NPs and PAs Fight For Your Rights Now!!

[Chronic Student]

Megboo, the only thing I would ask is that you keep an open mind (and I'm not saying that you don't).

However, you have some very strong opinions which come across as very anti-PA and I find myself thinking that my clinical skills are being judged by someone that has not been to Medical or PA school.

This makes me wonder if you might not change your mind after you are a Doc and have had a chance to work with PA's in the clinical setting.

I, like a lot of PA's, did not just fall of the turnip truck with a degree in modern dance and decide to go to PA school.

Here is a list of the courses I took before and during PA school:

2000 Fall: School of Allied Health Sciences

CLLS 3230 Mycology
CLLS 3231 Urine & Other Body Fluids
CLLS 3306 Immunology
CLLS 3314 Biochemistry
CLLS 3317 Hematology I
CORE 3124 Intro Mgt Skills Hlth/Cr



12/16/00

2001 Spring: School of Allied Health Sciences

CLLS 3307 Molecular Biology
CLLS 3326 Method Develop and Assess
CLLS 3514 Clinical Chemistry I
CLLS 4201 Coagulation
CORE 3321 Legal & Ethical Issues HC



2001 Summer: School of Allied Health Sciences

CLLS 3229 Parasitology
CLLS 4326 Research in CLS
CLLS 4416 Immunohematology



2001 Fall: School of Allied Health Sciences

CLLS 4204 Chem Automation/Mgmt
CLLS 4310 Clinical Chemistry II
CLLS 4312 Management Skills in CLS
CLLS 4317 Hematology II
CLLS 4412 Pathogenic Microbiology



2002 Spring: School of Allied Health Sciences

CLLS 4301 Clinical Preceptorship I
CLLS 4302 Clinical Preceptorship II
CLLS 4303 Clinical Preceptor III
CLLS 4304 Clinical Preceptorship IV

2002 Summer: School of Allied Health Sciences

CLLS 3228 Prof Ed Methods
CLLS 4107 Seminar in CLS
CLLS 4311 Case Studies in CLS



08/10/02

2004 Summer: School of Allied Health Sciences

HUBS 5503 Human Anatomy
PHAS 5301 Pathophysiology
PHAS 5303 Practice Issues



08/30/04

2004 Fall: School of Allied Health Sciences

CLLS 5227 Clinical Lab Methods
PHAS 5201 Clinical Psychiatry
PHAS 5302 Health Prom Dis Prevent
PHAS 5310 Physical Diagnosis
PHAS 5401 Research Methods



12/18/04

2005 Spring: School of Allied Health Sciences

PHAS 5202 Diagnostic Methods
PHAS 5304 Patient Assessment
PHAS 5402 Clinical Pharmacology
PHAS 5601 Clinical Medicine



2005 Summer: School of Allied Health Sciences

INDS 5001 Interdisc Prof Experience
PHAS 5204 Proposal Writing
PHAS 5210 Skills Practicum



2005-2006: School of Allied Health Sciences

PHAS 6401 Emergency Medicine
PHAS 6402 Surgery
PHAS 6403 Commun Underserved Med
PHAS 6405 Investigative Study
PHAS 6406 Elective II
PHAS 6407 Medicine I
PHAS 6408 Medicine II
PHAS 6601 General Pediatrics
PHAS 6602 Obstet and Gynecology
PHAS 6802 Elective I

TERM GPA/HOURS:

06/24/06

2006 Summer: School of Allied Health Sciences

INDS 5001 Interdisc Prof Experience
PHAS 6603 Project Prep Present

This does not include all of my EMT courses or the year I spent becoming a scrub tech with many classes dedicated to operative anatomy, surgical procedures, sterilization and disinfection, microbiology or my pre-reqs. Those included the traditional A&P, bio, micro, inorganic chem, organic chem, etc. For that matter, it does not show my six years of experience in the OR, my two years as a blood banker or the countless number of 24 hour shifts I spent as an EMT at a 911 service. In addition, I am a published, first author.

I guess what I'm saying is please don't write us all off yet, some of us may actually know what we are doing.

I AM NOT saying that we should be given carte blanche to do whatever the hell we want. But I have taken boards, am licensed by the state, have to pay for malpractice insurance, have a physician watching over my shoulder and can lose my license and career by causing or allowing a patient to come to harm. I might be able to do a few things without killing a patient.

-Mike

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[lawguil]

I'm not so sure... family doctors see it all and then refer what is out of their hands. But still, if I could choose between PA and MD/DO, I'd take MD/DO since the specialty training and responsibility of the patient appeal to me.

Again, I agree with this on some levels..... despite the insignificance of this, I do have experience with two local PA's who staff the local walkin clinic/fast track/ER, also 1st assist in surgery, and work in the private practice of local ortho clinic. The ER docs routinely consult with the PA's with ortho issues and the nurse triages most ortho cases to the PA's. If it were my son with an ortho issue - I would want them to see the PA's....

It sounds like you believe that medical school is the only path to medicine and clinical competence. I assure you, medical school isn't magical. It's darn good training, but has little if any impact on individual cognitive and kinesthetic abilities. As it is right now, a lot of the bright folks who would normally attend medical school or PT school or dentistry are beginning to split. PA school has become extremely appealing for obvious reasons.....

 

[jwk]

I'm sure after making it through med school (keeping fingers crossed), I will work with many PAs, and I won't have a problem with that. I just want to be able to do my job without the question in the back of my head of "If PAs can do all this stuff, what's the point of doctors?"

You should be asking this question as it relates to nurse practitioners and other advance practice nurses (and perhaps PT's and PharmD's), not PA's. PA's (and AA's) are always considered part of a team approach - we don't seek to practice independent of a physician.

 

[prairiedog]

You should be asking this question as it relates to nurse practitioners and other advance practice nurses (and perhaps PT's and PharmD's), not PA's. PA's (and AA's) are always considered part of a team approach - we don't seek to practice independent of a physician.

Seems as if PAs want to be dependent one day and independent the next day. I agree NPs want to be independent. I don’t agree that NPs are not working as part of the team. Maybe I misunderstood, can you explain what you mean by “team approach” ?

 

[guetzow]

Per the definition of a PA, he/she practices within the scope of his/her SP (Whatever the specialty may be). i.e.- (Read between the lines) generally, we practice medicine the same way. Reading off the same/similar sheet of music (Instead of, say, butting heads over how to manage different medical problems) is a team approach; the antithesis of nursing theory, for example.

