Practicing medicine with online degree

[EMEDPA]

trauma surgery rotations and electives are available at most programs if you seek them out. I knew I wanted to do em and did about 1/2 my rotations in em, peds em, or trauma surgery. we had 6 five week rotations and 2 twelve week preceptorships. I did trauma surgery for surgery, peds em for peds, the required em rotation, and a 12 week em preceptorship so 27 out of 54 weeks.

[EMSGuy1982]

Perhaps soon we will laid off for this state of the art patient interactive health model.

 

***Photo taken from the movie (documentary) Idoicracy.

[UpRegulated]

Bear in mind as you read this I am a huge critic of NP education. But I'll give you a brief run down of how my program is structured. I am in an acute care program so I was required to have a minimum of 2 years of ICU experience. So first of all, I don't know how my professor seeing me showered and paying attention is better than my patients, their families and my health care team members seeing me do those things while taking care of critically ill patients for the last 5 years. My classmates and I have experienced some of the most high stress situations possible. I think my school's requirement does a pretty good job of making sure those accepted are ready to practice medicine. BUT, not all schools require this - a big complaint of mine. However, you are required to have gone through a BSN program. So every NP matriculant has around 1000 hours of working with patients by simply having a BSN. Even direct entry programs. I also want to quickly point out that ACNP programs and CRNA programs have much stricter requirements than FNP. Not to the level of PA, but still an improvement.

 

My first Bachelor's degree and my BSN were in person and, so far, I love the online setup. My tests are conducted through a website called ProctorU. I am watched through the webcam, my browser is locked down so I can only access the exam, and the person is no kidding watching. If I look down too long they make me explain/show them what I'm doing. And if you are distracted at home that's your own fault. I was a distracted when attending class in person. Who's fault was that? My own.

 

Once my didactic portion is complete, we'll start the more clinically oriented classes for the last half of the program. During which, I have to go to campus each semester in order to learn/practice these skills, do simulations, standardized patients, practical exams, etc. Most "online" NP programs are actually modified distance programs that require visits to campus for experiences such as these. There are some programs that, with the exception of clinicals, are completely online. They're considered poor programs. But, there will always be students with bad stats who are desperate enough to pay the tuition. It's unfortunate for sure.

 

And, as an ICU nurse I've been doing complete systems assessments for years. I've heard normal and abnormal heart, lung, and abdominal sounds. When I've asked patients to close their eyes tight, puff out their cheeks, shrug their shoulders, etc I may not have known which cranial nerves I was assessing, but I've learned it now in NP school. NP school was meant to build on RN experience. Many schools are gotten away from this but there are still quite a few that do it right-ish. My main complaint is I had to take an extra class through the medical school for anatomy. It was inconvenient and is a huge downfall of 99% of NP programs.

+1. But...you...took...the...bait... :)

[roger777]

You got me there. California sucks. No offense Californians.

 

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I would freaking kill to live in CA right now, sorry. I'm not going to get into it with you guys but it is probably the most physically beautiful state in the lower 48. So it can only suck so bad.

[roger777]

Upregulated, not everyone has professors that just read the PowerPoints, there are also discussions and being called upon to think on your feet. When I say "easier" I am referring to the fact that with some online NP program, you can take exams at your home while being watched on webcam by a remote proctor. This opens up the possibility to cheat and not learn the material. I personally would not want to be diagnosed by someone that took all their didactic exams at their house with Google and other resources at their fingertips. The school I am interested in does not accept online prerequisites in certain subjects.

80% of our didactic was in the PBL rooms. This is a very intimate experience both when the facilitator is there and when they are not. It's very self-directed, but also very social. No one is allowed to hang back during the cases. Very dynamic. And when you are not there you spend an enormous amount of time researching. You live in Harrison's, Cecil etc. We have 100% PANCE every year and we don't teach to it and we have extremely low attrition. Like 1 person every 3 years for academics. We are a small fairly low budget program but I think we really punch above our weight in clinical reasoning and knowledge, because of PBL. The PBL groups are a lot like an infantry squad socially and structurally. We are enormously close to each other and I have also seen the craziest beefs and fights. No technology. We clip paper from rolls to the walls and write on them. Yes, really low tech but I don't think it could be made any better. We use the rolls for tablecloths at our white coat. Ours are in my loft. There are actually a couple people in our class who have said they would rather just have lecture/PP and learn material on their own. For someone like me who has introvert tendencies it's enormously additive. I don't think I would have made it in either a lecture or an online program. .

[EMEDPA]

PBL is the bomb. I like to teach and learn in this format with small groups no larger than 10, ideally more like 5-6.

[cinntsp]

I know you guys don't like it, but education will continue to shift to an online format, especially the didatic portions.  If there are too many distractions at home, well, that's honestly your own damn fault.  Many medical school programs don't even require medical students to be physically present at lectures.  They can stream it or download it to view and/or playback.

