Why do people recommend PA to medical students and premeds?

[Deecee2DO]

Not sure if this is what you are referring to, but there are numerous studies showing chiro is not effective except in very few circumstances, not to mention that subluxation does not exist. That chiro schools continue to teach it and chiros continue to offer treatment that don’t work based on pseudoscience is snake oil. You don’t have to be a chiro to see that.

That said, I agree with you wrt NPs and MDs. I have a couple friends who quit jobs where they had very little supervision and full autonomy because they felt unqualified to provide that kind of care with no supervision. And these people graduated from reputable programs with decent admissions standards.

Solid footnote/signature btw

---

Members don't see this ad.

 

[Matthew9Thirtyfive]

LOL you're right, I am absolutely not with you. No, I don't think that PAs after a year can work with little supervision, I KNOW many PAs who are working in the field as we speak who are relatively new (like a year or two) who are working with little supervision. Of course, this depends on the specialty, as well as the state you live in because PA laws are highly variable across the country. I never said that all of them can work fairly independently after a year, but it does happen a LOT. Does this mean that they are at the level of expertise as that of the doctor? Of course not!

I truly have no idea who the hell you think you are. Just because you're one med student, resident, whatever, does in no way indicate that you're able to speak on behalf of every doctor/PA relationship in the country. Your assumptions indicate that you're the one who needs their ego checked.

Just because something happens regularly doesn’t mean it is good. Many PAs work autonomously after graduation. IMHO, they shouldn’t. PA school is better than NP school, but I have a friend who got a job in primary care practicing completely autonomously but with physicians available if she needed it. She quit after a month because she felt woefully unprepared to care for anything more than basic sick call stuff. She now works as an RN and part time in a college heath center.

 

[Deecee2DO]

Just because something happens regularly doesn’t mean it is good. Many PAs work autonomously after graduation. IMHO, they shouldn’t. PA school is better than NP school, but I have a friend who got a job in primary care practicing completely autonomously but with physicians available if she needed it. She quit after a month because she felt woefully unprepared to care for anything more than basic sick call stuff. She now works as an RN and part time in a college heath center.

This is my point exactly. No comparison in training between NP/PA and DO/MD. They should NOT have equal job opportunity and should NOT be paid the same and aren't in most parts of the country.

 

[libertyyne]

"I would suggest doing a quick google search before having strong opinions about something you know nothing about." Exactly my point when you state your strong opinions about Chiros in past posts (something you know absolutely nothing about at all). Now you see what its like from the other side.Also, if an NP makes as much and has the same scope of practice as an MD/DO why did you switch careers and attend medical school? Most NPs and PAs I can still tell you are not making ~200K like many MD/DO PCPs however. I have a very intelligent friend who is in NP school and she says she can't stand it because all of the info is just way too superficial for her, that is why she wants to go to medical school after her NP. If NP and MD/DO are doing the same job for the same pay why is there such drastic differences in knowledge-base. I just don't understand.

Lol this nonesense again. Here is my summary from the last time you brought up chiroquackery.

1. Subluxations do not exist.
2. A majority of students surveyed in 2015 indicated "A majority agreed (35.6%) or strongly agreed (25.8%) the emphasis of chiropractic intervention is to eliminate vertebral subluxations/vertebral subluxation complexes." Chiropractic identity, role and future: a survey of North American chiropractic students This is not even including old chiropractors that have spent a lifetime treating subluxations and are unlikely to move away from that.
3. A large portion of State laws state that Chiropractors are licensed to treat "subluxations" . Such a thing doesnt exist, might as well be licensed to hunt unicorns, or perform dinosaur organ transplants.
4. Chiropractors more so than other health professionals tend to be anti-vaccine Are Chiropractors Backing The Anti-Vaccine Movement?
5. Chiropractic treatment is not better than standard of care for back pain and neck pain. (The only two areas where there is evidence to indicate it is useful at all)
6. The plural of anecdote is not Data. I am sure there is a similar amount of "data" to support homeopathy which is completely bunk.
7. Chiropracty is not without risk, strokes are a known complication for cervical work they do, but they tend to gloss over that.
8. Chiropractic benefits are overstated and the large studies indicate no benefit over standard of care.

• A 2011 Cochrane Systematic Review of spinal manipulative therapy for chronic low-back pain reported that “High-quality evidence suggests that there is no clinically relevant difference between SMT [spinal manipulative therapy] and other interventions for reducing pain and improving function in patients with chronic back pain”.
• A 2013 Cochrane review of spinal manipulative therapy for acute low-back pain concluded that “SMT is no more effective for acute low back pain than inert interventions, sham SMT or as an adjunct therapy. SMT also seems to be no better than other recommended therapies. Our evaluation is limited by the few numbers of studies; therefore, future research is likely to have an important impact on these estimates.”

You read that right, no better than SHAM!

• A 2012 National Center for Complementary and Alternative Medicine review of back-pain studies reported that “Overall, studies have shown that spinal manipulation is one of several options─including exercise, massage, and physical therapy─that can provide mild-to-moderate relief from low-back pain. Spinal manipulation also appears to work as well as conventional treatments such as applying heat, using a firm mattress, and taking pain-relieving medications.”
• https://sciencebasedmedicine.org/ch...manipulation-red-flags-a-comprehensive-review

In a world where chiropracters as a bunch cant stop teaching and practicing subluxation based medicine, and the paucity of evidence supporting its use over standard of care, Coupled with other crazy quackery and anti vax attitudes there is no reason to ever send a patient to chiropractic care. I would rather send my patients to a physical therapist.

Show me an honest chiropracter who practices according to their scope of practice and I will show you 2 dozen ones making outrageous claims.

