Can a PA become board certified?

[doctalaughs]

the PA postgrad programs are more than just a certification course. most are equivalent to the PGY-1 yr in the same specialty. 80-100 hrs/week, 1st call, off service rotations, crappy pay, journal clubs, QA projects, etc, etc. Also keep in mind these programs are started, run, and overseen by PHYSICIAN specialists. that being said, most programs are now called "PA Fellowships". At least in EM, these programs meet a standard developed by ACEP in conjunction with SEMPA(Soc of EM PAs). the trend is for programs to meet all eligibility requirements for the EM CAQ (see post # 27 above).

I don't see how "certification" would really diminish the work a PA did to get some extra training. But even if that year was equivalent to PGY-1 (which I highly doubt is true for many specialties and programs) it's still silly to call it the same word as a 3-7 year physician training. Who are they trying to trick? Certainly not the doctors they work for or the ones hiring then.

Here's a conversation I had recently with an NP at a social gathering:

Her: "So what do you do?"
Me: "I'm a doctor. I do X specialty"
Her: "Really? Me too! I just finished my residency at Y hospital."
Me (thinking she is also a doc): "No way, what a coincidence! I must have graduated before you. When did you finish? Where do you practice?"
Her "I just finished this year and I'm looking for a job."
Me "Nice. You should talk to Dr. Z (bigwig with lotta connections) - he knows everyone in this town."
Her "Dr. Z?"
Me "Um, what?" (Everyone at our residency spends many months of their life in his clinic)
Her "Oh yeah, I've heard of him. But I'm a nurse practitioner. I did the nurse practitioner residency."
Me: "oh.... um.... nurse practitioner what?"

Come to find out later they started a 1 year midlevel "residency" affiliated with my program. They rotate mainly at satellite clinics so have very little to do with the training, lectures , grand rounds etc. If she had just said she was an NP and was interested in my specialty, and had even done a 1 year certification I probably would have offered her to help with job connections next. But it was so off-putting -no way.



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[Darth Doc]

It depends on which PA school. At UIowa the PA students and med students have the exact same curriculum for preclinicals and they are indistinguishable from the MS1s/MS2s. At the other med school in the state (DMU) the med students and PA students take some of the same classes like pharm. I certainly would not say that the things they learn are "very different". The difference between a PA and an MD/DO is residency.

I went to a reputable PA school like that and took some classes with the MD students. I had physicians as 50% of my instructors. Keep in mind that a PA only has 1 year didactic and 1 year clinical. They can't learn in 1 year what a MD student learns in 2. (Can you imagine trying to learn MS2 while learning MS1? <shiver>) There's a reason I went back to school - and it wasn't for the money. Perhaps UIowa PA students take the same tests as med students, but at my school we had separate exams. On the surface, early MD students and PA students look the same, but another year or two and they won't. I went back for the deeper knowledge that I required the detailed biochemistry and pathology that gets skipped in PA school.

 

[filhodeinferno]

actually, those of us in the PA world with doctorates(such as myself) go out of our way to NOT use the term at work as it might cause confusion.
I have PA, DHSc on my name tag, scripts, etc, NOT Dr Emedpa. If anyone asks what the DHSc is, I explain it is a 4 year academic degree in global health, not a doctorate in medicine.

You put "DHSc" on your white coat? I find that odd....like you're tryin' too hard and want people to ask you about it or something.

 

[deleted6669]

You put "DHSc" on your white coat? I find that odd....like you're tryin' too hard and want people to ask you about it or something.

Like docs who have MD, PhD on theirs?
I don't list anything else. Level of certification and highest degree. PAs with a masters often have PA, MS on their coats.
docs who are double boarded list both on their coats:
Dr. Smith
Internal Medicine/Pediatrics

more than 2 is silly. for anyone.

 

[Psai]

Like docs who have MD, PhD on theirs?
I don't list anything else. Level of certification and highest degree. PAs with a masters often have PA, MS on their coats.
docs who are double boarded list both on their coats:
Dr. Smith
Internal Medicine/Pediatrics

more than 2 is silly. for anyone.

You're really trying to compare a phd with a bs degree that no one has ever heard of lol

 

[Psai]

I don't see how "certification" would really diminish the work a PA did to get some extra training. But even if that year was equivalent to PGY-1 (which I highly doubt is true for many specialties and programs) it's still silly to call it the same word as a 3-7 year physician training. Who are they trying to trick? Certainly not the doctors they work for or the ones hiring then.

Here's a conversation I had recently with an NP at a social gathering:

Her: "So what do you do?"
Me: "I'm a doctor. I do X specialty"
Her: "Really? Me too! I just finished my residency at Y hospital."
Me (thinking she is also a doc): "No way, what a coincidence! I must have graduated before you. When did you finish? Where do you practice?"
Her "I just finished this year and I'm looking for a job."
Me "Nice. You should talk to Dr. Z (bigwig with lotta connections) - he knows everyone in this town."
Her "Dr. Z?"
Me "Um, what?" (Everyone at our residency spends many months of their life in his clinic)
Her "Oh yeah, I've heard of him. But I'm a nurse practitioner. I did the nurse practitioner residency."
Me: "oh.... um.... nurse practitioner what?"

