FM Physicians being replaced by mid-levels

[residentdoc8]

So it's another application season and I have been thinking almost TOO much my future-- while I understand there is NO perfect specialty out there, I'm having legitimate concerns about FM that i'm sure may have already been addressed on this forum.

Are there any positions/fields within family medicine that CANNOT be replaced by a mid-level (PA/RN/NP/etc.)?? My dream job would be urgent care, but there are more and more Physicians being replaced by NP's, PA's do the same job at half the salary and that worries me. As scary as it sounds, we are starting to see hospitalists being replaced by mid-levels too...anesthesia is dealing with the same problem as i've scubbed in many surgeries to find out that an RN was the anesthetist. I never want my own private practice or run my own business, so i'm wondering what else is left out there within family medicine where we would have our own autonomy?

With mid-levels taking over primary care, I don't want to be forced to a location that no one else wants to live in order to secure some autonomy. I have six-figure loans to consider, so deciding what specialty to apply to is really important.

Anyone worried about the future of primary care? Again, any positions within family medicine that has complete autonomy and protection against mid-levels? Any thoughts?

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[deleted87716]

I don't know where you're getting your information. I've never heard of a physician in any specialty being replaced by a mid-level.

There are mid-levels in every field, sure. Not the same thing at all.

As for the issue of autonomy, if you intend to be an employed physician, that will be determined in large part by your employer.

 

[mohhaider]

I don't know where you're getting your information. I've never heard of a physician in any specialty being replaced by a mid-level.

There are mid-levels in every field, sure. Not the same thing at all.

As for the issue of autonomy, if you intend to be an employed physician, that will be determined in large part by your employer.

I'm sorry to say that it is the truth. No NP can run a clinic without MD supervision, I'm sure about that. They might need an MD license to check/sign 10 % of the clinic charts , but the NPs are working independently . I'm a family medicine resident and have NP friends . It is funny when I see a chart saying PCP XX,NP, when I ask what does the PCP stand for , they said Primary Care Provider, I must be mistakenly understood its a physician, but Wikipedia also confirms that PCP stands for Primary Care Physician. I'm not trying to make fun of NPs who work as PCPs, but the training they got can not be the same for the family medicine physicians.

 

[elfmonkey]

1. If we follow the rules of "Free Market", I think we can easily solve this problem.
So, if Family Doctors stop using NPs and PAs, and people had to choose, they would be expected to go to the most qualified, i.e., Physicians. You can always buy cheap, Chinese made electronics, but you will always choose the best medicine for your family. I mean no disrespect to any race or group.

2. NP`s and PA`s can try practicing medicine independently, but they will have to get their own malpractice, with that they need more accurate definition of their scope of practice and this mostly depends on their education and training.
There is NO way they can get the same privileges that we have.

So step one: let the PA`s and NP`s go.

 

[Socrates25]

I don't know where you're getting your information. I've never heard of a physician in any specialty being replaced by a mid-level.

There are mid-levels in every field, sure. Not the same thing at all.

As for the issue of autonomy, if you intend to be an employed physician, that will be determined in large part by your employer.

http://www.healthleadersmedia.com/c...oner-Elected-Medical-Staff-PresidentQuestion:

"I passed muster, if you will, as the first non-physician, full-time, sole provider here as an NP working in the ER alongside the docs," he says. "It was so successful that we ultimately eliminated all the docs here and replaced them all with nurse practitioners or physician assistants."

 

[deleted432032]

http://www.healthleadersmedia.com/c...oner-Elected-Medical-Staff-PresidentQuestion:

http://www.ellenvilleregional.org/

Looks like they employ 2 MD's, 3 PA's, and 3 NP's in their Emergency Room Services Department. Does not exactly look like a mid-level ran department like the article indicates.

