DO/MD vs PA vs NP

[Art3MiS]

Hey guys,

I was talking with one of my friends yesterday, and there was a discussion of why MD/D.O. when you can be a PA/NP?

I'm just interested in hearing what sold you all on becoming doctors and not going the other routes.

Personally I'm set on being a D.O. and will be starting this year, but what influenced the rest of you that being a DOCTOR is what you want to do, not be a PA/NP when the schooling is less, debt is less, and you do make a decent salary.

---

Members don't see this ad.

 

[Iliketoytles]

Hey guys,

I was talking with one of my friends yesterday, and there was a discussion of why MD/D.O. when you can be a PA/NP?

I'm just interested in hearing what sold you all on becoming doctors and not going the other routes.

Personally I'm set on being a D.O. and will be starting this year, but what influenced the rest of you that being a DOCTOR is what you want to do, not be a PA/NP when the schooling is less, debt is less, and you do make a decent salary.

I'm not too sure on the limits are of a PA/NP in practice, but I think having an DO/MD degree will give me more options. It'll let me go into a medical field that I enjoy, and have more of a leadership role in what I do... rather than having to be told. I don't mind being an "assistant" when I need to be, but I don't want to make a career out it. Hopefully that doesn't sound as rude as I think it does... haha.

 

[FrkyBgStok]

why be a manager, when you can be a supervisor?

 

[Art3MiS]

I'm not too sure on the limits are of a PA/NP in practice, but I think having an DO/MD degree will give me more options. It'll let me go into a medical field that I enjoy, and have more of a leadership role in what I do... rather than having to be told. I don't mind being an "assistant" when I need to be, but I don't want to make a career out it. Hopefully that doesn't sound as rude as I think it does... haha.

Haha. No I totally agree, and that's exactly the reasoning I had when choosing it.

PAs and NPs can do some prescribing, but the DO/MD has to write off on it for approval. Also they can specialize too, I'm not sure if the fields are as diverse though.

 

[Iliketoytles]

why be a manager, when you can be a supervisor?

 

[Art3MiS]

HAHAHAHAH. I love these memes

 

[TriagePreMed]

I really don't know how to answer your question besides saying that you're comparing 2 different job functions. A doctor has much more autonomy and responsibility over his or her patients. A PA or NP is a mid-level provider. It really depends on what you want out of your career. For me, I want that autonomy and the level of knowledge and expertise that can only be offered through becoming a physician.

 

[SpecterGT260]

why be a manager, when you can be a supervisor?

 

[dreamweaver1988]

Hey guys,

I was talking with one of my friends yesterday, and there was a discussion of why MD/D.O. when you can be a PA/NP?

I'm just interested in hearing what sold you all on becoming doctors and not going the other routes.

Personally I'm set on being a D.O. and will be starting this year, but what influenced the rest of you that being a DOCTOR is what you want to do, not be a PA/NP when the schooling is less, debt is less, and you do make a decent salary.

Darnit... I was hoping you are a pre-med so I could tell you not apply MD/DO. More room for the rest of us.

 

[Art3MiS]

Darnit... I was hoping you are a pre-med so I could tell you not apply MD/DO. More room for the rest of us.

Like I said, I wasn't asking for me. It just came up in a conversation, and I was wondering if anyone else chose to go D.O./M.D. route for other reasons besides the ones I had for doing it (pretty much what Triage said)

 

[SpecterGT260]

I really don't know how to answer your question besides saying that you're comparing 2 different job functions. A doctor has much more autonomy and responsibility over his or her patients. A PA or NP is a mid-level provider. It really depends on what you want out of your career. For me, I want that autonomy and the level of knowledge and expertise that can only be offered through becoming a physician.

however DNP's and PA's are pushing for autonomy approaching that of physicians. Just an interesting thing to keep in mind - the motivation to go PA vs MD/DO may not be responsibility based

 

[UTsksk]

Hey guys,

I was talking with one of my friends yesterday, and there was a discussion of why MD/D.O. when you can be a PA/NP?

I'm just interested in hearing what sold you all on becoming doctors and not going the other routes.

Personally I'm set on being a D.O. and will be starting this year, but what influenced the rest of you that being a DOCTOR is what you want to do, not be a PA/NP when the schooling is less, debt is less, and you do make a decent salary.

