It's official: Physician Associate (not Assistant).

[Lem0nz]

Only in medicine do we let ourselves be walked all over. And then have members of our own profession shame us for trying to stand up.

Depends on the lens. The anti midlevel crowd has no problem shaming other physicians themselves and does so frequently.

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[Matthew9Thirtyfive]

Depends on the lens. The anti midlevel crowd has no problem shaming other physicians themselves and does so frequently.

Uh yes. Because the people they are shaming are going out of their way to shame or guilt other physicians and med students for praising their own profession and pointing out the differences in education and care. Little bit of a difference there.

 

[Lem0nz]

Uh yes. Because the people they are shaming are going out of their way to shame or guilt other physicians and med students for praising their own profession and pointing out the differences in education and care. Little bit of a difference there.

No. It isn't. You can look at this thread, or many others, and see me or multiple others that frequent here and chat get vilified for sharing opinions that disagree. It is hardly 'going out of our way to shame you (or others)' to say that the problem is over stated compared to our real world experiences and midlevels are valuable additions to the team.

 

[Lawpy]

Depends on the lens. The anti midlevel crowd has no problem shaming other physicians themselves and does so frequently.

Those physicians are being called out for willingly destroying the profession and shaming residents and students

 

[Lawpy]

We need to stop giving midlevels this insane monopoly power when they themselves can and should be easily replaced.

 

[VA Hopeful Dr]

Uh yes. Because the people they are shaming are going out of their way to shame or guilt other physicians and med students for praising their own profession and pointing out the differences in education and care. Little bit of a difference there.

I dunno man, that's not how I see it. For me, I believe (and will tell med students who rotate me as much if they ask) that midlevels are in no way our equals but they do have value if utilized properly.

But, there's no reason to be jerks to midlevels you encounter. Show that you're better with your knowledge. And (for me personally) if a midlevel gets uppity with me or a medical student/resident I will happily smack them down. But in my experience that is very rarely needed. In 11 years of being a physician I've never had any trouble with one.

 

[Lem0nz]

Those physicians are being called out for willingly destroying the profession and shaming residents and students

Lawpy, I'm one of those physicians. Do you really think I'm here destroying the profession of medicine and shaming residents and students? Seriously?

 

[Lawpy]

Lawpy, I'm one of those physicians. Do you really think I'm here destroying the profession of medicine and shaming residents and students? Seriously?

I honestly think you're the only one in the pro midlevel physician crowd who isn't in that group. Everyone i witnessed in irl are rather selfish attendings who are willing to screw over med students. At least i got more hooked in surgical oncology from your posts

 

[Matthew9Thirtyfive]

I dunno man, that's not how I see it. For me, I believe (and will tell med students who rotate me as much if they ask) that midlevels are in no way our equals but they do have value if utilized properly.

But, there's no reason to be jerks to midlevels you encounter. Show that you're better with your knowledge. And (for me personally) if a midlevel gets uppity with me or a medical student/resident I will happily smack them down. But in my experience that is very rarely needed. In 11 years of being a physician I've never had any trouble with one.

Okay but that’s not what we’re talking about at all. The majority of the people who are speaking out about midlevel independence and scope creep are not being jerks to midlevels and will straight up say they have no problem with individual midlevels.

The ones who are being jerks to them just because they’re midlevels are just as bad as the simps.

 

[Matthew9Thirtyfive]

Lawpy, I'm one of those physicians. Do you really think I'm here destroying the profession of medicine and shaming residents and students? Seriously?

Are you shaming med students and residents for saying that physicians should lead the healthcare team and that midlevels shouldn’t be practicing independently? Are you posting that your midlevels are as good or better at your job than you?

If the answer to those questions is no, then you aren’t who we’re talking about.

 

[Lawpy]

Physician assistants are surgical residents. Shameful.

https://www.montefiore.org/pa-residency-program-overview MIMIS is a center of excellence to instruct surgeons, surgical residents (physician and PAs) in established laparoscopic techniques and to develop new techniques and instrumentation. For the PA and physician residents there are dry lab...

forums.studentdoctor.net

 

[NY_Med]

Statement on AAPA change of 'physician assistant’ title

The AAPA has changed the title ‘physician assistant’ to ‘physician associate’. The physician associate name change will only confuse patients about who is providing their care. Here's the AMA's position on the physician assistant name change.

www.ama-assn.org

A pretty weak statement, but at least it is something.

 

[Matthew9Thirtyfive]

Statement on AAPA change of 'physician assistant’ title

The AAPA has changed the title ‘physician assistant’ to ‘physician associate’. The physician associate name change will only confuse patients about who is providing their care. Here's the AMA's position on the physician assistant name change.

www.ama-assn.org

A pretty weak statement, but at least it is something.