 

[8studentdoc8]

Thank you everyone so much for your comments. I haven't read the article from the link above and don't plan to-- but from what you've quoted-- there are 6 "mid-levels" to 3 Physicians-- those 6 mid-level spots could have been filled with other Physicians, but those jobs were replaced. Again, I understand that midlevels cannot practice without a Physician overseeing them, but that means that someone (a hospital) could hire less Physicians and more mid-levels when Physicians USED to fill those same exact spots. I don't think there are any unemployed family physicians out there, but there are A LOT of them taking MUCH LESS pay than what their education/training/years of sacrifice calls for-- I've even heard of a PA and FP doc getting paid more or less the SAME.....PA school I think is only 2 years and then they could go out and practice, and FP doc-- 7 years of training-- to ultimately come out with MORE debt to be paid the same. I'm not trying to spark a debate about comparing an mid-level to an FP doc because there's absolutely NO comparison-- but it's so SAD that with what is coming in the future, I think FP docs will be replaced by cheaper less trained people....no wonder there are less interest among med students to go into primary care, there's absolutely NO incentive!

 

[altap]

I was about to say the same thing...

 

[deleted87716]

I understand that midlevels cannot practice without a Physician overseeing them...no wonder there are less interest among med students to go into primary care, there's absolutely NO incentive!

Contradictory statements, IMO.

Autonomy is one of the most important determinants of job satisfaction.

http://www.kevinmd.com/blog/2011/02/job-satisfaction-physicians.html

 

[Smokemont]

Contradictory statements, IMO.

Autonomy is one of the most important determinants of job satisfaction.

http://www.kevinmd.com/blog/2011/02/job-satisfaction-physicians.html

Agreed. However I interpreted the post as meaning there is less job security or fewer positions for FM, therefore decreasing incentive to choose as a field.

Both are good points though.

 

[primadonna22274]

I have a unique perspective as a longtime PA becoming a physician. IMO the practice you mention is just about the right ratio of physician to midlevel. PAs are physician extenders--when they are used well a practice can run more efficiently and at a lower cost. I have practiced in a similar environment but I was NOT used efficiently--I was the evening and weekend urgent care PA who took uncompensated call (ugh) and was responsible for very sick patients with supervising physicians I could hardly ever reach. Dangerous and without a doubt the longest year of my career. This practice encouraged people to come to the clinic first for ANY problem...rapid afib? Chest pain? Crush injury to an extremity? 27-wk preemie just sent home this week and apnea monitor keeps going off? Sure! We'll take it!! I was truly grateful nobody died on my watch and I transported more than a few to the HOSPITAL where they belonged. Keep in mind this job was in my 8th yr of PA practice so I was not a newbie by any means. Add to that underwhelming pay and high stress...yikes.
But I also had a great job where I was the only PA in 14-physician multispecialty group (FP, IM, Peds and Gen surg). I was a bit overprotected there but I was a younger PA. I had great rapport with the physicians and always knew they appreciated me and had my back. In hindsight it was silly that I left but I got bored....

Thank you everyone so much for your comments. I haven't read the article from the link above and don't plan to-- but from what you've quoted-- there are 6 "mid-levels" to 3 Physicians-- those 6 mid-level spots could have been filled with other Physicians, but those jobs were replaced. Again, I understand that midlevels cannot practice without a Physician overseeing them, but that means that someone (a hospital) could hire less Physicians and more mid-levels when Physicians USED to fill those same exact spots. I don't think there are any unemployed family physicians out there, but there are A LOT of them taking MUCH LESS pay than what their education/training/years of sacrifice calls for-- I've even heard of a PA and FP doc getting paid more or less the SAME.....PA school I think is only 2 years and then they could go out and practice, and FP doc-- 7 years of training-- to ultimately come out with MORE debt to be paid the same. I'm not trying to spark a debate about comparing an mid-level to an FP doc because there's absolutely NO comparison-- but it's so SAD that with what is coming in the future, I think FP docs will be replaced by cheaper less trained people....no wonder there are less interest among med students to go into primary care, there's absolutely NO incentive!

 

[tiotropium]

OP is hesitant about FM because of lack of jobs? I was under the impression that primary care, especially FMs, actually had the highest number of jobs available.

Furthermore, if OP had any interest in doing less urban care, I highly doubt PAs/NPs would get the same privileges as a FP, such as access to the operating room, endoscopy lab, etc.

 

[deleted6669]

Furthermore, if OP had any interest in doing less urban care, I highly doubt PAs/NPs would get the same privileges as a FP, such as access to the operating room, endoscopy lab, etc.

very true. pa's/np's in rural locations get more outpt privileges and do more in the e.d. but no one is going to let them do more things in the o.r. just because it is a rural/underserved location.

