NPs and PA students greatly outnumber med students now

[hyperbaric]

How true! Hyperbaric, I think the name kind of gives it away (Physician 'Assistant'), no?

Trust me. I know what the 'A' in P.A. stands for and I think, for the most part, it is a misnomer. Physician facilitator or physician practitioner might have been a better choice. Whatever the case, I think the above poster was trolling with his use of 'assistant'.

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[Chulito]

Pardon me if I'm the only one here who doesn't know this, but what is the difference between a physician assistant and a nurse practitioner? I have worked in contexts where there were many of both, and they seemed interchangeable. What I mean by that is that they had all the same responsibilities and equal authority to see all the same types of patient, etc. Someone mentioned a few posts back that NPs can in fact operate a clinic independent of any supervising physician, unlike PAs. What is the difference in their training? What is the difference in the level of responsibility that they can legally have? Why do we have both?

 

[mules05]

Pardon me if I'm the only one here who doesn't know this, but what is the difference between a physician assistant and a nurse practitioner? I have worked in contexts where there were many of both, and they seemed interchangeable. What I mean by that is that they had all the same responsibilities and equal authority to see all the same types of patient, etc. Someone mentioned a few posts back that NPs can in fact own operate a clinic independent of any supervising physician, unlike PAs. What is the difference in their training? What is the difference in the level of responsibility that they can legally have? Why do we have both?

My understanding of the difference is that to be a PA, one needs to complete a PA program, most of which are a master's degree level, but there are also some programs at the level of a batchelor's or associate's degree that confer the same certification. To complete a master's program one needs a batchelor's degree, but I believe your undergrad can be in any area prior to attending PA school.

NPs, on the other hand, must hold a batchelor's degree in nursing and be a licensed RN with several years of nursing experience prior to pursuing the master's level training to become an NP, CRNA, or nurse-midwife. In my opinion this makes NPs very different from PAs- and may account for the fact that in my experience (please note this is MY experience only, not necessarily a generalization) EVERY PA I've run into is severely lacking in their clinical skills and knowledge, at least two to the point of gross negligence. Every NP I've run into has impressed me with their knowledge, skills, and bedside manner. Perhaps this is just luck of the draw that I've run into bad PAs and good NPs...but if I had to choose who to work with or which type of mid-level I'd want providing care to myself or my family, there's no doubt in my mind which I'd choose.

 

[dutchman]

Lord knows I am no big fan of doctors, but even I will tell you that anyone
dreaming that at some point public perception will equate nurses and PAs with doctors needs to snap out of that funk.
All the success PAs and NPs are having comes from the fact that they are able to blend in i.e disguise themselves as real doctors. You guys forget that people typically take matters relating to their health seriously and will typically look for the best solution(not the cheapest). Even acne patients will not pass up an MD for a PA if they had the choice. Now if a PA happens to walk in and write them a prescription--ofcourse they will take it, especially if they can't tell the PA apart from a physician, but that is no indication that they think PAs and MDs are the same.

A couple tips about how society traditionally reasons(some of which I hate)
-'Doctor' means 'smart'
-When they are sick they typically want to see a DOCTOR, and if they are really sick they especially want to see a really good DOCTOR.
-Nurses dont diagnose, they only take care of patients.
-If your title has the word 'assistant' you are probably not as good as whomever you are assisting.

So PAs and NPs need to remember these things when they start thinking about bringing themselves out in the open with all this "private practice" talk. IMO lay low and make your money.

 

[Beau Geste]

Leett'ss fighting looovee.

Good Times With Weapons. A classic.

 

[soonereng]

Pardon me if I'm the only one here who doesn't know this, but what is the difference between a physician assistant and a nurse practitioner? I have worked in contexts where there were many of both, and they seemed interchangeable. What I mean by that is that they had all the same responsibilities and equal authority to see all the same types of patient, etc. Someone mentioned a few posts back that NPs can in fact operate a clinic independent of any supervising physician, unlike PAs. What is the difference in their training? What is the difference in the level of responsibility that they can legally have? Why do we have both?

The reason we have both is that the people who wanted to start PA programs initially wanted to use RNs. The nursing boards said no way, that doesn't fit in with who an RN is. They later realized they had made a mistake and started NP programs independently which is why in many states NPs are governed by the nursing board rather than the medical board who governs PAs. This has allowed the NPs, who operate under their own licenses and not the licenses of MDs, to become semi-independent practitioners who can run their own clinics, although most states require a collaborating physician for referrals/advice.

 

[Wizard of Oz]

To complete a master's program one needs a batchelor's degree, but I believe your undergrad can be in any area prior to attending PA school.

At my school, the PA program accepts people with 90 hours of undergrad. They confer a Master of Health Science. Some of the students' undergraduate schools will give them a Bachelor's after the first year of PA school.

This doesn't have anything to do with clinical training, however.

EVERY PA I've run into is severely lacking in their clinical skills and knowledge.

Just to offer a different opinion, this isn't true where I live at all.

Even acne patients will not pass up an MD for a PA if they had the choice.

Where I live, the probability of seeing an MD dermatologist for zits is low unless you want to wait some time. Since derm residency slots aren't increasing in number any time soon, I expect that the trend will ramp up. This type of care is one example where PA's are both needed and becoming more utilized. I was on Accutane for a course and never saw the MD once. I couldn't pick him out of a police lineup if I had to. BTW, I didn't care, and I intentionally passed up the MD because I was familiar with his PA. So I am an exception to your statement.

 

[deleted6669]

My understanding of the difference is that to be a PA, one needs to complete a PA program, most of which are a master's degree level, but there are also some programs at the level of a batchelor's or associate's degree that confer the same certification. To complete a master's program one needs a batchelor's degree, but I believe your undergrad can be in any area prior to attending PA school.

