Granting medical students PA degree as well

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I hope that the med orgs. that are accrediting PAs block the name change (physician assistant to physician associate) bec. as long as they have the assistant in their title it would be very hard for them to claim equivalency or it would be very hard for them to practice independently. For how can an assistant (of a physician) work without the supervision of a physician or how can an assistant (of a physician) be equal to a physician?

I'm all for midlevels working under the supervision of a physician.

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I hope that the med orgs. that are accrediting PAs block the name change (physician assistant to physician associate) bec. as long as they have the assistant in their title it would be very hard for them to claim equivalency or it would be very hard for them to practice independently. For how can an assistant (of a physician) work without the supervision of a physician or how can an assistant (of a physician) be equal to a physician?

I'm all for midlevels working under the supervision of a physician.

the matter of fact is the a name change wouldn't change scope of practice regulations one bit.

I dont get why someone would go to a rigorous PA program to come out and be an assistant. Theyre obviously not physicians, and NEED to be supervised, but theyre not coffee-makers either. They sound like techs honestly.

Honestly, this would have been much easier if in the beginning of the profession, they gave it an ambiguous name such as Clinical Officer (which is used in other places in the world as their version of PAs) or Clinical Associate (used in Canada). I think in Saudi Arabia they use Assistant Physician. But the underlying problem here is that people are going through an intensive study program coming out as competant practitioners, and then being called the "physician'S Assistant" (literally every time I've heard a doc/nurse/MA/resident say it, it's always the physician's assistant)


PA and MA sound synonymous to the lay person. Plus, how reassuring would it be to know that after an hour waiting, you get to see the doc's assistant, who is going to diagnose you?


Respiratory therapists used to be called respiratory technicians, which once again didn't reflect their level of knowledge. Ever since their name change, their scope of practice has hardly changed. No harm done.
 
They original werecalled physician associate, but some physicians had a problem with that and forced it to be changed to physician assistant. The Yale program has yet to comply and still calls itself a physician associate program.
 
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They original were called physician associate, but some physicians had a problem with that and forced it to be changed to physician assistant. The Yale program has yet to comply and still calls itself a physician associate program.

I think there are still 5 physician associate programs(stanford, oklahoma, yale, a few others). it's likely that several will change their name to physician associate programs and hopefully new programs will follow that trend as well. changing the name does nothing to the scope of practice and puts us no closer to indpendence. WE WORK FOR PHYSICIANS AND ARE OVERSEEN BY PHYSICIANS, What part of that don't folks understand?
 
I know what both the PA and NP agendas are.

I agree about NPs, as they've made it plainly obvious through their statements and changes over the past years. I disagree about PAs, and doubt you could find anything to back up your claim. Please feel free to enlighten us if you can. As for your attacks and opinions on emed, he doesn't need you or your opinion, he's already made it quite far in his life without either. He obviously works with great Docs, and I for one am very proud of all that he's accomplished thus far in his life and in the lives of his patients.

As to the actual topic of this thread, I think it's a great idea. Surely there could be some sort of program consisting of didactic and clinical testing, with a subsequent year long education option if necessary.
 
As an upper level resident I have authority over both med students and PA students who rotate thru --.

interesting. as an em pa I have authority over pa students, md students AND residents who rotate on my service.
 
Surely there could be some sort of program consisting of didactic and clinical testing, with a subsequent year long education .

there already is that option. it's called pa school. one of my students right now is an fmg from india who passed baords and couldn't match so went back to pa school. it's not that uncommon.
 
there already is that option. it's called pa school. one of my students right now is an fmg from india who passed baords and couldn't match so went back to pa school. it's not that uncommon.

Right, we have MD-PA's on our faculty board. But I'm talking about a year long education, sans the rotations if they've already had them. And that would be if they needed it, because if they pass the PANCE as well as a grueling clinical test ... then why not?
 
To emedpa: These FMGs in Florida that you like to cite who are doing a poor job as PAs did not pass the USMLEs. As I have said in my previous post, foreign born FMGs are heterogenous (some are good, some are great others are bad just like there are bad PAs, good and great PAs) Just because a handful of FMGs in Florida (who do not have the USMLEs under their belt) underperform means that all FMGs are incompetent. Sorry but your argument does not hold water.
Its not that all FMGs are incompetent, its that when placed in a job that they were not trained for (collaborative supervised medicine) they perform a poor job. To take Florida in particular its not just a few but over 100 FMGs. As you state its a heterogeneous group. Some were USMLE qualified and unable to get residencies. Others were unable to prove that they had graduated medical school since their school was in a country no longer friendly to the US government. The one universal truth is they were unable to pass a test on clinical knowledge specifically designed for them. The other opinion is that once in practice as a group they failed to preform at a level expected of PAs.

