Would you ask a PA for help?

[Carboxide]

Hey residents,

I'm interested in seeing what you think about this. Several PA students I know have made a big deal out of the fact that "PAs are just like doctors and can do the same things, and physicians will often go ask PAs for advice because the PA knows more about it than they do." Now, the issue of PA = doctor has been discussed ad nauseum; I'm NOT interested in addressing that. I would like to know if you, as a resident, would ask a PA for advice in diagnosing or treating a patient.

It sounds fishy to me, if only because I have a serious dislike of PAs, but as I'm neither a PA nor a physican, I wouldn't really have any insight to if this is realistic.

Thanks for your input!

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[glade]

Nope. The PAs I know are like nurses. They learn through experience, not through knowledge of disease processes or pathophysiology. This leads them to make some rather poor choices in many cases.

Although, I'm sort of wondering why a Pharmacy Student would care. I'd let you know that there's a 95% chance this thread will be shut down.

 

[Ashers]

If the PA has experience in an area in which I do not, I go to them a lot. Right now, I'm on a service that has a PA, and she's very helpful for advice about the patients. This doesn't mean she's the attending, he's the ultimate say, but I have no problem asking her questions about the patients.

FWIW: I'm on a bone marrow transplant service.

 

[Droopy Snoopy]

Hey residents,

I'm interested in seeing what you think about this. Several PA students I know have made a big deal out of the fact that "PAs are just like doctors and can do the same things, and physicians will often go ask PAs for advice because the PA knows more about it than they do." Now, the issue of PA = doctor has been discussed ad nauseum; I'm NOT interested in addressing that. I would like to know if you, as a resident, would ask a PA for advice in diagnosing or treating a patient.

It sounds fishy to me, if only because I have a serious dislike of PAs, but as I'm neither a PA nor a physican, I wouldn't really have any insight to if this is realistic.

Thanks for your input!

There's rarely a day that goes by that I, as a resident, don't ask someone's advice regarding something. Wound care, nutrition, tele staff, pharmacy, if you can help me help my patient then I'm not above asking advice from you. I think most docs are like that. A couple of months back in the ICU my staff (BC Pulm/CC) would routinely discuss cases involving difficult vent management with one of the longtime RTs on the unit.

The caveat is that any advice I seek, be it from a PA or a cardiologist, will be in the form of a very specific question. I'd never ask a PA for help 'diagnosing and treating' a patient in the broad sense, but when pre-rounding I might as a PA who's worked in a neurosurgical ICU for 10 years to help advise the team on how best to titrate various therapies and optimize ICP control.

 

[keeping-it-real]

I'm sure the Neurology PA who's been working for 20 years has little to impart on an intern or junior resident

Medicine is just knowledge. If you take the time to learn the material, read the current literature, and have extensive experience, it really doesn't matter what your formal degree is.

 

[glade]

a) I'm not saying they have nothing to impart. I'm just saying it's surprisingly little.

b) I'd rather get my info from another resident or attending.

Sorry I'm ruining your "let's hold hands around the campfire" mood, dude.

 

[notinkansas]

Depends on the setting. Sometimes a PA is the only one handy. You can't always necessarily wait for the attending to come around. Or page them.

I think it is true that a PA can know more about a very narrow topic than a resident, if they have been working in that area for years, and you are just rotating through. (example: ICU's) I didn't ask for advice a lot, and when I did I would usually ask it way as if I were asking if there is a protocol for something (as in the afore mentioned managing ICP thing- I might ask, "how do you guys usually titrate this med?" Will that neuro ICU PA know how to manage pts with severe CHF or necrotizing pancreatitis? I don't think so.

 

[Carboxide]

Nope. The PAs I know are like nurses. They learn through experience, not through knowledge of disease processes or pathophysiology. This leads them to make some rather poor choices in many cases.

Although, I'm sort of wondering why a Pharmacy Student would care. I'd let you know that there's a 95% chance this thread will be shut down.

Oh, I'm just curious because of what my former classmates were saying. They were essentially saying that physicians will refer a patient to the PA because the PA is 'better' at handling it, and they specifically mentioned difficult cases. Of course, these same students all said they wanted to be PAs because "You get to be a doctor, but for cheaper."