 

[deleted87716]

OP is hesitant about FM because of lack of jobs? I was under the impression that primary care, especially FMs, actually had the highest number of jobs available.

Correct.

http://www.aafp.org/online/en/home/...ofessional-issues/20110817merritthawkins.html

 

[altap]

Right now that ED employs 2 physicians. Five or ten yrs. ago, how many physicians were employed by that same ED?

 

[Smokemont]

OP is hesitant about FM because of lack of jobs? I was under the impression that primary care, especially FMs, actually had the highest number of jobs available.

I think the argument is that if FM docs move into the role of overseeing more and more midlevels then the jobs available would decrease. I'm not saying I think this will happen, just putting it out there for discussion.

 

[elfmonkey]

I think the argument is that if FM docs move into the role of overseeing more and more midlevels then the jobs available would decrease. I'm not saying I think this will happen, just putting it out there for discussion.

I know two of the largest groups here, where I live, and they are doing this right now. They use few MD`s to utilize PA`s, NP`s and dietitians to take care of more people. One of their docs told me that they got the idea from California. So it`s already happening. He said we are going to "oversee".

 

[Smokemont]

I know two of the largest groups here, where I live, and they are doing this right now. They use few MD`s to utilize PA`s, NP`s and dietitians to take care of more people. One of their docs told me that they got the idea from California. So it`s already happening. He said we are going to "oversee".

And it makes perfect sense why this would happen.

 

[altap]

IMHO, physicians esp. PCPs should not be the overseer of midlevels, rather PCPs should be the ones shaking the hands of pts., talking to them, establishing that personal connection/bond between a pt. and a healer (I'm not saying midlevels should not do this). Midlevels should be there to assist the PCPs.

 

[elfmonkey]

IMHO, physicians esp. PCPs should not be the overseer of midlevels, rather PCPs should be the ones shaking the hands of pts., talking to them, establishing that personal connection (I'm not saying midlevels should not do this). Midlevels should be there to assist the PCPs.

I totally agree with you.

And it makes perfect sense why this would happen.

Financially, yes. Ethically, no.

 

[primadonna22274]

In 12 yr as a PA I very rarely "assisted" my SP, except to make his/her workload lighter. When I quit the dangerous urgent care gig I spoke of above, guess who they hired to replace me? An EM physician.

 

[deleted6669]

yup, I never "assist" anyone. I provide solo coverage of an 11 bed dept on night shifts. I sign out to a doc in the morning but work alone. we staff pa's 24/7 with a doc on day shift only. Prior to pa's doing 24/7 coverage there they used moonlighting 2nd yr fp residents working alone, not a good idea.

 

[Smokemont]

I totally agree with you.

Financially, yes. Ethically, no.

Financially is all that matters when hospitals, insurance companies etc. are profit driven.

yup, I never "assist" anyone. I provide solo coverage of an 11 bed dept on night shifts. I sign out to a doc in the morning but work alone. we staff pa's 24/7 with a doc on day shift only. Prior to pa's doing 24/7 coverage there they used moonlighting 2nd yr fp residents working alone, not a good idea.

So are you saying that a patient is better off with a pa than a 2nd yr fm resident?

 

[deleted6669]

So are you saying that a patient is better off with a pa than a 2nd yr fm resident?