From what I've been around (very limited), PA's and NP's just seem to see patients, do vitals, write out the plan and really that's it. They aren't allowed to perform in clinic procedures or surgeries so they are extremely limited. Plus, PA/NP aren't reimbursed as much as a MD/DO in regards to insurance. I never really looked it up because I never wanted to pursue a PA or NP so I don't know too much of what they can and can't do.

 

[SpecterGT260]

From what I've been around (very limited), PA's and NP's just seem to see patients, do vitals, write out the plan and really that's it. They aren't allowed to perform in clinic procedures or surgeries so they are extremely limited. Plus, PA/NP aren't reimbursed as much as a MD/DO in regards to insurance. I never really looked it up because I never wanted to pursue a PA or NP so I don't know too much of what they can and can't do.

you are referring to primary care PA's.

there are surgical PA's as well. They will do things like open and close for the surgeon. In CV surgery they will harvest the saphenous vein from the leg if necessary. They have them in ortho as well, but I am less familiar with their role there

 

[UTsksk]

you are referring to primary care PA's.

there are surgical PA's as well. They will do things like open and close for the surgeon. In CV surgery they will harvest the saphenous vein from the leg if necessary. They have them in ortho as well, but I am less familiar with their role there

Thanks, never knew that. I've only been around cardio PA's and I guess ENT PA's (if they exist). lol my inexperience is showing.

 

[deleted6669]

senior pa's and np's can provide solo coverage of rural practices, emergency depts, and icu's and perform all procedures required to do so..
I'm working a solo night shift right now in an 11 bed dept. I run codes, intubate, cardiovert, etc
that being said if I had to do it over I would choose DO for the freedom/autonomy/options it provides.

 

[MT Headed]

From what I've been around (very limited), PA's and NP's just seem to see patients, do vitals, write out the plan and really that's it. They aren't allowed to perform in clinic procedures or surgeries so they are extremely limited. Plus, PA/NP aren't reimbursed as much as a MD/DO in regards to insurance. I never really looked it up because I never wanted to pursue a PA or NP so I don't know too much of what they can and can't do.

Oregon passed a law that NPs will be reimbursed at the same rate as MD/DO for the same procedures. So an NP spends less time and less money to be in a position where they do medical procedures and diagnoses and get reimbursed at medical rates. It's an attractive alternative, really.

 

[deleted432032]

Oregon passed a law that NPs will be reimbursed at the same rate as MD/DO for the same procedures. So an NP spends less time and less money to be in a position where they do medical procedures and diagnoses and get reimbursed at medical rates. It's an attractive alternative, really.

Nothing has been passed from what I can find.

House Bill 4010 from Oregon Capital News

and

House Bill 4010 from The Lund Report

 

[Wolverines83]

Hey guys,

I was talking with one of my friends yesterday, and there was a discussion of why MD/D.O. when you can be a PA/NP?

I'm just interested in hearing what sold you all on becoming doctors and not going the other routes.

Personally I'm set on being a D.O. and will be starting this year, but what influenced the rest of you that being a DOCTOR is what you want to do, not be a PA/NP when the schooling is less, debt is less, and you do make a decent salary.

Autonomy, leadership and knowing that when the **** hits the fan I'm the one who knows the answer (sort of). Also, a major difference for me is the depth of scientific knowledge (dorky, I know) that we receive compared to others. I know a few NPs and a PA and they don't know the depth we're learning. Who knows if it'll make a difference but I like knowing that I'm not missing anything.

EDIT: SDN put the **** in there for me, cool...I guess I can just type the curses as I want?

 

[SpecterGT260]

Nothing has been passed from what I can find.

House Bill 4010 from Oregon Capital News

and

House Bill 4010 from The Lund Report

And that also doesn't mean that they are open to the same scope of procedures. If a DNP gets reimbursed at the same rate for some stitches who cares? The expensive stuff still flows through docs

 

[deleted432032]

And that also doesn't mean that they are open to the same scope of procedures. If a DNP gets reimbursed at the same rate for some stitches who cares? The expensive stuff still flows through docs

My response was towards MT Headed's statement that the bill passed; nothing more, nothing less.

 

[SpecterGT260]

My response was agreeing with you and lending an additional point

 

[deleted432032]

My response was agreeing with you and lending an additional point

Ah, it is amazing what one can miss when reading a forum post.

I apologize and thank you.