Yeah. Better than nothing, but not as strong as the AOA statement.

 

[deleted966164]

But then... this is the mindset. Yesterday, I spoke with an incoming PA student. They are excited for the white coat ceremony etc. Ok. The program they will be attending has some classes shared with OMS1. Every time they said that they will have classes with the "first years" there was a lot of disdain in the voice. Like they're better than them. And the cherry on top of the cake - when I was asked about possible specialties I consider, I said "well, trauma surgery is on the radar." The response was - "I could totally see myself doing that in the future."

I am thinking of quitting medicine altogether.

 

[Matthew9Thirtyfive]

But then... this is the mindset. Yesterday, I spoke with an incoming PA student. They are excited for the white coat ceremony etc. Ok. The program they will be attending has some classes shared with OMS1. Every time they said that they will have classes with the "first years" there was a lot of disdain in the voice. Like they're better than them. And the cherry on top of the cake - when I was asked about possible specialties I consider, I said "well, trauma surgery is on the radar." The response was - "I could totally see myself doing that in the future."

I am thinking of quitting medicine altogether.

Eh. I have heard that from incoming PA students and preclinical PA students. A lot of them change their tunes after they do some rotations and see how much more the med students know.

 

[Lawpy]

But then... this is the mindset. Yesterday, I spoke with an incoming PA student. They are excited for the white coat ceremony etc. Ok. The program they will be attending has some classes shared with OMS1. Every time they said that they will have classes with the "first years" there was a lot of disdain in the voice. Like they're better than them. And the cherry on top of the cake - when I was asked about possible specialties I consider, I said "well, trauma surgery is on the radar." The response was - "I could totally see myself doing that in the future."

I am thinking of quitting medicine altogether.

... that seems dramatic

 

[deleted966164]

... that seems dramatic

Yeah... it's up there with some of the ED patients

 

[NY_Med]

But then... this is the mindset. Yesterday, I spoke with an incoming PA student. They are excited for the white coat ceremony etc. Ok. The program they will be attending has some classes shared with OMS1. Every time they said that they will have classes with the "first years" there was a lot of disdain in the voice. Like they're better than them. And the cherry on top of the cake - when I was asked about possible specialties I consider, I said "well, trauma surgery is on the radar." The response was - "I could totally see myself doing that in the future."

I am thinking of quitting medicine altogether.

Frankly, as a premed, I feel most students were back and forth between medicine and PA (me especially included) for some time. There were clear benefits and negatives of each, and there were reasons I chose medicine over the PA route. I feel most premeds go through that phase; I don't understand where these delirious students come from. Maybe accelerated programs that didn't give them the opportunity to choose anything different from the PA route?

 

[Arthur Morgan]

Frankly, as a premed, I feel most students were back and forth between medicine and PA (me especially included) for some time. There were clear benefits and negatives of each, and there were reasons I chose medicine over the PA route. I feel most premeds go through that phase; I don't understand where these delirious students come from. Maybe accelerated programs that didn't give them the opportunity to choose anything different from the PA route?

For me it was a mixed bag. Some knew they wanted PA straight out of high school and into college because of their parents being physicians and the lifestyle. Others drifted from being pre-med because they felt that midlevels could make a decent six figures after their training was done without the extra 4 + n years. Oddly, the latter group actually did well in weeder classes and could’ve had decent MD/DO apps if they chose to pursue it.

 

[Rhorn]

Statement on AAPA change of 'physician assistant’ title

The AAPA has changed the title ‘physician assistant’ to ‘physician associate’. The physician associate name change will only confuse patients about who is providing their care. Here's the AMA's position on the physician assistant name change.

www.ama-assn.org

A pretty weak statement, but at least it is something.

I don't get it. The AMA and other top level physician lobby groups are supposed to be the top level and the "ones in charge" when it comes to medicine. They are responsible for enabling the environment. Mid level creep wouldn't be an issue if the AMA saw patients as actual people instead of dollar signs. The AMA spends way more in lobbying than the AANP and AAPA. There wouldn't be a huge shortage of physicians in every state and many of the other problems with medicine if it wasn't for the AMA creating the shortage to facilitate corporate greed (makes sense that this happens because more physicians means less money going to others).

Seems to me like it's just all talk and no action which is not surprising.

 

[slowthai]

Every time they said that they will have classes with the "first years" there was a lot of disdain in the voice. Like they're better than them. And the cherry on top of the cake - when I was asked about possible specialties I consider, I said "well, trauma surgery is on the radar." The response was - "I could totally see myself doing that in the future."