Its also not just one experiment. The same experiment was tried in Oklahoma, California and on a smaller scale New York. All of these
experiments ended in dismal failure. One definition of insanity is doing the same thing over and expecting different results.

There are two issues here. One is public safety. If you look at either malpractice claims results or National Practitioner Data Bank data its obvious that physicians who do not complete residency have more claims than physicians that do. In a similar manner PAs that go to PA school have less claims that PAs that don't. What this says to me is that its not just having the knowledge but being trained in the role and getting appropriate exposure to the field.

The other issue is physician competition. You could easily let every FMG in the US work simply by implementing a new license type. Something like "supervised physician". This would allow all the FMGs and non-matching US grads to work as a physician under the supervision of a fully licensed physician. After all as graduates of medical school thats what they are - correct? Physicians?. On the other hand this will never happen. The US medical system is predicated on the concept that a physician has a unrestricted license to practice medicine. There is no political will or desire to introduce further competition into the system.

Foreign Medical Grads are a physician issue. If you want to solve any "problem" solve it in the physician system.
 
the change back to physician assoociate(which WILL happen sooner or later) is about not being confused with medical assistants, not a move for independence.

The public doesn't even know what a "medical assistant" is. To most patients, they're all "nurses." Just ask them.
 
The public doesn't even know what a "medical assistant" is. To most patients, they're all "nurses." Just ask them.

True, I had no clue they were any different until I started volunteering at a clinic in high school.
 
I think there are still 5 physician associate programs(stanford, oklahoma, yale, a few others). it's likely that several will change their name to physician associate programs and hopefully new programs will follow that trend as well. changing the name does nothing to the scope of practice and puts us no closer to indpendence. WE WORK FOR PHYSICIANS AND ARE OVERSEEN BY PHYSICIANS, What part of that don't folks understand?

Ok you got us MDs. We work for you too and are overseen by you all too. We will forever be loyal to you all, we promise. :xf::xf:

Somehow, I just don't believe that EMED was sincere when he wrote what I highlighted in his quote. Physicians beware.
 
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the matter of fact is the a name change wouldn't change scope of practice regulations one bit.

I dont get why someone would go to a rigorous PA program to come out and be an assistant. Theyre obviously not physicians, and NEED to be supervised, but theyre not coffee-makers either. They sound like techs honestly.

Honestly, this would have been much easier if in the beginning of the profession, they gave it an ambiguous name such as Clinical Officer (which is used in other places in the world as their version of PAs) or Clinical Associate (used in Canada). I think in Saudi Arabia they use Assistant Physician. But the underlying problem here is that people are going through an intensive study program coming out as competant practitioners, and then being called the "physician'S Assistant" (literally every time I've heard a doc/nurse/MA/resident say it, it's always the physician's assistant)


PA and MA sound synonymous to the lay person. Plus, how reassuring would it be to know that after an hour waiting, you get to see the doc's assistant, who is going to diagnose you?


Respiratory therapists used to be called respiratory technicians, which once again didn't reflect their level of knowledge. Ever since their name change, their scope of practice has hardly changed. No harm done.

Good post, very good points.
 
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To coreo: You take a number of foreign born FMGs in California, Oklahoma, Florida and NY who do not have the USMLEs under their belt and then you say, since these FMGs are incompetent then all FMGs must be incompetent. Sorry, but adding other states won't make emedpa's argument hold water, it still is flawed. Like I said, just as there are bad FMGs, there are also bad PAs and no profession is exempted from this.
 
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PAs are trying to make this as "just a name change" but this has huge ramification as this is one of the impediments for them to practice independently. If the name would be changed to physician associate then the public would then think that PAs are now MDs/DOs. The confusion is still there its just that PAs are now confused to being MDs/DOs instead of being confused as medical assistants. Why not just change medical assistant to medical clerk?
 
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To coreo: You take a number of foreign born FMGs in California, Oklahoma, Florida and NY who do not have the USMLEs under their belt and then you say, since these FMGs are incompetent then all FMGs must be incompetent. Sorry, but adding other states won't make your argument hold water, your argument and emedpa's are flawed. Like I said, just as there are bad FMGs, there are also bad PAs and no profession is exempted from this.