The next argument you make is shows me that just like math you have very little grasp on logic and reasoning and facts. You stated that primary care NPs do not practice medicine to the full exetent as MD/DO's. Any person who has read even a little about the push to grant full privledges to NPs knows that is FACTUALLY INCORRECT. 23 states have given full autonomy to NPs in primary care fields, they can make the same refferals, order the same tests, make diagnosis, sign death certificates and bill to medicare.

The next argument you make that I know nothing about chiropracty because I am not one, the above quoted list of facts disproves your claim. I did look at the literature surrounding chiropractic, (I did a pubmed search you should look into that). It paints a picture of a bunch of psuedoscientific snake oil sales men who are equivalent to sham masasage in terms of efficacy. If I apply the same logic to you , you have no business making any sort of claim since you are a pre-med with a previous career in pseudoscience .

I never said that all NPs make 150+ , I merely pointed that it is fairly common to see pysch NPs recieve that sort of reimbursement.

I have never claimed that NP/PA have the same training as an MD or that they have the same knowledge-base. I merely pointed to the plethora of low quality studies that indicate there is no difference in outcomes for their patients. I am making the argument that in the future when NPs become more prevelent, have 100%medicare billing and the ability to practice in all 50 states, they in all liklihood will drive down reimbursement for Primary care doctors. Your last point actually bolsters my point , if two people with different levels of training are allowed to do the same exact job with similar outcomes , their pay difference will shirnk.

And just to be clear , I am not an NP. But even If I was it would have no bearing on the quality of evidence I have presented (all peer reviewed), or the facts (allowed to practice independently in 23 states, or the quality of the arguments I am making. (this is another logical fallacy you fall into all the time)

 

[rlbk]

Just because something happens regularly doesn’t mean it is good. Many PAs work autonomously after graduation. IMHO, they shouldn’t. PA school is better than NP school, but I have a friend who got a job in primary care practicing completely autonomously but with physicians available if she needed it. She quit after a month because she felt woefully unprepared to care for anything more than basic sick call stuff. She now works as an RN and part time in a college heath center.

I disagree. You have to look at things more individually. I have worked with/shadowed PAs who are in the boat of working mostly independently after a year or so and they feel comfortable most of the time unless it's a case when they know they need the physician. And I've also worked with the physicians on the other side who rave about the PA. There are just a lot of variables involved so you can't make big generalizations like that. You have to consider the laws of the state in which you're practicing, how thoroughly you were taught, the specialty/setting you're in, how quick you're able to pick things up, the dynamic between the physician and PA, etc etc. If you as a physician want to have more oversight over what your PA is doing, then that's your choice and that's cool. But there are many physicians who don't feel the same way that you do. I don't see why it needs to be black and white, all one way or the other.

 

[rlbk]

This is my point exactly. No comparison in training between NP/PA and DO/MD. They should NOT have equal job opportunity and should NOT be paid the same and aren't in most parts of the country.

Uhhh where did anyone say they have equal job opportunity or be paid the same??? I certainly did not. Even if a PA is working mostly independently, they are still working under the doctor and must have their approval/signatures. I've never even brought up salary because I'm perfectly comfortable with a PAs current salary average and I understand why doctors get paid a lot more. There are two conversations going on in this current thread and maybe you have the wrong one lol.

 

[Deecee2DO]

Lol this nonesense again. Here is my summary from the last time you brought up chiroquackery.


The next argument you make is shows me that just like math you have very little grasp on logic and reasoning and facts. You stated that primary care NPs do not practice medicine to the full exetent as MD/DO's. Any person who has read even a little about the push to grant full privledges to NPs knows that is FACTUALLY INCORRECT. 23 states have given full autonomy to NPs in primary care fields, they can make the same refferals, order the same tests, make diagnosis, sign death certificates and bill to medicare.

The next argument you make that I know nothing about chiropracty because I am not one, the above quoted list of facts disproves your claim. I did look at the literature surrounding chiropractic, (I did a pubmed search you should look into that). It paints a picture of a bunch of psuedoscientific snake oil sales men who are equivalent to sham masasage in terms of efficacy. If I apply the same logic to you , you have no business making any sort of claim since you are a pre-med with a previous career in pseudoscience .

I never said that all NPs make 150+ , I merely pointed that it is fairly common to see pysch NPs recieve that sort of reimbursement.

I have never claimed that NP/PA have the same training as an MD or that they have the same knowledge-base. I merely pointed to the plethora of low quality studies that indicate there is no difference in outcomes for their patients. I am making the argument that in the future when NPs become more prevelent, have 100%medicare billing and the ability to practice in all 50 states, they in all liklihood will drive down reimbursement for Primary care doctors. Your last point actually bolsters my point , if two people with different levels of training are allowed to do the same exact job with similar outcomes , their pay difference will shirnk.

And just to be clear , I am not an NP. But even If I was it would have no bearing on the quality of evidence I have presented (all peer reviewed), or the facts (allowed to practice independently in 23 states, or the quality of the arguments I am making. (this is another logical fallacy you fall into all the time)

You have way too much time on your hands. Debating with you about all of this chiro and NP stuff is just like beating a dead horse. No matter what I say (truth or not) you'll always disagree. So I'm done with this, it is a waste of my energy. Someday you'll learn haha

 

[rlbk]

Also the decisions that PAs make while working mostly independent are still heavily influenced by the physician you work with. The way you handle certain circumstances is often based off of how the physician has taught you what they like done. Example: this physician I rotated under had a specific system in how much Ativan should be given and under what specific conditions for an alcohol withdrawal patient. He didn't like CIWA and had his own specific protocol that his PA would use as well when managing these types of patients on his own. Part of being a PA is being kind of like an extension of the physician. It's not like we can disagree with the physician and be like "nope I disagree I think it should be done this way" unless you adequately explain your reasoning to the point of the physician accepting and allowing it. Because they have the final say.