It interested me specifically because I've had nothing but extremely poor experiences with PAs. (An ER PA not only didn't realize from the x-ray that the bone I broke needed to be realigned, but also splinted it wrong, according to the orthopedic surgeon; suffice to say it caused me quite a lot of pain and agony in the long run because he did it improperly. He also introduced himself as a 'doctor'; if I'd have known he wasn't one, I would have asked to wait until a physician was available.) I suppose it's really a personal question, and not something that I want to know as a pharmacy student, certainly.

Just figured it couldn't hurt to see some opinions.

 

[glade]

Oh, OK. Just wondering. Yeah, that's the kind of stuff I'm talking about with PAs. My experience, PAs are kind of like interns, regardless of how long they've been working. They can be working for 20 years, they're still intern-level. They can deal with very simple floor problems and they're great at paperwork. That's about it. I know this one Cardiology PA who is like sixty years old and she can't even read an EKG. That group has her do discharges and write notes on the patients. I know a Surgery PA who is, to be fair, younger (thirties) but she can't even really handle someone who is hypotensive.

 

[EMDream]

Intern level my ass. I blow the interns out of the water. I teach residents. PGY I AND II residents ask me questions all the time and thank GOD they do because their plans are often so atrocious that the patients would be in serious trouble or sitting on floor for days when they can be discharged. BUT. I also see PAs and NPs that are just atrocious as well, and some interns are great! there are some attendings that we ALL scratch our heads at. Lets just say it has a lot to do with the quality of the program PA program they graduated from, or on the flip side residency program they are in currently. I think that there is a wider range among midlevels because theres only one certifying exam as opposed to THREE step 1 2 3 so its not as assured that everyones on the same level. And PA programs vary some have gross anatomy and are essentially compressed medical school 8-9pm for 2-3 years others arent as brutal. Just respect the fact that there are some PAs and NPs that know more than residents but as a rule probably a lot are around pgyI-II and it also depends on their attending doc and the amount of autonomy (I'm REALLY autonomous)

 

[Rendar5]

Sorry to hear that the PA's at your place work at such a level Glade. The PA's my hospital hires tend to work at the level of a good senior resident. I pick their brain as much as I pick the brain of my own senior residents. They know more, they've been around more, and yes, they can handle extremely critical patients no problem.

I work in EM, which tends to have quality PA's, though. Can't speak to other services.

 

[glade]

Intern level my ass. I blow the interns out of the water. I teach residents. PGY I AND II residents ask me questions all the time and thank GOD they do because their plans are often so atrocious that the patients would be in serious trouble or sitting on floor for days when they can be discharged.

Wow, you blow the interns out of the water? You're awesome!

 

[southerndoc]

I'm an attending and I've asked PA's questions before, especially those that have had a lot of time in ortho to give me second opinions on how to manage fractures, subtle x-ray findings, etc.

I ask nurses what they think of certain things.

I'm a physician, not God. I make mistakes and need guidance just like anyone else. If you think you're too good to ask someone their opinion, then you're begging for a lawsuit as arrogance will only land you in the middle of a malpractice suit.

 

[glade]

Yeah, but that's quite different in your situation. I might ask, heck, even an intern a question for something out of my field. Like, an OB-GYN intern knows more than me about OB. Probably even the medical student on service does. I don't care. But would I ask a PA in my field something? Uh, no.

Oh, and by the way, you should know (and I know you do) that curb-siding is a big no-no.

 

[Sneezing]

As a medical student for nevi excisions on a family med rotation I asked help from a PA who had been a surgical PA for years. It wasn't anything drastic but more for me to have my hand held and extra pair of eyes to make sure I did it right.

All my other experiences with midlevels leave something to be desired. I'll ask help on simple fact questions or basics I have momentarily lapsed. The types of basics I knew a few months earlier, or can vividly remember the lecture, or paragraph in a text, but can't quite pull it out. So, I'll ask if they're next to me. When they confirm the answer its one of those things you remember instantly if that is or isn't the right answer. Anything else more complicated, no, I won't waste my time. I'd rather go look it up myself, text another student, or ask the attending.

Hospitals have so many computers. Cell phones have internet. There are resources to get much of the knowledge that is in print. Yeah, it is possible to ask a NP/PA and they'll know, but again it has also been my limited experience that there is a work ethic difference and overall devotional difference to mastering the material. Why ask down when you can ask up?