You my good sir need to improve your literacy. His VERY FIRST SENTENCE goes against what you are fussing about.


Its not that all FMGs are incompetent, its that when placed in a job that they were not trained for (collaborative supervised medicine) they perform a poor job. To take Florida in particular its not just a few but over 100 FMGs. As you state its a heterogeneous group. Some were USMLE qualified and unable to get residencies. Others were unable to prove that they had graduated medical school since their school was in a country no longer friendly to the US government. The one universal truth is they were unable to pass a test on clinical knowledge specifically designed for them. The other opinion is that once in practice as a group they failed to preform at a level expected of PAs.

The argument holds water just fine. A program like what the OP wanted has been tried (with both good and bad FMGs) and the results were not good. You could argue that unmatched US MDs are more qualified than FMGs, might even be true. You're still ignoring that MDs are not trained to be PAs.

In addition, all of the US MDs I know who didn't match either got transition years or failed to match due to their own poor planning (student who changed from trying to match OB to trying to match FP AFTER all of the interviews were done). US medical students can all match somewhere, barring a stupid decision on their part.
 
PAs are trying to make this as "just a name change" but this has huge ramification as this is one of the impediments for them to practice independently. If the name would be changed to physician associate then the public would then think that PAs are now MDs/DOs. The confusion is still there its just that PAs are now confused to being MDs/DOs instead of being medical assistants. Why not just change medical assistant to medical clerk?

You're forgetting that PAs are licensed and under the control of the state Medical Board in most places. Until that changes, PAs aren't going to be able to change their scope without physician approval.
 
To va hopeful dr: Sir read coreo's whole statement (he was still generalizing) before you tell me to improve my literacy. I know you know better than that. I hope we can debate without resorting to questioning one's intelligence. Let us be more civil.
 
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To va hopeful dr: Sir read coreo's whole statement (he was still generalizing) before you tell me to improve my literacy. I know you know better than that. I hope we can debate without resorting to questioning one's intelligence. Let us be more civil.

I did read the whole thing. The only generalization that was made is that MD graduates have not done well as PAs (as the tests show, though one could argue that these particular MDs were not the most qualified). As for being incompetent, as I said I think he's only generalizing as far as being a PA is concerned. That's it.
 
To VA Dr: The statement of coreo was a sweeping statement, a statement that was based on limited evidence that he and emedpa are now spewing at sdn as gospel and universal truth. It basically was saying, since these foreign born FMGs performed a poor job as PAs then we should not let other foreign born FMGs as PAs if they don't go to PA school because they will also do a poor job just like their predecessors. Where is the fairness in that statement? It is prejudicial towards all foreign born FMGs.
 
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To VA Dr: The statement of coreo was a sweeping statement, a statement that was based on limited evidence that he and emedpa are now spewing at sdn as gospel and universal truth. It basically was saying, "since these foreign born FMGs performed a poor job as PAs then we should not let other foreign born FMGs as PAs if they don't go to PA school because they will also do a poor job just like their predecessors." Where is the fairness in that statement? It is prejudicial towards all foreign born FMGs.

Hmmm, if his statements are correct, two studies in different cities, consisting of approximately 100 FMGs each, as well as an additional study with a smaller n, doesn't sound like any type of agenda on his part; it sounds like facts. You might remember those before you start spouting accusations of prejudice. That being said, perhaps those statistics don't have to be a brick wall, but instead an indicator of what can be done differently.
 
I'm not accusing anyone of being biased towards FMGs (coreo and emedpa may have said those things to make a point without them knowing that they were being unfair). I was just pointing out that such sweeping statement is not fair to FMGs and that they should refrain from using it.
 
The connotations of such sweeping statement is that PAs are better clinicians than FMGs. Moreover, if FMGs cannot function well as PAs, how much more as resident-physicians? Such connotations are harmful to the reputation of FMGs.
 
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Another blockage between FMGs in your situation is a psychological one altap. FMGs trained outside the US are trained to be what I will call the "top gun." They are psychologically taught in an environment where they are expected to be ultimately responsible for their patients, without any so-called lifelines. Although, when they don't place into residency(for whatever reason), this training is incomplete. You are taught to be the final word, although you are taught so partially (without a mechanism like a residency, such skills are incomplete for all purposes of American physician practice). Not to say that mid-levels don't have the last say on their particular patients, they can and do, but they have an upper ceiling; and it is inevitable that they will have to consult on the more complex patients with the physician overseeing their practice. FMGs working as midlevels would be less likely to consult with their Supervising Physician (after all, that's not the mentality they are trained with), even when they probably should. I could see that being a big reason as to why the several FMG mid-level projects have failed in the past.