 

[JESSFALLING]

Typically, there is a $40-120k average annual differential between MD/DO and PA/NP, depending on specialty. So, essentially, you have to crunch the numbers to see if there is a cost/benefit based upon your age. For me, when I factor in the opportunity cost of the last two years of medical school and the lower salary in the residency years, I come out roughly even.......but since I want to be an independent, private-practice psychiatrist, I'm compelled to pursue the MD/DO. And frankly, I don't like being required to report to others (though I welcome good advice and cordiality), hence the pursuit of autonomy.

 

[ManBroDude]

I work in an emergency dept for a group that has ~25 MD/DO's and ~5 mid-levels.

The NP's were initially assigned the low-acuity patients (croup, simple lacs, URI's, etc) and banged them out autonomously. Now they're switching it up so they work the middle acuity patients too, but gave to have an attending physically get their own H & P. Slows the whole thing down.

That said, as a surgical PA, you will be first assist on all surgeries, plus all the pre-op and post-op is basically all you.

The whole "autonomous" line you hear on SDN is a little uninformed, if you ask me. The way health care is delivered in the next decade will see just about everyone working in a team, not just mid-levels.

The days of "Captain Doctor" are dwindling.

 

[cliquesh]

I work in an emergency dept for a group that has ~25 MD/DO's and ~5 mid-levels.

The NP's were initially assigned the low-acuity patients (croup, simple lacs, URI's, etc) and banged them out autonomously. Now they're switching it up so they work the middle acuity patients too, but gave to have an attending physically get their own H & P. Slows the whole thing down.

That said, as a surgical PA, you will be first assist on all surgeries, plus all the pre-op and post-op is basically all you.

The whole "autonomous" line you hear on SDN is a little uninformed, if you ask me. The way health care is delivered in the next decade will see just about everyone working in a team, not just mid-levels.

The days of "Captain Doctor" are dwindling.

Where I was for surgery there were two kinds of surgical PAs. The first type were basically residents that would round on patients from 5am to 1pm and after 1pm they would be done for the day. They would follow post-op patients and make recommendations to the chief resident or attending and, for the most part, their recommendations were used. The other type of surgical PAs did some pre-op stuff and were first assist on surgeries if there were no residents present. That's pretty much it. Both roles really seemed like their title implies; an assistant.

 

[Jlaw]

Not to rag on PA's and NP's, they do awesome work and have an important role but I once heard someone compare being a PA or MD/DO as being like an NBA player signing a contract that says they can play the entire regular season but will be benched once the team gets to the playoffs.

I guess the message was that as a physician you are the one ultimately responsible for the patient, so when the **** hits the fan it will be you making the decisions, not the PA or Nurse.

I looked into other options and even shadowed a PA and some Nurses but just felt that I had the most career options as a doctor.

The decision is highly personal though, some people just want to be involved patient care and not have as much of the responsibility/paperwork/etc.

 

[DrMaximus]

Another thing that factored into things for me was the ability to be on faculty at a teaching hospital and involved in research.

I may be mistaken, but I'm fairly sure that only MD/DOs can be clinical faculty. But again, this is a personal decision. I'm a hard science guy, so having the ability to participate and research and teach was a big deal to me.

 

[Iliketoytles]

Another thing that factored into things for me was the ability to be on faculty at a teaching hospital and involved in research.

I may be mistaken, but I'm fairly sure that only MD/DOs can be clinical faculty. But again, this is a personal decision. I'm a hard science guy, so having the ability to participate and research and teach was a big deal to me.

I feel exactly the same way. Research and teaching are two avenues I always want to have available.

Man I love science.

 

[eccentric jet]

however DNP's and PA's are pushing for autonomy approaching that of physicians. Just an interesting thing to keep in mind - the motivation to go PA vs MD/DO may not be responsibility based

I am pretty sure that PA's have nothing to do with trying to get more autonomy, as the very definition of their role is to practice under physician supervision.

Most NPs are not pushing for unlimited power either, but they have a strong lobby and the more politically active ones are making their voices heard.

Too often PAs are grouped with NPs, when the only similarity between the two is how they are being utilized in medicine currently. They come from different training paths and have different motivations.

 

[eccentric jet]

Having spent a couple of years after college before starting medical school, during which I got married and had my first kid, I thoroughly considered pursuing PA training, to the point where I applied to several programs. My thinking at the time was mostly in terms of the time I'd be able to spend with my family, and the differences in compensation in relation to length of training.