For the times I've made mistakes and explained my thinking, I do not want to have use the line, "well I did X because I asked the NP/PA and that's what they said to do based on their reasoning." I can already see an attending tearing me apart, or worse explaining that to the hospital lawyers how I just got into a mess. No, thanks. There is always some available to call for emergencies even at night for upper level residents and attendings.

 

[glade]

Actually, I can't think of a single residency where saying "I did it because the nurse/PA told me to" wouldn't make people question your clinical judgement. As in "do you have any?"

 

[core0]

Oh, I'm just curious because of what my former classmates were saying. They were essentially saying that physicians will refer a patient to the PA because the PA is 'better' at handling it, and they specifically mentioned difficult cases. Of course, these same students all said they wanted to be PAs because "You get to be a doctor, but for cheaper."

snip

Just figured it couldn't hurt to see some opinions.

I'll try to address this. In medicine time is money. In particular there are patient types that require tremendous amounts of time with low reimbursement. Instead of taking care of these patients you can have another provider see them freeing up the physician to either take care of more complex patients or do procedures which are more lucrative.

This is most common in specialty care. For example after seeing a patient and diagnosing them with IBD, the follow up care can be relatively straight forward but time consuming. You could then have them follow up with the PA allowing the physician to see new consults or do procedures with input as necessary by the physician.

Cardiology can do this with lipid clinics or any time something needs to be titrated. With good physician mentoring its relatively simple to become expert in a very narrow field. There is even someone at a relatively prestigious school that runs the "recurrent abdominal pain clinic". You could fill those appointments with a physician but thats probably not the best use of the physicians time.

David Carpenter, PA-C

 

[ResidentMD]

There's rarely a day that goes by that I, as a resident, don't ask someone's advice regarding something. Wound care, nutrition, tele staff, pharmacy, if you can help me help my patient then I'm not above asking advice from you. I think most docs are like that. A couple of months back in the ICU my staff (BC Pulm/CC) would routinely discuss cases involving difficult vent management with one of the longtime RTs on the unit.

The caveat is that any advice I seek, be it from a PA or a cardiologist, will be in the form of a very specific question. I'd never ask a PA for help 'diagnosing and treating' a patient in the broad sense, but when pre-rounding I might as a PA who's worked in a neurosurgical ICU for 10 years to help advise the team on how best to titrate various therapies and optimize ICP control.

I'm a physician, not God. I make mistakes and need guidance just like anyone else. If you think you're too good to ask someone their opinion, then you're begging for a lawsuit as arrogance will only land you in the middle of a malpractice suit.

 

[476515678234896]

 

[ResidentMD]

Looking at your previous contributions, this is probably the best you can do.

Go back to your pre-dental forums.

 

[deleted6669]

I work in facilities that have both family medicine and internal medicine residencies.
I get asked questions by residents rotating through the e.d. on a daily basis. for the most part these are em related questions, not questions related to their own field.
we also hire a lot of em attendings right out of residency. these guys ask me lots of primary care related questions. pa's regardless of specialty are required to recert on a primary care exam every 6 yrs so we often know primary care better than newer em docs who know em upside down but may forget how to tx BV or hemorrhoids( both questions I was asked by a brand new em doc yesterday).

 

[Dr Magpie]

I have asked PAs for help/advice before but generally these have been narrowly focused questions. One of the best ways I have learned from PAs is working with them in a "fast track" ER setting- a PA who has been suturing lacs, removing foreign objects from eyes, etc for decades has a lot of practical knowledge to impart to a med student or resident.

I doubt I would likely ask for assistance with managing a complex medical case. I would certanly ask for input regarding their field of specialty (the neurosurg PA example above was a good one) or a brief "should I or shouldn't I?" type of question where it's sometimes just good to get an extra input. This doesn't mean I will take their advice each time, but another opinion from a skilled clinician is always at least worth thinking about and may help you see the problem in a light you hadn't considered before.

 

[deleted6669]

One of the best ways I have learned from PAs is working with them in a "fast track" ER setting- a PA who has been suturing lacs, removing foreign objects from eyes, etc for decades has a lot of practical knowledge to impart to a med student or resident.

this is a fairly common way for residents to work with pa's. at one of my prior jobs the fp interns had a required month long procedures rotation with the em pa's covering suturing, slit lamp use, I+D's, toenail removal, fb removal, fx and dislocation reduction and management, splinting, management of epistaxis, dental, digital and regional blocks, etc in the fast track area of the dept.

