRNs vs PAs. You must meet all CT licensure requirements.

 
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TimesNewRoman

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This is so absurd

Job Description​

Overview

To be part of our organization, every employee should understand and share in the YNHHS Vision, support our Mission, and live our Values. These values - integrity, patient-centered, respect, accountability, and compassion - must guide what we do, as individuals and professionals, every day.

PA residents will be held to the same clinical and academic standards as EM physician residents. The clinical didactic curriculum will be based upon the AGCME Requirements for Graduate Medical Education in Emergency Medicine, and the 2011 EM Model of the Clinical Practice of EM. PA residents will be expected to attend weekly didactic conference. Residents will also participate in a variety of didactic offerings, including journal club, grand rounds, procedure labs, and simulation training. PA residents will complete the program with certification in ACLS, PALS, and ATLS. The PA resident will take medical histories, performs physical examinations, perform specified procedures , and develop patient treatment plans in collaboration with the attending physician. The PA resident will work primarily in the Emergency Department, (York Street, Chapel Street, and Shoreline Medical Center Campuse)

EEO/AA/Disability/Veteran
Responsibilities

  • 1. Clinical Rotations Rotations will be primarily at Yale New Haven Hospital (York Street and Chapel Street campuses). The rotation schedule will include: a. Emergency Medicine Orientation b. Emergency Medicine (York Street/Chapel Street/Shoreline) c. Pediatric Emergency Department d. MICU e. Trauma/EGS f. Orthopedics g. Ultrasound/Anesthesia h. ED Radiology i. Ophthalmology j. EMS k.Electives Duty hour limitations for PA residents will follow the same ACGME guidelines utilized for physician residents
  • 2. PA residents will complete the program with certifications in ACLS, PALS, and ATLS.
  • 3. PA residents will be expected to attend weekly conference with the Emergency Medicine physician residents. Residents will also participate in a variety of didactic offerings, including journal club, grand rounds, procedure labs, and simulation training.
  • 4. Discusses each case with the supervising attending physicians who sign (s) the medical record. Consults with community medical staff physicians as appropriate and discusses each patient's evaluation and plan
  • 5. Provides a complete medical record on all patients provided care.
  • 6. Practices within the policies and procedures of the Emergency Department and the policies of departments for rotations. Performs procedures including (but not limited to) lumbar puncture, suturing and management of wounds, minor burn care, arterial blood gas sampling, incision and drainage of abscess, thoracentesis, advanced cardiac life support procedures, paracentesis, urinary bladder catheterization, gastric lavage, central venous catheter insertion, advanced airway management, and bedside ultrasound.
  • 7. Assignment is based on rotation schedule.
  • 8. Provides clinical instruction to Physician Associate students and residents, Emergency Medical Technician and Paramedic Students.
  • 9. PA residents in collaboration with physicians, take medical histories, perform physical examinations , and perform specified procedures. The PA resident will work in the Emergency Department, at the York Street, Chapel Street and Shoreline Medical Center Campuses.
Qualifications

EDUCATION


EDUCATION (number of years and type required to perform the position duties): 1) Bachelors Degree required. 2) Graduation from an ARC-PA approved Physician Assistant program 3) Additional criteria may be specified by the residency program.


EXPERIENCE


EXPERIENCE New graduates and experienced providers are encouraged to apply.


LICENSURE


LICENSURE/CERTIFICATION: PA Required (State of Connecticut licensed/eligible) Current and active certification by the National Committee for Certification of Physician Assistants.


SPECIAL SKILLS


SPECIAL SKILLS: Excellent interpersonal, communication and leadership skills are required. Demonstrates the knowledge and skills necessary to provide quality care appropriate to the Emergency Department.


PHYSICAL DEMAND


This intensive 18-month program will providethe opportunity to learn emergency medicine in a world-class teaching institution. Yale-New Haven Hospital is a 1,541 bed tertiary care medical center; our emergency services treat over 140,000 patients/year. Structured didactic education will be provided on a weekly basis in conjunction with Yales emergency medicine physician residents and faculty. Coursework will include weekly lectures, small group sessions, and simulation training. Residents will obtain ACLS, PALS and ATLS certification.


Additional Information

This is an 18 month training position for the APP residency. Train alongside the EM medical residents, striving to achieve an advanced educational and dedicated as an APP. Receive multiple rotations, Ortho, MICU, Peds. EMS, ED, Ophthalmology, Tox, and ED. Rotations in the sim lab and US as well. Mulitple residency positions available. You must have graduated your program by May 2021 and be eligible to start before the end of May 2021. License requirements vary for APRNs vs PAs. You must meet all CT licensure requirements.


This is so absurd. I bet they pay the PAs more.
 
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southerndoc

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I doubt they pay them more. If they do, that would create a huge uproar. They probably pay them the same though. Personally I think they should make less than a PGY-1 since they've had 2 years of PA school vs 4 years of medical school. Maybe a PGY-0.5 or 0.75 salary.

This is a reality in our profession.
 
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I doubt they pay them more. If they do, that would create a huge uproar. They probably pay them the same though. Personally I think they should make less than a PGY-1 since they've had 2 years of PA school vs 4 years of medical school. Maybe a PGY-0.5 or 0.75 salary.

This is a reality in our profession.

It's reality because "we" let it happen. The sellout docs at Yale could have said no or not even created it in the first place.
 