I'm saying that a pt is better off with an EXPERIENCED emergency medicine pa than a 2nd yr fp resident with no prior em experience. I agree that a typical 2nd yr fp resident would be better than a typical pa without extensive em experience. how many months of em does an fp intern do? 3 ? plus maybe 1 month in med school? I did more than that as a pa student as all my electives were trauma, em, and peds em. 27 weeks just in those 3 areas.
I am not talking about typical pa's.
most pa's I work with have similar backgrounds to me(not trying to toot my own horn, just providing an example of the caliber of PA I work with):
25 years experience in emergency medicine. over 125,000 emergency medicine patients of all levels of acuity seen at level 1, 2, 3, and 5 emergency depts. in urban and rural settings in 7 states.. I have a postgrad masters in clinical emergency medicine. I am certified in acls, atls, pals, apls, fccs, also, abls, and the difficult airway course. I have worked as an instructor for several of these. I precept fp residents in the emergency dept and have for over 15 years. I have done fairly extensive international medical missions work including Haiti the week after the 2010 earthquake there. I have written multiple articles on em related topics which have been published in well known peer reviewed medical journals listed in the pubmed index.
I previously worked in 2 very busy ems systems as a paramedic(los angeles and philadelphia). I am very comfortable with difficult airways, running codes, difficult venous access situations, fracture and dislocation management including reductions and the use of procedural sedation, ent and ophtho emergencies, management of trauma, cardiac and neuro emergencies, etc
I am one of very pa's in the country to have passed a subspecialty exam in emergency medicine designed by emergency medicine physicians to certify the ability to work in any em setting from fast track to solo coverage of small depts.
yes, I run circles around the vast majority of fp residents in the ER.
you guys know family medicine. I know emergency medicine. I wouldn't set myself up as an expert in your field because I am not. The only provider who knows more about a given specialty than a pa in that specialty is a residency trained/board certified physician in the same specialty. you guys know more than family medicine pa's, an em doc knows more than me.(my caveat to the above is an fp physician who has worked extensively in emergency medicine for more years than I have. these guys are em docs as far as I am concerned. I work with several and they are excellent. most passed the em boards under a grandfather clause through the practice track in the 80's).
see post #42 in this thread for a surgeon's opinion of quality em pa's:
http://forums.studentdoctor.net/showthread.php?t=934124
from that thread: "At our ER, PA's participate in trauma when the residents are in protected teaching conferences/electures and such. They intubate, put chest tubes, put lines, etc. They are good. As a trauma chief, I rely on them to help supervise lines and tubes for my own junior residents and ER residents so I can supervise other aspects of the trauma resuscitation. When I was a PGY-1 and 2 I learned how to do subclavians from the PA's in the ICU who were the best at them."

 

[elfmonkey]

I'm saying that a pt is better off with an EXPERIENCED emergency medicine pa than a 2nd yr fp resident with no prior em experience.
.

Is a pt better off with a seasoned ED nurse ? She/He had seen the same number of patients and worked with better "providers" and probably can make safer decisions..

We are not talking about technicians. Hence, courses are only technically or legally significant.

With all due respect, PAs wont be able to tell the difference until they go to med school.
You can bring a teenager and teach him/her how to find a venous access but only through med school you might be privileged to practice the art of medicine.
Even the way you touch a patient is different then.

 

[deleted6669]

With all due respect, I teach em to fp residents. my EM knowledge far surpasses theirs. they know more about chronic management than I do. I write their evals.
you shouldn't underestimate the value of on the job training. keep in mind all my teachers were em docs. they want me to be able to see acute pts when they are busy and have trained me accordingly.
unless you are an em doc who works with me you are in no position to judge my level of competence to practice emergency medicine.
PS: PA's practice medicine. it says so right on my state license: "EMEDPA is hereby granted this license to practice medicine in the state of xyz".

 

[elfmonkey]

With all due respect, I teach em to fp residents. my EM knowledge far surpasses theirs and they know more about chronic management than I do. I write their evals. you shouldn't underestimate the value of on the job training. keep in mind all my teachers were em docs. they want me to be able to see acute pts when they are busy and have trained me accordingly.
unless you are an em doc who works with me you are in no position to judge my level of competence to practice emergency medicine.
PS: PA's practice medicine. it says so right on my state license: "EMEDPA is hereby granted this license to practice medicine in the state of xyz".

Sir/Ma`am, I really meant not to upset nor disrespect you. I apologize.
I`m talking about the system, it`s nothing personal. I was taught to listen and learn from everyone around me in the "world" not just on the "ward", but the official training of physicians should be provided by senior and experienced physicians. Again, it is not personal.
closest thing to an olive branch.

 

[deleted6669]

Sir/Ma`am, I really meant not to upset nor disrespect you. I apologize.
I`m talking about the system, it`s nothing personal. I was taught to listen and learn from everyone around me in the "world" not just on the "ward", but the official training of physicians should be provided by senior and experienced physicians. Again, it is not personal.
closest thing to an olive branch.