 

[prairiedog]

Per the definition of a PA, he/she practices within the scope of his/her SP (Whatever the specialty may be). i.e.- (Read between the lines) generally, we practice medicine the same way. Reading off the same/similar sheet of music (Instead of, say, butting heads over how to manage different medical problems) is a team approach; the antithesis of nursing theory, for example.

Please help me with one point of clarity, if the SP is IM and deals with adults only, can the PA see Peds? For example, a rural clinic has the IM doctor who refuses to do Peds and hired a PA who is comfortable with Peds. The PA can't see Peds patients legally?
Do you really think nursing theory is the antithesis of medicine? I agree there are really strange nursing theories, on the other hand there a few that really make sense.

 

[deleted6669]

Please help me with one point of clarity, if the SP is IM and deals with adults only, can the PA see Peds? For example, a rural clinic has the IM doctor who refuses to do Peds and hired a PA who is comfortable with Peds. The PA can't see Peds patients legally?
Do you really think nursing theory is the antithesis of medicine? I agree there are really strange nursing theories, on the other hand there a few that really make sense.

depends...a pa can have more than 1 sp. if they worked for a group of all im docs they are out of luck but if an alternate sp is peds or fp they are golden, they just need to direct the proper % of peds charts in the direction of the peds or fp doc. most pa's designate alternate supervisors so if something happens to the primary supervisor they can continue to work. I have 1 primary sp and the rest of the em group(40 or so) as alternates.
also some states have a basic scope of practice for all pa's in the state and all pa's are allowed those things regardless of where they work. if they want additional scope they need to apply for it specifically (say if they want to reduce fractures and it is not in the basic state scope).
so the answer is it really depends what state they practice in and if they have more than 1 sp and the specialties of those sp's.
also not too may rural docs who don't see peds so not much of an issue in most areas....

 

[anon-y-mouse]

I haven't read through the posts yet, but we talked about this at my professional ethics class at medical school. Our preceptor made an excellent case against these mid-level providers doing much more than looking at the 5-10 most common primary care-type diagnoses (cold, conjunctivitis, otitis media, etc.). I pretty much agree, and a former extremely experienced PA in my class was completely overwhelmed by how much we had to know even for our first block exam. You don't know what you don't know unless you're asked about it.

I challenge all these NP/PA people to try their hand at the USMLE, step 1 2 or 3, and see how many questions they can answer. This really will put these speciously "all knowing" NP/PA's back in their place. While there are many common problems in medicine, MD's obviously shine because they know more and can expect a lot more, and can reason out mechanisms of disease through their strong understanding of pathophysiology. "We take pathophysiology too!" Yeah shut up and try to take the USMLE and see how you do. I took anatomy and physiology in undergrad, but med school was 10 times as difficult, and it really was NOT because of the added clinical information. Also, rotations? Ok, I see all sorts of people on the team during rounds at my med school, but guess what, it's the med students that go home and study the 500 page textbooks (and 300 page review books) for the NBME NATIONAL shelf exams in those particular subjects, take multiple steps of the USMLE, multi-day specialty board certification exams, etc, and are held to higher standards by their attendings. I'm sure the PA students have to take their own exams, but from what that PA classmate has told me, it pales in comparison.

I also think it's professional suicide for an MD to "oversee" a PA and sign off on cases months after the patient has left the office... this is just a recipe for ruining one's medical career, just for some measly kickbacks from a midlevel. My medical school has been talking about this more and more with students and telling them of the drawbacks of "sponsoring" these potentially dangerous PA's and med students are realizing what trouble it could get them into... and that practice is likely to be lessened in the upcoming years based on what I've seen and from other med schools.

It's also disingenuous to introduce yourself as "Dr" in ANY clinical environment if you're not a physician, because this CONFUSES patients. EVEN IF YOU HAVE A PhD. Patient = first priority, ego = second.

Also, I hope midlevels NEVER become surgeons. That would just turn really ugly.

 

[njbmd]

I haven't read through the posts yet, but we talked about this at my professional ethics class at medical school. Our preceptor made an excellent case against these mid-level providers doing much more than looking at the 5-10 most common primary care-type diagnoses (cold, conjunctivitis, otitis media, etc.). I pretty much agree, and a former extremely experienced PA in my class was completely overwhelmed by how much we had to know even for our first block exam. You don't know what you don't know unless you're asked about it.

There is no comparison between the didatic training of a Physician Assistant and a Physician. This being said, Physician assistants can greatly extend what the Physician is able to provide for patients. Every PA that I have ever been associated with KNOWS that they are not physicians or physician subsititutes however, even a newly-minted PA is totally capable of handing the office care of more than "5-10 most common primary care-type diagnoses".

I challenge all these NP/PA people to try their hand at the USMLE, step 1 2 or 3, and see how many questions they can answer. This really will put these speciously "all knowing" NP/PA's back in their place. While there are many common problems in medicine, MD's obviously shine because they know more and can expect a lot more, and can reason out mechanisms of disease through their strong understanding of pathophysiology. "We take pathophysiology too!" Yeah shut up and try to take the USMLE and see how you do. I took anatomy and physiology in undergrad, but med school was 10 times as difficult, and it really was NOT because of the added clinical information. Also, rotations? Ok, I see all sorts of people on the team during rounds at my med school, but guess what, it's the med students that go home and study the 500 page textbooks (and 300 page review books) for the NBME NATIONAL shelf exams in those particular subjects, take multiple steps of the USMLE, multi-day specialty board certification exams, etc, and are held to higher standards by their attendings. I'm sure the PA students have to take their own exams, but from what that PA classmate has told me, it pales in comparison.

The PANCE exam is quite detailed and almost identical to USMLE Step II CK. I know this because I teach review for both exams and write questions for both exams. The number of pages in a textbook has no meaning in education. The most useful book I had in medical school was High Yield Biostats. Board exams are a miniscule part of a physician's training and have very little to do with day to day practice unless you fail them which a good many medical students manage to do.