NPs, on the other hand, must hold a batchelor's degree in nursing and be a licensed RN with several years of nursing experience prior to pursuing the master's level training to become an NP, CRNA, or nurse-midwife. In my opinion this makes NPs very different from PAs- and may account for the fact that in my experience (please note this is MY experience only, not necessarily a generalization) EVERY PA I've run into is severely lacking in their clinical skills and knowledge, at least two to the point of gross negligence. Every NP I've run into has impressed me with their knowledge, skills, and bedside manner. Perhaps this is just luck of the draw that I've run into bad PAs and good NPs...but if I had to choose who to work with or which type of mid-level I'd want providing care to myself or my family, there's no doubt in my mind which I'd choose.

A FEW PA/NP FACTS:
pa clinicals 2200 hrs+ vs 500-800 total for np. pa yr 2 is more similar to ms3. of the 2, pa's train in the medical model and are"more like doctors" in fact at many programs pa's do much of their didactic coursework with medstudents, while np's learn"advanced nursing practice". pa's and np's working in the same setting do the same things and make the same salary.the pa degree is a general medical exposure so pa's can see pts of all ages while the np training is limited to a specific field(peds, neonatal, etc). a peds np can't see adults. an adult np can't see kids. an ob np can't see men, etc fnp's(family nurse practitioner) is the most similar to pa in that they can see pts of all ages but they do not have the surgical training of the pa.
there are direct entry np programs that anyone with a bs in anything can get into so you don't need to be an rn with yrs of experience anymore. history major + prereqs+ 3 yrs = np. the traditional pa student was a paramedic/rn/rt before school although newer programs(unfortunately ) are admitting students with less experience now. there are lots of threads here about the differences between pa's and np's if you want to do a search.there are good and bad pa's and np's out there.

 

[Ypo.]

You guys forget that people typically take matters relating to their health seriously and will typically look for the best solution(not the cheapest).

hee hee. This statement makes me think that you have not yet actually practised medicine. Either that or you are out of touch with your patient's finances. People make decisions to cut their costs at the expense of their health all the time. When you have poor insurance (or no insurance) its a fact of life.


All this bull**** about NPs and PAs comes down to the fact that we are ALL VERY PROTECTIVE/DEFENSIVE/AGGRESSIVE ABOUT OUR SOURCES OF INCOME and we don't like competition. Nothing more (except for ego of course). Pretty crude when you look at it that way.

There is NOTHING to be worried about. Relax!

 

[8744]

Nice analogy Panda, but not quite 1:1 correlation (were you formerly an engineer?). The main difference between the two would be that midlevels are licensed to perform a certain scope of practice and have had training specific to that scope. Designer-drafters haven't had any engineering training nor are they licensed to perform any form of engineering, but rather they have had the drafting training, which really doesn't even qualify as a significant subset of engineering training (3 hrs out of >120 total in my undergrad). The midlevel training does quantify a significant subset of physician training.

PAs, NPs, CNMs, and CRNAs will never completely replace MDs; however, they should be allowed to practice within the scope of their training AND experience. If they can see 80% of the PCP patients effectively, let them do it. If through experience they can see 50-60% of the patients in a certain specialty, let them do it. We will have a better, more efficient, less expensive healthcare system in the end if we all work together, which was the topic of the article that was linked by the OP just in case no one took the time to read it.

- soonereng, PE

I was, in fact, a structural engineer for seven years of so. I had a PE license and my own engineering firm. I admit it's not a perfect analogy. But some of our design-draftsmen had taken associates-level degrees in Engineering Technology and could, for example, pick a W-section based on load and deflection.

We didn't use straight "draftsmen" much because by the time you finished explaining to the guy what you wanted, sometimes down to making an AutoCad drawing for him to use as a guide, you might as well have done it yourself. I also did a lot of mechanical design and detailing for the forest produicts industry (mostly materials handling) and we definitely wanted "mid-levels" who understood the purpose of the machine, how it worked, and where it went in the plant.

 

[Taurus]

hee hee. This statement makes me think that you have not yet actually practised medicine. Either that or you are out of touch with your patient's finances. People make decisions to cut their costs at the expense of their health all the time. When you have poor insurance (or no insurance) its a fact of life.

This is why midlevels are on the rise. For routine care, a midlevel is fine. If you are in serious trouble, then you find the best person which typically will be a doc and you will drain your entire life's savings if you have to.

 

[hyperbaric]

People make decisions to cut their costs at the expense of their health all the time.

Exactly. Can you say 'extra value meal'?

 

[core0]

hee hee. This statement makes me think that you have not yet actually practised medicine. Either that or you are out of touch with your patient's finances. People make decisions to cut their costs at the expense of their health all the time. When you have poor insurance (or no insurance) its a fact of life.


All this bull**** about NPs and PAs comes down to the fact that we are ALL VERY PROTECTIVE/DEFENSIVE/AGGRESSIVE ABOUT OUR SOURCES OF INCOME and we don't like competition. Nothing more (except for ego of course). Pretty crude when you look at it that way.

There is NOTHING to be worried about. Relax!

I agree with the part about sources of income. The part that McGyver and his ilk are desperate not to state is that with few exceptions, every PA and NP is working because a physician allows them to. In a lot of cases this is about protecting income. A PA or NP can bring in similar collections to a physician without the attached paycheck. There are also unlikely to expect partnership after a few years (there are rare exceptions to this). This is probably what has fueled the growth of PA's in specialty care.

Let's say you are a cardiologist. You make the most money sticking balloons in peoples arteries. You still have to take care of all those people with CHF and HTN and all the people that you have on Coumadin. Now to help with those you could bring on another physician which will mean a smaller piece of the angio pie for you or you could bring on a PA/NP to follow those chronic conditions (and whose salary will be largely paid for even with the medicare reimbursement rates).

Yes it's about income protection, but they also can be a substantial income booster. Don't forget that modern medicine is also a business.