Mid-levels are taught to work in a collaborative practice (atleast PAs are). Their curriculum thus emphasizes certain concepts of MD training and foregoes certain aspects of MD training; in the end in an effort to maximize patient care in a collaborative setting only. This psychology of being taught incompletely to be the top gun, but legally obliged to be the co-pilot, in practice can have even more serious ramifications then the ones you stated above.
 
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Another blockage between FMGs in your situation is a psychological one altap. FMGs trained outside the US are trained to be what I will call the "top gun." They are psychologically taught in an environment where they are expected to be ultimately responsible for their patients, without any so-called lifelines. Although, when they don't place into residency(for whatever reason), this training is incomplete. You are taught to be the final word, although you are taught so partially (without a mechanism like a residency, such skills are incomplete for all purposes of American physician practice). Not to say that mid-levels don't have the last say on their particular patients, they can and do, but they have an upper ceiling; and it is inevitable that they will have to consult on the more complex patients with the physician overseeing their practice. FMGs working as midlevels would be less likely to consult with their Supervising Physician (after all, that's not the mentality they are trained with), even when they probably should. I could see that being a big reason as to why the several FMG mid-level projects have failed in the past.

Mid-levels are taught to work in a collaborative practice (atleast PAs are). Their curriculum thus emphasizes certain concepts of MD training and foregoes certain aspects of MD training. This psychology of being taught incompletely to be the top gun, but legally obliged to be the co-pilot, in practice can have even more serious ramifications then the ones you stated above.

Astute observations, however, aren't FMG's basically at the same level as 4th years after graduation? The FMG's I worked with, one from India and the other from China, were extremely smart folk, but I wouldn't say they're ready for autonomy any more than I am. There was one time when one of them did great with a liver/coags issue that I asked him to help with, but the rest of the times I consulted with them we had to bring the Attending in.
 
Astute observations, however, aren't FMG's basically at the same level as 4th years after graduation? The FMG's I worked with, one from India and the other from China, were extremely smart folk, but I wouldn't say they're ready for autonomy any more than I am. There was one time when one of them did great with a liver/coags issue that I asked him to help with, but the rest of the times I consulted with them we had to bring the Attending in.


As you know the training of physicians overseas is incredibly variable. there are some great programs and some which are frankly scary. I have met several fmg's who have graduated from their programs and passed step 1 and 2 who freely admitted to me that they had never touched a pt(aside from their classmates) or done a procedure of any kind. a russian fmg volunteering at a free clinic with me now who is trying to get a u.s. residency told me all of his clinicals were "observational" only. he followed a team around the hospital but never had his own pts or did any procedures. I have been teaching him to draw blood, suture, do I+D's, etc. it seems this is mainly true of fmg's from eastern europe(at least in my experience). I'm sure these guys have adequate book knowledge as they passed step 1 and step 2 but clinically they were not at the level of a graduate pa. I know these are limited examples but there are fmg's who don't match who are like this....
 
Astute observations, however, aren't FMG's basically at the same level as 4th years after graduation? The FMG's I worked with, one from India and the other from China, were extremely smart folk, but I wouldn't say they're ready for autonomy any more than I am. There was one time when one of them did great with a liver/coags issue that I asked him to help with, but the rest of the times I consulted with them we had to bring the Attending in.

A) Not all FMGs are the same. Some FMGs from India/Europe/etc could be full-fledged attendings in their country prior to coming here. FMGs from most of the satellite "affiliation" american schools in the Caribbeans/india/etc are basically the equivalent of 4th years after graduation. There is a huge generalization when the word FMG is used.

B) Regardless of where a student trained to be a physician, the mentality is the same. It is fact that physicians are trained to be ultimately responsible for every patient that walks through the door, everywhere in the world. They are the highest trained personnel in medicine. This differs from the PA approach, where they will probably only be ultimately responsible for the majority of their patients and thus, rather then taught the intricate fine details to approaching every patient, are taught what 80-90% of patients present with and more importantly, when to appropriately consult & refer out when complex cases present (this is strongly emphasized in their curriculum). In this model, the entire system works extremely efficiently.

