Which route to go.. Nurse/NP,PA,MD

[Arekusu]

Hi All,

I've been lurking for a while, and figured I'd ask my question to people who have maybe thought the same thing or been in the same situation.


Ok, I'm 24, single, been in the military for 6 years now and have 2 to go.

I have my associates degree done and working on my bachelors now in what discipline now, I'm undecided.

I'd like to pursue a career in medicine I think. (I was a CNA for a few years before I joined the military, getting my feet wet for the ground work). But right now I'm having difficulty deciding on which route to take. (I know I ultimately need to do some shadowing but I'm looking for a "what might make most sense")

So I've been thinking about Nursing with a step towards NP, being a PA, or a MD.

With any of the choices, I'd like to go back into the military and finish my time towards retirement (I'm almost half way there). Unless for some reason I completely change my mind.

For the MD route, residency can be completed while being active duty, correct? Which cuts down the total time without pay.

For the nursing part, if I get my degree finished in whatever, I have prerequisites to do and I can apply for a accelerated program.

As for PA, I can apply to if I have my Bac. finished.. only thing that bothers me is that NP can now prescribe where PA's cant, and NP's can practice on there own while PA's cant.. and I've been hearing a lot of and reading a lot of complaints that PA's get second guessed a lot by nurses.. This I don't understand because PA's and NP's are almost the same thing (other than what I wrote about above) as they are both intermediate / mid level providers.

So now I guess I'm looking for maybe some guidance / experience from people that might have been in the same situation and why they choose the route they chose. I know it's a hell of a first post. But I have to start somewhere. Thanks.

Alex

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[bradt9881]

PAs can prescribe in all 50 states. Not sure where you came up with the notion at PAs can't prescribe. Controlled medicines will be limited to state law and DEA regs.

 

[Arekusu]

Sorry, guess I had that one wrong.

 

[princekc]

Hi All,

I've been lurking for a while, and figured I'd ask my question to people who have maybe thought the same thing or been in the same situation.


Ok, I'm 24, single, been in the military for 6 years now and have 2 to go.

I have my associates degree done and working on my bachelors now in what discipline now, I'm undecided.

I'd like to pursue a career in medicine I think. (I was a CNA for a few years before I joined the military, getting my feet wet for the ground work). But right now I'm having difficulty deciding on which route to take. (I know I ultimately need to do some shadowing but I'm looking for a "what might make most sense")

So I've been thinking about Nursing with a step towards NP, being a PA, or a MD.

With any of the choices, I'd like to go back into the military and finish my time towards retirement (I'm almost half way there). Unless for some reason I completely change my mind.

For the MD route, residency can be completed while being active duty, correct? Which cuts down the total time without pay.

For the nursing part, if I get my degree finished in whatever, I have prerequisites to do and I can apply for a accelerated program.

As for PA, I can apply to if I have my Bac. finished.. only thing that bothers me is that NP can now prescribe where PA's cant, and NP's can practice on there own while PA's cant.. and I've been hearing a lot of and reading a lot of complaints that PA's get second guessed a lot by nurses.. This I don't understand because PA's and NP's are almost the same thing (other than what I wrote about above) as they are both intermediate / mid level providers.

So now I guess I'm looking for maybe some guidance / experience from people that might have been in the same situation and why they choose the route they chose. I know it's a hell of a first post. But I have to start somewhere. Thanks.

Alex

..In your position (@ your age), will consider MD/DO. my 0.2c

 

[Boatswain2PA]

I did 20 years in military before getting into PA school.

My advice to you is try your hardest to get into MD/DO school. If you can't get in, then try for PA school. If you can't get into PA school, then go to nursing school and then go for PA or NP later.

I would have tried to go MD/DO route but, with my age and family situation, it wasn't feasible.

 

[Dr Oops]

If independent practice is something you value alot def go MD/DO. If lifestyle is more important to you I would go PA.

 

[Arekusu]

So far, thanks for your experiences. Right now, I do like the MD / PA route best.. Can anyone validate if my assumptions of MD residency in the military are correct?

I'm kind of gun shy of the school but I'm looking at it as the challenge to end all challenges. I'm not sure if thats the right way to go about things or not. I like the idea of constant learning and applying it throughout the rest of my life. Rather than what I'm doing now, learning another airplanes systems and after I memorize the book I'm done and smarter than the other guy with no outside application. Other than diagnosing what's wrong with a system what's broken, and how to fix it / press on with the mission.

I'm hoping by going back into the service after med school, it cuts down my debt, and helps me more ease into being a doctor (best case) and build experience.

Also, since I currently still do not have my entire degree finished (associates in Professional Aeronautics from Embry Riddle, aka. the aviation business degree) what would be the best thing to study once I get out of the military for a degree? Biology? Should I try to finish a degree in whatever now, quickly, for free through the military to just get out and go to school for two years for prerequisites? Thanks again for your experiences. It helps make educated decisions on life.

Alex

 

[Arekusu]

Dr. Oops, what do you mean by lifestyle?