David Carpenter, PA-C

 

[Beau Geste]

medicine has always been a business. Managed care made it the cluster *expletive* it is today.

 

[Miami_med]

Just as a personal observation, and there are about a bazillion exceptions to this, PAs probably have the more uniform training. My wife, who majored in Anthropology in college, though for a while about entering a direct NP program that involved only 2 years of training beyond her degree (she was once a science major and had some chem, physics, etc...). She could have been an NP with only about 1 year of TOTAL clinical training. PA training is really like MD training lite. NPs use a totally different model, often relying on previous clinical experience that never existed.

Of course, this doesn't include the NPs who did have extensive clinical training beforehand. If I were a patient, it would be in my best interest to know what the training requirements were for different midlevels. Due to the variability of quality between PAs and NPs, patients should want to know a little bit more about other credentials when they choose to rely on a midlevel who functions at a high capacity. This may be as simple as using a PA that is working for a doctor who you trust, who will likewise allow his midlevel to function at the appropriate level based of experience. I see no reason why PAs and NPs who manage to obtain significant experience on the job can't function at a reasonably high level, as long as the patient know who they are seeing.

 

[NonTradMed]

Thats because only in medicine do we have fools that decided to give away their profession.

Do you see lawyers letting paralegals file their own cases and open their own shops? Hell no.

Do you see dentists letting their dental assistants open up their own clinics? Hell no.

I think dental hygienists are trying to have legislation on the table which allows them to open up their own clinics (for cleanings only) and dentists are fighting to stop that. Turf wars are not exclusive to medicine.

 

[soeagerun2or]

Perhaps if we as MDs reigned in NPs and PAs on the state and national level we wouldn't be having these issues. A clearly defined role for NP/PAs as supervised mid-level care providers with sufficient training and oversight would go a long way. I'm not advocating GME style training for these people as they aren't qualified nor would that be beneficial to anyone. But some level of clinical competancy in the field, defined by MDs, should be required.

What I'm really trying to say is rather than let them define their role from the bottom up we need to do it from the top down and if they don't like it kick them out of allopathic medical hospitals.

 

[NonTradMed]

This is why midlevels are on the rise. For routine care, a midlevel is fine. If you are in serious trouble, then you find the best person which typically will be a doc and you will drain your entire life's savings if you have to.

This is very true. People are willing to cut corners but not when there's some serious consequences for it. Not many people are willing to have a nonsurgeon cut them open even if it does save them thousands of dollars. If NP/PAs are truly as good as they claim to be, market forces will bear them out. They will get paid the same amount for the same work that traditional primary care doctors have done. However, if they reach a limitation that is below their physician counterparts, then money will still flow into the coffers of the doctor for their extra training. People want the lowest prices for everything, but not when they end up losing an arm or leg or their lives over it. I think right now, we are not sure how much bearing the influx of NP/PA will have on the overall quality of care. Who knows? Maybe society will like the new arrangement b/c it delivers same care for less and the medical establishment will have to change their way of educating patients, or maybe the docs will have the last laugh when patients find out they are getting inferior care for the cheaper cost. Only time will tell.

 

[primadonna22274]

I think the unfortunate thing here is that you (Tired) might have been open-minded about allowing the PA to perform the procedure (and in most cases a relatively minor procedure unless the lipoma is deep and very large) but she lost clout by a) not identifying herself as "Ms. XYZ, Physician Assistant" and b) not wearing a name tag as required by law in I think every state where PAs are licensed that clearly states "Ms. XYZ, Physician Assistant" and c) her assistant misrepresented the provider who would be seeing you as "the doctor". Screwups x 3. Bummer. I'm sorry this happened and I think it happens more than it should.
I have been very conscientious to always wear my name tag with "PA-C" prominently displayed, because that's the law, and because it's the right thing to do. I also tell patients when I introduce myself that I am a Physician Assistant and only a handful of times in seven years has someone asked for another provider. Hundreds of times I have grabbed another provider (usually a doc) to look at the patient with me when I feel like I'm in over my head. Now, in a surgery setting, there should be a surgeon readily available if not in the immediate building at least by phone. But I'm afraid we can't rescue this particular situation as you already are ticked off.

And I'd be willing to bet most people would agree.

When I faced this situation, I would have been happy to let the PA do the case, as long as there were a supervising surgeon either in the room, or at bare minimum, readily available in case of complications.

I know exactly what it takes to get through a surgical residency and become board certified. But when the PA is holding the knife, I don't have a clue if this is her 1000th case, or 4th.

 

[Bitsy3221]

Perhaps if we as MDs reigned in NPs and PAs on the state and national level we wouldn't be having these issues. A clearly defined role for NP/PAs as supervised mid-level care providers with sufficient training and oversight would go a long way. I'm not advocating GME style training for these people as they aren't qualified nor would that be beneficial to anyone. But some level of clinical competancy in the field, defined by MDs, should be required.

What I'm really trying to say is rather than let them define their role from the bottom up we need to do it from the top down and if they don't like it kick them out of allopathic medical hospitals.

Done and done:

First off, please refer to post #87, which outlines the guidlines for PA-physician practice, which was adopted by the AMA.