In the end, as a PA I knew I'd always have a defined role and scope of practice, and likely a defined ceiling for salary. Basically, I didn't want to necessarily have to work FOR someone my entire career, not that it's always a negative thing.

In truth, I don't know how healthcare will change in upcoming years, and I'll likely end up working FOR a hospital anyway. But for another 20 months of school tuition (plus 3-8 years of postgraduate training for meager pay), I opted for the relative freedom of becoming a physician.

 

[TriagePreMed]

however DNP's and PA's are pushing for autonomy approaching that of physicians. Just an interesting thing to keep in mind - the motivation to go PA vs MD/DO may not be responsibility based

I disagree. Right now they don't, so I live in the present where PA's and NP's don't have this responsibility.

 

[SpecterGT260]

I disagree. Right now they don't, so I live in the present where PA's and NP's don't have this responsibility.

so the basis of your argument that they are not pushing for more autonomy is the fact that they dont currently have such autonomy?


or ar you disagreeing with my claim that someone may have reasons other than wanting less responsibility for going PA over MD/DO

 

[SpecterGT260]

I am pretty sure that PA's have nothing to do with trying to get more autonomy, as the very definition of their role is to practice under physician supervision.

Most NPs are not pushing for unlimited power either, but they have a strong lobby and the more politically active ones are making their voices heard.

Too often PAs are grouped with NPs, when the only similarity between the two is how they are being utilized in medicine currently. They come from different training paths and have different motivations.

the definition of a nurses role is to also work under a physician

There is/was recently a bill supported by PA's currently going through my home state's legislature which will increase the PA/MD allowed ratio in a clinic by a factor of 2-4. The major fear of the opposition (physicians) is that increased numbers of PA's allowed to work under a single doctor will create an opportunity for PA's to band together in their own practices and hire a physician to make it legit - functional autonomy.

you can say what you want about whether or not you think it is going on.... but these are real arguments that have been made concerning real laws that are currently being considered. you cannot validate your belief solely on the name or title....

 

[TriagePreMed]

so the basis of your argument that they are not pushing for more autonomy is the fact that they dont currently have such autonomy?


or ar you disagreeing with my claim that someone may have reasons other than wanting less responsibility for going PA over MD/DO

What I'm saying is that regardless of the push they have, they don't have that autonomy at this time, so it still stands that responsibility is a reason at the present time.

 

[SpecterGT260]

yes.... A reason

 

[TriagePreMed]

yes.... A reason

Have you become my nemesis or something? It's disingenuous.

 

[SpecterGT260]

IIRC you disagreed with my post which said there may be other factors besides responsibility and we have been addressing that. lemme look...

yep

 

[Iliketoytles]

 

[dreamweaver1988]

Typically, there is a $40-120k average annual differential between MD/DO and PA/NP, depending on specialty. So, essentially, you have to crunch the numbers to see if there is a cost/benefit based upon your age. For me, when I factor in the opportunity cost of the last two years of medical school and the lower salary in the residency years, I come out roughly even.......but since I want to be an independent, private-practice psychiatrist, I'm compelled to pursue the MD/DO. And frankly, I don't like being required to report to others (though I welcome good advice and cordiality), hence the pursuit of autonomy.

CRNA. The end. You'll still be "almost a doctor" but you'll make more than many docs.

Oh, and that the end of the day, people will want to see a true doctor. The only concern is that pts tend to not be very discerning and assume everyone is a doctor. But even dentists, who stack those bills high, are still considered "almost doctors." I want to end by saying something like, "It's all about the white coat," but everyone wears a white coat now so that doesn't work.

 

[deleted6669]

The major fear of the opposition (physicians) is that increased numbers of PA's allowed to work under a single doctor will create an opportunity for PA's to band together in their own practices and hire a physician to make it legit - functional autonomy.
..

this is already legal and done in many places. single pa's can do this as well. "banding together" is not required for a pa to own a practice. I have 5 friends who do this independent of each other. each has hired a doc to either work for them and provide review or provide review only. the docs make good money, the pa's make good money. what is the big deal if the pa is the owner and business manager or the doc is? pa's have owned practices for over 30 years and hired physicians. this is now new.
doc owns practice : pa works solo, doc signs charts, doc makes 80%. many rural practices function this way.
pa owns practice: pa works solo. doc signs charts. pa makes 80%. 4-5% of pa's own their own practice and do this.
either way the pa is providing the care with physician oversight. if the doc has a problem with it they can always withdraw their sponsorship and the practice closes. the only difference is who pays the bills. the pa as owner pays 100% of the practice costs including malpractice for themselves and the doc.