 

[drflower66]

Intern level my ass. I blow the interns out of the water. I teach residents. PGY I AND II residents ask me questions all the time and thank GOD they do because their plans are often so atrocious that the patients would be in serious trouble or sitting on floor for days when they can be discharged. BUT. I also see PAs and NPs that are just atrocious as well, and some interns are great! there are some attendings that we ALL scratch our heads at. Lets just say it has a lot to do with the quality of the program PA program they graduated from, or on the flip side residency program they are in currently. I think that there is a wider range among midlevels because theres only one certifying exam as opposed to THREE step 1 2 3 so its not as assured that everyones on the same level. And PA programs vary some have gross anatomy and are essentially compressed medical school 8-9pm for 2-3 years others arent as brutal. Just respect the fact that there are some PAs and NPs that know more than residents but as a rule probably a lot are around pgyI-II and it also depends on their attending doc and the amount of autonomy (I'm REALLY autonomous)

Thanks for posting this. I don't think many of the med students and even interns/residents realize how absolutely little they know about treating patients until they have been in the field for a little while. Some people get it right away, usually the more mature students, some people take years, and other never get it - those folks can even end up making beaucoup bucks in the radiology room for example. The facts you get in med school are just facts, they don't necessarily - depending on the program - really teach you how to be a doctor or even how to evaluate patients realistically. Orders and treatment can't be based on a set of facts on paper or on protocols. It comes from experience and it takes a while to figure out which facts they shove down your throat are actually useful, and then some time to get over the resentment when you figure out that most of what they teach you in med school is fairly useless when dealing directly with patients.

PA and/or an NP with years of experience can be goldmines of knowledge and wisdom, and if in a teaching hospital serve as instructors/mentors for inters and residents. Especially ED PA's - some of them rock. I never understood how they could be satisfied with the lower pay and lesser "status" when I see how many are just as if not more knowledgable than the docs. I dare you to tell the difference if everyone took off their ID tags and you came in with a trauma or even a complicated deep tissue lac... some of those PA dudes and dudettes are true artists with the suture kit.

 

[glade]

I dare you to tell the difference if everyone took off their ID tags and you came in with a trauma or even a complicated deep tissue lac... some of those PA dudes and dudettes are true artists with the suture kit.

a) Yeah, we should let PAs run traumas, it would be comedy gold.

b) Note how the PAs view traumas as just "let's suture it up! I have mad suturing skillz!"

 

[deleted6669]

b) Note how the PAs view traumas as just "let's suture it up! I have mad suturing skillz!"

yeah, that goes over really well when we take ATLS and FCCS every 4 yrs and the difficult airway course every 3 yrs....
pa's on trauma teams do more than suture...our trauma pa's put in chest tubes, central lines, etc and follow the pts through their stay in the trauma icu....
see this thread and take special note of the multiple positive comments from attending docs who actually work with these pa's and np's:
http://forums.studentdoctor.net/showthread.php?p=9655546#post9655546

 

[Doctor Bob]

a) Yeah, we should let PAs run traumas, it would be comedy gold.

I've worked with some great PAs in the military who did very well running traumas.

 

[glade]

Like I said, then let's let them run traumas. That's more time for me to be hitting the sack.

 

[jonb12997]

I'm not sure what Glade's problem is... I've always thought of medicine as a team sport.

 

[deleted6669]

I've worked with some great PAs in the military who did very well running traumas.

agree- trauma stabilization and resuscitation is pretty cookbook and if you have appropriate ancillary services( stat XR, CT, U/S, lab), etc it's not terribly challenging outside of the o.r.
obviously serious trauma is surgical disease and is managed by surgeons in the operative environment but the initial management can be done by any clinician who has mastered the lessons and procedures of ATLS.

 

[glade]

I'm not sure what Glade's problem is... I've always thought of medicine as a team sport.

My "problem" is that it's either/or. Either they're qualified to run it and then you don't need overlapping care or they're not and they shouldn't be. Pick one or the other, your choice.

 

[deleted6669]

My "problem" is that it's either/or. Either they're qualified to run it and then you don't need overlapping care or they're not and they shouldn't be. Pick one or the other, your choice.

it obviously depends on the pa. can a new pa right out of school run the serious traumas? no.
can my friend who has worked in trauma/critical care for 25 years and is on the faculty of an md critical care residency program? you bet.