 

You won't get any argument from me that clinical examination, anatomy lab/dissection, etc should be taught in person for now.  In a few years, though, VR and tactile feedback systems will be widespread and probably replace actor/models for training.  It could be even more effective as you could construct a patient with a rare diagnosis or presentation, or a catastrophic presentation (ie traumatic limb amputation).

 

Agreed. Online education is the future and those that oppose it tend to be older and did not necessarily grow up in a world built around computers, tech, the internet, etc.    

[Marinejiujitsu]

Yep, online is the future. Have you seen a group walk together. Everyone is on their cell phones, not even talking to each other. It's helps these antisocial kids nowadays get into medicine.

 

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[Reality Check 2]

Agreed. Online education is the future and those that oppose it tend to be older and did not necessarily grow up in a world built around computers, tech, the internet, etc.

 

OR - Us old folks know the limits of technology and still respect human interpersonal contact and the value of touch while allowing tech to merely augment an artform and profession.....

[Reality Check 2]

That's great that you had that kind of experience, but many PA students don't get that (I bet 95% of PA's, including me, never dealt with a traumatic limb amputation in an acute, emergent situation as a student or as a PA).  

 

AI and VR will reach a point, I am guessing in the next 10 to 20 years, where the computer can provide a good clinical simulation including team members.

 

So, go back to the idea that we should quit proliferating PA programs like mating rabbits and hone it down to "enough" PA programs with secured, vetted, invested rotation sites so that we can have some certainty that the majority of PA students get exposure to necessary hands on experiences. 

 

If we matched graduates with skills with available jobs, we will keep the market more secure, higher paying and less subject to dilution by volume.

 

If a student picks a school based on location, price and ease of entry but then complains that they didn't get enough exposure - well, bad choice. I would like to reduce those bad choices and make PA education more intense to a smaller number of students to ensure the quality of the profession endures.

 

Quantity has never equaled quality and online is not going to ever surpass a good hands on program.

[EMSGuy1982]

So, go back to the idea that we should quit proliferating PA programs like mating rabbits and hone it down to "enough" PA programs with secured, vetted, invested rotation sites so that we can have some certainty that the majority of PA students get exposure to necessary hands on experiences.

 

If we matched graduates with skills with available jobs, we will keep the market more secure, higher paying and less subject to dilution by volume.

 

If a student picks a school based on location, price and ease of entry but then complains that they didn't get enough exposure - well, bad choice. I would like to reduce those bad choices and make PA education more intense to a smaller number of students to ensure the quality of the profession endures.

 

Quantity has never equaled quality and online is not going to ever surpass a good hands on program.

I definitely agree.

These new schools could also require more prior healthcare experience. Here in the Northwest you better have at LEAST 2k hours, the average for my cohort was 7 years experience. I was shocked to see that 100 hours can satisfy some schools. I saw a traumatic limb amputation 3 weeks into my previous 13 year career as an EMT. The exposure is definitely out there.

 

The popping up of all these new schools (online or not) that hide behind the reason of opening as "meeting the future demands of medicine" really only have $$$ in mind. Not the quality patient care provided by their graduates.

 

It almost feels like when I was working as an EMT after 9/11. There was a GIGANTIC influx of EMT's, community colleges where I lived were quick to open courses (I got my EMT in a class given at a fire station). A few years went by and they stopped once the cash flow deminished. Hopefully in the future our profession doesn't amount to those of an EMT... "a dime a dozen".

[runforhotdogs]

What employers?  The vast majority of the hospital networks I have heard of in states where NPs have independence still have physician oversight on NP work.  The Docs are still on the hook.

My doc told me that NP's have independence in primary care only. In other specialties, they still have to have oversight. So, I think you are right. Maybe it's state dependent. I know NPs and their powerful union were making all kinds of demands and winning for themselves back East (PA's were not included in their perks).

 

As for online, I think if you are old school then it might seem confounding, but most exams in professional school are computerized anyway. Lectures are always in powerpoint. Most profs just go over the ppts. What's the point of going to class? Some D.O. schools have both in class and offsite, you can either come in or stay at home and listen to the lecture. During clinicals, you have to be hands on of course.

[overthehorizen]

These new schools could also require more prior healthcare experience. Here in the Northwest you better have at LEAST 2k hours, the average for my cohort was 7 years experience. I was shocked to see that 100 hours can satisfy some schools. I saw a traumatic limb amputation 3 weeks into my previous 13 year career as an EMT. The exposure is definitely out there.

 

Sorry but I believe that PA schools should abandon the HCE requirement and start the enforcement of the MCAT for admission. There should be a minimum MCAT for admission to PA school perhaps 25. I would recommend 30 for average acceptance (on the old MCAT). We would attract better applicants with broader educational preparation who are able to reason well in a number of areas. If someone cannot pass organic chem, biochem, general chemistry, physical and math, I have doubts about their intellectual capacity to practice medicine.

 

I have to smile at the "I was exposed to this or that before PA school because I was a whatever."  Being exposed is not the same as being responsible for. I am exposed to a lot of NFL football on Sundays. I doubt that I could start as Quarterback for a professional team next week. The only thing relevant is the experience you gain AFTER PA school. You will do absolutely well on clinical rotations by doing what Medical student do for rotations without HCE. Study. 