 

[TriagePreMed]

this is already legal and done in many places. single pa's can do this as well. "banding together" is not required for a pa to own a practice. I have 5 friends who do this independent of each other. each has hired a doc to either work for them and provide review or provide review only. the docs make good money, the pa's make good money. what is the big deal if the pa is the owner and business manager or the doc is? pa's have owned practices for over 30 years and hired physicians. this is now new.
doc owns practice : pa works solo, doc signs charts, doc makes 80%. many rural practices function this way.
pa owns practice: pa works solo. doc signs charts. pa makes 80%. 4-5% of pa's own their own practice and do this.
either way the pa is providing the care with physician oversight. if the doc has a problem with it they can always withdraw their sponsorship and the practice closes. the only difference is who pays the bills. the pa as owner pays 100% of the practice costs including malpractice for themselves and the doc.

That raises flags to me. It creates an incentive for the PA to take control over full patient care. Sure, you can say they review the charts, but when doctors are the ones feeding from the PA's hand, who do you think really has the last say? And I doubt it's that easy to just walk away from a clinic. There's really no contracts or anything? Come on, but I can see how it's legal. It generates money for the government and sweeps the physician shortage a bit more under the rug.

 

[ManBroDude]

emedpa: Please keep posting in this thread. It's refreshing to hear what actually goes on.

I'll be the first to admit that it's a sad state we live in where mid-levels can own a practice and farm out physician signatures and make good money.

God, I hate the medical industrial complex sometimes.

 

[SpecterGT260]

That raises flags to me. It creates an incentive for the PA to take control over full patient care. Sure, you can say they review the charts, but when doctors are the ones feeding from the PA's hand, who do you think really has the last say? And I doubt it's that easy to just walk away from a clinic. There's really no contracts or anything? Come on, but I can see how it's legal. It generates money for the government and sweeps the physician shortage a bit more under the rug.

That's why its currently being opposed.

Im not entirely sure what prompted that guys speech.... evidence that the protested actions are already happening to a small degree is irrelevant. The bill and subsequent protests still happened. I thought I was being clear I wasn't being hypothetical

 

[deleted6669]

That raises flags to me. It creates an incentive for the PA to take control over full patient care. Sure, you can say they review the charts, but when doctors are the ones feeding from the PA's hand, who do you think really has the last say? And I doubt it's that easy to just walk away from a clinic. There's really no contracts or anything? Come on, but I can see how it's legal. It generates money for the government and sweeps the physician shortage a bit more under the rug.

as I said, this has been a practice model for over 30 years in many states. the vast majority of states do not require a physician be present when a pa delivers care so what we are talking about is opposition to pa's being practice owners. either way the doc is not seeing the pt. the only difference is who pays the bills.
state medical boards still have to approve these arrangements on a case by case basis and the vast majority of these practices are not in competition with physician practices, they are in places where there are no other practices for example a pa deciding to return to his home town in Appalachia and open a medical clinic with distant supervision. if they didn't do this there would be no clinic there at all. these are not practices in beverly hills or palm springs.
state practice plans always make clear that the physician has final say in medical matters regardless of who owns the practice.

 

[deleted6669]

That's why its currently being opposed.

Im not entirely sure what prompted that guys speech.... evidence that the protested actions are already happening to a small degree is irrelevant. The bill and subsequent protests still happened. I thought I was being clear I wasn't being hypothetical

expanding the # of pa's a physician can supervise helps docs make more money in THEIR PRACTICES. this is a separate issue from pa practice ownership. most practices owned by pa's are one pa and one doc.

 

[SpecterGT260]

expanding the # of pa's a physician can supervise helps docs make more money in THEIR PRACTICES. this is a separate issue from pa practice ownership. most practices owned by pa's are one pa and one doc.

Who exactly are u arguing with? Technically I have YET to give an opinion on this.... my previous posts were statement of PAST EVENTS .... I could give a Damn what your rationale is, it wont change what OTHER PEOPLE have ALREADY DONE....


Jesus... it hurts a little to have to spell things out like that. Go re read and gain some context in this thread

 

[deleted6669]

Who exactly are u arguing with? Technically I have YET to give an opinion on this.... my previous posts were statement of PAST EVENTS .... I could give a Damn what your rationale is, it wont change what OTHER PEOPLE have ALREADY DONE....