 

[dilated]

Hey residents,

I'm interested in seeing what you think about this. Several PA students I know have made a big deal out of the fact that "PAs are just like doctors and can do the same things, and physicians will often go ask PAs for advice because the PA knows more about it than they do."

It's human nature to overinflate one's knowledge or role. What do you think they're going to say, "PAs know less than doctors and have to constantly ask them for permission"?

I will say I have run into the same annoying mentality among PA students of late. They have an infuriating tendency to claim that PA school is "all the same material" and "but we have to learn it faster" therefore they know just as much. Being geniuses that can learn it all in half the time, of course. I'm not ashamed of the fact that I resorted to trolling them by asking them how much it must suck to realize they were going to spend the rest of their careers knowing just as much as the doctors but not having an MD.

(they were)

 

[glade]

That's too bad, considering that we don't get that luxury of deciding when or if we want to be able to run traumas. That's not really a bust, since the reality is I don't expect PAs to run traumas, of course. But if it's going to be some PA coming on here talking smack about how they can, then they should all be able to. Otherwise, it just sounds more like "I'm a PA, but I'm still able to do anything a doctor can," in which case go ahead.

 

[glade]

Part of "being a team" is knowing what part of it you are. If we're going to be silly and asinine and say "medicine is about team work and everyone on the team is equal," then I'll have a ball with it. I have no problem with working with PAs, but anyone who thinks a PA is equal to a physician is incorrect.

 

[deleted6669]

That's too bad, considering that we don't get that luxury of deciding when or if we want to be able to run traumas. That's not really a bust, since the reality is I don't expect PAs to run traumas, of course. But if it's going to be some PA coming on here talking smack about how they can, then they should all be able to. Otherwise, it just sounds more like "I'm a PA, but I'm still able to do anything a doctor can," in which case go ahead.

I don't think PA=MD by any means.
my point is that with specific training( which may include a 1-2 yr postgrad residency or fellowship see www.appap.org) and on the job experience some pa's are able to function at the level of md's in some specific settings. take them out of that setting and they will know less than the md. a pa who works critical care 100% of the time will be good at critical care but will not be as good as the md intensivist when seeing patients in a general IM practice because the pa's focus is on pts in the ICU setting while the md intensivist is required to know the entire specialty in all settings.

 

[476515678234896]

What's wrong with the pre-dental forum?

Go back to your pre-dental forums.

 

[drflower66]

a) Yeah, we should let PAs run traumas, it would be comedy gold.

b) Note how the PAs view traumas as just "let's suture it up! I have mad suturing skillz!"

What exactly do you want Mr. Glade? All you ever do on these forums is cut up people's posts, create arguments where there are none, and tear apart people's reputations. Its getting old and boring, and truly it appears that nall you want is an argument. You are a bully. What is it that you want here? Attention? You have no clear agenda other than to put people down, never one supportive comment from you since I got here.

Anything anyone says is turned, with sarcasm into proof of how stupid they must be. Why don't you go beat up some puppies it might help you feel better.

 

[drflower66]

Asking another, more experienced professional for their input is a good and wise idea, and often good clinical practice. We work as teams, and we gather information from those around us who hvae had experiences that can be learned from. You don't work in a vacuum for good reason. But when you, or anyone, nurses included, are signing their name to an order, you do it ONLY because YOU believe it is the right thing to do, regardless of who had the better idea, or who made a suggestion. If you choose to take input from a nurse or a PA, which could very well be the right thing to do in many circumstances - that is one thing. Claiming that you did it because "they said so" is pretty lame, and I hope you have better clinical judgement that to actually believe that anything you sign your name to is done because you have decided that this is the right plan, not only because someone else told you to.

Often times things that make these people believe will make them look "weak" are the very things that make great practitioners grateful and nlike their jobs even more, and make them look strong. Anyone who is hung up on being made to look "weak" by admitting a nurse or a PA gave a better suggestion than the one they had is a sure fool, and is either very scared and afraid to ask for help (we all need help) or very insecure and will eventually maker enough mistakes that they will end up without a license someday.
Funny, then, if you get razzed for a poor decision it is suddenly the PA's fault, but if it is a great plan and you receive compliments, it is suddenly all your doing. Giving someone credit for a good judgment and making an excellent suggestion that you incorporate is not poor practice nor should you be "razzed" for taking suggestions from nurses or PA's, as long as you are aware that you are the one who makes the final decision if you are signing your name - always be grateful and give credit where credit is due. This is only difficult for the immature, inexperienced, arrogant and ego-inflated/hence insecure types.