Thank you. I agree that in a perfect world residents should be taught be experienced senior physicians. it just doesn't happen though. resident shows up for their em month with Dr X. Dr X says " I will grab you if I see anything cool. until then hang out with the pa's, they can teach you a lot." and we do. for the entire month, then we write and sign their eval at the end of the month and Dr. X cosigns it. not a great system but it's the system I have worked with in multiple places. until the medical system gives a financial incentive to physicians to teach they won't do it unless they are passionate about it. I work at an hourly rate. I don't care if a resident slows me down from 3 pts/hr to 2. many docs do care about this because they translate it to lost income.

 

[tony montana]

With all due respect, I teach em to fp residents. my EM knowledge far surpasses theirs. they know more about chronic management than I do. I write their evals.
you shouldn't underestimate the value of on the job training. keep in mind all my teachers were em docs. they want me to be able to see acute pts when they are busy and have trained me accordingly.
unless you are an em doc who works with me you are in no position to judge my level of competence to practice emergency medicine.
PS: PA's practice medicine. it says so right on my state license: "EMEDPA is hereby granted this license to practice medicine in the state of xyz".

This is rubbish...until you become a physician you are in no position to judge your EM abilities and consider them superior to FM residents.

All you have is technical knowledge that any FM resident could pick up in short time and just add it to her/his arsenal of medical knowledge.

You having more technical EM knowledge than a less exposed FM resident only gives you temporary inferior, and solely apparent advantage to an FM resident.

You are self-deluded if you feel your rotations in EM can make you a more capable provider than a typical 2nd year FM physician. Once the 2nd yr FM physician has picked up whatever EM skills you may have, she/he still has a load of preparation you will never obtain irrespective of how many resident evaluations you get to complete.

 

[deleted6669]

You are self-deluded if you feel your rotations in EM can make you a more capable provider than a typical 2nd year FM physician. .

it's not the 27 weeks of rotations, it's the 25 years of experience to back them up genius.
I'll let you argue with all the em and trauma surgical attendings here who say that skilled em pa's are better practitioners than residents.

 

[ghost dog]

I'm saying that a pt is better off with an EXPERIENCED emergency medicine pa than a 2nd yr fp resident with no prior em experience. I agree that a typical 2nd yr fp resident would be better than a typical pa without extensive em experience. how many months of em does an fp intern do? 3 ? plus maybe 1 month in med school? I did more than that as a pa student as all my electives were trauma, em, and peds em. 27 weeks just in those 3 areas.
I am not talking about typical pa's.
most pa's I work with have similar backgrounds to me(not trying to toot my own horn, just providing an example of the caliber of PA I work with):
25 years experience in emergency medicine. over 125,000 emergency medicine patients of all levels of acuity seen at level 1, 2, 3, and 5 emergency depts. in urban and rural settings in 7 states.. I have a postgrad masters in clinical emergency medicine. I am certified in acls, atls, pals, apls, fccs, also, abls, and the difficult airway course. I have worked as an instructor for several of these. I precept fp residents in the emergency dept and have for over 15 years. I have done fairly extensive international medical missions work including Haiti the week after the 2010 earthquake there. I have written multiple articles on em related topics which have been published in well known peer reviewed medical journals listed in the pubmed index.
I previously worked in 2 very busy ems systems as a paramedic(los angeles and philadelphia). I am very comfortable with difficult airways, running codes, difficult venous access situations, fracture and dislocation management including reductions and the use of procedural sedation, ent and ophtho emergencies, management of trauma, cardiac and neuro emergencies, etc
I am one of very pa's in the country to have passed a subspecialty exam in emergency medicine designed by emergency medicine physicians to certify the ability to work in any em setting from fast track to solo coverage of small depts.
yes, I run circles around the vast majority of fp residents in the ER.
you guys know family medicine. I know emergency medicine. I wouldn't set myself up as an expert in your field because I am not. The only provider who knows more about a given specialty than a pa in that specialty is a residency trained/board certified physician in the same specialty. you guys know more than family medicine pa's, an em doc knows more than me.(my caveat to the above is an fp physician who has worked extensively in emergency medicine for more years than I have. these guys are em docs as far as I am concerned. I work with several and they are excellent. most passed the em boards under a grandfather clause through the practice track in the 80's).
see post #42 in this thread for a surgeon's opinion of quality em pa's:
http://forums.studentdoctor.net/showthread.php?t=934124
from that thread: "At our ER, PA's participate in trauma when the residents are in protected teaching conferences/electures and such. They intubate, put chest tubes, put lines, etc. They are good. As a trauma chief, I rely on them to help supervise lines and tubes for my own junior residents and ER residents so I can supervise other aspects of the trauma resuscitation. When I was a PGY-1 and 2 I learned how to do subclavians from the PA's in the ICU who were the best at them."