 

[deleted6669]

If lifestyle is more important to you I would go PA.

this is true during training( 6 yrs pa vs 11+ md) but once out of training the docs for the most part have a far better lifestyle; less work for more money and more free time.(granted they have more debt but not 3x as much so they can pay it off more easily)
for example pa's in my em group work 18 ten hr shifts/mo. docs work 12-14 eight hr shifts/mo for 3 times the salary of the pa's. docs drive sports cars while pa's drive hondas.
so who has the better lifestyle?
many surgical pa's round while surgeons are still in bed, then they first assist, then they go to clinic AND handle all the floor calls AND new calls from the er(and write the admission h+p) as well as discharging pts home.
as a result the surgeons (if using their pa's well) spend most of their time in the o.r. and can work 50 hrs/week while their pa's work 60+ doing everything outside of the o.r.

 

[Boatswain2PA]

Also, since I currently still do not have my entire degree finished (associates in Professional Aeronautics from Embry Riddle, aka. the aviation business degree) what would be the best thing to study once I get out of the military for a degree? Biology? Should I try to finish a degree in whatever now, quickly, for free through the military to just get out and go to school for two years for prerequisites? Thanks again for your experiences. It helps make educated decisions on life.
Alex

When I was in the service I was an operator so I wasn't in one place long enough to finish up my undergrad degree. Because of that I went to American Military University (www.amu.apus.edu) and got my degree in emergency management and public health. My final tour was in a staff job (OMG I wanted to put a bullet in my head!!!) but it allowed me to do most of a Masters in Public Health through AMU as well. I have no desire to work in public health, but I knocked it out solely for the purpose of making me more competitive for PA programs. It seemed to work for me, so you might want to check them out.

 

[Arekusu]

I too am an operator and am never in one place. It's great but life kinda goes by quick. Anyway, I was looking at AMU. How did the Public Health degree work out for you, any carry over to help expedite the learning process?

Alex

 

[princekc]

this is true during training( 6 yrs pa vs 11+ md) but once out of training the docs for the most part have a far better lifestyle; less work for more money and more free time.(granted they have more debt but not 3x as much so they can pay it off more easily)
for example pa's in my em group work 18 ten hr shifts/mo. docs work 12-14 eight hr shifts/mo for 3 times the salary of the pa's. docs drive sports cars while pa's drive hondas.
so who has the better lifestyle?
many surgical pa's round while surgeons are still in bed, then they first assist, then they go to clinic AND handle all the floor calls AND new calls from the er(and write the admission h+p) as well as discharging pts home.
as a result the surgeons (if using their pa's well) spend most of their time in the o.r. and can work 50 hrs/week while their pa's work 60+ doing everything outside of the o.r.

And still we're often time treated like second class citizen!

 

[Dwindlin]

this is true during training( 6 yrs pa vs 11+ md) but once out of training the docs for the most part have a far better lifestyle; less work for more money and more free time.(granted they have more debt but not 3x as much so they can pay it off more easily)
for example pa's in my em group work 18 ten hr shifts/mo. docs work 12-14 eight hr shifts/mo for 3 times the salary of the pa's. docs drive sports cars while pa's drive hondas.
so who has the better lifestyle?
many surgical pa's round while surgeons are still in bed, then they first assist, then they go to clinic AND handle all the floor calls AND new calls from the er(and write the admission h+p) as well as discharging pts home.
as a result the surgeons (if using their pa's well) spend most of their time in the o.r. and can work 50 hrs/week while their pa's work 60+ doing everything outside of the o.r.

This is all extremely variable and is not the norm.

 

[Boatswain2PA]

I too am an operator and am never in one place. It's great but life kinda goes by quick. Anyway, I was looking at AMU. How did the Public Health degree work out for you, any carry over to help expedite the learning process?

Alex

Oh yeah, helped me a lot. I was accepted at all 4 schools I interviewed with, and we often talked about my PH degree in the interviews.

It certainly does help me in school, especially with epidemiology and professional issues.

 

[deleted6669]

This is all extremely variable and is not the norm.

this is the future.
it allows docs to do what they do best(surgeons to operate and spend less time outside the o.r. doing h+p's and d/c summaries for example).
there are skills that only physicians have (say doing a lap chole) and things that can be done equally well by an md or a pa(say a wound check in the office).
more efficient practices have each provider play to their strengths to maximize revenue.
it's more common than you think.

 

[Dr Oops]

Dr. Oops, what do you mean by lifestyle?

this is true during training( 6 yrs pa vs 11+ md) but once out of training the docs for the most part have a far better lifestyle; less work for more money and more free time.(granted they have more debt but not 3x as much so they can pay it off more easily)
for example pa's in my em group work 18 ten hr shifts/mo. docs work 12-14 eight hr shifts/mo for 3 times the salary of the pa's. docs drive sports cars while pa's drive hondas.
so who has the better lifestyle?
many surgical pa's round while surgeons are still in bed, then they first assist, then they go to clinic AND handle all the floor calls AND new calls from the er(and write the admission h+p) as well as discharging pts home.
as a result the surgeons (if using their pa's well) spend most of their time in the o.r. and can work 50 hrs/week while their pa's work 60+ doing everything outside of the o.r.

What emedpa said is quite different from what ive seen. Yes clearly the PAs are going to make less money, but they put in less time and money upfront, so they have 6 years more of earning potential.


