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Many clinicians I have spoke to believe that physicians have a much greater depth of scientific background than PAs. That makes sense as they are the ones supervising us. So I want to propose a question, what is your opinion on this?

 

I understand that while MD/DO programs have 2 years of didactic courses (eq. to 4 semesters), PA programs have 1 year of didactic courses (but is eq. to 3 semesters). We do not have summers off. Furthermore, PA programs have most of the prerequisites that MD/DO programs have (except physics) and more. PAs have to take anatomy, physiology, microbiology, and genetics. So it might not be necessary that we spend as much time in those subjects as MD/DO programs. 

 

In the end, I really don't think duration of the didactic portion that contributes to difference in scientific depth, but perhaps the intensity does. So I propose question #2, how much more intense do you think MD/DO programs are in terms of the didactic curriculum.

 

My second theory is that they have much more difficult tests than PAs. Does anyone have any experience with MCAT, step 1 and 2, or other boards that they have to take? How do these exams compare to the difficulty of the PANCE? 

 

For practicing PAs, do you feel like your knowledge is any less of those of your supervising physicians? 

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the MS1 year is very focused on basic medical sciences to a depth not explored in PA school. We had a few lectures on microbiology, they had a whole course. ditto neurophysiology, immunology, biochem, etc.

The best person to answer this question is someone who has attended both programs. we have a few of those folks on the board, hopefully they will chime in.

I'm sure the vast majority of physicians know a lot more basic medical sciences than I do. I can't say that it makes them better clinicians, however as much of that knowledge only applies to narrow fields or pursuits such as designing new medications or treatment protocols. the purpose of medical school is to create a medical scientist ready to start clinical training in earnest in residency. the purpose of PA school is to produce a clinician ready to practice primary care as part of a team the first week they are in practice.

USMLE step 1 is not clinical in nature. it is a mechanism for med students to demonstrate knowledge of the basic medical sciences learned in the MS1 year. step 2 and step 3 are fairly similar to PANCE and I believe most PA students could pass these, certainly step 3.

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Many clinicians I have spoke to believe that physicians have a much greater depth of scientific background than PAs. That makes sense as they are the ones supervising us. So I want to propose a question, what is your opinion on this?

 

I understand that while MD/DO programs have 2 years of didactic courses (eq. to 4 semesters), PA programs have 1 year of didactic courses (but is eq. to 3 semesters). We do not have summers off. Furthermore, PA programs have most of the prerequisites that MD/DO programs have (except physics) and more. PAs have to take anatomy, physiology, microbiology, and genetics. So it might not be necessary that we spend as much time in those subjects as MD/DO programs.

 

In the end, I really don't think duration of the didactic portion that contributes to difference in scientific depth, but perhaps the intensity does. So I propose question #2, how much more intense do you think MD/DO programs are in terms of the didactic curriculum.

 

My second theory is that they have much more difficult tests than PAs. Does anyone have any experience with MCAT, step 1 and 2, or other boards that they have to take? How do these exams compare to the difficulty of the PANCE?

 

For practicing PAs, do you feel like your knowledge is any less of those of your supervising physicians?

It's all about Step I. Hands down docs know more about embryology, immunology, biochemistry, and pathology at the cellular level.

 

PA's think they know as much as their SP's because 10 years out of residency most docs will forget most of that step I material except what relates to their specialty. The gap of knowledge is still there, it just seems smaller the farther out of med school they get.

 

Ex. I had overheard a med student talking to a physician about Albumino-cytologic dissociation in Guillain-Barre patient. I dont know much about it except what I see in the CSF in terms of protein and cell count. They were using words I did not understand...

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The question is does it matter? Obviously basic sciences are helpful and neccessary, but only if they are clinically relevant. For example, I care about embryology because it can tell me about muscle and nerve pathology. I don't know about you but I would rather not memorize biochem pathways to prove my worth. I need that energy to continue to be hungry to better myself and serve my patients once I get out.

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It's all about Step I. Hands down docs know more about embryology, immunology, biochemistry, and pathology at the cellular level.