Come to find out later they started a 1 year midlevel "residency" affiliated with my program. They rotate mainly at satellite clinics so have very little to do with the training, lectures , grand rounds etc. If she had just said she was an NP and was interested in my specialty, and had even done a 1 year certification I probably would have offered her to help with job connections next. But it was so off-putting -no way.



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Even the rns have their own "residencies". Basically this entails the 8 week training period that they already do when they get a job except at lower pay. It makes me sad that they would take my hard work and turn a word that means long hours and sacrifice into a joke

 

[littlejuan]

It depends on which PA school. At UIowa the PA students and med students have the exact same curriculum for preclinicals and they are indistinguishable from the MS1s/MS2s. At the other med school in the state (DMU) the med students and PA students take some of the same classes like pharm. I certainly would not say that the things they learn are "very different". The difference between a PA and an MD/DO is residency.

And 4 years of education as well. Most PA schools are 2 years and are not like UI where they take the same exact courses. The clinical years of medical school are very important in foundation building.

People really seem to want a shortcut to things that really should not have a shortcut.

 

[deleted6669]

You're really trying to compare a phd with a bs degree that no one has ever heard of lol

The DHSc is a common degree in the UK. The first program in the US opened in 2003 and several others have followed. Several holders of the DHSc have gone on to become deans of colleges, provosts, etc. The recent Assistant surgeon general (#2 in chain of command) at the US Public health service was a PA and holder of the DHSc degree.
Doctor of Health Science - Wikipedia
South College - Rear Admiral Michael Milner, DHSc, MMS, USPHS, PA-C

 

[deleted6669]

And 4 years of education as well. Most PA schools are 2 years and are not like UI where they take the same exact courses. The clinical years of medical school are very important in foundation building.

at a good PA program PA2=MS3. at my program we were scheduled interchangeably.

 

[littlejuan]

at a good PA program PA2=MS3. at my program we were scheduled interchangeably.

So MS1 and MS 2 are compressed into one year and there is no MS4. There were PAs at my medical school as well. They were smart and hardworking but the medical knowledge base just wasn't the same. Also 3-4 years of residency cannot be substituted by only 1 year. I am at a pretty intense 3 year program and there is no way that PGY1s should out running an ED after their first year.

 

[Lexdiamondz]

at a good PA program PA2=MS3. at my program we were scheduled interchangeably.

I dont know if I would say a PA2=MS3. In terms of clinical experience yeah they're probably equal. But in terms of the fund of knowledge that informs their clinical reasoning the average MS3 is more likely than not considerably further ahead.

 

[hoot504]

at a good PA program PA2=MS3. at my program we were scheduled interchangeably.

But at the end of the day, you aren't an M.D.

HAHAHA!

 

[WilcoWorld]

A few things.

1 =/= 3
2 =/= 4

AND

We would all do well to note that when people engage in a pissing contest everyone can get wet, but the one with the bigger stream stands to get it worse if the wind changes.

 

[deleted6669]

So MS1 and MS 2 are compressed into one year and there is no MS4. There were PAs at my medical school as well. They were smart and hardworking but the medical knowledge base just wasn't the same. Also 3-4 years of residency cannot be substituted by only 1 year. I am at a pretty intense 3 year program and there is no way that PGY1s should out running an ED after their first year.

Although it is not uncommon for EM PGY-2s to moonlight at the same kind rural EDs that PAs work at.
it is not the norm for PAs to run EDs, obviously. maybe 2% of EMPAs work solo in the way that I do, seeing every patient, doing every procedure, no back up, etc. probably 50 of us nationwide.
it's a pretty small club and most of us know each other. We have a few things in common. most of us we previously paramedics in busy systems and have > 20 years of experience in emergency medicine. Most of us like to teach and have academic appointments. I've taught EM to med students and (FP) residents for years.

 

[doctalaughs]

Although it is not uncommon for EM PGY-2s to moonlight at the same kind rural EDs that PAs work at.
it is not the norm for PAs to run EDs, obviously. maybe 2% of EMPAs work solo in the way that I do, seeing every patient, doing every procedure, no back up, etc. probably 50 of us nationwide.
it's a pretty small club and most of us know each other. We have a few things in common. most of us we previously paramedics in busy systems and have > 20 years of experience in emergency medicine. Most of us like to teach and have academic appointments. I've taught EM to med students and (FP) residents for years.

Thats great and I'm sure you are very competent after 20+ years of experience.

The problem I have is the very real and intentional trend of blurring lines between midlevels and board cert physicians. The:

- look, I took a few courses and tests in the same lecture hall as the med students (ignoring the other years they did) so we are "indistinguishable"
- look, theres this one PA/NP/crna who after 20 years of experience runs completely independently, kinda vaguely like a newly minted attending doc could! So now that <1% is representative of us all, and we should push legislation and propaganda to get rights for everyone in our profession to do this if they wish.
- What? I did a "residency" just like you! I don't care if it was 12 months with no call versus 5 years. It's still residency!
- I'm Dr. NP. What? I got an online 18 month doctorate and I see patients. So I'm a doctor.
- I see my own patients independently all day long so don't tell me I can't do the same thing you do!!! ( *whisper* ... but if I screw up you are still liable. ** whisper whisper** also I'm going to cherry pick the easy quick well-reimbursing cases while you handle the train-wreck complex low reimbursing ones )


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[filhodeinferno]

Like docs who have MD, PhD on theirs?
I don't list anything else. Level of certification and highest degree. PAs with a masters often have PA, MS on their coats.
docs who are double boarded list both on their coats:
Dr. Smith
Internal Medicine/Pediatrics

more than 2 is silly. for anyone.