Second, PAs are certified by the NCCPA (www.nccpa.net) by taking the national certifying exam on graduation and every six years. (That is where the "C" comes from in PA-C) Here is the NCCPA board of directors:
Randy Danielsen, PhD, PA-C - NCCPA Chair
William Kohlhepp, MHA, PA-C - NCCPA Immediate Past Chair

American Academy of Family Physicians
Frank Kane, MD, New Jersey

American Academy of Pediatrics
John W. Ogle, MD, Colorado

American Academy of Physician Assistants
John Davis, PA-C, Tennessee
Daniel L. McNeill, PhD, PA-C, Oklahoma

American College of Emergency Physicians
Lee Bryan Smith, MD, JD, West Virginia - NCCPA Chair Elect

American College of Physicians
Patricia Cook, MD, Canada

American College of Surgeons
Robert G. Martindale, MD, PhD, FACS, Oregon

American Hospital Association
Edward J. Dunn, MBA, SPHR, New Jersey - Executive Committee Member-at-Large

American Medical Association
Barbara Barzansky, PhD, Illinois

American Osteopathic Association
Donald Sefcik, DO, MBA, Illinois - NCCPA Treasurer

Association of American Medical Colleges
Emil R. Petrusa, PhD, Tennessee

Physician Assistant Education Association
Mark Christiansen, PA-C, Nebraska
William Kohlhepp, MHA, PA-C, Connecticut - NCCPA Immediate Past Chair

Federation of State Medical Boards
Ellen Harder, PA, Washington

As you can see, all the major medical organizations are represented by MDs or DOs.

In addition, the NCCPA with other organizations drafted in 2003 the Clinical Competencies. Here's what they had to say:

"The public demand for higher quality and greater accountability in health care has been growing steadily over the last several years, and various health care professions are responding in different ways. To address that issue within the PA profession, the four national PA organizations featured above joined together to define PA competencies, a critical starting point to identify opportunities for improvement in the development and assessment of those competencies.
The true value of this document, and of the competencies it describes, will be in how these are incorporated into the practice, training, and continuing education and evaluation of PAs. Our four organizations are exploring opportunities to refine and retool our programs to reflect these competencies. More importantly, all PAs can use the Competencies for the PA Profession document to evaluate their individual strengths and opportunities for personal growth, to help guide their choice of future CME and other training activities, and ultimately to become ever better clinicians. "

Here's the link, if you'd care to read the document: http://www.nccpa.net/pdfs/Definition of PA Competencies 3.5 for Publication.pdf

I apologize for the long link, but I am just trying, in the interest of evidence-based discussion, to let all the med students out there that are suspicious, distrustful or just not exposed to PAs that the PA governing organizations are aware of all the concerns discussed here and are promoting the profession not as a substitution or to trump physicians, but to complement MD's care. PAs do not govern themselves--even on the national and lawmaking level they work very closely and intimately with MDs in defining and redefining their role and the track of PA education.

 

[MacGyver]

I apologize for the long link, but I am just trying, in the interest of evidence-based discussion, to let all the med students out there that are suspicious, distrustful or just not exposed to PAs that the PA governing organizations are aware of all the concerns discussed here and are promoting the profession not as a substitution or to trump physicians, but to complement MD's care. PAs do not govern themselves--even on the national and lawmaking level they work very closely and intimately with MDs in defining and redefining their role and the track of PA education.

I appreciate your sincerity but with all due respect you are tremendously naive.

I'm so sick of hearing this BS about how PAs dont want to replace doctors, they just want to "complement" us. Meanwhile they are going behind your back and pulling stuff like this: http://www.ohiopa.com/PA%20Bulletin.htm

PAs who work at hospitals and other defined “health care facilities” are not required to have physician supervisory plans or special services plans. Rather, those PAs may practice in accordance with the credentialing and policies of the hospital or health care facility.

For those who dont want to click the link, basically what happened is that the pro-PA lobby in Ohio pushed thru a new state law which says that all PAs who work in hospitalist settings NO LONGER NEED PHYSICIAN SUPERVISION.

So pardon those of us who dont believe that the PAs and NPs just want to "complement" doctors. Thats a load of crap.

 

[Bitsy3221]

I appreciate your sincerity but with all due respect you are tremendously naive.

Wow...thanks for your opinion. Having gone to PA school, worked full time as a PA for several years, and now completing medical school I am inclined to disagree that I am "tremendously naive" to this discussion

I'm so sick of hearing this BS about how PAs dont want to replace doctors, they just want to "complement" us. Meanwhile they are going behind your back and pulling stuff like this: http://www.ohiopa.com/PA%20Bulletin.htm
For those who dont want to click the link, basically what happened is that the pro-PA lobby in Ohio pushed thru a new state law which says that all PAs who work in hospitalist settings NO LONGER NEED PHYSICIAN SUPERVISION.

So pardon those of us who dont believe that the PAs and NPs just want to "complement" doctors. Thats a load of crap.

Actually, you should read the website you posted, and ask about the dialogue and terminology you clearly do not understand, not that I expect you would since you are not a PA and clearly only interested in name calling and ignorance than actually learning more about who PAs are, how they are trainined, and what their work entails.

Let me see if I can clarify using the following posts from YOUR website:
"A physician supervisory plan or special services plan is not required for the services a PA provides in a hospital or other specified health care facility." Many hospital used to require this DOCUMENT be completed prior to work beginning. The legislation simply states that a little less paperwork which has nothing to do with actual supervision does not need to be completed, it does not actually significantly change the working relationship between the PA and MD, as evidenced further by this:

"Supervision Agreements Still Required. The new PA law continues to require all PAs to have a supervision agreement with their supervising physician regardless of whether the PA practices under a physician supervisory plan or works at a hospital or other health care facility. Supervision agreements currently in place will still be valid and recognized under the new PA law."

This is a direct cut and paste from your website....I guess I don't understand what you mean when you wrote "all PAs who work in hospitalist settings NO LONGER NEED PHYSICIAN SUPERVISION." Anyone who took the time to read this website can clearly see that is not at all the case.

Please, try and educate yourself about the issues at hand (which is why I posted my previous post) rather than post your own erroneous summaries about PAs.

 

[soeagerun2or]

Done and done:

You wouldn't happen to have a logical flow chart of providers and where PAs/NPs lie in there do you?