I havent seen ED PAs, but in surgery it was quite different from what you describe. The PAs would come in 9 leave by 5 while the doc would stay.

So When i meant lifestyle I meant you wont be doing call you'll be working less hours. Yea you'll be making less money but id say around 100K, If emedpa would care to comment on this. Which is quite good for the 2 year education investment.

 

[deleted6669]

it's not a 2 yr education investment, it's 6+.
the majority of pa programs are ms level now so 4 yrs bs + 2-3 yr pa program=6-7 yrs...and most programs want prior experience of several thousand hrs so add on that time for training and on the job experience...another 1-2 yrs.
my path was
emt in high school
er tech during college 26 hrs/week/full time summers
paramedic school right after college( 1 yr)
5 yrs as a medic before becoming a pa
3 yr pa program( bs #2)
1 yr postgrad masters in em
1 yr postmasters adv. certification in family and emergency med.


so a lot more than 2 yrs....

most surgical and ortho pa's I know take call...including nights/weekends/holidays.
aside from folks who choose to work part time I don't know any pa's who work full time who work fewer hrs than the docs they work with. they either work the same hrs(whenever the office is open) or they work more because they take 1st call and do hospital er consults/admits/rounding/discharges.

10% of all pa's work in em so around 8000 pa's nationally.

last yr the avg pa across all specialties who was out of school at least 1 yr made 90k.
new grads averaged around 75k or so.
pa's making > 110k/yr are in the upper 10% and almost always work em, surgery(or surgical subspecialty), ortho, or derm.

 

[drift]

it's not a 2 yr education investment, it's 6+.
the majority of pa programs are ms level now so 4 yrs bs + 2-3 yr pa program=6-7 yrs...and most programs want prior experience of several thousand hrs so add on that time for training and on the job experience...another 1-2 yrs.
my path was
emt in high school
er tech during college 26 hrs/week/full time summers
paramedic school right after college( 1 yr)
5 yrs as a medic before becoming a pa
3 yr pa program( bs #2)
1 yr postgrad masters in em
1 yr postmasters adv. certification in family and emergency med.


so a lot more than 2 yrs....

most surgical and ortho pa's I know take call...including nights/weekends/holidays.
aside from folks who choose to work part time I don't know any pa's who work full time who work fewer hrs than the docs they work with. they either work the same hrs(whenever the office is open) or they work more because they take 1st call and do hospital er consults/admits/rounding/discharges.

10% of all pa's work in em so around 8000 pa's nationally.

last yr the avg pa across all specialties who was out of school at least 1 yr made 90k.
new grads averaged around 75k or so.
pa's making > 110k/yr are in the upper 10% and almost always work em, surgery(or surgical subspecialty), ortho, or derm.

Actually gonna have to agree with this.

My younger brother went to the same undergrad program as me, took the same year off for research that I took, and then instead of med school, went to PA school (33 month local program, compared to 45 months for local med school). All in all, he spent 8 years of study, none was part-time at all in any way. He was able to bypass a residency in the process, and it was a better choice for him. It's not because he wasn't smart enough, infact he had a much higher GPA then me and I could honestly say he is brighter them me any-day. He already has his own website business from which he makes over 200k/yr from anyways, he simply wanted a job he could be proud of, even if it meant bypassing a potential 250-300k salary for a "mere" 100k one.

 

[BLKPA2MD]

What emedpa said is quite different from what ive seen. Yes clearly the PAs are going to make less money, but they put in less time and money upfront, so they have 6 years more of earning potential.


I havent seen ED PAs, but in surgery it was quite different from what you describe. The PAs would come in 9 leave by 5 while the doc would stay.

So When i meant lifestyle I meant you wont be doing call you'll be working less hours. Yea you'll be making less money but id say around 100K, If emedpa would care to comment on this. Which is quite good for the 2 year education investment.

It doesn't take 2-years to train a PA!

 

[deleted6669]

in 2010 coming right out of high school the min time investment to become a pa is 6 yrs.
there are still some non-masters programs(and only a few) but they require significant prior medical experience( paramedic, rn, etc) so really not a time savings when you compare to an ms program because they probably spent at least 2 yrs to get trained and get health care experience.
most reputable pa programs want at least 1000 hrs of health care experience with many requiring 2000-4000. one program that I precept for requires 4000 and their avg for the accepted class is always > 8000 hrs.
granted 6 yrs is still less than 11(the min to become an md/do out of high school) .
6 yrs of school debt can still be significant.

 

[Dwindlin]

most surgical and ortho pa's I know take call...including nights/weekends/holidays.
aside from folks who choose to work part time I don't know any pa's who work full time who work fewer hrs than the docs they work with. they either work the same hrs(whenever the office is open) or they work more because they take 1st call and do hospital er consults/admits/rounding/discharges.

While I do not doubt this is what is going on in your area this is still anecdotal, and I doubt the norm. I would like to see some actual figures on PA hours. In this area PA's work much, much less than the docs. They do not take any call. In this area the surgical PAs handle a lot of the clinic time then some do 1st assists. Finding a PA in the ED is not common either, they mainly work fast track type positions. Again this is anecdotal (like your examples), but just another way the system works in many places (especially in the mid-east region).