I also think it's professional suicide for an MD to "oversee" a PA and sign off on cases months after the patient has left the office... this is just a recipe for ruining one's medical career, just for some measly kickbacks from a midlevel. My medical school has been talking about this more and more with students and telling them of the drawbacks of "sponsoring" these potentially dangerous PA's and med students are realizing what trouble it could get them into... and that practice is likely to be lessened in the upcoming years based on what I've seen and from other med schools.

I don't think you understand or have any experience with the scope and practice of a Physician Assistant. If you did, you would not have made the above statement (which was likely meant to be inflammatory but is uninformed nevertheless).

It's also disingenuous to introduce yourself as "Dr" in ANY clinical environment if you're not a physician, because this CONFUSES patients. EVEN IF YOU HAVE A PhD. Patient = first priority, ego = second.

Also, I hope midlevels NEVER become surgeons. That would just turn really ugly.

Have not run into any mid-levels either in my clinic, the VA, or any of the hosptials from which I practice or have been treated that introduced themselves as "Dr." Every nurse practictioner or physician assistant that I have worked with knows full-well the scope of their practice. These folks are professionals who know the legal implications of exceeding their scope of practice.

I do perform surgery with mid-level practictioners and they do not and are not responsible for the same tasks in the OR as I. I love having a physician assistant on a lap chole because this person is the ultimate camera driver and assistant who can get exposure when the going gets difficult. This comes from experience and the experience of a good PA is invaluable to me as a surgeon. There are plenty of parts of a case that I do not have to physically perform like closing skin for example. I can simply tell my physician assistant how I want the closure done and go speak with the patient's family.

You may learn , as you go a bit further in your studies that a good physician assistant is a valuable asset. When you get to third year, you may find that your former PA classmate or any PA can teach you a thing or two about patient assessment or even some procedures. I was taught to open and close the chest cavity by an experienced physican assistant who taught me well and I appreciate that teaching everytime I perform a thoracotomy.

Take some time to get to know the scope of practice of nurse practictioners, physican assistants, anesthesia assistants. If you have never worked in a professional setting with these professions, you really cannot understand how they aid you in your profession. A physican is always going to be at the top of the healthcare team so you don't have to be insecure that a PA or NP is going to come along and take your place.

 

[Baylee]

I always thought PAs worked under their supervising physician's scope of practice. They do surveys every year on who is the most respected, it isn't the PA or NP. Probably because the general public isn't aware of the roles. The RN is usually on top of the list.

FYI, all NP's are RN's, so they would be included in that list. Depending on where you live, most people know what a NP is, but maybe not a PA. I believe NP's outnumber PA's something like 10 to 1, but I could be wrong.

 

[Baylee]

I don't know who you are, but I've been a CA pharmacist for 30 years. You don't have a clue what you're talking about. Tylenol & Motrin are not scheduled at all & neither are antibiotics, antneoplastics or antihypertensives.

The "Scheduled" drugs are only those who have addictive &/or abusive potential & there are NONE in Schedule I which are legally available for prescription. Mid levels who are authorized to write for Schedule II's & are acting within their scope of practice & under the supervision of their physician do so all the time and without harm.

Don't confuse the marijuana issue - it is political & is still classified as Schedule I.

You're also confused about the old triplicates....but, they are old news & nothing to get worked up about here. Those folks who have DEA #'s know exactly what they can write for & we know what we can fill for. They don't apply to the non-scheduled medications which actually are the bulk of available medications prescribed.

I'm curious about something. I have a friend who has a PA and NP working for him. When he isn't there, he leaves "presigned" triplicates for them to use, since they can't legally write those in that state. I told him this was illegal, but he said it wasn't. Who's right What would happen if he got caught?

 

[lawguil]

I haven't read through the posts yet, but we talked about this at my professional ethics class at medical school. Our preceptor made an excellent case against these mid-level providers doing much more than looking at the 5-10 most common primary care-type diagnoses (cold, conjunctivitis, otitis media, etc.). I pretty much agree, and a former extremely experienced PA in my class was completely overwhelmed by how much we had to know even for our first block exam. You don't know what you don't know unless you're asked about it.

I challenge all these NP/PA people to try their hand at the USMLE, step 1 2 or 3, and see how many questions they can answer. This really will put these speciously "all knowing" NP/PA's back in their place. While there are many common problems in medicine, MD's obviously shine because they know more and can expect a lot more, and can reason out mechanisms of disease through their strong understanding of pathophysiology. "We take pathophysiology too!" Yeah shut up and try to take the USMLE and see how you do. I took anatomy and physiology in undergrad, but med school was 10 times as difficult, and it really was NOT because of the added clinical information. Also, rotations? Ok, I see all sorts of people on the team during rounds at my med school, but guess what, it's the med students that go home and study the 500 page textbooks (and 300 page review books) for the NBME NATIONAL shelf exams in those particular subjects, take multiple steps of the USMLE, multi-day specialty board certification exams, etc, and are held to higher standards by their attendings. I'm sure the PA students have to take their own exams, but from what that PA classmate has told me, it pales in comparison.

I also think it's professional suicide for an MD to "oversee" a PA and sign off on cases months after the patient has left the office... this is just a recipe for ruining one's medical career, just for some measly kickbacks from a midlevel. My medical school has been talking about this more and more with students and telling them of the drawbacks of "sponsoring" these potentially dangerous PA's and med students are realizing what trouble it could get them into... and that practice is likely to be lessened in the upcoming years based on what I've seen and from other med schools.

It's also disingenuous to introduce yourself as "Dr" in ANY clinical environment if you're not a physician, because this CONFUSES patients. EVEN IF YOU HAVE A PhD. Patient = first priority, ego = second.

Also, I hope midlevels NEVER become surgeons. That would just turn really ugly.

What do you say about the PA's that take the patho phys with medical students? Also, there is a ton of literature about the issues of tailoring one's educational curriculum to prepare students for standardized testing.

I recently attended a conference for pre-professional advisors (sponsored by the AMA). One of the issues was the increasing attrition rates of PA students. Some of the take home points were:

PA school is 3/4 of medical school...if you actually count the last 8 months of med school.
PA students may actually cover as much as 10-20% more material per week than an MD student based on curriculum, volume, and hours spent in classroom.
PA attrition has increased likely because of the new trend of accepting more traditional pre-medical students who would normally go to medical school as opposed to students pursuing a second professional career.

The message for pre-professional advisors - be more selective of the students you recommend to PA school - it's strikingly similar to MD education but "less friendly" to students pursuing their first professional career. These students are better prepared for medical school.