Comparing MD, PhD on a white coat to "DHCSCS" or whatever is a stretch. You want to be held in the same esteem as a "doctor" so you put it on there so people mistake you for an actual doctor, which you are always trying SO hard to be, apparently. You are a PA. Nothing wrong with that, but putting "doctor" on your coat while you see patients is just misleading, IMO.

 

[Makati2008]

Although it is not uncommon for EM PGY-2s to moonlight at the same kind rural EDs that PAs work at.
it is not the norm for PAs to run EDs, obviously. maybe 2% of EMPAs work solo in the way that I do, seeing every patient, doing every procedure, no back up, etc. probably 50 of us nationwide.
it's a pretty small club and most of us know each other. We have a few things in common. most of us we previously paramedics in busy systems and have > 20 years of experience in emergency medicine. Most of us like to teach and have academic appointments. I've taught EM to med students and (FP) residents for years.

EMEDPA-
I say this an equal since we are both PAs (although I am a Physician now I do realize the struggles of being a PA still) I think my Physician colleagues are irritated because of some of the possible encroachment. Look at it like this- your heading has globaldoc on it after you completed a none clinical degree (or at least one that doesn't advance your practice rights.), as well as voiced wanting to be a Physician in the past. This makes my colleagues go hmmmmm.

Also getting your Dhsc. degree was the same thing that we complain about our NP counterparts doing and paints PAs in a bad light to some extent. I can understand why you did it->to teach. But when you add everything together it seems bad.

Also many physicians have issues with midlevels teaching residents. I can understand their reservations on this issue as well.


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[SpacemanSpifff]

typical communities that have PAs running EDs are population <25,000, often less than 10,000. the place I am working today sees about 5000 pts/year. in a typical 24 hr shift I see 8-18 pts with the full range of acuity. have intubated 20 times in the last year, multiple codes, cardioversions, traumas, reductions, etc.

the PA postgrad programs are more than just a certification course. most are equivalent to the PGY-1 yr in the same specialty. 80-100 hrs/week, 1st call, off service rotations, crappy pay, journal clubs, QA projects, etc, etc. Also keep in mind these programs are started, run, and overseen by PHYSICIAN specialists. that being said, most programs are now called "PA Fellowships". At least in EM, these programs meet a standard developed by ACEP in conjunction with SEMPA(Soc of EM PAs). the trend is for programs to meet all eligibility requirements for the EM CAQ (see post # 27 above).

at a good PA program PA2=MS3. at my program we were scheduled interchangeably.

Correct me if I'm misinterpreting, but the trend of your posts reads as if the PA degree is, in some cases, a backdoor to a physician-level practice (training is at equivalent levels, doing procedures typically under the umbrella of MD's...). Not trying to put words in your mouth, just hoping to clarify your message.

Depends on the individual PA, their training and experience, and the needs of their community. while most EM PAs do low acuity work(and there is certainly a place for that), PAs with a desire to see sicker patients who get additional training beyond what is available in PA school can find places that will utilize their skills. typically these are very rural or undesirable areas that can not attract/afford/retain an EM boarded physician. A good em pa is a better fit for a rural ED than your avg FP physician. After 30 years working in emergency medicine, I now work exclusively single coverage, rural, critical access hospitals seeing every patient and performing every procedure. high acuity and low volume is a lot more fun than high volume and low acuity.

Which leads me back to my original question: what is the role of a PA in the ED? The answer above is incredibly fluid. I agree, high acuity is more fun than low acuity, which is why I went to medical school. As an EM physician I will be expected to have the training to manage critically ill patients. Should PA's have the same expectations after graduating from one of these residencies?

 

[NeuroPA]

Hypothetically let's say there are 2 PA's that work at hospital X in the EM Department, one PA has completed a residency in EM, and the other has not. Could the PA with the residency training see higher acuity patients than the PA without? Who makes this decision within a hospital? Also, could this cause bad blood with other PA's?

Do any physicians see a EM residency relevant for a PA to complete? Personally I would see it's a good opportunity to learn since these programs are at large teaching hospitals, this is of course an assumption.


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[WilcoWorld]

Hypothetically let's say there are 2 PA's that work at hospital X in the EM Department, one PA has completed a residency in EM, and the other has not. Could the PA with the residency training see higher acuity patients than the PA without? Who makes this decision within a hospital? Also, could this cause bad blood with other PA's?

Do any physicians see a EM residency relevant for a PA to complete? Personally I would see it's a good opportunity to learn since these programs are at large teaching hospitals, this is of course an assumption.


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I work in an ED with APP's of varying levels of experience/training. Their scope of practice is determined by institutional policy, not by their CV.

Now, the ones with a lot of experience tend to be more comfortable managing patients, and I give a longer "leash" to the ones I know are particularly good. But in the end it all comes down to institutional policy and the co-signing doc's level of comfort (both of which vary widely).