 

[deleted6669]

It really varies a lot by location.
some states are very pro-pa like nc, ny, wa, me, vt, nh. pa's can run er's solo in those states(among others).
other states like ohio, indiana, louisianna, missouri, missippi etc have very poor pa utilization and practice legislation. also rural settings utilize pa's to a greater extent than major metro areas so nyc for example isn't a great area for pa's but in upstate ny pa's have great autonomy and scope of practice.

 

[Dwindlin]

It really varies a lot by location.
some states are very pro-pa like nc, ny, wa, me, vt, nh. pa's can run er's solo in those states(among others).
other states like ohio, indiana, louisianna, missouri, missippi etc have very poor pa utilization and practice legislation. also rural settings utilize pa's to a greater extent than major metro areas so nyc for example isn't a great area for pa's but in upstate ny pa's have great autonomy and scope of practice.

This is all I was getting at.

 

[Arekusu]

So in my position of where I am, PA or MD would still be a good choice. It comes down to how I want to live. Do all MDs work crazy amount of hours? Or do some do the 3 on 4 off 12 hr schedule? I would prefer not to work the same amount of hours that I work when I'm deployed,(12hrsx7days), cause that gets old after a few months. I'd rather not even come close to that with another job if able. Three or four 12 hr. days a week doesn't sound bad. I guess I'll head over to the military part of the board to ask about residency for doctors. So now I'm kinda stuck with the PA or the MD thing.. guess I'll try to shadow a few? Thanks to everyones for their input .

Alex

 

[Dr Oops]

So in my position of where I am, PA or MD would still be a good choice. It comes down to how I want to live. Do all MDs work crazy amount of hours? Or do some do the 3 on 4 off 12 hr schedule? I would prefer not to work the same amount of hours that I work when I'm deployed,(12hrsx7days), cause that gets old after a few months. I'd rather not even come close to that with another job if able. Three or four 12 hr. days a week doesn't sound bad. I guess I'll head over to the military part of the board to ask about residency for doctors. So now I'm kinda stuck with the PA or the MD thing.. guess I'll try to shadow a few? Thanks to everyones for their input .

Alex

Well residency is different from actual practice. You will be working ~80 hours a week, sometimes more sometimes less (probably more).

Depending on the residency you do, this will be at minimum 3 years at max 7 years.

It sounds like you would want to do EM (soley based on schedule). You can do 3/4 days on at 12 hours shifts. You can also do 24 hour shifts. In other specialties expect to work 60-70 hours a week. Also if you go into private practice/open your practice you have more say over what hours you want to work.

 

[Evil_Abed]

this is true during training( 6 yrs pa vs 11+ md) but once out of training the docs for the most part have a far better lifestyle; less work for more money and more free time.(granted they have more debt but not 3x as much so they can pay it off more easily)
for example pa's in my em group work 18 ten hr shifts/mo. docs work 12-14 eight hr shifts/mo for 3 times the salary of the pa's. docs drive sports cars while pa's drive hondas.
so who has the better lifestyle?
many surgical pa's round while surgeons are still in bed, then they first assist, then they go to clinic AND handle all the floor calls AND new calls from the er(and write the admission h+p) as well as discharging pts home.
as a result the surgeons (if using their pa's well) spend most of their time in the o.r. and can work 50 hrs/week while their pa's work 60+ doing everything outside of the o.r.

And still we're often time treated like second class citizen!

What you guys are saying is pretty anecdotal. Attending physicians don't have any limits to how much they work (ie. the 80 hrs/week averaged over 4 weeks rule does not apply to attending physicians, only residents). Sure, in some specialties, physicians will definitely have somewhat of a 40hr workweek. This is very unlikely in surgical specialties though...Most physicians I have interacted with (yes, this is anecdotal, I know) have nowhere near the kind of lifestyle "normal" people have.

It doesn't take 2-years to train a PA!

in 2010 coming right out of high school the min time investment to become a pa is 6 yrs.
there are still some non-masters programs(and only a few) but they require significant prior medical experience( paramedic, rn, etc) so really not a time savings when you compare to an ms program because they probably spent at least 2 yrs to get trained and get health care experience.
most reputable pa programs want at least 1000 hrs of health care experience with many requiring 2000-4000. one program that I precept for requires 4000 and their avg for the accepted class is always > 8000 hrs.
granted 6 yrs is still less than 11(the min to become an md/do out of high school) .
6 yrs of school debt can still be significant.

I think the 2 years that the poster mentioned is referring to post-bacc training. If you want to go with the 6 years of post-HS training number though, physicians, at the very least have nearly double that (11 years post-HS). And that's significantly greater than the amount of training that any midlevel goes through.

 

[jl lin]

Yes. I don't get why people begin with the baccalaureate degree when attempting to compare with medicine. There are pre-medical science requirements, the undergrad degree, and MCATs (as well as other requirements for application to MS), but the medical education beyond the pre-medical sciences begins AFTER the Baccalaureate--not in it and other stuff. The pre-med sciences set the foundation and are used competitively to attempt to find the best candidates for medical school seats.

There seems to be a lot of comparing apples to oranges.