Anyone who sends an intern out into the wild wild world telling them they are prepared to "be a doctor" is creating a serious problem for some poor kid who becomes then afraid to appear clueless - which is exactly what they are - clueless. And it is OK. You are clueless, and everyone knows it, and most of the PA's and nurses want to help as long as you don't start throwing attitude around and get some real live asking-for-help-humility. Then, you are on your own baby. And expect some middle of the night calls for a 3.9 K when you get all pissed off before it is explained to you how quickly it is down trending - cause that is probably why you got the call, but you are too inexperienced to know that yet. Instead, it is easier to puff yourself up by saying how stupid that nurse was for calling. I mean 3.9 is almost 4.0 isn't it. Not for long.

 

[FutureDoc4]

Asking another, more experienced professional for their input is a good and wise idea, and often good clinical practice. We work as teams, and we gather information from those around us who hvae had experiences that can be learned from. You don't work in a vacuum for good reason. But when you, or anyone, nurses included, are signing their name to an order, you do it ONLY because YOU believe it is the right thing to do, regardless of who had the better idea, or who made a suggestion. If you choose to take input from a nurse or a PA, which could very well be the right thing to do in many circumstances - that is one thing. Claiming that you did it because "they said so" is pretty lame, and I hope you have better clinical judgement that to actually believe that anything you sign your name to is done because you have decided that this is the right plan, not only because someone else told you to.

Often times things that make these people believe will make them look "weak" are the very things that make great practitioners grateful and nlike their jobs even more, and make them look strong. Anyone who is hung up on being made to look "weak" by admitting a nurse or a PA gave a better suggestion than the one they had is a sure fool, and is either very scared and afraid to ask for help (we all need help) or very insecure and will eventually maker enough mistakes that they will end up without a license someday.
Funny, then, if you get razzed for a poor decision it is suddenly the PA's fault, but if it is a great plan and you receive compliments, it is suddenly all your doing. Giving someone credit for a good judgment and making an excellent suggestion that you incorporate is not poor practice nor should you be "razzed" for taking suggestions from nurses or PA's, as long as you are aware that you are the one who makes the final decision if you are signing your name - always be grateful and give credit where credit is due. This is only difficult for the immature, inexperienced, arrogant and ego-inflated/hence insecure types.

Anyone who sends an intern out into the wild wild world telling them they are prepared to "be a doctor" is creating a serious problem for some poor kid who becomes then afraid to appear clueless - which is exactly what they are - clueless. And it is OK. You are clueless, and everyone knows it, and most of the PA's and nurses want to help as long as you don't start throwing attitude around and get some real live asking-for-help-humility. Then, you are on your own baby. And expect some middle of the night calls for a 3.9 K when you get all pissed off before it is explained to you how quickly it is down trending - cause that is probably why you got the call, but you are too inexperienced to know that yet. Instead, it is easier to puff yourself up by saying how stupid that nurse was for calling. I mean 3.9 is almost 4.0 isn't it. Not for long.

I am SSSSOOOO sick of this stigma. Interns don't medicine right? PGY II are more worthless than a PA, right? You better learn that you are worthless as a intern or else, right?

GEEZZZ.... get over it. Of course, a brand new intern who has only 2 years (MS3-MS4) of limited experience on the floor is going to be clueless on the actual practice of medicine. Why is this argument even made?

Oh, I know.... so, all the midlevels can say... look at me I have been practicing for 10-15 years and I know more than the interns..... CONGRATULATIONS!!! How is this suprising?

But, we all know by the time that "idiot" intern finsihes that residency they will be running circles around those mid-levels. Why? cause they caught up on the practical knowledge (with TONS of time on the floor during residency), and had an awesome theoretical foundation from medical school (which these other practictioners lack)

I don't even understand this argument anymore.

"We are just as qualfified as MDs because I have been doing this narrow job for 10 years that I know more about than the brand new intern" (this is NOT news)

How about we compare a brand new intern to a brand new PA? or DNP? Oh wait? we wouldn't because we all know the MD would crush them in knowledge and skill.

All this does is create more and more conflict between our professions.