 

[libertyyne]

You have way too much time on your hands. Debating with you about all of this chiro and NP stuff is just like beating a dead horse. No matter what I say (truth or not) you'll always disagree. So I'm done with this, it is a waste of my energy. Someday you'll learn haha

lol, show me good quality evidence and scientific underpinning showing efficacy and i will change my mind about chiropractic. That is the difference between you and I.

The reality is chiropracty is a pseudoscience, maybe your training in actual science/medicine might help you understand that one day.

 

[Deecee2DO]

lol, show me good quality evidence and scientific underpinning and i will change my mind about chiropractic. That is the difference between you and I.

The reality is chiropracty is a pseudoscience, maybe your training in actual science/medicine might help you understand that one day.

To say chiropractic is pseudoscience because SOME schools still have a VERY SMALL PORTION (1 or 2 courses at most) on chiro philosophy because the OLD chiros as part of the ACA who are out of date require it as part of the curriculum JUST LIKE DO SCHOOLS still have required courses on OMT and osteopathic philosophy is very ignorant of you to say. I studied from the same textbooks as I will use in medical school. Chiros get more training in MSK and rehab than PTs, they get more training overall than PTs. Comparing the knowledge of a PT and a DC is hilarious, a DC will outsmart a PT any day of the week. Try looking at a chiro curriculum for once. I studied and practiced with MDs, PTs, DOs PAs etc. My professors for OB gyn in chiro school were MD OB/Gyns, my professors for path were MD pathologists, my professor for Cardiorespiratory diagnosis was a cardiologist, my professor for internal disorders was an Internal medicine physician. All of these professors used the same textbooks they did for our courses as they did with their MD students, our syllabus followed the same outline. This isn't witchcraft it is medicine we learn in chiro school, the small part that is pseudoscience is brushed under the mat (it is NOT the core of the curricula). This post is not saying chiro students get the same education as MDs or DOs because that is NOT the case AT ALL.

 

[libertyyne]

To say chiropractic is pseudoscience because SOME schools still have a VERY SMALL PORTION (1 or 2 courses at most) on chiro philosophy because the OLD chiros as part of the ACA who are out of date require it as part of the curriculum JUST LIKE DO SCHOOLS still have required courses on OMT and osteopathic philosophy is very ignorant of you to say. I studied from the same textbooks as I will use in medical school. Chiros get more training in MSK and rehab than PTs, they get more training overall than PTs. Comparing the knowledge of a PT and a DC is hilarious, a DC will outsmart a PT any day of the week. Try looking at a chiro curriculum for once. I studied and practiced with MDs, PTs, DOs PAs etc. My professors for OB gyn in chiro school were MD OB/Gyns, my professors for path were MD pathologists, my professor for Cardiorespiratory diagnosis was a cardiologist, my professor for internal disorders was an Internal medicine physician. This isn't witchcraft it is medicine we learn in school, the small part that is pseudoscience is brushed under the mat (it is NOT the core of the curricula).

You have not responded to a single fact I listed above.
Subluxations are a fantasy.
Chiropracters believe their profession is to treat subluxations.
A MAJORITY OF Chiropractors believe that. ( the study linked was students from all chiro schools)
Chiropractors are only legally licensed in all 50 states to treat subluxations.

And anything you do is about as good as sham massage.

So yes take your snake oil out of here. Just because you learned physiology doesnt mean squat. I am sure homeopathic schools also have biology and physiology taught.

 

[rlbk]

You have not responded to a single fact I listed above.
Subluxations are a fantasy.
Chiropracters believe their profession is to treat subluxations.
A MAJORITY OF Chiropractors believe that. ( the study linked was students from all chiro schools)
Chiropractors are only legally licensed in all 50 states to treat subluxations.

And anything you do is about as good as sham massage.

So yes take your snake oil out of here. Just because you learned physiology doesnt mean squat. I am sure homeopathic schools also have biology and physiology taught.

One of my close friends is in ND school to be a naturopathic doctor (there are only 7 programs in the US) and they study roughly all of the same sciences as an MD. They just focus on alternative treatments and take a more holistic approach. A vast majority of their patients are those with chronic health problems that they haven't found effective treatment for aka usually were seeing medical doctors before trying the alternative stuff. It's not like they don't believe in traditional medicine, they just are passionate about promoting more natural remedies as an option. My friend went into it because a naturopathic doctor was the only one who was able to get her PCOS symptoms under control. I mean you can choose to believe in their efficacy or not anyway you please, but just putting that out there.

 

[libertyyne]

One of my close friends is in ND school to be a naturopathic doctor (there are only 7 programs in the US) and they study roughly all of the same sciences as an MD. They just focus on alternative treatments and take a more holistic approach. A vast majority of their patients are those with chronic health problems that they haven't found effective treatment for aka usually were seeing medical doctors before trying the alternative stuff. It's not like they don't believe in traditional medicine, they just are passionate about promoting more natural remedies as an option. My friend went into it because a naturopathic doctor was the only one who was able to get her PCOS symptoms under control. I mean you can choose to believe in their efficacy or not anyway you please, but just putting that out there.

there was once a lady cured of aids by homeopathic medicine. What was your point? Naturopathic has nothing to do with chiropractic either. Thats a seperate ball of wax.

 

[rlbk]

there was once a lady cured of aids by homeopathic medicine. What was your point? Naturopathic has nothing to do with chiropractic either. Thats a seperate ball of wax.