Mostly the graduate level degrees in other fields are primarily for research or in order to teach on the university level.

 

[atcpt1]

"A Physician Assistant is a licensed healthcare professional who provides medical care under a physician supervision. Physician Assistant school is almost as long as medical school; the average program is 111 weeks long, compared with 155 for medical school. Physician Assistant programs require students to complete 9 to 12 months of classroom studies, followed by 9 to 15 months of clinical supervision. To prepare for Physician Assistant school, students must complete prerequisite coursework and have healthcare experience."​

It's better to compare the content of the programs. The real difference between a newly minted board certified physician in family practice and a newly minted PA, is residency - which is obviously a lot.

Also, it's fair to point out, at least by some reasonably credible sources, there will be a trend towards 3-year medical school programs for general practitioners in the future.

"In June, the Carnegie Endowment for the Advancement of Teaching will release a major study of medical education, and it will recommend, among other things, that all medical schools consider three-year options"

Google it - it's everywhere in the news. http://www.usatoday.com/news/education/2010-03-25-medical-school-early_N.htm

PA's have similar pre-requisites to Med students
Their didactic and clinical training is similar (although PA is shorter, but likely very similar in weeks and hours of actual training to a newly proposed 3-year medical program)
PA's can do an optional residency (typically 1 year)
Again, the major difference between the two is residency

Residency makes the physician
Supervision and experience is what makes the PA

 

[jl lin]

"A Physician Assistant is a licensed healthcare professional who provides medical care under a physician supervision. Physician Assistant school is almost as long as medical school; the average program is 111 weeks long, compared with 155 for medical school. Physician Assistant programs require students to complete 9 to 12 months of classroom studies, followed by 9 to 15 months of clinical supervision. To prepare for Physician Assistant school, students must complete prerequisite coursework and have healthcare experience."​

It's better to compare the content of the programs. The real difference between a newly minted board certified physician in family practice and a newly minted PA, is residency - which is obviously a lot.

Also, it's fair to point out, at least by some reasonably credible sources, there will be a trend towards 3-year medical school programs for general practitioners in the future.

"In June, the Carnegie Endowment for the Advancement of Teaching will release a major study of medical education, and it will recommend, among other things, that all medical schools consider three-year options"

Google it - it's everywhere in the news. http://www.usatoday.com/news/education/2010-03-25-medical-school-early_N.htm

PA's have similar pre-requisites to Med students
Their didactic and clinical training is similar (although PA is shorter, but likely very similar in weeks and hours of actual training to a newly proposed 3-year medical program)
PA's can do an optional residency (typically 1 year)
Again, the major difference between the two is residency

Residency makes the physician
Supervision and experience is what makes the PA

About CEAT recommendations and what comes of that, well, it remains to be seen.

Now, let's just look at supervised clinical hours--for post-med graduates--AFTER medical school (so, not including clerkship hours) compared with the PA hours of clinical.

OK. Assuming PA clinical hours indeed equal 60 per week (obviously over full-time) compared with the requirement of no more than 80 hours for post MS grads---and given those hours could be hours pounded on top of each other when moving from week to week overlap--so consecutive hours can certainly be way above 80 for the PGY 1 or ?> when they work out there call and rounding schedules, etc, here's how I have basically figured out the difference in clinical training hours. Again, this is not including MS clerkships, nor does it entail the heavy prep for the MS shelves, All the Steps, Orals and other prep for Board Certifications.

OK So If PA clinical supervised hours are consistently 60 hours per week times 9 mo.s--> 9(60)= 540 hours. And if PA clinical supervised hours are consistently at least 60 hours per week times 15 mo.s--> 15 (60) = 900 hours.

Now, if MS PGY 1 or > is working 80 hours per week times 36 months--minimal residency supervised clinical time - not including greater time for many other residencies (4-5year or >) and of course does not include fellowship:

80 hrs/wk *(36 mo.s) = 2,880 hours, and 80 hrs/w * (48 mo.s) = 3,840 hours. There are many five year programs and extended fellowships as you know, so that's even way more hours--and let's not talk about neonatology residency

540-900 hours contrasted with 2440 - 3,840+ hours. That's a big difference.

What's more, the quality of supervised training most will tell you is more intense, and that would include those agreeing with this statement that were once PAs or NPs that went on to MD or DO.


I think everyone should do what they want and be respected for it, but fair is fair. Is it OK to try to put things into perpective here?

The overall depth of knowledge that is expected for the most part is not the same either. Sure, everyone eventually gets on their own curve of learning and gains or losses from their own clinical experiences and study time--reinforcement, researching clinical topics, teaching, etc. But clearly there is a very significant difference in education in class and in clinical.


I can tell you one about the Carnegie POV. Once physicians and medical schools admins see PAs and NPs jumping on this, it will make them even more determined NOT to go that way. Just one person's perspective.

Fire away.

 

[atcpt1]

About CEAT recommendations and what comes of that, well, it remains to be seen.

Now, let's just look at supervised clinical hours--for post-med graduates--AFTER medical school (so, not including clerkship hours) compared with the PA hours of clinical.