 

[adamdowannabe]

NOPE....a pa must be supervised by an md/do only.
certainly a dpm could oversee the work of a pa if they worked together in a setting that also used md/do folks but they could not sign off on their charts and be the legal supervisor of record.

Lewis-Gale Clinic, a hospital and clinic group owned by HCA-Virginia has a podiatry practice that employs a PA, he works as such, and is in the hospital providers list under Podiatry as a PA-C.

 

[deleted6669]

Lewis-Gale Clinic, a hospital and clinic group owned by HCA-Virginia has a podiatry practice that employs a PA, he works as such, and is in the hospital providers list under Podiatry as a PA-C.

I imagine he has an off site md preceptor/sp who is an orthopedist.I have heard of pa's working in podiatry but they are not supervised by a podiatrist. most outpt podiatry could be done by any pa; diabetic foot care, ingrown toenails, pre/post op evals, etc

 

[anon-y-mouse]

Thanks, NJBMD, for your wise words. Perhaps the attendings who were up in arms at our ethics session somehow had different experiences.

However, consider people like lawguil, who claim that "PA school is 3/4 of med school"... umm, what? Based on what? Sheer time spent in the classroom? "10% more?"? Since when did time spent translate into volume of content? I for one know that if I took my exams solely based on what was covered in class, I'd do really poorly on my exams... there's a lot more to it than that. And yes, physicians will always be at the top of the healthcare team, but when you have these uninformed people who think they have most of the education of a physician ("75%, probably more since the last 8 months don't count"), that completely contradicts what you said about PA's knowing their own scope of practice.

Also, which PA schools have students take path with the med students?

Also, with respect to USMLE Step II CK, many of my friends made 99's studying just 2-3 weeks for the course... but what about steps I and III?

 

[Jengirl18]

Anon-y-mouse,

Lawguil doesn't mean the amt of time spent in the classroom (Lawquil, please correct me if I put words in your mouth). He means that it is often more volume in a shorter period of time. If PA students only studied from what was taught in class, we would be screwed also..at home I studied from Cecils, Harrisons, etc. I have some friends in med school who are just amazed at the amount of info I had to know in the first year of PA school (and I envied them b/c they got a summer off.) I, in my 2nd semester of PA school, was ratteling off things like Horner's Syndrome, SIADH, etc, when my med school friends still didnt know those terms yet.

Now I am in my 2nd rotation (primary care), I diagnosed acute angle glaucoma on a patient that my physician preceptor would have missed, and my roomate (also in her 2nd rotation in PA school..with 2 med students) had to explain what Propanolol was and how it worked to one of them..the guy could barely even pronounce the word.

I don't mean any disrespect, but I thought I needed to mention a little something about the rigors of PA school, and how we learn how to diagnose and treat the same diseases as you do..and it can be a PA that saves the SP's butt by catching something that could have been missed (so we do a little more than tx the common cold ).

Oh yeah, PA students often also take the same Gross Anatomy class as the med students.

 

[anon-y-mouse]

Anon-y-mouse,

Lawguil doesn't mean that amt of time spent in the classroom. He means that it is more volume in a shorter period of time. If PA students only studied from what was taught in class, we would be screwed also. I have some friends in med school who are just amazed at the amount of info I had to know in the first year of PA school (and I envied them b/c they got a summer off.) I, in my 2nd semester of PA school, was ratteling off things like Horner's Syndrome, SIADH, etc, when my med school friends still didnt know those terms yet.

Now I am in my 2nd rotation (primary care), I diagnosed acute angle glaucoma on a patient that my physician preceptor would have missed, and my roomate (also in her 2nd rotation in PA school..with 2 med students) had to explain what Propanolol was and how it worked to one of them..the guy could barely even pronounce the word.

I don't mean any disrespect, but I thought I needed to mention a little something about the rigors of PA school, and how we learn how to diagnose and treat the same diseases as you do..and it can be a PA that saves the SP's butt by catching something that could have been missed (so we do a little more than tx the common cold ).

Oh yeah, PA students often also take the same Gross Anatomy class as the med students.

What would YOU say the difference between PA and MD is then? It's clear you're the expert, even though the PA in my class finds herself utterly overwhelmed, much more than she did in her PA school days... By the way, we covered Horner's in our H+N block of anatomy, and SIADH in histology... and propranolol is a pretty basic beta blocker (covered in our cell class), I'm really surprised that the med students didn't know any of that stuff.

 

[core0]

Are PA/NPs able to work with DPMs?

Depends on the state. In Colorado they can.

David Carpenter, PA-C

 

[core0]

What would YOU say the difference between PA and MD is then? It's clear you're the expert, even though the PA in my class finds herself utterly overwhelmed, much more than she did in her PA school days... By the way, we covered Horner's in our H+N block of anatomy, and SIADH in histology... and propranolol is a pretty basic beta blocker (covered in our cell class), I'm really surprised that the med students didn't know any of that stuff.

A PA is trained to see about 85% of family practice complaints. We use a different model. Most PA training is integrated and systems based. For example opthamology is taught as part of ENT where the clinical science, pharmacology, anatomy and physiology is taught as a block (this is the common model some follow the medical school model). PBM is also very popular even if it isn't referred to that way. School for PA's is very clinically focused. We don't have the level of understanding of biochemistry or path that you have.

Also the model is similar to the old GP model. You have some clinical and didactic training, but the finishing occurs on the job. This is the essence of the dependent practicioner. The supervising physician helps the PA with more difficult problems and eventually the PA gains more autonomy.

When you finish your residency, your it. Any problems or failures are on your head. With a PA your also responsible for another person's medical decisions. If your are uncomfortable with this, then employing a PA is not for you. If you want to provide better service, have a better quality of life and be more efficient then you should consider a PA. My SP compares me to a 2nd or 3rd year fellow in GI. I don't have the the depth of clinical knowledge, but I can treat most GI conditions and more importantly I know when to ask for help. In certain very focused areas such as HCV treatment I have developed significant clinical knowledge.

So the short answer to your question is that an MD is an MD and a PA is a PA. We both have our place. If your not comfortable with working with a PA that's fine. However, PA's see millions of patients every year with outcomes that are similar to Physicians.