C) Didn't see your post there, emed
 
B) Regardless of where a student trained to be a physician, the mentality is the same. It is fact that physicians are trained to be ultimately responsible for every patient that walks through the door, everywhere in the world. They are the highest trained personnel in medicine.

A) Please re-read my previous post and B) yes, emed brings up some good points.
 
Great points drift! You are one of the voices of reason in this forum. Since some PAs here claim that PA school=med school only shorter and some PAs imply that they are better than physicians (including FMGs), I asked some friends about the abilities/capabilities of PAs in the clinical setting and I was told that they ask a lot of questions and that they only get the simple cases (nothing wrong as they are midlevels).
 
The connotations of such sweeping statement is that PAs are better clinicians than FMGs. Moreover, if FMGs cannot function well as PAs, how much more as resident-physicians? Such connotations are harmful to the reputation of FMGs.
Actually I never said that PAs are better clinicians than FMGs. What I said was that FMGs placed in the PA role they fail to preform at a level expected of PAs. To be truthful the full statement should have been that FMGs that are not trained as PAs when placed in a PA role fail to preform as expected of PAs.

We know that FMGs can do a good job as PAs. The simple fact that 2-3% of PA students are physicians (all FMGs to the best of my knowledge) and that they do as well as non-physician PA students by all measures shows this is true. Also given their relatively small numbers they do not show up disproportionately on the BOMs or National Practitioner Data Bank.

You can argue any number of reasons why this disparity, but I think that it comes down to a few factors. One is that the population of FMGs that cannot get a residency is probably different than the one that can. Whatever the reason, low step I, multiple step failures etc, for the most part there is a reason that the PDs have not selected them for residency. These same reasons make it unlikely that they will preform well as a PA without additional training (as a PA). The second point at least anectdotally looking at FMG PA students is that most of them have been out of medicine for a period of time. The state BOMs are starting to use a two year rule that has some validity looking at the NPDB data. Basically if you have been out of medicine as a physician (or PA) for more than 24 months you are going to have to show in a structured setting that you know how to practice medicine. Given that some of these FMGs have been out of medicine for five years or longer its very unlikely that they will be successful practicing as PAs for the same reason that its unlikely that they will be successful in a residency.

If you want to be a physician the way to do that is go to medical school. There should be no shortcuts. The same way if you want to be a PA, you should go to PA school. No shortcuts. They are two separate and distinct careers with separate training pathways which are well documented to produce competent providers.
 
I asked some friends about the abilities/capabilities of PAs in the clinical setting and I was told that they ask a lot of questions and that they only get the simple cases (nothing wrong as they are midlevels).
so you have never worked with a pa and yet you make lots of statements here about our abilities and what we should call ourselves? WTF IS THAT? that is insincere AT BEST.....I've reviewed your post hx here and the vast majority of your posts are about undercutting pa's/np's who apparently you have no personal experience with.

guess what? not all pa's "get simple cases". many of us staff icu's and emergency depts without a physician present and work with a high degree of autonomy(with physician phone back up as needed)....my last shift several of my "simple cases" ended up getting admitted to the icu and the first physician to be involved in their care in any way was the admitting intensivist....
(are you perhaps one of those fmg's who couldn't match and think you should be able to do my job? does "post doc" perhaps actually mean "pre-intern"? )
I've worked with MANY fmg's from all over the world over the last 24 years. many are truly cream of the crop, top notch physicians. at my first job I precepted an fp intern who used to be an ent doc in south africa. incredible doc. I have also worked with many fmg's who either couldn't pass boards or passed boards and couldn't match who were frankly unsafe and dangerous. core0 brought up an excellent point elsewhere. for these folks to practice they don't need to be pa's. a category of "supervised physician" could be created. these folks are physicians and if they are going to work they should work in that capacity either with supervision if that's the best they can do or as fully licensed docs if they can match and finish a residency.
 
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I feel like everyone really learns a lot from these little battles.
 
I feel like everyone really learns a lot from these little battles.
things like it's nice to respect your colleagues and not bad mouth entire professions without any direct knowledge?
yeah, I would agree with that...
 
I asked some friends about the abilities/capabilities of PAs in the clinical setting and I was told that they ask a lot of questions and that they only get the simple cases (nothing wrong as they are midlevels).