 

[NeuroPA]

This leash you speak of, is it set through the establishment of a relationship/rapport with Docs? Also, does anyone know about the PA's role within a trauma setting? For instance, I had a unique experience of interning/volunteering (as an EMT) within a level 1 trauma center in Socal, it was a teaching hospital by the way, but I don't remember seeing very many PA's or NP's, but I also don't think I really knew the difference at the time (this was before I made the decision to pursue medical school). I have always been fascinated by trauma centers.

 

[deleted6669]

EMEDPA-
Look at it like this- your heading has globaldoc on it after you completed a none clinical degree (or at least one that doesn't advance your practice rights.
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My doctorate is in global health. I am literally a doctor of health science and global health. I have an academic appointment as a professor of global health, thus "global doc".
I spent 4 years working on this, including 12 trips abroad to do original research on an issue with significant public health implications. it was not an inconsequential endeavor.
regarding teaching residents: I have worked at several facilities with FP residents over the years. Makati, you have to agree that with 30 years experience in EM working in all settings from rural to level 1 trauma ctr and probably close to 150,000 patient encounters I know more about em than an FP resident who has spent MAYBE 3-6 months in the ER over their medical careers. why can't a PA teach an FP resident on rotation how to do a digital block or suture a complex lac, or use a slit lamp or work up undifferentiated belly pain? more often than not PAs teach because physicians assign us the task because they don't want a resident slowing them down. I have never worked at a facility with an em residency, so have not been involved with teaching em residents, except on rare occasion when they are on an away rotation.
I have all the respect in the world for a residency trained and boarded doc in any specialty. it's a butt load of work to get there. I understand that. I don't ever try to pass myself off as a physician and begin every consult call with "hi, this is emedpa, I'm one of the PAs working at xyz hospital". most of my consultants over time have come to appreciate the fact that I call them with the same kinds of questions that my physician colleagues do and I don't ask them to admit stupid crap. I try to be polite with everyone on this and other forums and would just like the same respect in return. no, I'm not a physician, but I have seen a lot and done a lot and have been doing this for a very long time, longer than many residents on these forums have been alive.

 

[Fox800]

Yes, but putting that as your tagline on a forum primarily intended for physicians is a bit disingenuous, don't you think?

 

[deleted6669]

in answer to several posts above:
If you don't like the PA scope of practice where you work you either advocate to change it or move to a place with institutional policies which appreciate your training and experience. I have done both in the past, as well as creating training pathways with docs to get skill sign offs on certain procedures.
An established postgrad program generates a procedure log. medical staff services generally will allow you to do things you have been trained to do if you have the backing of your physician group. I worked with a PA several years ago who had thousands of u/s studies in his log. he taught residents at several programs. he lectured on the topic of u/s use in em. he was one of just a handful of PAs at that facility to get unrestricted u/s privileges. it really is a case by case thing at many places. I have worked places where 1/2 the PAs could do LPs, paracentesis, thoracentesis, etc because they could show prior exposure and experience and the other 1/2 couldn't. it is getting harder every year to get that kind of procedural training outside of a postgrad program. I recommend in 2017 that every PA interested in practicing EM beyond fast track do a postgrad program, ideally one 18 months in length , which makes you eligible to take the EM CAQ exam. Simply passing that exam got me full procedural sedation privileges at one of my jobs, the only PA there who does not need to call in anesthesia for reductions, elective cardioversions, etc
regarding PAs role in trauma: if that is your main focus it makes sense to get a job working with a trauma service(generally under the dept of surgery) rather than an EM job. trauma PAs who have undergone postgraduate training or extensive OJT can place central lines, chest tubes, etc and at some facilities are the first call folks in house while the surgeons are coming from home. They work with the ED staff to stabilize the pt then follow the surgeon into the OR when they arrive and continue to 1st assist. a good trauma PA can also do trauma ICU rounds, take 1st night call, etc. I have worked at both level 1 and 2 trauma ctrs that use this model of in-house PAs 24/7 with physician backup from home(typically must be available within 20 min).

 

[deleted6669]

Yes, but putting that as your tagline on a forum primarily intended for physicians is a bit disingenuous, don't you think?

read my signature. it's under every post. it's pretty clear that I am a PA with a doctorate and not a physician. physicians don't own the title of doctor outside a hospital. inside a hospital I don't ever refer to myself as Dr Emedpa. In the lecture hall powerpoint #1 has my credentials on it, so anyone in the audience also will not be confused, even when I am introduced as Dr or Professor Emedpa.

 

[doctalaughs]

My doctorate is in global health. I am literally a doctor of health science and global health. I have an academic appointment as a professor of global health, thus "global doc".
I spent 4 years working on this, including 12 trips abroad to do original research on an issue with significant public health implications. it was not an inconsequential endeavor.

What does it matter except for ego? You can be certain that 99.99% of patients in the usa have no idea what it means. Hell, even most educated US physicians don't know, and those that do will be thinking "oh, he wants to call himself a doctor even though he's a PA."