Ok.

The exam you wrote: was this the ER exam taken by ER MD physicians, or a watered down version for PAs?

I have no doubt you have some serious skills, but I'm sure a family MD practicing as long in the ER would be just as good ( if not better ).

In regards to expecting a 2nd year family med resident to fill your shoes: not only is this unreasonable, it is dangerous. Of course you are more knowledgeble; of course you are going to be more competent. You've been doing it for a quarter of a century! On the financial side of things, I would be willing to wager they got paid somewhat less ??

 

[deleted6669]

Ok.

I have no doubt you have some serious skills, but I'm sure a family MD practicing as long in the ER would be just as good ( if not better ).

In regards to expecting a 2nd year family med resident to fill your shoes: not only is this unreasonable, it is dangerous. Of course you are more knowledgeble; of course you are going to be more competent. You've been doing it for a quarter of a century! On the financial side of things, I would be willing to wager they got paid somewhat less ??

nope, the residents got significantly more( 30 dollars/hr more). I've been there for 10 years now and I don't make yet what they made then...but I'm getting close.
you will notice a few posts ago that I said:
"(my caveat to the above is an fp physician who has worked extensively in emergency medicine for more years than I have. these guys are em docs as far as I am concerned. I work with several and they are excellent. most passed the em boards under a grandfather clause through the practice track in the 80's).".
of course an fp doc working in em for 25 years is excellent. they are an er doc in my book and someone I would be willing to listen to any day of the week. there are lots of fp docs working in em and I love to work with them. my rural per diem job is at a place that double staffs 1 fp md and 1 em pa.
my only argument was vs resident level skills, not senior attending level skills. I have a world of respect for residency trained and boarded fp docs. if I ever went back to med school I would do a rural fp track residency.

 

[deleted6669]

You are self-deluded if you feel your rotations in EM can make you a more capable provider than a typical 2nd year FM physician. .

Originally Posted by ghost dog
"In regards to expecting a 2nd year family med resident to fill your shoes: not only is this unreasonable, it is dangerous. Of course you are more knowledgeble; of course you are going to be more competent. You've been doing it for a quarter of a century! "

 

[deleted6669]

Ok.

The exam you wrote: was this the ER exam taken by ER MD physicians, or a watered down version for PAs?

certainly shorter as it had no orals but not "watered down". it's not an np exam....
the test was written by em docs and it was based on the em abem board exam from which they developed the content blueprint. lots of tox/critical care/etc.
A prior president of acep(american college of em physicians), Dr. linda lawrence, chaired the committee that wrote it. She is also on the advisory board of the society of emergency medicine PA's. nice lady and a fantastic lecturer.
see the link below about the exam:
http://www.nccpa.net/Emergencymedicine.aspx
from that site: NCCPA's specialty CAQ process is predicated on a strong belief in the value and importance of the physician-PA team, and in support of the procedures and patient case requirement, each applicant must provide attestation from a supervising physician who works in the specialty and is familiar with the PA's practice and experience.
the abem (md) exam is 305 questions(allowed time=6.5 hrs) + an oral board exam: http://www.abem.org/PUBLIC/portal/alias__Rainbow/lang__en-US/tabID__3368/DesktopDefault.aspx
ours is 120 questions(allowed time 2 hrs) so 1/3 as long more or less. I'm sure their exam is more "difficult". if you want to call ours "watered down" I guess that's fair. I would say ours focuses on key areas in the specialty while theirs is comprehensive. I've heard a lot of bitching from em docs about stuff on there that they never use and would never try like applying cervical tongs for traction of unstable c-spine fxs, etc

 

[altap]

This kind of mindset (I'm as good as you or even better attitude by midlevels) is dangerous for the medical profession and for patients. The question is how many midlevels who garner a few years of experience working for physicians have this kind of mindset?