Ofcourse they ask questions (I remember how many infinite minute questions I asked as an intern, I'm sure you did too, everyone does). Any responsible healthcare provider would ask questions when in doubt, it's how they learn. It's a good (great) sign that they are willing to acknowledge that they still have something to learn (some aren't even willing to admit that, and thats when the real damage happens). Although, while this is how it may seem on paper, if you are able to observe them in practice, you will see that this is generally only true in the first 1-2 years as a new-grad PA and absolutely not representative of their role as a whole. The simple cases, yes PAs often will deal with simpler cases then physicians, but once again, that's not to mention that a PA with say 4-5 years of experience in a field can probably see just about as high acuity patients as many physicians could. Actually in several hospitals, PAs and MDs will see patients interchangeably; same acuity. The key here is they should know when to consult their SP, and know when to refer cases out. I think you are giving PAs a bit too little credit.
so you have never worked with a pa and yet you make lots of statements here about our abilities and what we should call ourselves? that is insincere AT BEST.....
guess what? not all pa's "get simple cases". many of us staff icu's and emergency depts without a physician present and work with a high degree of autonomy....my last shift several of my "simple cases" ended up getting admitted to the icu and the first physician to be involved in their care was the admitting intensivist....
(are you perhaps one of those fmg's who couldn't match and think you should be able to do my job? does "post doc" perhaps actually mean "pre-intern" )

see above
 
Drift- thank you once again for injecting sanity and reason into this discussion. I do appreciate it and your ongoing support of pa's. it's physicians like you who are a pleasure to work with and be supervised by.
 
Actually in several hospitals, PAs and MDs will see patients interchangeably; same acuity. The key here is they should know when to consult their SP, and know when to refer cases out.

this is the case at all of my current jobs; one chart rack that all pa's and docs draw from. I could be working up elderly chest pain while the doc is suturing a thumb lac or vis versa. I have left several jobs that were not structured this way when I felt like I was ready to step up to a higher scope of practice with more autonomy. of course when I need help I ask for it. most pa's should not start out with this kind of scope of practice, it should be something you work your way up to over many years of supervised practice gaining knowledge and skills along the way. right out of school I did glorified fast track (FT+ abd pain). after a few years of that I worked my way into a position seeing sicker folks with a doc there every moment. now after 20+ years most of my shifts I work as solo nights or when I work with a doc on day shift we pull from the same chart rack as above. I'm now a member of state, federal, and international disaster medical teams and when I deploy am used interchangeably with a doc with no formal oversight.
 
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The public doesn't even know what a "medical assistant" is. To most patients, they're all "nurses." Just ask them.

That's because most doctors refer to their office staff (MAs) as "nurses." No wonder patients are confused.
 
altap said:
To coreo: You take a number of foreign born FMGs in California, Oklahoma, Florida and NY who do not have the USMLEs under their belt and then you say, since these FMGs are incompetent then all FMGs must be incompetent. Sorry, but adding other states won't make emedpa's argument hold water, it still is flawed. Like I said, just as there are bad FMGs, there are also bad PAs and no profession is exempted from this.


To Altap, Drift, and other proponents of FMG => PA:

Should every FMG who scores better-than-average on the USMLE be able to take a seat in a US residency program, displacing US-students who did not score better than average (i.e., should US students have to directly compete with FMGs for residencies)? Why or Why not?

Admittedly, wouldn't this be a better option than letting FMGs become PAs? After all, FMGs were trained to go into residencies as opposed to trained to become PAs.
 


To Altap, Drift, and other proponents of FMG => PA:

Should every FMG who scores better-than-average on the USMLE be able to take a seat in a US residency program, displacing US-students who did not score better than average (i.e., should US students have to directly compete with FMGs for residencies)? Why or Why not?

Admittedly, wouldn't this be a better option than letting FMGs become PAs? After all, FMGs were trained to go into residencies as opposed to trained to become PAs.

fmg's who pass usmle steps already compete with us medical grads for residency seats. the current problem is that there are now many more qualified applicants than seats. for us residency slots as a general rule for those with the same scores us md grads>us do grads>fmg's so the fmg's -even with good scores- can get left high and dry.
the do's have their own residency slots so they have a fall back if they don't get a desired md slot that md's and fmg's can't currently apply for. it used to be that going to a good fmg program-say grenada for example - and doing well on usmle guaranteed a slot in a us residency. that is no longer the case.
 
fmg's who pass usmle steps already compete with us medical grads for residency seats. the current problem is that there are now many more qualified applicants than seats. for us residency slots as a general rule for those with the same scores us md grads>us do grads>fmg's so the fmg's -even with good scores- can get left high and dry.
the do's have their own residency slots so they have a fall back if they don't get a desired md slot that md's and fmg's can't currently apply for. it used to be that going to a good fmg program-say grenada for example - and doing well on usmle guaranteed a slot in a us residency. that is no longer the case.
Are you referring strictly to FMGs who are US-citizens. I'm referring to FMGs of any nationality. From what I've read, FMGs of foreign nationalities are expected to perform exceptionally well on a USMLE in order to be considered for a residency.
 