I mean homeopathic (which you mentioned) is quite similar to naturopathic, just much more narrow. But maybe you need to simmer down, not sure why you're so riled up about any of this anyway I think you just enjoy disputing with people

 

[libertyyne]

I mean homeopathic (which you mentioned) is quite similar to naturopathic, just much more narrow. But maybe you need to simmer down, not sure why you're so riled up about any of this anyway I think you just enjoy disputing with people

Word of advice, if you gave me that story and I was your attending. I would make sure that every patient you saw had more supervision than necessary because I wouldnt trust you with a prescription for a bandaid. But dont worry, if you are anything like you are online they are going to figure that out anyway.

 

[rlbk]

Word of advice, if you gave me that story and I was your attending. I would make sure that every patient you saw had more supervision than necessary because I wouldnt trust you with a prescription for a bandaid. But dont worry, if you are anything like you are online they are going to figure that out anyway.

HAH I literally just laughed out loud. Oh lordy, I wouldn't have to worry about that because there's no way in hell I'd work with an attending like you nor want any association with. If you are anything like you are online, I can't imagine any other mid-level would either. It's cute to act like you're very powerful, but reality is it would be very easy to find a different attending to work for, one who isn't a total ass. All you're doing is propelling the stereotype of doctor-types being self-righteous dinguses who think waving their title in the air is supposed to intimidate people lol. Which is a shame, by the way, I generally like every med student or doctor I've met. No worries, I've gotten nothing but perfect reviews from attendings on rotations thus far I'll take the opinion of people who actually give me a reason to respect them, thanks though!

 

[libertyyne]

HAH I literally just laughed out loud. Oh lordy, I wouldn't have to worry about that because there's no way in hell I'd work with an attending like you nor want any association with. If you are anything like you are online, I can't imagine any other mid-level would either. All you're doing is propelling the stereotype of doctor-types being self-righteous dinguses who think waving their title in the air is supposed to intimidate people lol. No worries, I've gotten nothing but perfect reviews from attendings on rotations thus far I'll take the opinion of people who actually give me a reason to respect them, thanks though!

I would suggest you read about homeopathy before parroting testimonials. You misunderstand, i respect PA's , i dont respect idiots.If you were a resident I would do the same thing. Once you are out practicing you will see, how little control you have picking the physicans who oversee you if you work in a hospital setting.

 

[rlbk]

I would suggest you read about homeopathy before parroting testimonials. You misunderstand, i respect PA's , i dont respect idiots.If you were a resident I would do the same thing. Once you are out practicing you will see, how little control you have picking the physicans who oversee you if you work in a hospital setting.

Actually false, sorry you don't understand how it works. When you apply for a job, you interview with the physician too. If I don't click with the physician, I simply look for a position elsewhere. PAs aren't stuck working for anyone. The job market for us is so plentiful that it's quite easy to hop someplace else. I know PAs who didn't jive with their physicians (even in a hospital setting) and they just found another one they liked better.

If you're going to be the kind of doctor who takes one tiny viewpoint as a reason to not trust someone with patients, I'm sorry but that would make you a horrible doctor. You're quick to jump to conclusions....not a good quality and also would be an abuse of power. Side note, I never even said I advocate for homeopathic medicine, literally all I did was explain my friend's reasoning why she chose to go into it. That's an objective statement, I never said I even know anything about it because I don't, I only know the general description of what they do. It's important to be able to look at things objectively to try and understand why people think the way they do, whether or not you agree with it. I don't freaking care if people want to use homeopathic medicine or not, it doesn't affect me in the slightest nor does it affect you. Even if I did support homeopathic medicine, it shouldn't matter. Makes you look extremely close-minded and intolerant of anyone who thinks differently than you.

Mic drop.

 

[libertyyne]

Actually false, sorry you don't understand how it works. When you apply for a job, you interview with the physician too. If I don't click with the physician, I simply look for a position elsewhere. PAs aren't stuck working for anyone. The job market for us is so plentiful that it's quite easy to hop someplace else. I know PAs who didn't jive with their physicians (even in a hospital setting) and they just found another one they liked better.

If you're going to be the kind of doctor who takes one tiny viewpoint as a reason to not trust someone with patients, I'm sorry but that would make you a horrible doctor. You're quick to jump to conclusions....not a good quality and also would be an abuse of power. Side note, I never even said I advocate for homeopathic medicine, literally all I did was explain my friend's reasoning why she chose to go into it. That's an objective statement, I never said I even know anything about it because I don't, I only know the general description of what they do. It's important to be able to look at things objectively to try and understand why people think the way they do, whether or not you agree with it. I don't freaking care if people want to use homeopathic medicine or not, it doesn't affect me in the slightest nor does it affect you. Even if I did support homeopathic medicine, it shouldn't matter. Makes you look extremely close-minded and intolerant of anyone who thinks differently than you.

Mic drop.

Haha, the irony. you calling me a horrible doctor. Over my view on pseudoscience being pseudoscience. Get a grip.

I know plenty of PA's who work in hospitals and they have ZERO input into the doctors that oversea them. Hospitalist, EM, CC. Even in large PC settings they have zero control. You should bookmark this and come back after 5 years, or better yet ask any working PA if they have that level of granular control over who will oversee them.

You interjecting yourself into an argument about pseudoscience with the testimony that a different psuedoscience worked in one patient just shows me you have difficulty with critical thinking, evidence evaluation, and a host of other issues. It would make me question your judgement.

I never said anything about what I would say to my patients who choose to take homeopathic medications. It is a free country, people believe in witchcraft, not my business. I would just inform them that based on the studies there is no evidence for efficacy, but if they want to continue on that , its fine. Hint( homeopathic medications are sugar pills)
I do however care if people who are providing care under me are competent and are not pushing witchcraft as the cures for my patients.