 

[tony montana]

it's not the 27 weeks of rotations, it's the 25 years of experience to back them up genius.
I'll let you argue with all the em and trauma surgical attendings here who say that skilled em pa's are better practitioners than residents.

This kind of mindset (I'm as good as you or even better attitude by midlevels) is dangerous for the medical profession and for patients. The question is how many midlevels who garner a few years of experience working for physicians have this kind of mindset?

No need to argue dear oracle, on your command, let's just abolish medical education as we know it and let's have all med students quit and just shadow ER docs and Trauma docs...

Much cheaper, and I'm sure you will argue, also safer for patients.

You don't know how much you don't know.

 

[deleted6669]

you don't know how much you don't know.

neither do you medstudent. The "doc" you quoted is an fmg who can't match to a us residency and has been posting about he should be allowed to be a pa...He is currently working as a nurse...he is jealous of pa's....
ghost dog is an ACTUAL physician with a LICENSE. read again what he said if you didn't catch it the first time...

 

[tony montana]

neither do you medstudent. The "doc" you quoted is an fmg who can't match to a us residency and has been posting about he should be allowed to be a pa...He is currently working as a nurse...he is jealous of pa's....
ghost dog is an ACTUAL physician with a LICENSE. read again what he said if you didn't catch it the first time...

I couldn't care less about his licensing status, we are not weighing in on the drama of his life. We are debating the correctness of his statement not the ad hominem you are trying to pull on him or myself.

I am a fully licensed attending. If you put your trust on SDN career statutes you need to be reminded once again that -->
You don't know how much you don't know!.

 

[deleted6669]

I am a fully licensed attending.

if that is true do the following:
1.change your status
2.get one of those nifty badges from sdn that says "verified physician". until then for all we know you are some high school kid with delusions of grandeur.

I could create a new account right now and say I am chief of neurosurgery at hopkins and would have as much credibility as you do right now.

 

[tiotropium]

I've heard a lot of bitching from em docs about stuff on there that they never use and would never try like applying cervical tongs for traction of unstable c-spine fxs, etc

This sounds like terrible justification. Following your logic, why have medical school at all? Why learn any of the stuff from didactic years? Why have future orthopods learn any other medicine at all except for ortho surgery? Why doesn't everyone just attend a LVN/LPN program and learn along the way and get '25 years experience' to do their jobs well? Why not have every single school and licensing exam through medical school just 'watered down' if we're only going to use a portion of it?

Let's not forget ~50% of PAs/NPs failed a simplified version of Step 3 in a research study...

 

[altap]

Emedpa you are the one who have delusions of grandeur (you are a pa and you think you are as good or even better than physicians).

 

[deleted87716]

Let's not forget ~50% of PAs/NPs failed a simplified version of Step 3 in a research study...

It was DNPs, and it wasn't a "research study." It just didn't count for anything.

http://www.ama-assn.org/amednews/2009/06/08/prl10608.htm

 

[smq123]

Ok.

Yes, this is a physician forum. And yes, a non-FM physician coming here and denigrating FM doctors would not be welcome. However, it doesn't look like anyone's done that yet. So there's no need for hostility and insults. If you disagree with someone, please do so respectfully. Otherwise, infractions will get handed out, and the thread will get closed.

I, like many other family med residents before me, have had the opportunity to learn from PAs. I am particularly grateful to the general surgery PA who helped me out a ton of times when I was an intern on the floors during my gen surg rotation (which was also my first month as an intern!) She never made fun of me, despite my many phone calls to her which all started with a "Uhhh...<gulp>...HELP!?!?!"

Did she, as an experienced general surgery PA with 15 years experience, know a lot more about surgery than I, a scared little FM PGY-1, did? Of course. Did she ever confuse herself with a physician, or claim that she knew more than the gen surg attending on service? No, never.

So let's all be nice to each other, and lay off the insults. Thanks.

 

[tiotropium]

It was DNPs, and it wasn't a "research study." It just didn't count for anything.

http://www.ama-assn.org/amednews/2009/06/08/prl10608.htm

I stand corrected. Apologies and thanks for putting me in my place.

 

[DrAwsome]

This kind of mindset (I'm as good as you or even better attitude by midlevels) is dangerous for the medical profession and for patients. The question is how many midlevels who garner a few years of experience working for physicians have this kind of mindset?