P.S. Back to the point of the thread. I do ask other practitioners for help and advice. Including RNs, residents, and PAs. Guess what? they have been doing this longer than I have. So, I will constantly be incorporating knowledge and feedback (some good and some bad). Anyone "above" asking for an opinion with someone with more experience is being an idiot.

 

[Apollyon]

I work full-time side-by-side mid levels in the ED (all PA save one NP), and I see stylistic differences - one guy has 25 years, and I trust his judgment. Another has 20 years, and I - literally - have to look over his shoulder, and have (more than once) threatened to not sign his chart if he went a certain way with treatment.

There's one guy that's part-time, who is an active duty Army PA, who seeks my advice, but he's been unerringly spot-on. He asks "Is it?" and I reply "It is". He surprises me (in a good way) how well he practices.

Have I asked? Not yet. Would I? Sure.

 

[EMDream]

not all new attendings run circles. there is one in particular that is a new attending and i **** you not has asked me how to wean steroids, if he can change the lovenox to IM in the patients thigh, how to start a lasix gtt..and a myriad of other questions that a new grad nurse could probably answer. how does he not know these answers? i dont know... obviously he turned his pager off during residency or someone pushed him through... I know, its not the rule, but still wouldnt it suck if i made generalizations based on him? an internal med pa with 15 years of autonomous steep learning curve experience vs a new attending from a mediocre residency? im goin with the pa. but in general i think once a new doc has had some years of experience in their field they should be able to kick most of our asses.

thanks for all the positive team comments people. i am glad that most of the people i encounter day to day are like you but every once in a while you get someone with a chip.... as seen above

 

[maceo]

Medicine is just knowledge. If you take the time to learn the material, read the current literature, and have extensive experience, it really doesn't matter what your formal degree is.

exactly.. its called medical school and residency..

 

[maceo]

i ask nurse quacktitioners frequently where the crapper is... does that count?

 

[glade]

The judges say yes.

 

[cartoondoc]

In my training, I've asked PAs for help/advice dozens of times. Some of them are amazing, especially the ones who have been practicing for many years.

 

[Socrates25]

Sorry to hear that the PA's at your place work at such a level Glade. The PA's my hospital hires tend to work at the level of a good senior resident. I pick their brain as much as I pick the brain of my own senior residents. They know more, they've been around more, and yes, they can handle extremely critical patients no problem.

I work in EM, which tends to have quality PA's, though. Can't speak to other services.

Let me guess, you go to one of those EM "residencies" where PAs run the show solo with no attending support -- the kind of "residency" that emedpa works at, right? How does it feel presenting all of your patients to the PA?

Does he approve your treatment plans very often? Do the PAs let you do any procedures? LMAO

 

[Socrates25]

My "problem" is that it's either/or. Either they're qualified to run it and then you don't need overlapping care or they're not and they shouldn't be. Pick one or the other, your choice.

I agree. IF attendings are asking for PAs to help them, the department should fire all the attendings and hire PAs only instead.

Why should we pay for an MD to "supervise" someone if they are in reality just letting the PA run everything solo?

P.S. Here comes emedpa with the typical response: "actually there's this podunk hospital in nowhere alaska in which there are no MDs on staff -- only PAs"

 

[Socrates25]

I'm an attending and I've asked PA's questions before, especially those that have had a lot of time in ortho to give me second opinions on how to manage fractures, subtle x-ray findings, etc.

I ask nurses what they think of certain things.

I'm a physician, not God. I make mistakes and need guidance just like anyone else. If you think you're too good to ask someone their opinion, then you're begging for a lawsuit as arrogance will only land you in the middle of a malpractice suit.

You're confusing the issue. I've fgot no problem asking a PA in another field a simple question. On the other hand, am I going to refer a patient to a cardiologist to see his PA? Nope I want the cardiologist, not his PA.

The question is this -- would you, as an EM attending, routinely ask your EM PAs for guidance with patients? Because if you do, you are superfluous and there's no reason that society should pay EM attendings 250k per year when a PA making 100k per year can totally replace your job.

Either you offer value as an attending over a PA in your field, or you dont. If you dont, then I'd be prepared to get laid off or get a major pay cut.

 

[Socrates25]

couple of months back in the ICU my staff (BC Pulm/CC) would routinely discuss cases involving difficult vent management with one of the longtime RTs on the unit.

Your idiot faculty needs to step down and let the RT run rounds then. What a joke. Why am I paying your attending 250k per year when a simple RT with only an associates degree knows more about vent management?