 

[thatchemguy]

I don't get it. The AMA and other top level physician lobby groups are supposed to be the top level and the "ones in charge" when it comes to medicine. They are responsible for enabling the environment. Mid level creep wouldn't be an issue if the AMA saw patients as actual people instead of dollar signs. The AMA spends way more in lobbying than the AANP and AAPA. There wouldn't be a huge shortage of physicians in every state and many of the other problems with medicine if it wasn't for the AMA creating the shortage to facilitate corporate greed (makes sense that this happens because more physicians means less money going to others).

Seems to me like it's just all talk and no action which is not surprising.

Does the AMA really spend more in lobbying than the AANP and AAPA? That is news to me.

 

[SurfingDoctor]

I have yet to experience any of it at my school’s sites, but I know friends at other schools who have plenty of attendings who are clearly there for the prestige of academics and/or the research opportunities.

To be fair, academic promotion is based on research, not how many patients you see and RVUs you generate. Thus, having someone else generate the RVUs that you can signoff on whilst you go and do the thing that actually nets you a long-term reward is a no-brainer for most. You can fault those attendings, but you really should be faulting the system that lead to that being the pathway to success.

Don't hate the player, hate the game.

 

[Lawpy]

To be fair, academic promotion is based on research, not how many patients you see and RVUs you generate. Thus, having someone else generate the RVUs that you can signoff on whilst you go and do the thing that actually nets you a long-term reward is a no-brainer for most. You can fault those attendings, but you really should be faulting the system that lead to that being the pathway to success.

Don't hate the player, hate the game.

Wait i thought there were education and clinical tracks for tenure at many schools? So it's just not research based?

 

[Matthew9Thirtyfive]

Don't hate the player, hate the game.

Or I can hate the game and call out the people willingly playing it at the expense of others. It’s a false dichotomy to imply you can only blame one.

 

[SurfingDoctor]

Wait i thought there were education and clinical tracks for tenure at many schools? So it's just not research based?

There are education tracks, they typically require publication and curriculum development for promotion. Students and trainees have this false belief that teaching students at bedside is academics. I mean, it’s a part of it, but it is not considered to be an educational track nor does it yield promotion.

There’s no such thing as clinical or educational tenure. Tenure tracks are generally reserved for physician-scientists and what’s more, scientists with consistent NIH funding (tenure is also mostly BS... but that’s a different discussion). More commonly, there are clinical spots in academics since even teaching hospitals know medicine is a business that needs to generate profits. Typically their educational responsibilities are nil. I think ideally, the make up of departments is 25% staff scientists, 25% educators and 50% clinical track, realizing there is a lot of variation in those models. But nearly for all of those tracks, while bedside teaching is somewhat expected, it is not rewarded, so you can imagine how that turns out.

 

[SurfingDoctor]

Or I can hate the game and call out the people willingly playing it at the expense of others. It’s a false dichotomy to imply you can only blame one.

I mean, nearly every single academic hospital I’ve been employed at in the past decade uses advanced practitioners (in my training, that wasn’t true, but times change). So I guess you’d being calling out a lot of people nowadays. Nay, nearly everyone at a hospital.

 

[Matthew9Thirtyfive]

I mean, nearly every single academic hospital I’ve been employed at in the past decade uses advanced practitioners (in my training, that wasn’t true, but times change). So I guess you’d being calling out a lot of people nowadays. Nay, nearly everyone at a hospital.

Well it’s not the use of them. I don’t care if you use midlevels appropriately. The NICU and gen surg NPs here are amazing. But when you’re regularly putting down the physician profession, saying that you couldn’t do your job without them and that they know more medicine than you, and you’re shaming other physicians for promoting physician-led care, then it’s a problem.

 

[futureapppsy2]

Oh yeah this is awful too. But I don’t think it’s many, I think it’s just the minority. The biggest social media med student personality in my class failed out by the end of M1.

There's also this fairly public case: https://advancingwomen.com/diva-failing-med-school-became-biggest-success/

 

[SurfingDoctor]

Well it’s not the use of them. I don’t care if you use midlevels appropriately. The NICU and gen surg NPs here are amazing. But when you’re regularly putting down the physician profession, saying that you couldn’t do your job without them and that they know more medicine than you, and you’re shaming other physicians for promoting physician-led care, then it’s a problem.

Oh. Well, that’s never been my personal experience. Most APs shy away from responsibility in my field and literally function as just super residents.