 

[Matthew9Thirtyfive]

I disagree. You have to look at things more individually. I have worked with/shadowed PAs who are in the boat of working mostly independently after a year or so and they feel comfortable most of the time unless it's a case when they know they need the physician. And I've also worked with the physicians on the other side who rave about the PA. There are just a lot of variables involved so you can't make big generalizations like that. You have to consider the laws of the state in which you're practicing, how thoroughly you were taught, the specialty/setting you're in, how quick you're able to pick things up, the dynamic between the physician and PA, etc etc. If you as a physician want to have more oversight over what your PA is doing, then that's your choice and that's cool. But there are many physicians who don't feel the same way that you do. I don't see why it needs to be black and white, all one way or the other.

This is exactly my point. New grad midlevels need a period of close supervision so that they can learn what they don’t know and what that boundary is where they need the doctor. Most midlevels don’t have that right away. Of course the time period will depend on the individual.

But let’s think about this logically. Medical school teaches you what you need to know to start learning how to be a doctor. You then go through residency which really prepares you to practice medicine. That’s 7+ years of education. Do you really think a PA, after 2.5 years of school that has less depth and breadth than medical school, is ready to function independently at graduation? No, they are ready to learn on the job how to best extend the care of the physician.

 

[rg2o3]

Haha, the irony. you calling me a horrible doctor. Over my view on pseudoscience being pseudoscience. Get a grip.

I know plenty of PA's who work in hospitals and they have ZERO input into the doctors that oversea them. Hospitalist, EM, CC. Even in large PC settings they have zero control. You should bookmark this and come back after 5 years, or better yet ask any working PA if they have that level of granular control over who will oversee them.

You interjecting yourself into an argument about pseudoscience with the testimony that a different psuedoscience worked in one patient just shows me you have difficulty with critical thinking, evidence evaluation, and a host of other issues. It would make me question your judgement.

I never said anything about what I would say to my patients who choose to take homeopathic medications. It is a free country, people believe in witchcraft, not my business. I would just inform them that based on the studies there is no evidence for efficacy, but if they want to continue on that , its fine. Hint( homeopathic medications are sugar pills)
I do however care if people who are providing care under me are competent and are not pushing witchcraft as the cures for my patients.

I would like to piggy-back off of this response. I am not sure what your job experience is like rlbk, but if it's minimal, you will eventually see that it is not quite as easy to change jobs "because you don't jive with your boss" as you think it is. As life goes on, and you age and have people depend upon you, you can't always just pick up and leave employment as you please. My former s/o is an RN and even she had to deal with extremely sour attending every single day. This was in both pc and hospital settings. The PA's she worked with had to deal with the same. The PA's had their follow-ups to take care of, and if they got in the way, or causing more problem than the money they were bringing in for the physicians, then they would get treated horribly. This was also the largest Urology practice in the area. Just some anecdotal claims to add to the discussion, but I think you will be disappointed as you begin to spend some time in the employment world.

 

[rlbk]

You interjecting yourself into an argument about pseudoscience with the testimony that a different psuedoscience worked in one patient just shows me you have difficulty with critical thinking, evidence evaluation, and a host of other issues. It would make me question your judgement.

I never said anything about what I would say to my patients who choose to take homeopathic medications. It is a free country, people believe in witchcraft, not my business. I would just inform them that based on the studies there is no evidence for efficacy, but if they want to continue on that , its fine. Hint( homeopathic medications are sugar pills)
I do however care if people who are providing care under me are competent and are not pushing witchcraft as the cures for my patients.

Once again, you prove that you're prone to massively jump to conclusions. How would a small statement about why someone you know practices homeopathic medicine indicate in ANY way that I would push it to patients?? How in the hell did you get from point A to point B?
My friend went to be an ND because she said seeing an ND was the only thing that helped her PCOS = I can't be trusted to put on a bandaid because I'll be pushing a homeopathic medicine agenda???
If you are going to make incredible false judgments based on something that clearly doesn't indicate such, you wouldn't be any doctor I would want to be seeing as a patient or working for as a PA.
Just stop, you can't talk your way around rationalizing that absurd conclusion.

If a patient who I would be giving medical advice to as a health professional, I'd do my research and come back to them with studies that I can cite for them, because I haven't read up on it. I would not take what someone said as evidence for my patients, including someone online telling me about the studies. I'd look at them myself so I can see the data to know how to present it to my patient. That is what they teach us in one of our classes in PA school. We literally had a whole class on this.

 

[rlbk]

I would like to piggy-back off of this response. I am not sure what your job experience is like rlbk, but if it's minimal, you will eventually see that it is not quite as easy to change jobs "because you don't jive with your boss" as you think it is. As life goes on, and you age and have people depend upon you, you can't always just pick up and leave employment as you please. My former s/o is an RN and even she had to deal with extremely sour attending every single day. This was in both pc and hospital settings. The PA's she worked with had to deal with the same. The PA's had their follow-ups to take care of, and if they got in the way, or causing more problem than the money they were bringing in for the physicians, then they would get treated horribly. This was also the largest Urology practice in the area. Just some anecdotal claims to add to the discussion, but I think you will be disappointed as you begin to spend some time in the employment world.

There's a difference between working with other attendings in the hospital and your own attending that you work under. An attending in some other department that I'd be working in collaboration with doesn't have that big of an effect on the level of autonomy I'd have with patients across the entire hospital. I could deal with that ass hole from cardiology as a hospitalist PA for example, not a big deal. Only the attending whose service I am with could have that much of an influence.

 

[libertyyne]

Once again, you prove that you're prone to massively jump to conclusions. How would a small statement about why someone you know practices homeopathic medicine indicate in ANY way that I would push it to patients?? How in the hell did you get from point A to point B?
My friend went to be an ND because she said seeing an ND was the only thing that helped her PCOS = I can't be trusted to put on a bandaid because I'll be pushing a homeopathic medicine agenda???
If you are going to make incredible false judgments based on something that clearly doesn't indicate such, you wouldn't be any doctor I would want to be seeing as a patient or working for as a PA.
Just stop, you can't talk your way around rationalizing that absurd conclusion.