 

PA's think they know as much as their SP's because 10 years out of residency most docs will forget most of that step I material except what relates to their specialty. The gap of knowledge is still there, it just seems smaller the farther out of med school they get.

 

Ex. I had overheard a med student talking to a physician about Albumino-cytologic dissociation in Guillain-Barre patient. I dont know much about it except what I see in the CSF in terms of protein and cell count. They were using words I did not understand...

I'm guessing most non-internal medicine physicians would also go "huh, what?" if they overheard that conversation. They might have known it once for about 5 minutes for an exam, but I guarantee you 95% + of ER docs would have no idea what you were talking about if you asked them to discuss that.

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I'm guessing most non-internal medicine physicians would also go "huh, what?" if they overheard that conversation. They might have known it once for about 5 minutes for an exam, but I guarantee you 95% + of ER docs would have no idea what you were talking about if you asked them to discuss that.

Exactly, but what about the neurologist who has 20 of these patients and it is relevant to him on a daily basis. Everyone in medicine becomes specialized. A neurologist has no need to discuss ketamine for procedural sedation or induction agents for RSI in Peds/pregnant patients. so to an extent we learn what docs know about physiology, biochem, embryology "on the fly" in our given specialty. Some more than others. Problem is, we are always playing catch up and MOST PAs (not all) never reach the knowledge base of the SP in their given specialty until the end of their careers, >10-15-even 20 years down the road.

 

We have no structured residency. It's a few rotations to get our feet wet and then we are off. Those that have done a residency understand that the knowledge gap gets significant closed because of "reading, practicing, sleeping" in their given field. New grad PAs don't get that because it would be a full time job for their SP and the practice would lose money if every patient became a teaching case.

 

A residency is technically more important than the MS1 year, but that year definitely provides a basis in topics that PAs should learn at some point in their given specialty.

 

Here is another example for you E: Why is gram negative sepsis so much worse than Gram positive sepsis? On a physiological level this extremely important to understand as LPS and compensatory mechanisms of our immune system are in a battle and severe inflammation occurs. Anyone can follow a protocol and give three empiric antibiotics and pressors and the like... It's so easy a PA can do it. But when I ask PA students why we do it the way we do it and to explain it to me, they have no clue. It's not their fault, it's just not important enough to be taught in PA school. They are told sepsis=bad, give abx, fluids, pressors, and patient gets better. These are the backbones of "why" which are not taught. I've seen med students who dont know how to talk to patients but can explain this to me and so it's a catch-22. The thing about med students is that they have several more years to figure the rest out in residency.

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I think it comes down to the PA program. Different programs prepare students differently. My program is very much concerned with the why and the minute differences. Also helps that I am in a slightly longer program (27 months versus 24 month), established (20 year history versus just starting) and some other factors. Just like not every med student is the same, neither is every PA student. Obviously there are trends, but at the end of the day a med student has 10 months of basic science and 11 months of clinical science. I will have 14 months of 20% basics and 80% clincal science. The difference in clinical science education is not as significant as most believe in my opinion

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I think it comes down to the PA program. Different programs prepare students differently. My program is very much concerned with the why and the minute differences. Also helps that I am in a slightly longer program (27 months versus 24 month), established (20 year history versus just starting) and some other factors. Just like not every med student is the same, neither is every PA student. Obviously there are trends, but at the end of the day a med student has 10 months of basic science and 11 months of clinical science. I will have 14 months of 20% basics and 80% clincal science. The difference in clinical science education is not as significant as most believe in my opinion

 

I agree with this, the PA program where I did my undergrad (University of Iowa) has PA students in the same class as med students and are graded on the same scale. Not sure how many classes they take together though. They must be doing something right, they have 100% first time taker pass rate since 1996....

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I think it comes down to the PA program. Different programs prepare students differently. My program is very much concerned with the why and the minute differences. Also helps that I am in a slightly longer program (27 months versus 24 month), established (20 year history versus just starting) and some other factors. Just like not every med student is the same, neither is every PA student. Obviously there are trends, but at the end of the day a med student has 10 months of basic science and 11 months of clinical science. I will have 14 months of 20% basics and 80% clincal science. The difference in clinical science education is not as significant as most believe in my opinion

Uhhhh so you are saying you get 20% of the basic sciences but it all equals out because you get 80% of the clinical sciences? *sigh* PA's don't get to say they have equal education as med students. Only those that take USMLE Step I and pass it. Take Step 2 and pass it. And make it through intern year alive.