 

[deleted6669]

You wouldn't happen to have a logical flow chart of providers and where PAs/NPs lie in there do you?

md/do
pa/np
rn

 

[Elysium]

Well, folks, I think the only option we have left is clear: we need to kill all the NPs and PAs in the US. And the students too. All of them. Starting with Emedpa, because he's mouthy and just gets in the way. Then that Oz guy, because he's in medical school for god's sake, and he still defends these fvcking loosers. Mcsmalldickparinoidyver has convinced me this time. PAs have no roll in health care, people. They are going to take every single job away from every single doctor. Neurosurg? You're next! Look out, we're coming for you dinguses! Ortho? Interventional cards? Rads? Optho? Screw all you guys. We'll be putting in stents in two shakes of a lambs tail two weeks after we graduate. Matter of fact, all we learn, basically (shhhh, don't tell anyone) is that, essentially, docs are fcking useless and that we're good enough to take over the whole medical enchilada. In the second semester, right after they teach us how to suture pigs feet, there's a class in "Overthrowing The Medical Establishment And Putting All Doctors Out of Work". We just don't generally list it in the public catalogue because we don't want word to get out and all that. No, no. We're all lying in wait, biding our time, waiting to take over FM and IM and peds from you chumps that are paying back your ******ed loans and working for $120.000.

Come on now. Do you really think we (me) fvcking care? Do you really think we want your fcking stupid, shtty job? Do you really think we couldn't do your stupid shtty job? Are you serious? More than half my class could hack med school (and I know because I've been there and hacked it myself) with NO problem. They just don't want to do the 7+ year 200,000 debt thing. A lot of them are older with families and can't afford it. Get off your fvcking high horse. All of you look like whiney little superior dinguses, do you know that? You look like pathetic little small dick bitches. If you have security in your intelligence and your profession and your abilities as a clinician you don't fcking care about PAs. You don't worry about them taking your patients. You don't worry about them knowing more than you. Or being better than you. Or taking your jobs. Nut up, guys. Seriously. WE ARE NOT TRYING TO BE BETTER THAN YOU. WE WANT TO WORK WITH YOU. NOT AGAINST YOU.

Stop listening to fvcking paranoid propaganda from a delusional angry black hearted evil man with too much time on his hands and not nearly enough empathy. Jesus, go try to find something bigger than yourself.

And, everybody, seriously, we're all on the same goddamned team.

 

[Tired]

Get off your fvcking high horse. All of you look like whiney little superior dinguses, do you know that? You look like pathetic little small dick bitches.

Thanks. I'll keep this in mind down the road.

 

[deleted6669]

thanks for the heads up. Ill start wearing my flak jacket to work....
elysium, classic post. will probably get you banned but it was worth it

 

[Tired]

thanks for the heads up. Ill start wearing my flak jacket to work....
elysium, classic post. will probably get you banned but it was worth it

I understand the desire to express your frustrations, especially towards med students who have limited experience with PAs. However, the experiences that have been described here are real, and the opinions being expressed by the med students (some reasonable, some rude) represent real questions and concerns in the minds of tomorrow's physicians.

Feel free to come into our forum (and yes, this is the "Allopathic MD Student Forum") and flame the crap out of us. But keep in mind that the image you cultivate for your profession in our minds now, may still be there in the future when we are attendings. Thus you have the choice to take cracks at us while you can, or not. Guess some of you have made your choices on this already.

 

[deleted6669]

I understand the desire to express your frustrations, especially towards med students who have limited experience with PAs. However, the experiences that have been described here are real, and the opinions being expressed by the med students (some reasonable, some rude) represent real questions and concerns in the minds of tomorrow's physicians.

Feel free to come into our forum (and yes, this is the "Allopathic MD Student Forum") and flame the crap out of us. But keep in mind that the image you cultivate for your profession in our minds now, may still be there in the future when we are attendings. Thus you have the choice to take cracks at us while you can, or not. Guess some of you have made your choices on this already.

I understand your position on this. understand that the medstudents also come into the clinicians forum here at sdn and pa only forums outside of sdn to give us crap out of the blue so it works both ways.
peace friend. I'm sure we would get along fine in the real world.

 

[Tired]

I understand your position on this. understand that the medstudents also come into the clinicians forum here at sdn and pa only forums outside of sdn to give us crap out of the blue so it works both ways.
peace friend. I'm sure we would get along fine in the real world.

I'm sure we would as well. Although I have my issues with the "White Coat" thing (no point in rehashing that here), I will say that my clinical experiences with PAs in the real world have been singularly excellent. I especially appreciate the willingness of PAs to teach me, which at times has been above and beyond some of my attendings and residents.

It was painful though, to see a week's worth of sensible, intelligent posts from you get dragged down (at least in my mind) by a rant that juxtaposed, "We all just want to work with the team" and "You are a bunch of <insert profanity here>."

[Although, in all fairness, I do get the sentiment. God knows I go off on people on these forums often enough . . . ]

 

[tkim]

And, everybody, seriously, we're all on the same goddamned team.

What she said - without all the '****s'.

 

[8744]

Well, folks, I think the only option we have left is clear: we need to kill all the NPs and PAs in the US. And the students too. All of them. Starting with Emedpa, because he's mouthy and just gets in the way. Then that Oz guy, because he's in medical school for god's sake, and he still defends these fvcking loosers. Mcsmalldickparinoidyver has convinced me this time. PAs have no roll in health care, people. They are going to take every single job away from every single doctor. Neurosurg? You're next! Look out, we're coming for you dinguses! Ortho? Interventional cards? Rads? Optho? Screw all you guys. We'll be putting in stents in two shakes of a lambs tail two weeks after we graduate. Matter of fact, all we learn, basically (shhhh, don't tell anyone) is that, essentially, docs are fcking useless and that we're good enough to take over the whole medical enchilada. In the second semester, right after they teach us how to suture pigs feet, there's a class in "Overthrowing The Medical Establishment And Putting All Doctors Out of Work". We just don't generally list it in the public catalogue because we don't want word to get out and all that. No, no. We're all lying in wait, biding our time, waiting to take over FM and IM and peds from you chumps that are paying back your ******ed loans and working for $120.000.