OK. Assuming PA clinical hours indeed equal 60 per week (obviously over full-time) compared with the requirement of no more than 80 hours for post MS grads---and given those hours could be hours pounded on top of each other when moving from week to week overlap--so consecutive hours can certainly be way above 80 for the PGY 1 or ?> when they work out there call and rounding schedules, etc, here's how I have basically figured out the difference in clinical training hours. Again, this is not including MS clerkships, nor does it entail the heavy prep for the MS shelves, All the Steps, Orals and other prep for Board Certifications.

OK So If PA clinical supervised hours are consistently 60 hours per week times 9 mo.s--> 9(60)= 540 hours. And if PA clinical supervised hours are consistently at least 60 hours per week times 15 mo.s--> 15 (60) = 900 hours.

Now, if MS PGY 1 or > is working 80 hours per week times 36 months--minimal residency supervised clinical time - not including greater time for many other residencies (4-5year or >) and of course does not include fellowship:

80 hrs/wk *(36 mo.s) = 2,880 hours, and 80 hrs/w * (48 mo.s) = 3,840 hours. There are many five year programs and extended fellowships as you know, so that's even way more hours--and let's not talk about neonatology residency

540-900 hours contrasted with 2440 - 3,840+ hours. That's a big difference.

What's more, the quality of supervised training most will tell you is more intense, and that would include those agreeing with this statement that were once PAs or NPs that went on to MD or DO.


I think everyone should do what they want and be respected for it, but fair is fair. Is it OK to try to put things into perpective here?

The overall depth of knowledge that is expected for the most part is not the same either. Sure, everyone eventually gets on their own curve of learning and gains or losses from their own clinical experiences and study time--reinforcement, researching clinical topics, teaching, etc. But clearly there is a very significant difference in education in class and in clinical.


I can tell you one about the Carnegie POV. Once physicians and medical schools admins see PAs and NPs jumping on this, it will make them even more determined NOT to go that way. Just one person's perspective.

Fire away.

That was my point....the real difference b/t PA and MD is residency
Residency is a big deal

I won't be suprised if more 3 year med schools for primary care are developed


Also,
"OK So If PA clinical supervised hours are consistently 60 hours per week times 9 mo.s--> 9(60)= 540 hours. And if PA clinical supervised hours are consistently at least 60 hours per week times 15 mo.s--> 15 (60) = 900 hours.-jl lin"

As I see it, 9 months x 60 hours week = 2160 hours, not 540...ect. (9months*4weeks/month*60hours=2160)

 

[deleted6669]

Somebody's math is way off....my clinical yr was 54 weeks and over 3000 hrs.....

 

[Denatured]

Somebody's math is way off....my clinical yr was 54 weeks and over 3000 hrs.....

Because Jl lin doesn't know, in her infinite wisdom, thinks there are 4 weeks in a month. But she knows what she's talking about. Not only is she a nurse, but she's a premed. I can't imagine a more logical and intelligent human being.

 

[atcpt1]

http://video.foxbusiness.com/v/4128426/med-school-tackles-rising-education-costs/?playlist_id=87185

Texas Tech offers 3 year medical school for primary care

 

[deleted6669]

http://video.foxbusiness.com/v/4128426/med-school-tackles-rising-education-costs/?playlist_id=87185

Texas Tech offers 3 year medical school for primary care

lecom also has a 3 yr primary care scholars pathway for new applicants straight out of college and separate pa to physician 3 yr bridge program.

I agree that we will see more of this. also more part time medschool options like the 5 yr option at stanford.

 

[jl lin]

Because Jl lin doesn't know, in her infinite wisdom, thinks there are 4 weeks in a month. But she knows what she's talking about. Not only is she a nurse, but she's a premed. I can't imagine a more logical and intelligent human being.

Denature, regardless of the weeks error (actually there are more than 4 weeks in many months--on average 4.33333 weeks, etc), proportionally it is similar. Point being it is many more hours.

I respect the work and education of advanced practice nurses and PAs, etc. I simply cannot agree that an apple is an orange. They are simply both listed under fruits and have some similar shaping. But fundamentally they are both quite different. How is that illogical?

 

[jl lin]

Somebody's math is way off....my clinical yr was 54 weeks and over 3000 hrs.....

Duly noted emedpa. See below. emedpa, does that include clinical rotations as well as post graduate hours? Don't have a clue what you get in terms of time off, if any, but that's no big thing either.

It still reflected many times more hours--total hours really should be averaged on 4.3 weeks/mo. .

That was my point....the real difference b/t PA and MD is residency

Residency is a big deal

I won't be suprised if more 3 year med schools for primary care are developed


Also,
"OK So If PA clinical supervised hours are consistently 60 hours per week times 9 mo.s--> 9(60)= 540 hours. And if PA clinical supervised hours are consistently at least 60 hours per week times 15 mo.s--> 15 (60) = 900 hours.-jl lin"

As I see it, 9 months x 60 hours week = 2160 hours, not 540...ect. (9months*4weeks/month*60hours=2160)

atcpt1: ( 9 mo.s--> (9)(4.3)(60) ≠ 540 hours (Whoops. Dropped a factor.)