 

Can we stop acting like we know everything and just do our job and do it well. That will earn the respect we deserve and the benefits will follow.

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I agree with this, the PA program where I did my undergrad (University of Iowa) has PA students in the same class as med students and are graded on the same scale. Not sure how many classes they take together though. They must be doing something right, they have 100% first time taker pass rate since 1996....

Go to PA school first then you can start debating this topic...

 

I took classes with med students. Including gross anatomy. You know-- muscles and nerves. Kind of a big deal. I know I didn't have to take this one class called PATHOLOGY with them. The amount studied for anatomy was minuscule compared to that class. Go memorize Robbins Pathology in a semester. That'll take a few hours of studying every day. Is that material applicable now? That is the debate, but it sure didn't hurt them. It makes them better clinicians. It probably caused a few more hours of lost sleep though.

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Uhhhh so you are saying you get 20% of the basic sciences but it all equals out because you get 80% of the clinical sciences? *sigh* PA's don't get to say they have equal education as med students. Only those that take USMLE Step I and pass it. Take Step 2 and pass it. And make it through intern year alive.

 

Can we stop acting like we know everything and just do our job and do it well. That will earn the respect we deserve and the benefits will follow.

^This.  Seriously.  If we learned everything med students/doctors did, why would there even be two different program/degrees?  Yes, years of experience can begin to even things out and we each have our strengths, but out of the gate? Nope.  

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It seems to me that this forum generally underemphasizes the notion that your education is supposed to prepare you to be able to self-educate any pertinent clinical material.  Albuminocytologic dissociation and the pathology of gram negative sepsis are readily researchable and not exceedingly mysterious complex topics.

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It seems to me that this forum generally underemphasizes the notion that your education is supposed to prepare you to be able to self-educate any pertinent clinical material. Albuminocytologic dissociation and the pathology of gram negative sepsis are readily researchable and not exceedingly mysterious complex topics.

Any topic can be looked up on Dr. Google. If my education and patients relied on how well I look stuff up on UpToDate I am pretty certain diagnostic skills should just be removed from PA curriculum. Just punch a bunch of symptoms into a computer and BAM ----> your top three DDx and even a printout of key points to counsel your patients on.

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Uhhhh so you are saying you get 20% of the basic sciences but it all equals out because you get 80% of the clinical sciences? *sigh* PA's don't get to say they have equal education as med students. Only those that take USMLE Step I and pass it. Take Step 2 and pass it. And make it through intern year alive.

 

Can we stop acting like we know everything and just do our job and do it well. That will earn the respect we deserve and the benefits will follow.

 

I would love it if PAs were allowed to sit for USMLE exams. It isn't the PAs that are preventing this opportunity.

 

I certainly don't think I got the exact same education in PA school as one gets in medical school, but I don't think it is as wide a gap as some do, and I certainly don't think it is an insurmountable challenge to prep for the USMLE.

 

My PA program is 28 months long. Our didactic phase is 16 intense months of 8-5 classes with two exams a week. The same univesity has a medical school that divides the didactic phase of their education into two 9 month blocks with far less time in the classroom.  16 months vs 18 months. My program credits us with 101 semester hours for our 16 months. The MDs get 64.

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Of course it's not insurmountable information. Standardized tests are just that-- standardized w/ a blueprint of all the information that will be on it.

 

There is no reason for a PA to sit for USMLE exams. Unless we were allowed to attend physician residencies. Which at that point we would be physicians because that is where real medicine is learned, not by learning simple word association mnemonics for tests.

 

Most of you seem to be arguing for PA education to be a stepping stone to becoming a physician. You are saying that the only thing separating us is a residency? Well there is your answer-- go to med school and a residency will be yours.