Are you referring strictly to FMGs who are US-citizens. I'm referring to FMGs of any nationality. From what I've read, FMGs of foreign nationalities are expected to perform exceptionally well on a USMLE in order to be considered for a residency.

That is what his post said. He said all things being equal the pecking order in terms of competitiveness is US MD > US DO > FMG/IMG. This pretty much goes for any FMG/IMG.
 
You're forgetting that PAs are licensed and under the control of the state Medical Board in most places. Until that changes, PAs aren't going to be able to change their scope without physician approval.

Oh sure, but you are blind to the bigger picture.

PAs are essentially "sweet talking" their way to independence. This is how it works

1. PAs ask state medical boards to loosen supervision requirements. Their pitch on this is that MDs should be able to "supervise" 300 PAs, even at remote distant clinical sites with no direct patient oversight.

2. The MDs on the board love this idea. Its enticing to the PCPs that they can "supervise" PAs and easily quadruple their income.

3. 10-15 years pass by

4. PAs go back to the state legislatures and say "this is sham supervision, we have essentially been working independently for 10 years. Our "supervisors" have never laid hands on any of our patients. We deserve independence"

Just like the NPs, just like the CRNAs, its the MDs themselves who sold out our profession for a few extra dollars. The PAs recognize this and they will use it to their advantage.
 
interesting. as an em pa I have authority over pa students, md students AND residents who rotate on my service.

Emed:

You know I'm pro-PA, but "authority over md students and residents"? I smell an ACGME violation....and that must be one awful residency program.

Sorry dude, but no program worth it's salt has midlevels anywhere near an "authority" over med studs or residents..
 
What about US DO/MD grads who can't land a residency?

We'll see this in the future....it's gonna be a bloodbath. Let em work as "midlevels" to pay off their now 300k+ and rising loans for goodness sakes...

Its not that all FMGs are incompetent, its that when placed in a job that they were not trained for (collaborative supervised medicine) they perform a poor job. To take Florida in particular its not just a few but over 100 FMGs. As you state its a heterogeneous group. Some were USMLE qualified and unable to get residencies. Others were unable to prove that they had graduated medical school since their school was in a country no longer friendly to the US government. The one universal truth is they were unable to pass a test on clinical knowledge specifically designed for them. The other opinion is that once in practice as a group they failed to preform at a level expected of PAs.

Its also not just one experiment. The same experiment was tried in Oklahoma, California and on a smaller scale New York. All of these
experiments ended in dismal failure. One definition of insanity is doing the same thing over and expecting different results.

There are two issues here. One is public safety. If you look at either malpractice claims results or National Practitioner Data Bank data its obvious that physicians who do not complete residency have more claims than physicians that do. In a similar manner PAs that go to PA school have less claims that PAs that don't. What this says to me is that its not just having the knowledge but being trained in the role and getting appropriate exposure to the field.

The other issue is physician competition. You could easily let every FMG in the US work simply by implementing a new license type. Something like "supervised physician". This would allow all the FMGs and non-matching US grads to work as a physician under the supervision of a fully licensed physician. After all as graduates of medical school thats what they are - correct? Physicians?. On the other hand this will never happen. The US medical system is predicated on the concept that a physician has a unrestricted license to practice medicine. There is no political will or desire to introduce further competition into the system.

Foreign Medical Grads are a physician issue. If you want to solve any "problem" solve it in the physician system.
 
What about US DO/MD grads who can't land a residency?

We'll see this in the future....it's gonna be a bloodbath. Let em work as "midlevels" to pay off their now 300k+ and rising loans for goodness sakes...

no one is against them working, just not as pa's. as david says call them" supervised physicians" and let them work with a doc for a yr or 2 until they land a residency slot. they are physicians. there is no reason to call them pa's or license them as such..
 
Unbelievable immaturity in this thread. It's a shame that those exhibiting this are allowed to provide health care to patients.
 
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