If a patient who I would be giving medical advice to as a health professional, I'd do my research and come back to them with studies that I can cite for them, because I haven't read up on it. I would not take what someone said as evidence for my patients, including someone online telling me about the studies. I'd look at them myself so I can see the data to know how to present it to my patient. That is what they teach us in one of our classes in PA school. We literally had a whole class on this.

Do you not see the problem?

You literally not doing research any research on ND is, and what Homeopathy is is doing the opposite of what they teach you . Do you not see how bias prone your opinion on this is, considering 1. it was a single patient, it is a testimonial, it it is meaningless in terms of evidence for efficacy.

Furthermore you interjecting ND into the discussion of chiropracty is like jumping into a discussion about the politics of South Africa with a fact about the roads in Egypt. It makes zero sense.I am going to think you are an idiot. So yes I am going to think you have issues with logical thinking, and evidence evaluation. I am going to oversee the heck out of your patients.

You are a bit delusional in terms of the level of control you will have over who will oversee you. But you will figure this out soon enough.

You go to work as a hospitalist at a midsize 300 bed hospital. You interview with the CMO and start working. There will be 10+ doctors on different shifts that you will have to work with. You will have little control over who is overseeing you. Same applies for any CC, EM, PCP large group job. Individual single doctor practices are quickly becoming extinct and being replaced with large group practices. You wont get to pick and choose who you work with at large groups.

I would also include this on your list of interview subjects . Tell this story to the CMO, tell him you can manage patients just as well as he can, and that you need zero oversight. Good luck with all that.

 

[rg2o3]

There's a difference between working with other attendings in the hospital and your own attending that you work under. An attending in some other department that I'd be working in collaboration with doesn't have that big of an effect on the level of autonomy I'd have with patients across the entire hospital. I could deal with that ass hole from cardiology as a hospitalist PA for example, not a big deal. Only the attending whose service I am with could have that much of an influence.

I don't think you understand what I'm saying. For example, at the urology practice, there were multiple partners. If one of the Physicians told you to do something, you better damn do it, or you won't have a job. So, yes there are multiple attending that you will need to be pleasing in many scenarios. Or another example, working in the ED, there will be multiple attending, better please them all or life will be hell...Not so cut and dry. Not like you're only going to work at a FM office with one attending and he's going to be so pleasant. It seems as if you lack real world experience.

So yes, exactly like libertyyne stated, you will have significantly less control over who is in charge of you than you think. Also, you will constantly be needing to please multiple attendings or life will be pretty poor at work.

 

[rlbk]

Do you not see the problem?

You literally not doing research any research on ND is, and what Homeopathy is is doing the opposite of what they teach you . Do you not see how bias prone your opinion on this is, considering 1. it was a single patient, it is a testimonial, it it is meaningless in terms of evidence for efficacy.

Furthermore you interjecting ND into the discussion of chiropracty is like jumping into a discussion about the politics of South Africa with a fact about the roads in Egypt. It makes zero sense.I am going to think you are an idiot. So yes I am going to think you have issues with logical thinking, and evidence evaluation. I am going to oversee the heck out of your patients.

You are a bit delusional in terms of the level of control you will have over who will oversee you. But you will figure this out soon enough.

You go to work as a hospitalist at a midsize 300 bed hospital. You interview with the CMO and start working. There will be 10+ doctors on different shifts that you will have to work with. You will have little control over who is overseeing you. Same applies for any CC, EM, PCP large group job. Individual single doctor practices are quickly becoming extinct and being replaced with large group practices. You wont get to pick and choose who you work with at large groups.

I would also include this on your list of interview subjects . Tell this story to the CMO, tell him you can manage patients just as well as he can, and that you need zero oversight. Good luck with all that.

I can't believe someone could be so overdramatic regarding a little argument about chiropracty on an Internet forum
How is my opinion bias prone when I literally never said that my friend's testimonial had any affect over my own views??

It's very cute that you think that you think logically. Yeah, interjecting ND into your discussion of chiropracty and homeopathic med is ABSOLUTELY a legitimate reason for concluding that someone can't be trusted to care for patients. Do you even hear yourself??? Hate to break it to you but your pointless online arguments really aren't that serious You're just irrational and like to threaten that you'd abuse your power based on not liking one small thing someone says. Makes you sound like a 5 year old throwing a temper tantrum, fyi.

Apparently it doesn't matter how many times I repeat on this thread that I literally never said that I can manage patients as well as my superior as a PA or that I need zero oversight. You selectively ignore it so that you can put words into my mouth for the purpose of backing up your weak arguments. You're not worth arguing with because I can't even take you seriously. Best of luck in your future career!!

 

[rlbk]

I don't think you understand what I'm saying. For example, at the urology practice, there were multiple partners. If one of the Physicians told you to do something, you better damn do it, or you won't have a job. So, yes there are multiple attending that you will need to be pleasing in many scenarios. Or another example, working in the ED, there will be multiple attending, better please them all or life will be hell...Not so cut and dry. Not like you're only going to work at a FM office with one attending and he's going to be so pleasant. It seems as if you lack real world experience.

So yes, exactly like libertyyne stated, you will have significantly less control over who is in charge of you than you think. Also, you will constantly be needing to please multiple attendings or life will be pretty poor at work.