Come on now. Do you really think we (me) fvcking care? Do you really think we want your fcking stupid, shtty job? Do you really think we couldn't do your stupid shtty job? Are you serious? More than half my class could hack med school (and I know because I've been there and hacked it myself) with NO problem. They just don't want to do the 7+ year 200,000 debt thing. A lot of them are older with families and can't afford it. Get off your fvcking high horse. All of you look like whiney little superior dinguses, do you know that? You look like pathetic little small dick bitches. If you have security in your intelligence and your profession and your abilities as a clinician you don't fcking care about PAs. You don't worry about them taking your patients. You don't worry about them knowing more than you. Or being better than you. Or taking your jobs. Nut up, guys. Seriously. WE ARE NOT TRYING TO BE BETTER THAN YOU. WE WANT TO WORK WITH YOU. NOT AGAINST YOU.

Stop listening to fvcking paranoid propaganda from a delusional angry black hearted evil man with too much time on his hands and not nearly enough empathy. Jesus, go try to find something bigger than yourself.

And, everybody, seriously, we're all on the same goddamned team.

You don't have to sugar-coat it. Tell us how you really feel. Don't hold back.

 

[primadonna22274]

seriously, this lady (I use that term loosely) likes to cuss in posts. It's uncouth and I don't like it, and most of us on PAforum have told her so. I understand the role of sarcasm but this is offensive. Mods? Mods?
ugh

Well, folks, I think the only option we have left is clear: we need to kill all the NPs and PAs in the US. And the students too. All of them. Starting with Emedpa, because he's mouthy and just gets in the way. Then that Oz guy, because he's in medical school for god's sake, and he still defends these fvcking loosers. Mcsmalldickparinoidyver has convinced me this time. PAs have no roll in health care, people. They are going to take every single job away from every single doctor. Neurosurg? You're next! Look out, we're coming for you dinguses! Ortho? Interventional cards? Rads? Optho? Screw all you guys. We'll be putting in stents in two shakes of a lambs tail two weeks after we graduate. Matter of fact, all we learn, basically (shhhh, don't tell anyone) is that, essentially, docs are fcking useless and that we're good enough to take over the whole medical enchilada. In the second semester, right after they teach us how to suture pigs feet, there's a class in "Overthrowing The Medical Establishment And Putting All Doctors Out of Work". We just don't generally list it in the public catalogue because we don't want word to get out and all that. No, no. We're all lying in wait, biding our time, waiting to take over FM and IM and peds from you chumps that are paying back your ******ed loans and working for $120.000.

Come on now. Do you really think we (me) fvcking care? Do you really think we want your fcking stupid, shtty job? Do you really think we couldn't do your stupid shtty job? Are you serious? More than half my class could hack med school (and I know because I've been there and hacked it myself) with NO problem. They just don't want to do the 7+ year 200,000 debt thing. A lot of them are older with families and can't afford it. Get off your fvcking high horse. All of you look like whiney little superior dinguses, do you know that? You look like pathetic little small dick bitches. If you have security in your intelligence and your profession and your abilities as a clinician you don't fcking care about PAs. You don't worry about them taking your patients. You don't worry about them knowing more than you. Or being better than you. Or taking your jobs. Nut up, guys. Seriously. WE ARE NOT TRYING TO BE BETTER THAN YOU. WE WANT TO WORK WITH YOU. NOT AGAINST YOU.

Stop listening to fvcking paranoid propaganda from a delusional angry black hearted evil man with too much time on his hands and not nearly enough empathy. Jesus, go try to find something bigger than yourself.

And, everybody, seriously, we're all on the same goddamned team.

 

[Ypo.]

If you want to be worried and paranoid about threats, the bigger threat to our income is the push for a nationalized health care system. ESPECIALLY the specialties; sorry but we're not going to be able to afford angioplasty for every 80 year old who needs it.

I mean, come on people, there are bigger fish to fry here.


Laaaame.

 

[soeagerun2or]

And, everybody, seriously, we're all on the same goddamned team.

That's probably where the issue lies, we feel as though you're the farm team..

 

[sirus_virus]

Well, folks, I think the only option we have left is clear: we need to kill all the NPs and PAs in the US. And the students too. All of them. Starting with Emedpa, because he's mouthy and just gets in the way. Then that Oz guy, because he's in medical school for god's sake, and he still defends these fvcking loosers. Mcsmalldickparinoidyver has convinced me this time. PAs have no roll in health care, people. They are going to take every single job away from every single doctor. Neurosurg? You're next! Look out, we're coming for you dinguses! Ortho? Interventional cards? Rads? Optho? Screw all you guys. We'll be putting in stents in two shakes of a lambs tail two weeks after we graduate. Matter of fact, all we learn, basically (shhhh, don't tell anyone) is that, essentially, docs are fcking useless and that we're good enough to take over the whole medical enchilada. In the second semester, right after they teach us how to suture pigs feet, there's a class in "Overthrowing The Medical Establishment And Putting All Doctors Out of Work". We just don't generally list it in the public catalogue because we don't want word to get out and all that. No, no. We're all lying in wait, biding our time, waiting to take over FM and IM and peds from you chumps that are paying back your ******ed loans and working for $120.000.