 

I won't argue about the whole didactic education anymore because NO WAY course credit hours=knowledge. If MDs only get 64 credits and you get 101 credits at your school... You are getting played to the tune of thousands of dollars in extra tuition money. All credit hours are for is so that the student accounts office knows how much to charge you next semester :)

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I won't argue about the whole didactic education anymore because NO WAY course credit hours=knowledge. If MDs only get 64 credits and you get 101 credits at your school... You are getting played to the tune of thousands of dollars in extra tuition money. All credit hours are for is so that the student accounts office knows how much to charge you next semester :)

 

This.

 

Otherwise what you're arguing is...you're learning 1.6x the amount of information the MS are? If your program is taking 18months to teach less information than the MS are getting in 16months what that tells me is that the expectations are much lower for the PA students.  Also, the "2 exams a week" argument is kind of silly as well.  So you've got to get the information in and then are able to dump it for the next test?  I'm a much bigger fan of traditional midterms/finals where you have to actually retain information for a significant period of time.

 

As mentioned in about a gazillion other places on this forum, the information they are obtaining is not necessarily pertinent to clinical practice down the road, but a certain amount of it helps to truly understand what you learn as you grow clinically, as opposed to simply memorizing it.  

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Any topic can be looked up on Dr. Google. If my education and patients relied on how well I look stuff up on UpToDate I am pretty certain diagnostic skills should just be removed from PA curriculum. Just punch a bunch of symptoms into a computer and BAM ----> your top three DDx and even a printout of key points to counsel your patients on.

 

This is an entirely different issue, though.  Those examples have nothing to do with diagnostic skills.  They are factual material that is trivial to learn and are good examples of what occurs during Step 1.  Your education is more than the facts you LEARN, but the demonstrated ability to integrate new information.  They are your examples, not mine.

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This is an entirely different issue, though. Those examples have nothing to do with diagnostic skills. They are factual material that is trivial to learn and are good examples of what occurs during Step 1. Your education is more than the facts you LEARN, but the demonstrated ability to integrate new information. They are your examples, not mine.

I am agreeing with you. Education is more than facts. But I wouldn't call Step I trivial... hah! Only nurses have the guts to say that :). Good luck in nursing school. Just try to keep the brain larger than the ego.

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Of course it's not insurmountable information. Standardized tests are just that-- standardized w/ a blueprint of all the information that will be on it.

 

There is no reason for a PA to sit for USMLE exams. Unless we were allowed to attend physician residencies. Which at that point we would be physicians because that is where real medicine is learned, not by learning simple word association mnemonics for tests.

 

Most of you seem to be arguing for PA education to be a stepping stone to becoming a physician. You are saying that the only thing separating us is a residency? Well there is your answer-- go to med school and a residency will be yours.

I won't argue about the whole didactic education anymore because NO WAY course credit hours=knowledge. If MDs only get 64 credits and you get 101 credits at your school... You are getting played to the tune of thousands of dollars in extra tuition money. All credit hours are for is so that the student accounts office knows how much to charge you next semester :)

 

Yes. I believe that PAs who can demonstrate strong clinical experience, academic performance and the ability score competitively on the same licensing exams that physicians take should be allowed to apply for residencies.

 

Why not? Call me naive, but I think a PA who has been practicing medicine in a discipline like orthopedics would probably make a great orthopedic resident and would probably have a huge well of knowledge and experience that would make them as likely (if not more) to excel than somebody fresh out of med school. Same with other disciplines like FM or EMED.

 

So why doesn't this happen? Why can't PAs easily bridge up to physician? Some of it is limited numbers of residencies, but if PAs wouldn't be competitive in the first place, nobody would really be worried.

You will hear some say, "you can't match. You didn't take Step 1." True. Allow us to take it.

Then they may say, "there is no way you could pass it with you education." Maybe. Let's see. If I can't pass it, you have nothing to worry about.

Then ultimately, they will say, "well... that isn't how we've always done it. That isn't how I did it." Again, true. We didn't go to med school. But we did go to PA school and we do have years of clinical experience. And as I have said, i don't think the gap between the two is insurmountable.