I don't think you understood what I was originally saying anyway. I get that I'd be working with multiple physicians in a hospital setting. I plan on doing my best to please every attending I work with to any extent. I never implied that if a physician told me to do something that I wouldn't do it, that would just be dumb. If there's an attending who is upset with me for something that I did wrong, then that's on me and I'd do my damn best to correct myself. If there is an attending who is trying to abuse their power and wrongfully diminish my autonomy based on something as ridiculous and irrational as libertyyne who makes jumping to conclusions an Olympic sport, you bet your ass I am going to find a new job. (thankfully I really can't imagine any physician would be so stupid) I'm not saying I would just hop from job to job because an attending is giving my life hell. I just refuse to waste my time working with someone who is so irrational and it is NOT hard to find a new environment to work in, it's just not. Maybe if you live in a small area and not a city that is a medical hub with multiple hospitals and numerous facilities. But also there are some specialties within a hospital where you really don't have multiple attendings like surgery where the patients you have are exclusive to one specific surgeon and no one tells surgery what to do. Also regarding practices with multiple partners, many of them all have their own designated PA. I am currently rotating at a practice like this. The PA barely even has any interaction with any of the physicians other than his own.

 

[libertyyne]

I can't believe someone could be so overdramatic regarding a little argument about chiropracty on an Internet forum
How is my opinion bias prone when I literally never said that my friend's testimonial had any affect over my own views??

It's very cute that you think that you think logically. Yeah, interjecting ND into your discussion of chiropracty and homeopathic med is ABSOLUTELY a legitimate reason for concluding that someone can't be trusted to care for patients. Do you even hear yourself??? Hate to break it to you but your pointless online arguments really aren't that serious You're just irrational and like to threaten that you'd abuse your power based on not liking one small thing someone says. Makes you sound like a 5 year old throwing a temper tantrum, fyi.

Apparently it doesn't matter how many times I repeat on this thread that I literally never said that I can manage patients as well as my superior as a PA or that I need zero oversight. You selectively ignore it so that you can put words into my mouth for the purpose of backing up your weak arguments. You're not worth arguing with because I can't even take you seriously. Best of luck in your future career!!

You better believe people like me will have oversight of you and judge you. So you can think what ever you want. I could care less. What is ironic is you labeling me a bad doctor on an internet comment. So somehow the same standards don't apply to you.

You still can't seem to admit that your argument was simultaneously stupid and irrelevant. But you are going to double down. You say something stupid like that as a part in front of me I am going to judge you. And pal I'm not trying to hurt your feelings, but being under the supervision of doctors is part of your career, we decide how much supervision . It is not a punishment . I am protecting my self because if you say stupid stuff
and do stupid stuff I get sued.
Say stupid things be treated like you are stupid. Simple as that. Good luck with your career sounds like you have a lot of growing up to do .

 

[rg2o3]

I don't think you understood what I was originally saying anyway. I get that I'd be working with multiple physicians in a hospital setting. I plan on doing my best to please every attending I work with to any extent. I never implied that if a physician told me to do something that I wouldn't do it, that would just be dumb. If there's an attending who is upset with me for something that I did wrong, then that's on me and I'd do my damn best to correct myself. If there is an attending who is trying to abuse their power and wrongfully diminish my autonomy based on something as ridiculous and irrational as libertyyne who makes jumping to conclusions an Olympic sport, you bet your ass I am going to find a new job. (thankfully I really can't imagine any physician would be so stupid) I'm not saying I would just hop from job to job because an attending is giving my life hell. I just refuse to waste my time working with someone who is so irrational and it is NOT hard to find a new environment to work in, it's just not. Maybe if you live in a small area and not a city that is a medical hub with multiple hospitals and numerous facilities. But also there are some specialties within a hospital where you really don't have multiple attendings like surgery where the patients you have are exclusive to one specific surgeon and no one tells surgery what to do. Also regarding practices with multiple partners, many of them all have their own designated PA. I am currently rotating at a practice like this. The PA barely even has any interaction with any of the physicians other than his own.

Well, I wish you the best. I hope you find that gig and you and your attending do jive. No one wants to dread going to work.

 

[Ho0v-man]

This is a cooks vs chefs argument at the end of the day. Are cooks capable of becoming chefs? Probably. Does that fact alone make them chefs? No! All of the equivalency studies are garbage. They basically say that when both groups make hamburger helper it usually tastes the same. No ****!?

The fact that it’s considered unethical to conduct actual equivalency studies should be telling in and of itself but apparently we all live in that idiocracy movie.

 

[libertyyne]

This is a cooks vs chefs argument at the end of the day. Are cooks capable of becoming chefs? Probably. Does that fact alone make them chefs? No! All of the equivalency studies are garbage. They basically say that when both groups make hamburger helper it usually tastes the same. No ****!?

The fact that it’s considered unethical to conduct actual equivalency studies should be telling in and of itself but apparently we all live in that idiocracy movie.

I agree with you , however could you give me more information surrounding this .
Studies like this do exactly that through randomization.
Primary Care Outcomes in Patients Treated by Nurse Practitioners or Physicians

 

[W19]

I have not looked at these studies, but diagnosing is more difficult than treating. If these studies focus only on treatment, i don't think they mean that much...

 

[libertyyne]

I have not looked at these studies, but diagnosing is more difficult than treating. If these studies focus only on treatment, i don't think they mean that much...

I don't think it matters much since they have the same legal right to practice in 23 states and counting. It doesn't differentiated between diagnostics or treatment. Plus the studies that do exisit als look at outcomes which is really the only metric that matters. It's not like bean counters are going to read the studies anyway.I just wish there was more concrete evidence to point towards to say see, this is why an Doctor is better.

 

[Matthew9Thirtyfive]

Furthermore you interjecting ND into the discussion of chiropracty is like jumping into a discussion about the politics of South Africa with a fact about the roads in Egypt.

Yo the roads in Egypt suck though.

 

[libertyyne]

Yo the roads in Egypt suck though.

True dat.