It's sort of like when I introduce myself to a patient.
"Mr. Patient, I'm Dr. Doctalaughs. Nice to meet you."
Occasionally there will be one that says "No its actually DOCTOR Patient".
I reply "Sorry Dr. Patient. What type of medicine do you practice?" But I already know what will follow- because the physicians always let the assumed "Mr./Mrs." pass and then it comes up later in the conversation that they are an anesthesiologist, or a surgeon, or a cardiologist etc.

The ones who ALWAYS correct me are either in a field unrelated to medicine (like a PhD in literature) but more often an NP with a doctorate or something like a global health doctorate like above. Fine- you want to make sure I know you are important, but in my head the rest of the visit I'm thinking they are Dr. Douchebag."

I only introduce myself to let the patient know the credentials that are directly relevant to my treating them, nothing more and nothing less. Patients aren't interested in alphabet soup and it can only serve to confuse them. After the intro I don't care what they call me.


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[deleted6669]

it actually has some bearing as I have fairly extensive training in tropical medicine, something which(rarely) comes into play. some of my physician colleagues actually will occasionally curbside me and ask"hey can you check this guy out and tell me if you think he has xyz weird tropical disease? he just got back from abc developing country and has a fever without an obvious source/funky rash, etc". I've seen dengue, malaria, worked at a cholera tx ctr, seen filariasis, zika, chikungunya, etc. I was 3 days away from deploying to Liberia with an Ebola tx team a few years ago, etc
I don't do the "Dr thing" at cocktail parties, medical appts, etc
docs I work with who are FB friends will see my posts from all over the world and ask me about medical missions, my training, role on the team, etc.
my listing DHSc on things is really no different than a physician with a PhD putting MD, PhD on stuff. I'm proud of the degree. I put a lot of sweat and tears into it. It wasn't easy. If that makes me an egomaniac, so be it.

 

[Makati2008]

My doctorate is in global health. I am literally a doctor of health science and global health. I have an academic appointment as a professor of global health, thus "global doc".
I spent 4 years working on this, including 12 trips abroad to do original research on an issue with significant public health implications. it was not an inconsequential endeavor.
regarding teaching residents: I have worked at several facilities with FP residents over the years. Makati, you have to agree that with 30 years experience in EM working in all settings from rural to level 1 trauma ctr and probably close to 150,000 patient encounters I know more about em than an FP resident who has spent MAYBE 3-6 months in the ER over their medical careers. why can't a PA teach an FP resident on rotation how to do a digital block or suture a complex lac, or use a slit lamp or work up undifferentiated belly pain? more often than not PAs teach because physicians assign us the task because they don't want a resident slowing them down. I have never worked at a facility with an em residency, so have not been involved with teaching em residents, except on rare occasion when they are on an away rotation.
I have all the respect in the world for a residency trained and boarded doc in any specialty. it's a butt load of work to get there. I understand that. I don't ever try to pass myself off as a physician and begin every consult call with "hi, this is emedpa, I'm one of the PAs working at xyz hospital". most of my consultants over time have come to appreciate the fact that I call them with the same kinds of questions that my physician colleagues do and I don't ask them to admit stupid crap. I try to be polite with everyone on this and other forums and would just like the same respect in return. no, I'm not a physician, but I have seen a lot and done a lot and have been doing this for a very long time, longer than many residents on these forums have been alive.

I agree with you. Procedures are something that can be taught via a seasoned PA/NP, and I would allow one to teach me the skill personally. The undifferentiated patients work up should be taught by Attendings though. Those attendings are doing the residents a disservice by not taking the time to do so. Also I assume these attending are getting paid to "teach" these residents which also another reason why they should be involved in their cases.


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[deleted6669]

Also I assume these attending are getting paid to "teach" these residents which also another reason why they should be involved in their cases.
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nope. the EM docs didn't work for the hospital or get anything for working with residents. it was an eat what you kill environment for pay. pure RVU-driven. hated it. I was on the board for a few years as lead PA and heard the docs griping about the FP residents on many occasions.

 

[Makati2008]

nope. the EM docs didn't work for the hospital or get anything for working with residents. it was an eat what you kill environment for pay. pure RVU-driven. hated it. I was on the board for a few years as lead PA and heard the docs griping about the FP residents on many occasions.

Can't blame them then. Must have been forced by admin to take them on?


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[deleted6669]

Can't blame them then. Must have been forced by admin to take them on?


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bingo. yet another uncompensated responsibility for the docs and PAs in the group.

 

[doctalaughs]

it actually has some bearing as I have fairly extensive training in tropical medicine, something which(rarely) comes into play. some of my physician colleagues actually will occasionally curbside me and ask"hey can you check this guy out and tell me if you think he has xyz weird tropical disease? he just got back from abc developing country and has a fever without an obvious source/funky rash, etc". I've seen dengue, malaria, worked at a cholera tx ctr, seen filariasis, zika, chikungunya, etc. I was 3 days away from deploying to Liberia with an Ebola tx team a few years ago, etc
I don't do the "Dr thing" at cocktail parties, medical appts, etc
docs I work with who are FB friends will see my posts from all over the world and ask me about medical missions, my training, role on the team, etc.
my listing DHSc on things is really no different than a physician with a PhD putting MD, PhD on stuff. I'm proud of the degree. I put a lot of sweat and tears into it. It wasn't easy. If that makes me an egomaniac, so be it.