David Carpenter, PA-C

 

[Jengirl18]

I agree with Core0- I learned as much anatomy as any med student out there, but we did not have biochem in our training nor histology. Some histology was integrated in pathophyz... Anyway, as a PA I will treat patients using the knowledge I have, but if there is a problem beyond my scope, then its time for the pt. to see the physician. I am becoming a dependent practitioner for a reason, and respect physicians for the years of schooling and the sacrifices...they are at the top of the pole, and always will be.

Anon-y-mouse, I'm just curious-have you not gone on any rotations where there are PA students?

Good luck with school,

Jenny

 

[50960]

You did not take bio-chem?? This is getting scarey.

 

[core0]

You did not take bio-chem?? This is getting scarey.

I took biochem as an undergrad. You get some biochem as part of pharmacology but not a seperate class or to the level that med students get.

David Carpenter, PA-C

 

[Jengirl18]

yep..i took plenty of biochem in undergrand, and it was integrated in pharmacology in PA school....true, not as in depth at all as it would be in med school, but ide love to ask some docs who have been outta school a while how much biochem they remember other than what is pertinent to understanding pharm, etc

 

[Chronic Student]

I also took biochem and molecular in undergrad. My program covered some in pharm and pathophysiology, as well as the pertinent biochem in each block of clinical medicine.

Most assuredly not to the level of the med students, but it was not just glossed over.

-Mike

 

[lawguil]

Thanks, NJBMD, for your wise words. Perhaps the attendings who were up in arms at our ethics session somehow had different experiences.

However, consider people like lawguil, who claim that "PA school is 3/4 of med school"... umm, what? Based on what? Sheer time spent in the classroom? "10% more?"? Since when did time spent translate into volume of content? I for one know that if I took my exams solely based on what was covered in class, I'd do really poorly on my exams... there's a lot more to it than that. And yes, physicians will always be at the top of the healthcare team, but when you have these uninformed people who think they have most of the education of a physician ("75%, probably more since the last 8 months don't count"), that completely contradicts what you said about PA's knowing their own scope of practice.

Also, which PA schools have students take path with the med students?

Also, with respect to USMLE Step II CK, many of my friends made 99's studying just 2-3 weeks for the course... but what about steps I and III?

Just so you know, I'm not a PA and I don't know of any schools that take Pathphys with med students - I was writing without thinking and without evidence. Clearly, Med school is different. The point I simply wanted to get across was that PA school is significant and when you compare the 4 years of med school and PA school, they aren't apples and oranges. I think the biggest difference b/t a med student and a PA student is the residency - I'm just an outsider though. What I do know is that pre-professional students looking at med school and PA school might have different qualifications. In the academic world of pre-professional advising, PA programs are known for their volume and intensity...Folks with some type of medical background are better suited for PA school (the idea is that a portion of the information will be review and come more easily to the PA student).

 

[Josh L.Ac.]

Okay folks, I know all the midlevels think this bill is directed at them [as do some acupuncturists for some reason], but I do have an example of who this bill should be directed at:

http://www.healthegoods.com/2006/01/quackery-are-nds-quacks-am-i-quack.html


I recieved my master's degree in acupuncture from Bastyr University, which also happens to be one of the largest naturopathic medical schools in the country. The most ridiculous thing I heard there was from ND students that claimed their training was equivalent to medical school [as does the ND student in his blog].

Enjoy.

 

[50960]

Biochem, O-chem, A and P are not the same undergrad as they are grad. I took biochem, o-chem, neuro-chem and many more undergrad and there was no real similarity to the same at a grad/med school level. WHY?? because of who teaches it...and who they are teaching at.

 

[oldpro]

Why do you think PA's and NP's should not be allowed to prescribe? Complex procedures is a misleading statement because what one person considers complex, another may not.

With all due respect, med school is not for everyone interested in medicine.

dxu

OK I'm an RN and I'm in Medschool, and I think this is just silly, Fight for what???
NP's and PA's should not be replacing MD's and DO's in primary care. How in the heck is that making health care better? I know you will come down on me but I think to make health car better we need more MD's and DO's not more Physcian assistants and Nurse practicioners, they ARE NOT THE SAME as an MD no matter how long they practice, by law. A critical care RN practicing for 20years may know way more then even a 3rd year resident but the fact is the RN cannot replace the MD. I know they can become certified and a specialist and a PHD but they are a Nurse, Physciacians Assistant.........why do I even have to explain?

To say they can be the House officer and "Flight Surgeon" Is just plain mixing words, a PA will never never out rank me once I'm a Board certified MD. Sorry but you want it then do what I'm doing, go to medschool. I'm so sorry so many PA's and NP's want to be Doctors, they should have sacraficed more like I am doing.

Yea this is my opinion I can see you all have one too, I do respect yours and the career of NP and PA very much I know they work hard and do great jobs. We need them to be NP's and PA's, leave the Full practice of Medicine to the Docs please. Thats what the DO and MD is for. With all due respect.

 

[oldpro]

Just so you know, I'm not a PA and I don't know of any schools that take Pathphys with med students - I was writing without thinking and without evidence. Clearly, Med school is different. The point I simply wanted to get across was that PA school is significant and when you compare the 4 years of med school and PA school, they aren't apples and oranges. I think the biggest difference b/t a med student and a PA student is the residency -.

WHOA here there is an NP at my school and she has said there is a big difference, PA or NP is not a stepping stone to MD, the intensity of the material studied is different in med school, theres a lot more of it and covered and the USLME is no picnic either. This is the problem with premeds and prePA they have no clue to what Medschool is like till they get here. It's way harder than I thought. This is like saying an RN and a NP are only different in a few places but are the same, they are not.

If you go to PA or NP school you will have to start Medschool from scratch if you go later, if they were so much the same then that would not be the case.

 

[lawguil]

If you're not a PA, then how do you know what med school vs. PA school is like? It seems there are more differences than just the residency. Midwestern (IL) has both a DO program and PA program and while some classes overlap, there are significant differences in the curriculums. A lot of graduate healthcare programs are known for volume and intensity (CRNA, PT, OT, SLP, etc.).