 

What I would like is a system in place that recognizes the clinical experience and demonstrable academic proficiency of motivated PAs and allows them an opportunity at applying and interviewing for the match.

 

As for your cynical view that my program is "playing me to the tune of thousands of dollars in extra tuition money." uh... nope. My program doesn't charge tuition. Not a dime. In fact, it pays students to go through it. Not an issue.

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Regardless of money paid, credit hours between programs have no equivalence if there is not an established tradition of accepting transfer credits.

 

I am guessing you are military.  I bet if I suggested that nothing in this world is free, you would agree to that.

 

Lastly, while it is awesome to dream about challenging the steps, you know they would never allow it.  Both PAs and MDs would find a way to shut it down.  Really, it is nearly just as easy to learn step1 on your own and then attend the LECOM bridge.

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Maybe I am in the minority but I truly have no interest in becoming a doctor, completing their examinations or participating in an MD residency. If I did, I would of applied to medical school. I swung for PA school because I am more interested in the patient then the bureaucracy of becoming a doctor. I have my own ideas for how to develop my clinical expertise that differs from the traditional residency required to become a PCP. I believe that work experience (and possibly a 1 year residency) in orthopedics or dermatology as a PA makes you more valuable than a fresh MD (or even a seasoned MD) from a 3 year family medicine residency (and I have MD's that agree with me.) And for those hammering that PA education is inferior to MD education, we never said it was equal to MD, only comparable. Which isnt a new idea as we were designed to be a solution for the  deficiency of MD/DOs in the workforce. So stop thinking of our profession as some D2 team compared to your vaulted Alabama status. In reality we have scratched and clawed our way onto the same paying field. Maybe not every PA can be the starting quarterback, but we sure as hell are a major reason why medical teams are staying afloat during these tumultuous times. And if you don't believe me ask a successful MD to do what they do without the support of a highly trained PA. Their answer will tell you all you need to know. So to summarize, I do not care about the insignificant differences in didactic education between an PA versus an MD. I care only that they are comparable. Because at the end of the day patients rely on clinicians no matter their title for peace of mind and answers. And I promise the letters behind your name do not innately make providing that any easier.

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Go to PA school first then you can start debating this topic...

 

I took classes with med students. Including gross anatomy. You know-- muscles and nerves. Kind of a big deal. I know I didn't have to take this one class called PATHOLOGY with them. The amount studied for anatomy was minuscule compared to that class. Go memorize Robbins Pathology in a semester. That'll take a few hours of studying every day. Is that material applicable now? That is the debate, but it sure didn't hurt them. It makes them better clinicians. It probably caused a few more hours of lost sleep though.

I had a full semester of patho taught by a pathologist, same course she gave the do students. Also, same for physiology.
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My take is a tad different:

I cannot remember who introduced this idea to me but it has stuck with me all these years.

I understand the basic pathophys of disease processes. I am not a research scientist nor an epidemiologist - the PA strongpoint is helping the PATIENT understand their condition in terms that they understand and makes sense to them.

 

My patients could care less about Krebs Cycle or nephrons for the most part but want to know why their kidneys don't work right. They don't get endotoxins and gram negative - they understand sick and feel like crap.

 

If I can explain it to the patient and family and they gain understanding, comfort and can participate - all the while the patient has received the right meds, IVs, labs etc from me -- we have a winning situation.

 

The best compliment I can get from a patient is that they understand their disease, illness, injury and know how to help themselves.

 

Not to say physicians do not know how to do this - I am not sure it is stressed in their education or demonstrated.

 

My program all those years ago touched on a key to healthCARE - education and participation.

 

In moments of bitterness or feeling unvalued - I have wanted to prove my worth and take the FLEX and become a doctor - but wouldn't want it to change the provider I have become over the years. I know what I know and don't know and know where to look for answers. I have to be proud of what I do and stop comparing myself to other professionals - no purpose in it.

 

Yep, old and waxing philosophic.....

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Just yesterday I swear my brain turned to mush.  Can I still be a PA? I just can't remember what I know and don't know.  I'm doomed.  The pathophys I learned has taken flight from the brain cells.  I either need a good night's sleep or crack open that step 1 book.

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