 

[Rhorn]

Does the AMA really spend more in lobbying than the AANP and AAPA? That is news to me.

Yes.

AMA Budget 2019 ~$21 Million

AAPA Budget 2019 ~$670k

AANP Budget 2019 ~$800k

You can look at 2020 but the pattern is similar. I used 2019 because its a "normal" year compared to 2020, so the budget isn't an outlier.

With the amount of money that the AMA pumps out you'd expect alot of the issues in medicine to be resolved but they persist because they have ulterior motives. You can even look at the ANA (Nurse Association) and their lobbying budget still pales in comparison.

 

[Matthew9Thirtyfive]

Oh. Well, that’s never been my personal experience. Most APs shy away from responsibility in my field and literally function as just super residents.

Yeah it’s a Twitter phenomenon.

 

[Matthew9Thirtyfive]

Yes.

AMA Budget 2019 ~$21 Million

AAPA Budget 2019 ~$670k

AANP Budget 2019 ~$800k

You can look at 2020 but the pattern is similar. I used 2019 because its a "normal" year compared to 2020, so the budget isn't an outlier.

With the amount of money that the AMA pumps out you'd expect alot of the issues in medicine to be resolved but they persist because they have ulterior motives. You can even look at the ANA (Nurse Association) and their lobbying budget still pales in comparison.

AFAIK, the AMA has actually been fairly successful at squashing a lot of bills at the state level. We just hear about the ones they can’t. That said, they haven’t been successful in preventing FPA in half the states in the country, so...

 

[Rhorn]

AFAIK, the AMA has actually been fairly successful at squashing a lot of bills at the state level. We just hear about the ones they can’t. That said, they haven’t been successful in preventing FPA in half the states in the country, so...

Yes exactly, using their cash flow to halt bills and be defensive of mid levels from creeping up while simultaneously creating and maintaining the physician shortage.

AAPA and AANP aren't the reason why there is a physician shortage. The environment only gives them more leverage to address the issue and gain more responsibility which is why its happening.

 

[Lem0nz]

Well it’s not the use of them. I don’t care if you use midlevels appropriately. The NICU and gen surg NPs here are amazing. But when you’re regularly putting down the physician profession, saying that you couldn’t do your job without them and that they know more medicine than you, and you’re shaming other physicians for promoting physician-led care, then it’s a problem.

Is this a thing you actually see in real life? And is common on Twitter? A doctor saying a midlevel knows more than him or her?

Your level of anger makes it seem commonplace but I have never seen any this behavior even in the most malignant institutions I’ve had the displeasure of having to be at. Genuinely curious, not sure what is lost in text. I originally thought your anger was more directed towards people like me but that seems wrong.

I have seen docs defend their midlevels against residents but the residents were legitimately being confrontational and rude which is poor form and I don’t think that’s what you’re talking about at all.

 

[Matthew9Thirtyfive]

Is this a thing you actually see in real life? And is common on Twitter? A doctor saying a midlevel knows more than him or her?

Your level of anger makes it seem commonplace but I have never seen any this behavior even in the most malignant institutions I’ve had the displeasure of having to be at. Genuinely curious, not sure what is lost in text. I originally thought your anger was more directed towards people like me but that seems wrong.

I have seen docs defend their midlevels against residents but the residents were legitimately being confrontational and rude which is poor form and I don’t think that’s what you’re talking about at all.

I’ve seen it on Twitter on at least a weekly basis, and almost a daily basis at times when averaged out. Any time the AMA or any group posts something about physician led care, the posts saying midlevels are all amazing and that we couldn’t do it without them come out in droves.

I have yet to see it in real life, but I am only at military facilities where the dynamic is different.

My “anger,” if you want to call it that, is directed at people who are actively pushing for midlevel independence, who employ or utilize midlevels without properly supervising them, and who actively try to shame anyone who wants physician-led care. I have zero problem with physicians who use midlevels in the way they were meant to be used, and I have had great experiences with midlevels in subspecialty settings like the NICU, where you have an NP who was a nicu nurse for years before becoming a nicu NP who is working under the supervision of a neonatologist. That’s literally the ideal scenario.

 

[Lem0nz]

I’ve seen it on Twitter on at least a weekly basis, and almost a daily basis at times when averaged out. Any time the AMA or any group posts something about physician led care, the posts saying midlevels are all amazing and that we couldn’t do it without them come out in droves.

I have yet to see it in real life, but I am only at military facilities where the dynamic is different.