This is what I frequently question. The idea that midlevels have that they are equivalent or better than physicians is not just scary and delusional, but dangerous to patients. Why would we go through the trouble of med school if we can pick everything up as "on the job training"? Seriously?

 

[deleted87716]

I stand corrected. Apologies and thanks for putting me in my place.

Not "putting you in your place." What place would that be, anyway? This is STUDENT Doctor Network. I'm the interloper here.

 

[deleted6669]

This sounds like terrible justification. Following your logic, why have medical school at all? Why learn any of the stuff from didactic years? Why have future orthopods learn any other medicine at all except for ortho surgery? Why doesn't everyone just attend a LVN/LPN program and learn along the way and get '25 years experience' to do their jobs well? Why not have every single school and licensing exam through medical school just 'watered down' if we're only going to use a portion of it?

you misunderstood me friend. look at what I wrote:
ours is 120 questions(allowed time 2 hrs) so 1/3 as long more or less. I'm sure their exam is more "difficult". if you want to call ours "watered down" I guess that's fair. I would say ours focuses on key areas in the specialty while theirs is comprehensive. I've heard a lot of bitching from em docs about stuff on there that they never use and would never try like applying cervical tongs for traction of unstable c-spine fxs, etc

I called theirs both more difficult and more comprehensive. they need to know a lot of theoretical stuff even if they never use it and I understand that. I have a world of respect for residency trained and boarded physicians in any specialty. I only ask to be respected in return for my experience and contributions to this forum over the last 10 years. I have been working in medicine as a pa, paramedic, and er tech longer than many med students on this board have been alive. along the way I learned some valuable things. that's all I'm saying.

 

[altap]

To emedpa: I don't envy you. I was arguing for IMGs/FMGs/AMGs who did not match who would be working odd jobs (nothing wrong) or worse end up jobless. I was thinking how can someone who graduated frm med school and passed the mle's not be able to work as a physician extender. By the way, these unmatched MGs could be paid half of what midlevels make and it would be ok to them and more importantly they would not be thinking or saying that they are as good or even better than physicians (my opinion).

Whether I'm a nurse, a resident or a janitor is beside the point. You were saying some ridiculous assumptions about yourself and about physicians so I disagreed.

 

[deleted6669]

To emedpa: I don't envy you. I was arguing for IMGs/FMGs/AMGs who did not match who would be working odd jobs (nothing wrong) or worse end up jobless. I was thinking how can someone who graduated frm med school and passed the mle's not be able to work as a physician extender. By the way, these unmatched MGs could be paid half of what midlevels make and it would be ok to them and more importantly they would not be thinking or saying that they are as good or even better than physicians (my opinion).
Whether I'm a nurse, a resident or a janitor is beside the point. You were saying some ridiculous assumptions about yourself and about physicians so I disagreed.

A med school graduate who has not done a residency will NEVER be able to get licensed as a pa, sorry. it's an issue of quality control. there are laws against it plain and simple. these laws will not change.
if you want, you could go to pa school like many others in your position have. I have worked with several fine pa's who were previously IMG's. several of them now teach at pa programs as faculty. best of luck matching in the future(and I mean that sincerely) but if it doesn't happen consider the pa option.

 

[Makati2008]

To emedpa: I don't envy you. I was arguing for IMGs/FMGs/AMGs who did not match who would be working odd jobs (nothing wrong) or worse end up jobless. I was thinking how can someone who graduated frm med school and passed the mle's not be able to work as a physician extender. By the way, these unmatched MGs could be paid half of what midlevels make and it would be ok to them and more importantly they would not be thinking or saying that they are as good or even better than physicians (my opinion).

Whether I'm a nurse, a resident or a janitor is beside the point. You were saying some ridiculous assumptions about yourself and about physicians so I disagreed.

I have to disagree with your opinion about how unmatched Amg/fmgs would act if they were allowed to function as mlps. ( I would see them pushing for indepence like nps are now and we see how well that is working for patients. And just because you passed the steps shouldn't give you a free pass! Anyone can pass the test if they try hard enough)

To be blunt if you haven't matched in several cycles hang it up and go to PA school if your truly into patient care and not concerned about the monetary component as you claim.