You can obviously do whatever you want. I have a PhD in another field but don't list it, since it's irrelevant. Yours is honestly one of the less egregious things I've seen in the brave new world of "blurring the lines between medical doctor and midlevel." Worse is the NP with an alphabet soup on the ID badge that introduces themselves as a doctor in a medical setting, but then claims the label is very clear since there is no "MD" in that mess. You should understand why some get irritated though.


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[deleted6669]

You can obviously do whatever you want. I have a PhD in another field but don't list it, since it's irrelevant. Yours is honestly one of the less egregious things I've seen in the brave new world of "blurring the lines between medical doctor and midlevel." Worse is the NP with an alphabet soup on the ID badge that introduces themselves as a doctor in a medical setting, but then claims the label is very clear since there is no "MD" in that mess. You should understand why some get irritated though.
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fair enough. I understand why physicians in training get irritated by other folks saying they are Dr Jones in a hospital setting when they are not a physician. like I said, I don't ever do that and don't have Dr Emedpa on anything clinical. The students I teach typically call me by my first name after they get to know me.

 

[NeuroPA]

Nothing funnier, than getting dispatched to a call and while were transporting the patient to the hospital the daughter of the patient asserts to us that she a "doctor" almost as a reminder to take extra good care of her mom, after about 5 minutes of talking with this lady it surfaces that shes a "D.Ed" LOL.....

 

[NeuroPA]

The doctor I work with now has been in medicine since around the Vietnam War and when I first asked him what FACP, and FACC stood for he told me it meant child molester. Probably one of the funniest ice breakers I will ever remember.

 

[deleted6669]

Nothing funnier, than getting dispatched to a call and while were transporting the patient to the hospital the daughter of the patient asserts to us that she a "doctor" almost as a reminder to take extra good care of her mom, after about 5 minutes of talking with this lady it surfaces that shes a "D.Ed" LOL.....

as a paramedic I remember "Drs" showing up on scene for car accidents and saying " I'm Dr Lopez, can I help?"
what kind of doctor are you? trauma surgeon I hope? nope, generally dentist or podiatrist. great, thanks doc. The chest tube this guy needs is higher than the ankle and lower than the jaw, so thanks, but no thanks. all the respect in the world for these folks in their chosen fields, but in an emergency clarity is kind of relevant...

 

[schmoob]

as a paramedic I remember "Drs" showing up on scene for car accidents and saying " I'm Dr Lopez, can I help?"
what kind of doctor are you? trauma surgeon I hope? nope, generally dentist or podiatrist. great, thanks doc. The chest tube this guy needs is higher than the ankle and lower than the jaw, so thanks, but no thanks. all the respect in the world for these folks in their chosen fields, but in an emergency clarity is kind of relevant...

I see your point. Just keep in mind some dentists can do procedures lime that.
Depending on their level of training, some of these docs (dentist, podiatrist) see trauma while in residency. Coming over to see if they can help, they may not know the patient's status, which is why they ask.

 

[bobtheweazel]

as a paramedic I remember "Drs" showing up on scene for car accidents and saying " I'm Dr Lopez, can I help?"
what kind of doctor are you? trauma surgeon I hope? nope, generally dentist or podiatrist. great, thanks doc. The chest tube this guy needs is higher than the ankle and lower than the jaw, so thanks, but no thanks. all the respect in the world for these folks in their chosen fields, but in an emergency clarity is kind of relevant...

Every podiatry residency includes emergency medicine rotations. Many include trauma rotations as well. And of course they all include general surgery rotations too. It's obviously not their specialty but if we're talking life and death they can probably lend a hand at least. Dentists would be a different story I suppose.

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[racerwad]

I see your point. Just keep in mind some dentists can do procedures lime that.
Depending on their level of training, some of these docs (dentist, podiatrist) see trauma while in residency. Coming over to see if they can help, they may not know the patient's status, which is why they ask.

Are you saying that dentists are trained, let alone competent at things like airways, chest tubes, etc? I know where the teeth are, and I know how to floss, but that certainly does not make me a dentist.

No dentist (or podiatrist, internist, cardiologist, intensivist, trauma surgeon, or non-EMS EM physician) is going to be able to do anything useful on an accident scene.

Does anyone really think (even if they learned once in their training) that dentists are able to intubate, dart a chest, start an IV, etc in an urgent or emergent scenario better than the EMS professionals on the scene? Moreover, it isn't just doing a single thing in isolation; EMS crews do these things in the context of crew and pt safety, taking into account weather, hazmat on the scene, traffic patterns, etc. The only thing non-EMS providers do on a scene is get in the way.

Every podiatry residency includes emergency medicine rotations. Many include trauma rotations as well. And of course they all include general surgery rotations too. It's obviously not their specialty but if we're talking life and death they can probably lend a hand at least. Dentists would be a different story I suppose.

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Again, even though they have done an EM rotation once in residency and are trained surgeons, they are not EMS providers nor are they EM physicians, by choice. Their aptitudes and interests have led them down alternate paths for a reason and one of those reasons is likely because they weren't all that interested in emergency or trauma care. The exposure they got in their one month of EM was probably cursory at best, seeing low acuity patients while not being held to a very high standard. Surgeons are particularly unhelpful outside of the hospital because surgeons need an OR to be the most help. They are not trained to work in an austere environment without scrub techs or circulators. If we're talking about a life and death scenario, this is exactly the time when untrained and unprepared "helpers" are needed least.