Come on now. Do you really think we (me) fvcking care? Do you really think we want your fcking stupid, shtty job? Do you really think we couldn't do your stupid shtty job? Are you serious? More than half my class could hack med school (and I know because I've been there and hacked it myself) with NO problem. They just don't want to do the 7+ year 200,000 debt thing. A lot of them are older with families and can't afford it. Get off your fvcking high horse. All of you look like whiney little superior dinguses, do you know that? You look like pathetic little small dick bitches. If you have security in your intelligence and your profession and your abilities as a clinician you don't fcking care about PAs. You don't worry about them taking your patients. You don't worry about them knowing more than you. Or being better than you. Or taking your jobs. Nut up, guys. Seriously. WE ARE NOT TRYING TO BE BETTER THAN YOU. WE WANT TO WORK WITH YOU. NOT AGAINST YOU.

Stop listening to fvcking paranoid propaganda from a delusional angry black hearted evil man with too much time on his hands and not nearly enough empathy. Jesus, go try to find something bigger than yourself.

And, everybody, seriously, we're all on the same goddamned team.

Stop whining.

 

[turkleton]

Yea, elysium, stop whining. That post was ******ed- but humerous. Emedpa, you came off so reasonable until you defended that ascinine rant. I like my job, would go through it again loans, med school, the whole package. I'm not sure how you go and call our jobs crappy and useless (I'm substituting your eloquent choice of words with my far more crass ones) and then make the claim that we're on the same team- that says something about your job too. I could be wrong. As for insecurity in our intelligence- dude are you kidding! Of course med students are just as PA's are. You're taking a group of highly successful, motivated, and intelligent students used to getting straight A's, 1500's on SAT's, 37 on MCATS who got into medical school because they distanced themselves from other students every step of the way. Then comes the cold realization that certain clinical aspect of their job- which is far more visible to non medical people than the in depth scientific aspect- can be and has been mastered by others who they thought they had separated themselves from. To MD's, they think that they are being seens as equals with non-MD clinicians in the eyes of others, which is difficult after a life predicated on demonstrating how much more intelligent you are than the rest of the crowd. A friend of mine once told me that after all this (med school, 7 year residency) he wanted to be viewed like an astrophysicist- clearly recognized as being amongst the most intelligent in society, privy to a knowledge base not just inaccessable to others but beyond their comprehension. Vanity? You bet. Am I guilty of it? Yup, just like most MD's I know. But it's overall not malicious, and usually only a passing thought- and eventually most of us mature to not give a damn about it. Life's too good and too short. And to think PA's/NP's are immune to the same vanity is patently absurd. You can paint the picture of stuck up doctors stepping over humble PA's/NP's all you want, but you know it's not true, as evidenced by some of these posts. Everyone, and I mean everyone who buys a stethescope is guilty of worrying about being seen as intelligent and irreplacable to the medical machinery. So chalk up all this avarice and vanity to human nature, quit whining, and just do your g** d**m job.

 

[ForbiddenComma]

Vanity? You bet. Am I guilty of it? Yup, just like most MD's I know. But it's overall not malicious, and usually only a passing thought- and eventually most of us mature to not give a damn about it. Life's too good and too short. And to think PA's/NP's are immune to the same vanity is patently absurd.

True... an NP will go on and on about how people shouldn't worry about the letters after one's name when compared to docs, but then in the next breath angrily denounce anyone who calls her a mere "nurse."

Few people are more obsessed with the letters after their names than the typical NP. (ARNP, CNP, MSN, etc etc -- and you better believe all of them will be on her lab coat.) I'm not sure why this is, but it's nuts!

 

[anon-y-mouse]

I understand your position on this. understand that the medstudents also come into the clinicians forum here at sdn and pa only forums outside of sdn to give us crap out of the blue so it works both ways.
peace friend. I'm sure we would get along fine in the real world.

You defended yourself by saying "But they do it too" (?!?)... I'm honestly surprised that someone with so much experience, probably about double the age of most of the would-be attendings on this particular forum, would just do that. Maybe it's an online thing, and maybe you're certainly a lot different in the real world.

 

[sunnyjohn]

How 'bout dem Bears?

 

[Wizard of Oz]

Well, folks, I think the only option we have left is clear: we need to kill all the NPs and PAs in the US. And the students too. All of them. Starting with Emedpa, because he's mouthy and just gets in the way. Then that Oz guy, because he's in medical school for god's sake, and he still defends these fvcking loosers. Mcsmalldickparinoidyver has convinced me this time.

 

[zenman]

seriously, this lady (I use that term loosely) likes to cuss in posts. It's uncouth and I don't like it, and most of us on PAforum have told her so. I understand the role of sarcasm but this is offensive. Mods? Mods?
ugh

I want to see her tattoos!

 

[Taurus]

seriously, this lady (I use that term loosely) likes to cuss in posts. It's uncouth and I don't like it, and most of us on PAforum have told her so. I understand the role of sarcasm but this is offensive. Mods? Mods?
ugh

Don't you worry about a thing. We here in the allo forum have much thicker skin. It's gonna take a lot more than a few bad words to hurt our feelings.

 

[beefballs]

I wonder if the beaver in elysium's avatar is bleeding? get it bleeding beaver... elysium really upset...god I know how to entertain myself

 

[beefballs]

Well, folks, I think the only option we have left is clear: we need to kill all the NPs and PAs in the US. And the students too. All of them. Starting with Emedpa, because he's mouthy and just gets in the way. Then that Oz guy, because he's in medical school for god's sake, and he still defends these fvcking loosers. Mcsmalldickparinoidyver has convinced me this time. PAs have no roll in health care, people. They are going to take every single job away from every single doctor. Neurosurg? You're next! Look out, we're coming for you dinguses! Ortho? Interventional cards? Rads? Optho? Screw all you guys. We'll be putting in stents in two shakes of a lambs tail two weeks after we graduate. Matter of fact, all we learn, basically (shhhh, don't tell anyone) is that, essentially, docs are fcking useless and that we're good enough to take over the whole medical enchilada. In the second semester, right after they teach us how to suture pigs feet, there's a class in "Overthrowing The Medical Establishment And Putting All Doctors Out of Work". We just don't generally list it in the public catalogue because we don't want word to get out and all that. No, no. We're all lying in wait, biding our time, waiting to take over FM and IM and peds from you chumps that are paying back your ******ed loans and working for $120.000.