To be honest, I think the most recent comments on this post are taking things out of context. I don't remember anybody saying that the PA could replace the MD/DO. That's what some of the latest posters are saying and I suspect that anybody on this forum agrees that the midlevels don't replace the docs! I'm simply stating something as I understand it. Perhaps I should restate an earlier comment...PA training is more similar to MD/DO training than any other professional degree. PA's are dependent healthcare provider and work under the supervision of an MD/DO. They are qualified to prescribe certain drugs and practice medicine as an extension of their supervising physician. Currently, they are doing this and without incident as I know it. PA's do not call themselves "dr". PA's that want to become physicians go to medical school.

To argue about what program is more intense isn't easily debatable. Perhaps the best to answer the question would be a PA who went to medical school or we could analyze the number of hours in the classroom and the material that folks are tested on. It's foolishness! I can tell you this - A student taking an anatomy test with another professor wouldn't want to take my anatomy test and vice versa. I suspect it would be the same for a med student taking a PA exam or PA taking an MD exam.

I find it hilarious to read what students talk, debate and write about.

 

[Baylee]

A family practitioner couldn't begin to compete with a PA within the content area of Derm, ortho, potentially EM.....That family physician probably hasn't seen these specialties since med school.....just a thought! L.

Wait a minute! Do you honestly think a PA can run rings around a family physician simply because they complete a 4 week rotation in each specialty? I checked out one of those PA forums and was surprised to see so many of them complaining about being treated like medical assistants during their training. PA's can tout this "I spent 2000 hours in training" all they want, but when that "training" was 4-6 weeks in each specialty and they barely got their feet wet before moving onto another specialty, then forget it! However, if they spent those 2,000 hours in one specialty (ER, IM, ortho, etc), then I'll be impressed. The way it is now, PA's are a jack of all trades and a master of NONE until they get out there and specialize in one and only one specialty!

 

[lawguil]

Wait a minute! Do you honestly think a PA can run rings around a family physician simply because they complete a 4 week rotation in each specialty? I checked out one of those PA forums and was surprised to see so many of them complaining about being treated like medical assistants during their training. PA's can tout this "I spent 2000 hours in training" all they want, but when that "training" was 4-6 weeks in each specialty and they barely got their feet wet before moving onto another specialty, then forget it! However, if they spent those 2,000 hours in one specialty (ER, IM, ortho, etc), then I'll be impressed. The way it is now, PA's are a jack of all trades and a master of NONE until they get out there and specialize in one and only one specialty!

Baylee, you managed to be somewhat selective with what I acually wrote and thought. Below is a more complete quote:

PA's have a great deal of latitute and can work essentially any specialty without additional certification or training. Imagine a PA who worked IM, then ER, then Derm, then ortho, each for a few years.... then took a position in family medicine....imagine the experience and specialty knowledge this PA could bring to a practice.. A family practitioner couldn't begin to compete with a PA within the content area of Derm, ortho, potentially EM.....That family physician probably hasn't seen these specialties since med school.....just a thought

Mt point was that a PA can work in many specialties without additional formal training. This had nothing to do with clinical training in PA school. Let me break it down:

PA resume in practice (not PA school):
2 years experience working in ER (4160 hours)
1 year practice working in internal med (2080 hours)
2 years in ortho (4160 hours)
1 year in derm (2080 hours)
Remember this is clinical practice and learning under a physician specialist!
I think this particular PA could hold his own against a family physician within the content area of these specialties and potentially be a great asset to a family practice! My suspicion is this is quite a bit more experience and training than the family physician ever had in these specific areas. The exception might be emergency medicine. My understanding is that many family docs also work in some ER's. (?)

***Hours are based of average of 40 hours a week for 52 weeks = 1 year**

 

[deleted6669]

lawguil is right about this one. a specialty pa runs circles around any physician except those practicing their own specialty. as an em pa with almost 20 yrs working exclusively in em I know a lot more em than anyone except an em physician.
I precept fp residents pgy 1-3 in em and know they are not even close. I work with fp locums docs who have been out of residency for years and they still ask me questions every shift and have me do procedures they are not comfortable with like fx and dislocation reduction, management of epistaxis, fb removal from eye/ear/nose and complex facial lac repair, etc.
regarding pa school training- of my 54 week clinical year, 27 weeks were directly related to em with 27 weeks in other primary care specialties.
trauma surgery 5 weeks
peds em 5 weeks
trauma ctr em 5 weeks
community em elective 12 weeks
family medicine 12 weeks
hospital based obgyn 5 weeks
inpt psych 5 weeks
inpt medicine 5 weeks

and prior to becoming a pa I worked in ems for 10 years......

 

[FoughtFyr]

lawguil is right about this one. a specialty pa runs circles around any physician except those practicing their own specialty. as an em pa with almost 20 yrs working exclusively in em I know a lot more em than anyone except an em physician.
I precept fp residents pgy 1-3 in em and know they are not even close. I work with fp locums docs who have been out of residency for years and they still ask me questions every shift and have me do procedures they are not comfortable with like fx and dislocation reduction, management of epistaxis, fb removal from eye/ear/nose and complex facial lac repair, etc.
regarding pa school training- of my 54 week clinical year, 27 weeks were directly related to em with 27 weeks in other primary care specialties.
trauma surgery 5 weeks
peds em 5 weeks
trauma ctr em 5 weeks
community em elective 12 weeks
family medicine 12 weeks
hospital based obgyn 5 weeks
inpt psych 5 weeks
inpt medicine 5 weeks

and prior to becoming a pa I worked in ems for 10 years......

Yeah, I generally agree with you, except that Lawguil's statement "A family practitioner couldn't begin to compete with a PA within the content area of Derm, ortho, potentially EM.....That family physician probably hasn't seen these specialties since med school.....just a thought!" is blatantly false. An FP will spend rotations in all of these areas in residency. A "newly minted" FP against a "newly minted" PA - PA loses everytime. Now, if we take an experienced specialty PA, such as yourself, and compare them against an FP, sure, the PA will usually "win". But that is comparing apples and organges. Take a 20 year experienced specialty PA against a 20 year experienced MD/DO specialist - it ain't even close.

- H

 

[lawguil]

Yeah, I generally agree with you, except that Lawguil's statement "A family practitioner couldn't begin to compete with a PA within the content area of Derm, ortho, potentially EM.....That family physician probably hasn't seen these specialties since med school.....just a thought!" is blatantly false. An FP will spend rotations in all of these areas in residency. A "newly minted" FP against a "newly minted" PA - PA loses everytime. Now, if we take an experienced specialty PA, such as yourself, and compare them against an FP, sure, the PA will usually "win". But that is comparing apples and organges. Take a 20 year experienced specialty PA against a 20 year experienced MD/DO specialist - it ain't even close.