TL;DR - if you see an accident, call 911 and continue on.

 

[schmoob]

Are you saying that dentists are trained, let alone competent at things like airways, chest tubes, etc? I know where the teeth are, and I know how to floss, but that certainly does not make me a dentist.

No dentist (or podiatrist, internist, cardiologist, intensivist, trauma surgeon, or non-EMS EM physician) is going to be able to do anything useful on an accident scene.

Does anyone really think (even if they learned once in their training) that dentists are able to intubate, dart a chest, start an IV, etc in an urgent or emergent scenario better than the EMS professionals on the scene? Moreover, it isn't just doing a single thing in isolation; EMS crews do these things in the context of crew and pt safety, taking into account weather, hazmat on the scene, traffic patterns, etc. The only thing non-EMS providers do on a scene is get in the way.

You seem upset - this was not my intention.
The dentists I was referring to were those OMFS trained, which is why I specified "some." I also specified "depending on their level of training." I did not make a blanket statement that All dentists are prepared to handle any emergency medical situation, that would be ridiculous.
I also think you are confusing EMS with Police and Fire Department services. The scene needs to be cleared for medical personnel (unless the Fire Department have their own paramedic on scene). EMS are not clearing HAZMAT or redirecting traffic.
You should also consider scenarios involving multiple patients. Another set of capable hands (surgeon, podiatrist, dentist, PA, NP, nurse, etc) to ask emergency personnel if they would like any help while they triage is something I'm sure would not be unwelcome.
You're making it sound as if I'm said it's perfectly OK for someone to march up to a gunshot wound victim, and tell EMS "Step aside Scooter, I'm an optometrist."

 

[racerwad]

You seem upset - this was not my intention.
The dentists I was referring to were those OMFS trained, which is why I specified "some." I also specified "depending on their level of training." I did not make a blanket statement that All dentists are prepared to handle any emergency medical situation, that would be ridiculous.
I also think you are confusing EMS with Police and Fire Department services. The scene needs to be cleared for medical personnel (unless the Fire Department have their own paramedic on scene). EMS are not clearing HAZMAT or redirecting traffic.
You should also consider scenarios involving multiple patients. Another set of capable hands (surgeon, podiatrist, dentist, PA, NP, nurse, etc) to ask emergency personnel if they would like any help while they triage is something I'm sure would not be unwelcome.
You're making it sound as if I'm said it's perfectly OK for someone to march up to a gunshot wound victim, and tell EMS "Step aside Scooter, I'm an optometrist."

Sorry, not upset, but I appreciate the conscientiousness.

Background: I am a paramedic and EM resident.

In the scenario that an OMFS surgeon rolls up and offers to help, there still needs to be an ALS level EMS provider on scene with the equipment available to secure that airway to said OMFS. In that scenario, who would you want to be getting that airway?

EMS absolutely need to be aware of hazmat and traffic. I know that PD and Fire are available to perform these tasks primarily, but these scenes do not happen in discrete bits where first one issue is addressed, then another, etc in a sequential fashion. Few non-public safety people are aware of these issues. EMS are definitely addressing low-level hazmat and redirecting traffic.

In MCIs, one of the first things we do is clear out additional non-injured personnel. Hands are only capable if they are in a context that is familiar to them. It is much easier to just deal with patients than trying to figure out who is capable of what and then assigning them tasks unless I am literally the only rescuer there. Having been in such a scenario, it doesn't matter if those additional hands are janitors or neurosurgeons, because unless they are other EMS trained folks, it's all the same. If I am truly shorthanded, I just need people that can follow simple commands without asking too many questions.

I don't think you are saying non-EMS people who have some sort of medical background routinely march into scenes and take them over (actually, it is really rare for anyone to even offer to help). My point is that the skills are not as interchangeable as many people think.

 

[InternistDO]

This is anecdotal, but in 5 years of working EMS I've had exactly one non-EMS healthcare provider be actively helpful on scene, and she was a nurse from one of our EDs who helped bag a pediatric code near her house.

I'm sure situations have arisen where help is needed--I did EMS in some places where the next medic was 30 minutes away, but I only caution that hospital medicine doesn't translate over to pre-hospital medicine as smoothly as one would think, and emergency medicine isn't something one just remembers from a handful of rotations in school.

I think there are definitely situations where an emergency physician with pre-hospital experience on scene would be helpful (chest tubes, etc--London EMS does something like this I believe), but that is not the same as a podiatrist trying to remember something from a trauma rotation they had 3 years ago to help.

 

[schmoob]

Makes sense. You folks have the firsthand knowledge and have been in those scenarios, so I will take your word for it and keep that in mind for the future.
Thanks for the feedback!

 

[bobtheweazel]

This is anecdotal, but in 5 years of working EMS I've had exactly one non-EMS healthcare provider be actively helpful on scene, and she was a nurse from one of our EDs who helped bag a pediatric code near her house.

I'm sure situations have arisen where help is needed--I did EMS in some places where the next medic was 30 minutes away, but I only caution that hospital medicine doesn't translate over to pre-hospital medicine as smoothly as one would think, and emergency medicine isn't something one just remembers from a handful of rotations in school.