My “anger,” if you want to call it that, is directed at people who are actively pushing for midlevel independence, who employ or utilize midlevels without properly supervising them, and who actively try to shame anyone who wants physician-led care. I have zero problem with physicians who use midlevels in the way they were meant to be used, and I have had great experiences with midlevels in subspecialty settings like the NICU, where you have an NP who was a nicu nurse for years before becoming a nicu NP who is working under the supervision of a neonatologist. That’s literally the ideal scenario.

Most of those are easy to imagine, even in real life. The only thing I can’t picture and haven’t ever really come close to is doctors shaming other doctors for wanting physician led care.

Fair reply. Thanks.

 

[Chads2]

There's also this fairly public case: https://advancingwomen.com/diva-failing-med-school-became-biggest-success/

I clicked on it and read most of it and I feel dumber as a result.

 

[Matthew9Thirtyfive]

Most of those are easy to imagine, even in real life. The only thing I can’t picture and haven’t ever really come close to is doctors shaming other doctors for wanting physician led care.

Fair reply. Thanks.

Yeah I haven’t seen that part in real life. Only on Twitter. I feel like it’s for fake internet points so they can get some sort of weird Twitter clout. Apparently that’s a real thing in medtwitter.

 

[Lawpy]

Is this a thing you actually see in real life? And is common on Twitter? A doctor saying a midlevel knows more than him or her?

This is pretty common from what i'm seeing irl

Although maybe i just have the misfortune of seeing crappy attendings more often than not

 

[VA Hopeful Dr]

AFAIK, the AMA has actually been fairly successful at squashing a lot of bills at the state level. We just hear about the ones they can’t. That said, they haven’t been successful in preventing FPA in half the states in the country, so...

They are usually successful but it's a slow erosion. This year 2 state senators support unsupervised practice. Next year it's 5. The next it's 10. You get the idea.

 

[Ho0v-man]

 

[Lawpy]

View attachment 338793

I need to watch it soon

 

[The kitchen sink]

It's hard not to get that first part from your post because you actually said it. This isn't a case of being misunderstood. Your words stand on their own there. All I did was bold it for emphasis. This post I'm quoting now might add some qualifying statement (that I agree with) but it still doesn't change the fact that you legitimately said that.

Why call other physicians a colleague? Do you even actually think they are? Your actions don't particularly agree with that if you can't be bothered to support a movement because someone online wasn't nice to you. Some person online was a meanie so I'm taking my ball and going home haha. Patient safety be damned. Less work be damned. Less annoying consults be damned. This person hurt my feels. Alright, man, I get it. It's cool. They are colleagues when you want to turf some BS to them but not colleagues when outside forces are trying to destroy their field. That's convenient, though I can't blame anyone. I think Ortho is the smartest guys in the hospital by far and hold no ill will toward them. I don't hold any ill will toward surgery trying to operate as much as possible and avoid other things if they have the power to do so. I would do it too if I didn't think it would shoot myself in the foot with more work in a midlevel hellscape. Let's just keep it real though on the relationship.

And for the record, I have a pretty pragmatic view of human behavior and motivation. I really don't care what surgery says or does. I don't think it ultimately matters and I'm ultimately not worried about it (I meant what I said about self-sufficiency in my life). I just think you, as a poster here, are funny to watch in these threads play both sides of the ball then get upset and play the victim too.

Jeez man, you didn’t have to do him like that sheeeeesh

….. well nah nvm you probably did 🤣

 

[Ho0v-man]

I need to watch it soon

I only did because of the memes. Ended up binging it. Pretty good.

 

[Matthew9Thirtyfive]

I only did because of the memes. Ended up binging it. Pretty good.

Eh it’s okay. Based on the first episode I am not thrilled to keep watching.

 

[Lawpy]

Eh it’s okay. Based on the first episode I am not thrilled to keep watching.

The memes were basically spoilers that went out of control

 

[Ho0v-man]

Eh it’s okay. Based on the first episode I am not thrilled to keep watching.

Yeah. It’s got a bit of a generic vibe at first. Gets better when the mc starts striking out on his own.

 

[Konigstiger]

Eh it’s okay. Based on the first episode I am not thrilled to keep watching.

There were multiple points during the first episode where I almost dropped it because it was so badly written, but the ending of that episode was what got me to keep watching.

Sadly the generic writing/dialogue does not stop there, but I will admit it is better than I thought it would be (though I still haven't finished it yet).

 

[Lawpy]

There were multiple points during the first episode where I almost dropped it because it was so badly written, but the ending of that episode was what got me to keep watching.

Sadly the generic writing/dialogue does not stop there, but I will admit it is better than I thought it would be (though I still haven't finished it yet).

Is it bad i only watched the last episode and read the wiki to understand the story