- H

I think you were somewhat selective in quoting me! I'm not comparing entry level PA's vs. MD's.

The following is a more complete quote of my original post!


PA's have a great deal of latitute and can work essentially any specialty without additional certification or training. Imagine a PA who worked IM, then ER, then Derm, then ortho, each for a few years.... then took a position in family medicine....imagine the experience and specialty knowledge this PA could bring to a practice.. A family practitioner couldn't begin to compete with a PA within the content area of Derm, ortho, potentially EM.....That family physician probably hasn't seen these specialties since med school.....just a thought

 

[FoughtFyr]

I think you were somewhat selective in quoting me! I'm not comparing entry level PA's vs. MD's.

The following is a more complete quote of my original post!


PA's have a great deal of latitute and can work essentially any specialty without additional certification or training. Imagine a PA who worked IM, then ER, then Derm, then ortho, each for a few years.... then took a position in family medicine....imagine the experience and specialty knowledge this PA could bring to a practice.. A family practitioner couldn't begin to compete with a PA within the content area of Derm, ortho, potentially EM.....That family physician probably hasn't seen these specialties since med school.....just a thought

I'd still disagree with you. If we take that PA - who by the quote above would be ~ 10 years outside of school, and compared them to an FP who worked in a busy academic center for 10 years, the FP wins "hands down". The reality is that half of an FP (or EM) practice is knowing what can be handled at the office (or ED) and what should / must be referred out. Now, you can argue that this uber-PA would do a better job at that screening except that they really couldn't, for two reasons. First, if there were a procedure that this experienced PA felt comfortable doing, but the FP was not comfortable with and facile at, it shouldn't be performed. At the end of the day, the FP will be liable. Let me give you an example. Let's say that a PA spends two years in a general surgery practice, then goes to an FP practice. A patient with a 4 cm lipoma comes in. Now the FP says "I usually refer those (moderate lipomas) to general surgery" and the PA says "You know, I've done 15 of these in the past year - no big deal" and excises it. During the procedure it is discovered that the lipoma has significant neovasculature and the bleeding is fairly profound and difficult to control. Eventually, it is controlled in the office, but the patient has to be transferred to the local ED for a transfusion and admission. A lawsuit follows. You don't think the FP would be named? Well, that is a true case and the FP was not only named but lost because he "allowed" a PA in his employ to perform a procedure he was not himself comfortable with. Like it or not, individually fair or not, the "buck stops" with the MD/DO. If the FP isn't facile enough at some procedure etc. to "pull the PA's butt out of the fire" if something goes wrong, then the procedure shouldn't be done. The second reason is one of the truths of EM (and FP) that not many people realize. We should be over-triaging. For example, if absolutely every patient admitted to cardiology for a "rule out" MI had an MI, then the EP isn't referring enough. Someone went home with the missed MI. Those not in EM or FM seem to always believe that the goal should be 100% accuracy. That isn't the case. 100% accuracy implies a 0% false positive and 0% false negative rate (regarding assessment of serious pathology). The real goal is 100% false negative. I don't see a PA improving on that rate measured against an MD/DO FP with a similar length of time in practice. If you have data that suggest otherwise, please post them.

- H

 

[lawguil]

I'd still disagree with you. If we take that PA - who by the quote above would be ~ 10 years outside of school, and compared them to an FP who worked in a busy academic center for 10 years, the FP wins "hands down". The reality is that half of an FP (or EM) practice is knowing what can be handled at the office (or ED) and what should / must be referred out.

True! But what I said was:
............A family practitioner couldn't begin to compete with a PA within the content area of Derm, ortho, potentially EM................

I still think KNOWLEDGE within this specific content area goes to the PA. I didn't make any comments on how it would affect clinical practice.

Now, you can argue that this uber-PA would do a better job at that screening except that they really couldn't, for two reasons. First, if there were a procedure that this experienced PA felt comfortable doing, but the FP was not comfortable with and facile at, it shouldn't be performed. At the end of the day, the FP will be liable. Let me give you an example. Let's say that a PA spends two years in a general surgery practice, then goes to an FP practice. A patient with a 4 cm lipoma comes in. Now the FP says "I usually refer those (moderate lipomas) to general surgery" and the PA says "You know, I've done 15 of these in the past year - no big deal" and excises it. During the procedure it is discovered that the lipoma has significant neovasculature and the bleeding is fairly profound and difficult to control. Eventually, it is controlled in the office, but the patient has to be transferred to the local ED for a transfusion and admission. A lawsuit follows. You don't think the FP would be named? Well, that is a true case and the FP was not only named but lost because he "allowed" a PA in his employ to perform a procedure he was not himself comfortable with. Like it or not, individually fair or not, the "buck stops" with the MD/DO. If the FP isn't facile enough at some procedure etc. to "pull the PA's butt out of the fire" if something goes wrong, then the procedure shouldn't be done. The second reason is one of the truths of EM (and FP) that not many people realize. We should be over-triaging. For example, if absolutely every patient admitted to cardiology for a "rule out" MI had an MI, then the EP isn't referring enough. Someone went home with the missed MI. Those not in EM or FM seem to always believe that the goal should be 100% accuracy. That isn't the case. 100% accuracy implies a 0% false positive and 0% false negative rate (regarding assessment of serious pathology). The real goal is 100% false negative. I don't see a PA improving on that rate measured against an MD/DO FP with a similar length of time in practice. If you have data that suggest otherwise, please post them.

Do you think that the PA would have any 'consultation' value within the provisions of ortho, derm, Internal Med, EM to a family doc assuming the same scenario? I really don't know! I suspect if I were a doc and had something interesting ortho/derm...., I might ask the PA to come take a peak.

 

[FoughtFyr]

True! But what I said was:
............A family practitioner couldn't begin to compete with a PA within the content area of Derm, ortho, potentially EM................

I still think KNOWLEDGE within this specific content area goes to the PA. I didn't make any comments on how it would affect clinical practice.

I'm not sure. It would really depend on the PA and what they have picked up and how much they were allowed to do at their previous jobs. I'm not sure it translates universally.