Yepper, you are perfectly correct. Thanks. (I pounded that out too quickly and did think that it indeed sounded quite low. Guess I was crossing over some car payment calculations I was doing about the same time—36 mo.s vs 48 vs 60--hybrid vs non-hybrid gas savings.)


So really if you go by 4.3 weeks (since some mo.s have more than 4 weeks), wouldn't that be 2322 hrs based on 9 mo.s? And that is great.

But of course that would go also for medical residency.
So: 3 years*50weeks (got have a least 2 weeks off for vacation or allotted personal time)*80 = 12000 hours. It is still at least 5 times as much clinical hours—and that’s only looking at three years and is NOT including clerkships, which really shouldn’t be taken out.

So If a person does 5 years post-MS grad, 5 years * 50 weeks * 80 = 20,000 hours.

Great big difference.

I feel reasonably confident in that time alone IS NOT the only big difference between the two (or three—if you include NPs) as well.

I think it is silly to compare apples to oranges—or pineapples to pumpkins. J They aren’t close to being the same, and that is the point.

Now, when you talk about individual differences between practitioners, whether they be MDs, PA s, DO s, or NPs, yes, the individual can make a huge difference in terms of quality and effectiveness. But this is a tough thing to quantify.

Ultimately it is always up to the individual practitioner in terms of what and how she or he will excel in his or her practice. Some people go the extra mile or are especially talented and continue to grow, and some folks don’t.

 

[Cmaj7th]

Because Jl lin doesn't know, in her infinite wisdom, thinks there are 4 weeks in a month. But she knows what she's talking about. Not only is she a nurse, but she's a premed. I can't imagine a more logical and intelligent human being.

what does her being a nurse and a pre-med have anything to do with her opinion? your post is unneccessarily rude and makes you come off as extremely arrogant.

 

[deleted6669]

Duly noted emedpa. See below. emedpa, does that include clinical rotations as well as post graduate hours? ]

nope. 3000 hrs of clinical rotations in pa school.
I also did an (optional) 1 yr post grad ms in em with clinical, didactic, and research components and published my thesis in a peer reviewed medical journal.

 

[jl lin]

nope. 3000 hrs of clinical rotations in pa school.
I also did an (optional) 1 yr post grad ms in em with clinical, didactic, and research components and published my thesis in a peer reviewed medical journal.

So then what would you say your total hours of clinical education were? Did you also do the extra/optional for teaching purposes? Also, do you ever teach NPs? Just curious.

Thanks.

 

[deleted6669]

So then what would you say your total hours of clinical education were? Did you also do the extra/optional for teaching purposes? Also, do you ever teach NPs? Just curious.

Thanks.

prior experience included 5 yrs as an emt/er tech, a 1 yr paramedic program and 5 years as a paramedic in los angeles and philadelphia.
In pa school I did around 3000.
the postgrad masters was to gain graduate level specialty credentials, not for teaching purposes. the ms requires 800 hrs of specialty clinical experience but I did quite a bit more that yr( it was a full time yr of work + overtime).
additionally I did a 1 yr postmasters cert in "adv. clinical studies in family and emergency medicine" which was 16 credits of didactic coursework.
I also have done a lot of specialty specific cme in order to get better em jobs(acls, atls, pals, apls, abls, fccs, difficult airway course, global health coursework, etc, etc).
I have taught paramedic, pa, np, md, do students as well as md fp residents.
by the time all was said and done I should have just gone to medschool in the first place.
I'm still considering the 3 yr pa to do bridge at lecom and/or an mph with a tropical med or global health focus or a DHSc.

 

[jl lin]

prior experience included 5 yrs as an emt/er tech, a 1 yr paramedic program and 5 years as a paramedic in los angeles and philadelphia.
In pa school I did around 3000.
the postgrad masters was to gain graduate level specialty credentials, not for teaching purposes. the ms requires 800 hrs of specialty clinical experience but I did quite a bit more that yr( it was a full time yr of work + overtime).
additionally I did a 1 yr postmasters cert in "adv. clinical studies in family and emergency medicine" which was 16 credits of didactic coursework.
I also have done a lot of specialty specific cme in order to get better em jobs(acls, atls, pals, apls, abls, fccs, difficult airway course, global health coursework, etc, etc).
I have taught paramedic, pa, np, md, do students as well as md fp residents.
by the time all was said and done I should have just gone to medschool in the first place.
I'm still considering the 3 yr pa to do bridge at lecom and/or an mph with a tropical med or global health focus or a DHSc.

Wow. Can I asked why you'd just do DO and not consider allopathic schools? Not that it's a big deal. Just curious. Is it b/c it's the 3 years? Seems like you have a TON of great experience.

I know I'm a bit biased, but I think you'd be an excellent candidate for med school. Don't know all you got going on, but really, if you can, I say just go for it.

 

[deleted6669]

Wow. Can I asked why you'd just do DO and not consider allopathic schools? Not that it's a big deal. Just curious. Is it b/c it's the 3 years? Seems like you have a TON of great experience.

I know I'm a bit biased, but I think you'd be an excellent candidate for med school. Don't know all you got going on, but really, if you can, I say just go for it.