I am not arguing with anyone. I am educating you guys about pa practice.many on this thread are saying if xyz happens the world will end , pa's will own practices. they will make independent care decisions.
I was pointing out to the sdn newbies that this is not something new, pa's already own practices and make decisions whether or not the doc or the pa pays the bills and the supervision ratio has nothing to do with their ability to do so.
sdn is full of posts with no basis in fact about pa's only do this or pa's can't do that when the truth of the matter is we can essentially do anything except be a primary surgeon in the o.r.
every few years some new premed acts like the world is ending because pa's practice medicine. guess what folks. this is not new. we have been around for almost 50 years doing these things. get used to it.
deliver babies? yup
teach at md/do residency programs? yup.
have our own sch 2-3 dea certifications? yup.
own a practice? yup
solo staff a ER or ICU, work as a hospitalist? yup
easily make over 100k 5 yrs out of school? yup
reach flag rank and be commanding medical officers in all armed services? yup
do postgrad residencies and fellowships in almost any specialty? yup(see www.appap.org)
become an EMS medical director? yup
get credit for a full yr of rotations when returning to medschool? yup(lecom PA to DO bridge program, the first of many)
be president of state medical boards? yup (3-4 states now have had a pa as president of the medical board)
run a specialty group? yup. the president of the johns hopkins em group is an em pa with an mba.see http://www.hopkinsmedicine.org/emergencymedicine/Faculty/JHH/scheulen.html
work for the CIA, CDC, state dept, peace corps? yup
take care of the president and vice president of the u.s. as primary white house medical officers? yup. guess who saved cheney's hunting partner?
be appointed as a county coroner? yup( coroner of publo, colorado is a pa. been there for over 30 yrs.) see http://county.pueblo.org/government/county/coroner
etc, etc
the whole purpose of this thread is for folks to make educated decisions about pursuing pa vs do/md.
it comes down to this: if you are young and can afford it, go to medschool. If you are older and have some prior medical experience and significant outside responsibilities go pa.
I just don't want some 45 yr old paramedic to think they have to go to medschool because "pa's can't own practices or work alone" or "pa's can't do xyz" when chances are we can and have been doing so for longer than the vast majority of sdn posters have been alive.

 

[flyhi]

as usual, a great post by emedpa filled with factual information so others can use as they wish. I, as well, enjoy reading your posts since it is real world stuff and not speculation. thanks

 

[gators21]

What are the specialty requirements of PAs?
Its my understanding the as long as you have a PA-C, you can work in any field willing to hire you. This includes the coveted ROAD specialties, minus rads, plastics, ect. Also, if at any point you wanna switch fields, you just have to find someone willing to hire you. Get sick of derm, now I wanna be a hopitalist kinda thing. Md/DO would have to complete a new residency (unless switching to general internist). I know an ex-CCU doc who lost some of his hearing and had to open up an internal med clinic. Not a bad perk to being a PA.


The real question you have to ask is do you want to have complete control of your patient care. As a mid-level there will be restrictions. If you live in a rural area, you might get to do more. I personally want to work in a larger city. I want to be able to have no restrictions.

 

[SpecterGT260]

I was pointing out to the sdn newbies that this is not something new, pa's already own practices and make decisions whether or not the doc or the pa pays the bills and the supervision ratio has nothing to do with their ability to do so.
sdn is full of posts with no basis in fact about pa's only do this or pa's can't do that when the truth of the matter is we can essentially do anything except be a primary surgeon in the o.r.

There is no harm in spreading information. Most of the times you quoted me I got the impression of "I disagree and let me tell you why you're wrong" which.... is impossible... because one cannot disagree with a statement of fact

In all of these discussions it is hard for a medical student to not be seen as disapproving of PAs and DNPs as a whole. When the conversation comes up between my classmates and I there are the people who shy so far away from any non-PC statements that they will claim PA education is superior to that of MD (this actually happened last week in a small group), and there are those that are too afraid of expressing their own opinions for fear of being judged that they go along with it until they are sure of the opinions of present company.

from my perspective that is not what these discussions are about. mid-levels are great and a highly needed resource to healthcare as a whole. The discussions are more about where the roles will serve the greatest benefit, and in that spirit I stand by the opinions ive expressed all over SND regardless of what 4-5% of cases potentially say.