Come on now. Do you really think we (me) fvcking care? Do you really think we want your fcking stupid, shtty job? Do you really think we couldn't do your stupid shtty job? Are you serious? More than half my class could hack med school (and I know because I've been there and hacked it myself) with NO problem. They just don't want to do the 7+ year 200,000 debt thing. A lot of them are older with families and can't afford it. Get off your fvcking high horse. All of you look like whiney little superior dinguses, do you know that? You look like pathetic little small dick bitches. If you have security in your intelligence and your profession and your abilities as a clinician you don't fcking care about PAs. You don't worry about them taking your patients. You don't worry about them knowing more than you. Or being better than you. Or taking your jobs. Nut up, guys. Seriously. WE ARE NOT TRYING TO BE BETTER THAN YOU. WE WANT TO WORK WITH YOU. NOT AGAINST YOU.

Stop listening to fvcking paranoid propaganda from a delusional angry black hearted evil man with too much time on his hands and not nearly enough empathy. Jesus, go try to find something bigger than yourself.

And, everybody, seriously, we're all on the same goddamned team.

had to quote in case it gets edited

 

[dutchman]

Well, folks, I think the only option we have left is clear: we need to kill all the NPs and PAs in the US. And the students too. All of them. Starting with Emedpa, because he's mouthy and just gets in the way. Then that Oz guy, because he's in medical school for god's sake, and he still defends these fvcking loosers. Mcsmalldickparinoidyver has convinced me this time. PAs have no roll in health care, people. They are going to take every single job away from every single doctor. Neurosurg? You're next! Look out, we're coming for you dinguses! Ortho? Interventional cards? Rads? Optho? Screw all you guys. We'll be putting in stents in two shakes of a lambs tail two weeks after we graduate. Matter of fact, all we learn, basically (shhhh, don't tell anyone) is that, essentially, docs are fcking useless and that we're good enough to take over the whole medical enchilada. In the second semester, right after they teach us how to suture pigs feet, there's a class in "Overthrowing The Medical Establishment And Putting All Doctors Out of Work". We just don't generally list it in the public catalogue because we don't want word to get out and all that. No, no. We're all lying in wait, biding our time, waiting to take over FM and IM and peds from you chumps that are paying back your ******ed loans and working for $120.000.

Come on now. Do you really think we (me) fvcking care? Do you really think we want your fcking stupid, shtty job? Do you really think we couldn't do your stupid shtty job? Are you serious? More than half my class could hack med school (and I know because I've been there and hacked it myself) with NO problem. They just don't want to do the 7+ year 200,000 debt thing. A lot of them are older with families and can't afford it. Get off your fvcking high horse. All of you look like whiney little superior dinguses, do you know that? You look like pathetic little small dick bitches. If you have security in your intelligence and your profession and your abilities as a clinician you don't fcking care about PAs. You don't worry about them taking your patients. You don't worry about them knowing more than you. Or being better than you. Or taking your jobs. Nut up, guys. Seriously. WE ARE NOT TRYING TO BE BETTER THAN YOU. WE WANT TO WORK WITH YOU. NOT AGAINST YOU.

Stop listening to fvcking paranoid propaganda from a delusional angry black hearted evil man with too much time on his hands and not nearly enough empathy. Jesus, go try to find something bigger than yourself.

And, everybody, seriously, we're all on the same goddamned team.

You had me until you started talking about dick. You getting any?

 

[primadonna22274]

Well, we have thick skins too, I'm not worried. But it bugs me to see a PA student (and DO -school dropout, and even worse a PA student at my alma mater so I'm more defensive) make the rest of us PAs look so idiotic when so many of you meds and pre-meds already have a substandard opinion of us. That's all. She'll get hers on clinical rotations

Don't you worry about a thing. We here in the allo forum have much thicker skin. It's gonna take a lot more than a few bad words to hurt our feelings.

 

[beefballs]

Well, we have thick skins too, I'm not worried. But it bugs me to see a PA student (and DO -school dropout, and even worse a PA student at my alma mater so I'm more defensive) make the rest of us PAs look so idiotic when so many of you meds and pre-meds already have a substandard opinion of us. That's all. She'll get hers on clinical rotations

wait elysium dropped out of med school? whoa, puts her hate filled rant in a whole new perspective. Elysium don't hate us because we are beautiful, we are all part of the same team right?

 

[Taurus]

Pennsylvania is pushing for more rights for midlevels

http://www.post-gazette.com/pg/07017/754473-100.stm

"Still other provisions in the plan are aimed at expanding the practice capabilities of certain health professionals, such as nurse practitioners and dental technicians"

Let's stop this nonsense bickering between docs and midlevels. They're here to stay, like it or not. And it's the NP's who are governed by nursing boards who we should be concerned about, not PA's.

 

[Ypo.]

Well, we have thick skins too, I'm not worried. But it bugs me to see a PA student (and DO -school dropout, and even worse a PA student at my alma mater so I'm more defensive) make the rest of us PAs look so idiotic when so many of you meds and pre-meds already have a substandard opinion of us. That's all. She'll get hers on clinical rotations

That's not very professional of you, either. In addition, it's against the rules to expose personal information about sdn users without their permission. I'm assuming you have told other people on these forums where you go to school and I'm not sure that Elysium would want that news broadcasted. If you have a problem with her, take it up with the mods, don't further clutter this thread with a personal vendetta.

Chill on Elysium, you guys. Her post was directed at people who were being rude to PAs, not to all MDs. I'm in MD school and that much was plain to me.

As for me, I'm looking forward to working with PAs and NPs and I'm sure I'll learn a lot from them. Unless people act as stupid in real life as they have been doing on this thread.