TimesNewRoman

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I doubt they pay them more. If they do, that would create a huge uproar. They probably pay them the same though. Personally I think they should make less than a PGY-1 since they've had 2 years of PA school vs 4 years of medical school. Maybe a PGY-0.5 or 0.75 salary.

This is a reality in our profession.

it’s only the reality because we let it happen. This has got to stop.
 
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sylvanthus

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Time to start getting angry and go on the offensive, weve been sittin back playing defense and losing ground. Clearly the strategy needs to change. No farging clue how though.
 

AlmostAnMD

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Poke AAEM to revoke the membership of anyone active at Yale and forbid membership until this goes away

Probably not many members there but it would be more symbolic than anything else

Could do the same for ACEP but this is secretly ACEPs goal to replace us all with CMG's and midlevels so probably not an efficacious route there. If anything if ACEP found out about this at a high level they'd probably start endorsing it.
 

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I doubt they pay them more. If they do, that would create a huge uproar. They probably pay them the same though. Personally I think they should make less than a PGY-1 since they've had 2 years of PA school vs 4 years of medical school. Maybe a PGY-0.5 or 0.75 salary.

This is a reality in our profession.
I wonder. I'd be surprised if they really only made a resident's salary. Avg PA salary is 125k/yr, so it's a pretty big paycut for 18 mo of voluntary advanced training. Also, I doubt they work a resident's schedule, so I'm sure they're at least getting more per hour.
 

jw3600

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I doubt they pay them more. If they do, that would create a huge uproar. They probably pay them the same though. Personally I think they should make less than a PGY-1 since they've had 2 years of PA school vs 4 years of medical school. Maybe a PGY-0.5 or 0.75 salary.

This is a reality in our profession.
Wait are you serious? Most PA “residencies” and “fellowships” pay 90k a year....

AKA 1.5 times more than their third year residents in a lot of situations. And it’s 36 hours a week.
 
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Matthew9Thirtyfive

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I wonder. I'd be surprised if they really only made a resident's salary. Avg PA salary is 125k/yr, so it's a pretty big paycut for 18 mo of voluntary advanced training. Also, I doubt they work a resident's schedule, so I'm sure they're at least getting more per hour.

This was for the 2015 class by someone from the program posting an ad on the PA forum:

1BA73D99-AF15-49C4-81AF-2708A003CFFF.jpeg

With inflation, that would be $64,229 in 2020. Residents get $69k now. So I’m guessing that now it’s probably the same pay as the residents.
 

UrbanEM2

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I'm confused, is the outrage that there simply is a PA residency? Or am I missing something else?

Many academic institutions have these for ER PAs and have for many years. One started at a shop I worked at a few years after I left.

As an ER attending, wouldn't you rather be working with PAs that have 1-2 years of extra residency training? Presumably makes the risks associated with supervision and signing charts a little lower. I worked with PAs right out of PA school, maybe a few years of outpatient experience and really wished there was a way for them to get extra training.

The overall premise seems good here, no? Unless I'm missing something.
 
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TimesNewRoman

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I'm confused, is the outrage that there simply is a PA residency? Or am I missing something else?

Many academic institutions have these for ER PAs and have for many years. One started at a shop I worked at a few years after I left.

As an ER attending, wouldn't you rather be working with PAs that have 1-2 years of extra residency training? Presumably makes the risks associated with supervision and signing charts a little lower. I worked with PAs right out of PA school, maybe a few years of outpatient experience and really wished there was a way for them to get extra training.

The overall premise seems good here, no? Unless I'm missing something.
You’re missing something.
 
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TimesNewRoman

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What am I missing? I'm genuinely asking.

I feel like better trained PAs make ER attending life easier. What is the bit I'm not getting here?

APPs, particularly NPs, absolutely love to walk around calling themselves doctors. They love to put out little garbage studies with some garbage sample size and data saying they are equivalent. They love to talk about how they are equivalent even though that is patently false. Their compensation is going up and ours is going down. We are now actively promoting extra training for them that we are voluntarily calling “residency.” Just stroll over to the anesthesia forums and ask how much they appreciate the crnas they trained over the past 2 decades.

I, for one, don’t want to give away this profession. I owe it to myself, my family and my patients.
 
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sylvanthus

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I reallllllyy hate to sound pessimistic but I think the ship has sailed long ago. Midlevels are gonna persist and if anything be independent everywhere. Only a matter of time before we get midlevel surgeons. “ohhh ive assisted with 75 gallbladders, I got this!”. They are already doing colonscopies because they are “faster”. Yaaaa thats what we want, churn those colonoscopies out and make bank, who gives a crap if somethings missed.

Were hosed, only genuine hope I see is if it becomes a two tier system. Doctors organize, take private insurance, maintain some level of autonomy. I highly doubt the public is suddenly gonnna only want to see doctors. Midlevels see the medicare medicaid public insurqnce patients. Aaaaannd patients lose.

Either that, or our salaries tank, we become “supervisors/collaborators” and are nothing but a billing/liability shields and give up our independence.


Id love to hear other peoples thoughts, but the above is what I foresee happening. Get out of debt asap, get a side gig/niche, and ride the ever decreasing wave as far as you can before swimming the rest of the way to the shore.
 
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sylvanthus

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“Available studies in the literature suggest that non-physicians perform endoscopic procedures, especially lower endoscopies, with outcomes and adverse events in line with physicians.”

Poor GI bastiches.
 
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