DO programs value life experience and older students much more so than md programs. DO's also just seem a lot mellower and a lot less anal than their md counterparts, both during training and in practice.
the 3 yr deal is appealing but even at 4 yrs I would still go DO over md.
at this point in my life it's unlikely to happen. married/kids/mortgage/no significant debt, etc
my "opportunity cost"(lost income+loans+price of school)is over 1 million dollars. if someone gave me that million bucks I would go but breaking even at this point in my life financially by going the doc route is not guaranteed. I already make as much as many primary care docs and if I went back I would probably do full scope rural fp, not a big money maker. before my kids were born I went back to school part time and took a yr of physics, genetics, stats, etc in anticipation of going back but adding kids to the equation made it a lot more complicated.

 

[jl lin]

DO programs value life experience and older students much more so than md programs. DO's also just seem a lot mellower and a lot less anal than their md counterparts, both during training and in practice.
the 3 yr deal is appealing but even at 4 yrs I would still go DO over md.
at this point in my life it's unlikely to happen. married/kids/mortgage/no significant debt, etc
my "opportunity cost"(lost income+loans+price of school)is over 1 million dollars. if someone gave me that million bucks I would go but breaking even at this point in my life financially by going the doc route is not guaranteed. I already make as much as many primary care docs and if I went back I would probably do full scope rural fp, not a big money maker. before my kids were born I went back to school part time and took a yr of physics, genetics, stats, etc in anticipation of going back but adding kids to the equation made it a lot more complicated.

About the kids, well, it always does. At least for me it did.

But with your background, doing FM w/ ED fellowship or something similar could help you make up that money. EM - you could make up for that too. I think it depends on what other income you have flowing other than your own during the process. But don't they use PAs PT or per diem--something?

Also, in some remote areas, the pay for physicians is greater.

Don't know if you are military or not, but that could help with funding couldn't it?

OTOH, if you are happy with what you are doing now, why put the added stress and debt on your back?

So I guess it depends on how happy you are with what your are doing.


Doesn't change the fact that you make a difference, even if patients don't always appreciate it--especially in the ED. Good luck whatever you choose.

 

[princekc]

prior experience included 5 yrs as an emt/er tech, a 1 yr paramedic program and 5 years as a paramedic in los angeles and philadelphia.
In pa school I did around 3000.
the postgrad masters was to gain graduate level specialty credentials, not for teaching purposes. the ms requires 800 hrs of specialty clinical experience but I did quite a bit more that yr( it was a full time yr of work + overtime).
additionally I did a 1 yr postmasters cert in "adv. clinical studies in family and emergency medicine" which was 16 credits of didactic coursework.
I also have done a lot of specialty specific cme in order to get better em jobs(acls, atls, pals, apls, abls, fccs, difficult airway course, global health coursework, etc, etc).
I have taught paramedic, pa, np, md, do students as well as md fp residents.
by the time all was said and done I should have just gone to medschool in the first place.
I'm still considering the 3 yr pa to do bridge at lecom and/or an mph with a tropical med or global health focus or a DHSc.

..emedpa without any doubt you're a fat cat ($$$) hence you would think it through before taking the jump. But here's a hypothetical scenario:

1) Let say you get accepted @ LECOM bridge program. I'm sure you could still pick up preferably per diem/weekend shift & pick up extra hrs during holidays.

2) Let say you pursue EM/IM residency training, particularly program that provides moonlighting opportunity for pgy2 resident. Moonlighting as a resident =$$$ & could probably = your current PA take home income. With your experience as a PA, you'll be a valuable asset to residency program.

3) Say you ended up pursuing 3-years EM residency program. Starting salary ranges from $180-250K/yr. Must note, salary varies by region.

In scenario # 2 above, say you match at a residency program that provides moonlighting opportunity, you could start recovering lost wages & eventually make up the rest post residency training.

 

[deleted6669]

the whole point of someone GIVING me the million dollars is so that I don't have to work while in school and would retain the ability to stay married and see my kids....
I don't know too many FP residents that make my salary by moonlighting....I make in the uper 5% of pa's nationally....( > 100k and <200k). in fact I know quite a few fp attendings who make less than I do...

 

[princekc]

the whole point of someone GIVING me the million dollars is so that I don't have to work while in school and would retain the ability to stay married and see my kids....
I don't know too many FP residents that make my salary by moonlighting....I make in the uper 5% of pa's nationally....( > 100k and <200k). in fact I know quite a few fp attendings who make less than I do...

..I was referring to EM or IM residency program not FP program. I know quite a few EM & IM program that provides moonlighting opportunity for their pgy2 resident. I've seen quite a few IM (pgy2 & pgy 3) that moonlight @ 75/hr rate as a Hospitalist & doing mainly admission. A friend of mine; an IM resident (pgy2) makes >$100k last yrs & knows people that makes more than him moonlighting. I think with careful planning, pursuing the bridge program @ LECOM is doable beside your reasons stated above. I personally have my reservation about DO program in general & will pursue MD program instead as a PA. However, I intend to apply broadly.

 

[Denatured]

what does her being a nurse and a pre-med have anything to do with her opinion? your post is unneccessarily rude and makes you come off as extremely arrogant.

Bah, you're right. Im just being cranky these days. Apologies.

As far as the nurse/premed thing I was just making a joke on stereotypes.