 

[Matthew9Thirtyfive]

I agree with you , however could you give me more information surrounding this .
Studies like this do exactly that through randomization.
Primary Care Outcomes in Patients Treated by Nurse Practitioners or Physicians

The flaws with this study are exactly what I said upthread. Measuring systolic bp and a1c over 6 months is meaningless. If a corpsman can effectively manage hypertension with even less training than an NP, I would hope an NP could do it as well. That in no way shows equivalency.

 

[libertyyne]

The flaws with this study are exactly what I said upthread. Measuring systolic bp and a1c over 6 months is meaningless. If a corpsman can effectively manage hypertension with even less training than an NP, I would hope an NP could do it as well. That in no way shows equivalency.

just an example that IRBs do approve studies like this. Contrary to the belief that they are unethical to run. Plus plenty of natural experiments with NP only primary care clinics in states like washington where IRBs wouldnt bat an eye approving a study.

 

[Matthew9Thirtyfive]

just an example that IRBs do approve studies like this. Contrary to the belief that they are unethical to run. Plus plenty of natural experiments with NP only primary care clinics in states like washington where IRBs wouldnt bat an eye approving a study.

That’s not a helpful study and isn’t likely to hurt anyone. A study to show equivalency would need to follow patients for decades and have patients with comorbidities, etc be included, as well as tracking how many misdiagnoses are made, number of unnecessary tests, etc. It will never happen. And the nursing lobby knows this. They also know that their peons can’t really hurt anyone too much in the short term, so any study that comes out isn’t likely to show anything.

 

[libertyyne]

That’s not a helpful study and isn’t likely to hurt anyone. A study to show equivalency would need to follow patients for decades and have patients with comorbidities, etc be included, as well as tracking how many misdiagnoses are made, number of unnecessary tests, etc. It will never happen. And the nursing lobby knows this. They also know that their peons can’t really hurt anyone too much in the short term, so any study that comes out isn’t likely to show anything.

A 5-10 year study looking at various outcomes strictly looking at NP only practices vs MD only practices would be able to accomplish that. Its just sad that FP Docs have to deal with this nonsense. Hopefully it wont impact them negatively too much, but I am not very optimistic.

 

[Matthew9Thirtyfive]

A 5-10 year study looking at various outcomes strictly looking at NP only practices vs MD only practices would be able to accomplish that. Its just sad that FP Docs have to deal with this nonsense. Hopefully it wont impact them negatively too much, but I am not very optimistic.

Yeah, but it’s not going to happen. Nevermind the logistics. NPs won’t agree to it because it will show that they are not equipped to handle more than basic stuff on their own.

These studies show that NPs can handle hypertension and diabetes. Well I sure ****ing hope so, since that’s the whole point of hiring them.

 

[Ho0v-man]

I agree with you , however could you give me more information surrounding this .
Studies like this do exactly that through randomization.
Primary Care Outcomes in Patients Treated by Nurse Practitioners or Physicians

Like all of these equivalency studies, it picks the simplest possible tasks and says “look, there’s no difference omg!”. It’s barely more impressive than comparing handwriting and saying there’s no statistically significant difference.

I get your point and it needs to be made more. What drives me nuts is studies like these translate to NPs/PAs thinking there’s no difference in training. What it really means is that me and a pro body builder can both pick up a 5lb weight. It would be crazy if I thought I could bench 350lb but for whatever reason that seems to end up being the take home with these types of studies.

 

[Psai]

This thread is cancer

All I know is that every time I think I have things figured out, I get humbled. If you think you know what you're doing after doing some dinky little PA program and a year of work, you've got something else coming.

 

[Mad Jack]

Because it's a solid route. Now that I've gone through a lot of this, I can clearly state that medical school was a mistake and I should have gone to PA school. Too late to change my mind, but that's life.

 

[giantswing]

did you say spiders? *burn it all down*

By spiders they really mean heroin needles, but same difference.

 

[W19]

Because it's a solid route. Now that I've gone through a lot of this, I can clearly state that medical school was a mistake and I should have gone to PA school. Too late to change my mind, but that's life.

When you start making 300k+/year working 40 hrs/wk as a psych doc, you probably will change your mind again...

 

[libertyyne]

Because it's a solid route. Now that I've gone through a lot of this, I can clearly state that medical school was a mistake and I should have gone to PA school. Too late to change my mind, but that's life.

Mad jack, you got into the residency you wanted. Are you sure you are not trying to become @failedatlife 2.0?

 

[W19]

One thing people undervalue about being a physician is flexibility. For instance, a psych doc can work 3 days/wk (30 hrs) and still make ~200k/year with full benefits. I know a psych doc who has that kind of deal. He even brags about being on vacation every week because he only works M-T-W.

 

[libertyyne]

One thing people undervalue about being a physician is flexibility. For instance, a psych doc can work 3 days/wk (30 hrs) and still make ~200k/year with full benefits. I know a psych doc who has that kind of deal. He even brags about being on vacation every week because he only works M-T-W.

To add to this, I feel like personality wise I could never be a PA for the rest of my life. I want to be the person driving the ship, making the difficult decisions, and leading the team. I want to be the expert. Someone else nitpicking my work all the time for no logical reason is quick way to make me unhappy, especially if I know what i am doing.

 

[W19]

To add to this, I feel like personality wise I could never be a PA for the rest of my life. I want to be the person driving the ship, making the difficult decisions, and leading the team. I want to be the expert.

As much as I don't like to admit it, I am the type of person that like the prestige associated with being a doc.

 

[Mad Jack]

Mad jack, you got into the residency you wanted. Are you sure you are not trying to become @failedatlife 2.0?

But I've realized that home is more important to me than anything and I just can't handle another move emotionally. I could be living a damn good life two years ago as a PA and here I am four years deep with four years to go and off to the middle of nowhere to a specialty I'm starting to feel isn't what I want. I did this to myself though.