I think there are definitely situations where an emergency physician with pre-hospital experience on scene would be helpful (chest tubes, etc--London EMS does something like this I believe), but that is not the same as a podiatrist trying to remember something from a trauma rotation they had 3 years ago to help.

I don't know why we're still talking about this. I think we all agree that doctors and surgeons aren't EMS and nobody would expect a doctor to jump in and be some kind of sideroad emergency expert. I'm just saying I would rather take some kind of doctor who at some point had some kind of trauma training if there was absolutely nobody else around or it was some kind of mass situation like a derailed train or a bombing or something.

If I were in a horrible accident in the middle of nowhere in Oregon and the first people on the scene were a family medicine doctor and some hippie, I'd rather have the family med doc at least do what they could to try to stabilize me until EMS arrived than the hippie rubbing me with some chakra infused crystal and splashing homeopathic solution (water) on my face.

I mean, if I were on a 747 going down and I knew there was a guy on the plane who had only ever flown small single prop planes I wouldn't say "sit down buddy, there's nothing you can do here".

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[InternistDO]

I don't know why we're still talking about this. I think we all agree that doctors and surgeons aren't EMS and nobody would expect a doctor to jump in and be some kind of sideroad emergency expert. I'm just saying I would rather take some kind of doctor who at some point had some kind of trauma training if there was absolutely nobody else around or it was some kind of mass situation like a derailed train or a bombing or something.

If I were in a horrible accident in the middle of nowhere in Oregon and the first people on the scene were a family medicine doctor and some hippie, I'd rather have the family med doc at least do what they could to try to stabilize me until EMS arrived than the hippie rubbing me with some chakra infused crystal and splashing homeopathic solution (water) on my face.

I mean, if I were on a 747 going down and I knew there was a guy on the plane who had only ever flown small single prop planes I wouldn't say "sit down buddy, there's nothing you can do here".

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I agree, that's why I say there are definitely times when help is needed and there's no harm in asking (unless you block traffic on the freeway to do so or something).

All I'm saying is don't assume that being a some flavour of doctor (or PA, or nurse, or whatever) makes you helpful on an emergency scene, assuming fire and rescue have arrived.

Sorry if that wasn't more clear.

 

[MSmentor018]

And be sure to capitalize the word "Doctor."

the ENTIRE word

 

[MSmentor018]

The DHSc is a common degree in the UK. The first program in the US opened in 2003 and several others have followed. Several holders of the DHSc have gone on to become deans of colleges, provosts, etc. The recent Assistant surgeon general (#2 in chain of command) at the US Public health service was a PA and holder of the DHSc degree.
Doctor of Health Science - Wikipedia
South College - Rear Admiral Michael Milner, DHSc, MMS, USPHS, PA-C

guess he's as impressive as this person:
Rear Admiral (RADM) Sylvia Trent-Adams, Ph.D., R.N., F.A.A.N.
you've done the training , wear the letters. I don't care what dsc, pa, rn, HNIC (for those who remember the movie "lean on me") as long as you don't introduce yourself as "doctor" in the hospital setting, when you say doctor, that's what pts expect. a physician.

What does it matter except for ego? You can be certain that 99.99% of patients in the usa have no idea what it means. Hell, even most educated US physicians don't know, and those that do will be thinking "oh, he wants to call himself a doctor even though he's a PA."

It's sort of like when I introduce myself to a patient.
"Mr. Patient, I'm Dr. Doctalaughs. Nice to meet you."
Occasionally there will be one that says "No its actually DOCTOR Patient".
I reply "Sorry Dr. Patient. What type of medicine do you practice?" But I already know what will follow- because the physicians always let the assumed "Mr./Mrs." pass and then it comes up later in the conversation that they are an anesthesiologist, or a surgeon, or a cardiologist etc.

The ones who ALWAYS correct me are either in a field unrelated to medicine (like a PhD in literature) but more often an NP with a doctorate or something like a global health doctorate like above. Fine- you want to make sure I know you are important, but in my head the rest of the visit I'm thinking they are Dr. Douchebag."

I only introduce myself to let the patient know the credentials that are directly relevant to my treating them, nothing more and nothing less. Patients aren't interested in alphabet soup and it can only serve to confuse them. After the intro I don't care what they call me.


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this is the most accurate post in this thread
just wanted to add when pts say "I am in the medical field" its' usually someone without a professional degree like a tech/aide

 

[NeuroPA]

I got home, logged on the SDN, and fell head first into this rabbit hole!

 

[deleted109597]

just wanted to add when pts say "I am in the medical field" its' usually someone without a professional degree like a tech/aide

Except that it is what I say outside of the hospital when people ask where I work. I don't like explaining that a)EM is a real specialty, and b)no I can't diagnose that rash/joint/sex organ problem.

 

[GonnaBeADoc2222]

You want the white coat and fancy letters? More power to ya. Honestly, I couldn't care less about that part. In the end, patients, staff and you know what's what.

I will say this: With great power comes great responsibility.

AKA full independence means:

1) Full patient load. The attending or resident is carrying 15-20 patients? You should be too.

2) Full liability. All ESI levels. All procedures. And none of this "Hey Doc, I got one for ya..."