Do you think that the PA would have any 'consultation' value within the provisions of ortho, derm, Internal Med, EM to a family doc assuming the same scenario? I really don't know! I suspect if I were a doc and had something interesting ortho/derm...., I might ask the PA to come take a peak.

Nope! I work with, and really respect PAs. That said I've never used them as a "consulting service". Regardless, even if I did "run something by them", I'm not sure I would allow it to change my management.

- H

 

[lawguil]

I'm not sure. It would really depend on the PA and what they have picked up and how much they were allowed to do at their previous jobs. I'm not sure it translates universally.



Nope! I work with, and really respect PAs. That said I've never used them as a "consulting service". Regardless, even if I did "run something by them", I'm not sure I would allow it to change my management.

- H

I understand

 

[matt1234321]

Maybe all should just stop using abreviations.

Dr. Swane
Nurse Practitioner

Dr. Mark
Physician

Dr. Bob
Physicians Assistant

Dr. Costa
Nurse Anesthetist

Dr. Penn
Anesthesiologist

That would clearly state everyones level of education and what they truly are, i think. Im not even in the medical field my wife is. I just enjoy reading the forums LOL.

 

[jwk]

Maybe all should just stop using abreviations.

Dr. Swane
Nurse Practitioner

Dr. Mark
Physician

Dr. Bob
Physicians Assistant

Dr. Costa
Nurse Anesthetist

Dr. Penn
Anesthesiologist

That would clearly state everyones level of education and what they truly are, i think. Im not even in the medical field my wife is. I just enjoy reading the forums LOL.

That would clear nothing up for the patient. The only ones who win in your concept are the physician wannabees.

 

[matt1234321]

That would clear nothing up for the patient. The only ones who win in your concept are the physician wannabees.

hmmph

I dont know what all that mda, crna, pa, np, and aa stuff means if i am a patient. I just assume you are all physicians. I know what the titles mean without the abreviations though. I see Nurse anesthetist i think of Nurse. I see Physicians assistant i think assistant. I think that grades the position as well as making it clear what level of education they all have.

 

[matt1234321]

Isn't that the point since they haven't been to med school?

I can't debate here i'm just an average Joe. Don't really know what med school has to do with patient knowledge. I just read the first page and thought it looked simple, just put everything on the table in the badge.

 

[rn29306]

hmmph

I dont know what all that mda, crna, pa, np, and aa stuff means if i am a patient. I know what the titles mean without the abreviations though. I see Nurse anesthetist i think of Nurse. I see Physicians assistant i think assistant.

Trolly trolly trolly.

Perhaps, if you are being genuine here, you should educate yourself prior to ranting about titles and education that you don't know much about. Just a thought.

 

[matt1234321]

You always know you are right when both parties disagree. LOL

Nursing model =

Dr. Evans
CRNA

Physician model =

Mr. Evans
Nurse anesthetist

My model=

Dr. Evans
Nurse anesthetist

 

[zenman]

I can't debate here i'm just an average Joe. Don't really know what med school has to do with patient knowledge.

FYI...med school has nothing to do with knowledge...only information.
Information is knowing H20; knowledge is knowing how to make it rain.

 

[matt1234321]

FYI...med school has nothing to do with knowledge...only information.
Information is knowing H20; knowledge is knowing how to make it rain.

Once upon a time I i was nine years old. I hope this is as relevant to the subject as your post.

 

[rn29306]

Once upon a time I i was nine years old. I hope this is as relevant to the subject as your post.

about as relevant as you double typing an "I", one in uppercase and lowercase.

 

[Baylee]

Baylee, you managed to be somewhat selective with what I acually wrote and thought. Below is a more complete quote:

PA's have a great deal of latitute and can work essentially any specialty without additional certification or training. Imagine a PA who worked IM, then ER, then Derm, then ortho, each for a few years.... then took a position in family medicine....imagine the experience and specialty knowledge this PA could bring to a practice.. A family practitioner couldn't begin to compete with a PA within the content area of Derm, ortho, potentially EM.....That family physician probably hasn't seen these specialties since med school.....just a thought

Mt point was that a PA can work in many specialties without additional formal training. This had nothing to do with clinical training in PA school. Let me break it down:

PA resume in practice (not PA school):
2 years experience working in ER (4160 hours)
1 year practice working in internal med (2080 hours)
2 years in ortho (4160 hours)
1 year in derm (2080 hours)
Remember this is clinical practice and learning under a physician specialist!
I think this particular PA could hold his own against a family physician within the content area of these specialties and potentially be a great asset to a family practice! My suspicion is this is quite a bit more experience and training than the family physician ever had in these specific areas. The exception might be emergency medicine. My understanding is that many family docs also work in some ER's. (?)

***Hours are based of average of 40 hours a week for 52 weeks = 1 year**

Let's fast forward to the real world. Even if the PA spent all those hours with all those specialists, how do we know they were trained appropriately? I know specialty docs who have no business practicing medicine, let alone training PA's. Don't get me wrong, experience is important, unless you got that experience working under a quack. I don't have a problem with mid-levels, but I think they should only be trained to work in one specialty. You guys just don't get enough clinical hours in college to work in any specialty you choose. If I went to see a a brand new PA working in an internal medicine practice, I would feel much more secure knowing that PA had actually spent his 2,000 hours of training in internal medicine. Four weeks just doesn't cut it.

I also think it's extremely important that all mid-levels actually have a few years of experience in the medical field (nurse or paramedic) before starting a PA program. I've read several resumes from freshly minted PA's and they have ZERO experience other than their "4 weeks in each specialty." FOUR WEEKS? They didn't even have time to get their feet wet!

 

[freedaheel]

I think you have a good point and concern, I felt that it was the delegation of autonomy, that the physician provides the PA, that should prevent the above situation occurring. A newly minted PA is not going to have near the autonomy that a say a PA of ten years, as dictated in there contract with the supervising physician. As time goes on greater autonomy is earned, not granted, from the supervising physician. This does not translate if the PA switches supervising physicians, once again they will have to earn that autonomy form the physician, it may be a lot faster/easier to gain that respect and trust if the PA clearly can show there knowledge. Anyone else please correct or add on, I am 1st year PA student and a have lot to learn. I can only speak for PAs as I do not know a whole lot of the NP profession.