[EMSGuy1982]

Sorry but I believe that PA schools should abandon the HCE requirement and start the enforcement of the MCAT for admission. There should be a minimum MCAT for admission to PA school perhaps 25. I would recommend 30 for average acceptance (on the old MCAT). We would attract better applicants with broader educational preparation who are able to reason well in a number of areas. If someone cannot pass organic chem, biochem, general chemistry, physical and math, I have doubts about their intellectual capacity to practice medicine.

 

I have to smile at the "I was exposed to this or that before PA school because I was a whatever." Being exposed is not the same as being responsible for. I am exposed to a lot of NFL football on Sundays. I doubt that I could start as Quarterback for a professional team next week. The only thing relevant is the experience you gain AFTER PA school. You will do absolutely well on clinical rotations by doing what Medical student do for rotations without HCE. Study.

Interesting. Did you forget the history of our profession? (If you are even a PA) It's built on prior healthcare experience. Pick up a book. Obviously the new programs sprouting up aren't aware of it. My program hasn't forgotten..If we replaced HCE with MCAT what's the point? Funny you mention the basic science courses and math. For most programs those are a prerequsite to even applying. It's not like there is a shortage of great applicants. It the MCAT is used why wouldn't you just go into medical school after taking the MCAT?

 

I agree that being responsible for is better than exposure. Save that for the scribes. I was responsible for a lot of patients. Combat medic/EMT/paramedic experience will always be superior experience. To say experience prior to school is irrelevant is ridiculous. It makes you a better PA AFTER school. I am sure those who have precepted students that have had quality HCE vs none can tell the difference.

 

How is Joe blow the college student that heard that being a PA sounds cool and applying better than a combat medic or an EMT with years of service that has been in the $hit and has experienced medicine? Hands down I want someone who's experienced.

 

Alas, you obviously don't like our profession. You make it abundantly clear every time you post on this forum and it's quite sad. I wonder how your patients feel..

[EMEDPA]

EMSGUY, totally agree with all of the above. unfortunately, I have already maxed out my likes for the day.

I will take someone with prior experience every day as a student over someone who was a bio major and couldn't get into med school.

If I had to take the mcat back in the day I would definitely have bypassed PA. I would probably be a double boarded DO FP/EM working in a small town somewhere as the ED medical director. I looked at going back to school several times over the years and even had a rank list worked out for residencies already...alas, life happened. next time....:)

[runforhotdogs]

EMSGUY, totally agree with all of the above. unfortunately, I have already maxed out my likes for the day.

I will take someone with prior experience every day as a student over someone who was a bio major and couldn't get into med school.

If I had to take the mcat back in the day I would definitely have bypassed PA. I would probably be a double boarded DO FP/EM working in a small town somewhere as the ED medical director. I looked at going back to school several times over the years and even had a rank list worked out for residencies already...alas, life happened. next time....:)

That's a nice honest assessment. Being a doc has headaches. I don't really see the perks. You have insurance liability, staff, and tons of paperwork to worry about. The PA basically practices medicine and leaves at the end of the day. But as these words were coming from you, I think I will give thoughts about taking the MCAT a closer look. But 4 years+3 years of residency isn't appealing. I have a family member who is a doctor. After working since 2004, he's tired of all the work and ready to hang his stethoscope. It's just not worth it to him anymore to deal with all the hoopla and liability issues that comes with his area.

[EMEDPA]

That's a nice honest assessment. Being a doc has headaches. I don't really see the perks. You have insurance liability, staff, and tons of paperwork to worry about. The PA basically practices medicine and leaves at the end of the day. But as these words were coming from you, I think I will give thoughts about taking the MCAT a closer look. But 4 years+3 years of residency isn't appealing. I have a family member who is a doctor. After working since 2004, he's tired of all the work and ready to hang his stethoscope. It's just not worth it to him anymore to deal with all the hoopla and liability issues that comes with his area.

FWIW, most docs today are employees, just like pas, so malpractice, etc is paid by the group or hospital. THE SOLO DOC WHO OWNS THEIR OWN PRACTICE IS RAPIDLY BECOMING A THING OF THE PAST. where i work solo at a rural facility, docs doing exactly the same job make one third more without any additional responsibility.

[Reality Check 2]

FWIW, most docs today are employees, just like pas, so malpractice, etc is paid by the group or hospital. THE SOLO DOC WHO OWNS THEIR OWN PRACTICE IS RAPIDLY BECOMING A THING OF THE PAST. where i work solo at a rural facility, docs doing exactly the same job make one third more without any additional responsibility.

 

And I work for one of those solo docs who could really use a good accountant. I do as much as he does and make less than market. It is harder to keep compliant with state regs for labs, meds, MAs, etc - we have no one really in charge of that. So, I feel more vulnerable and have to be more aware of what is happening. He isn't willing to give me any responsibility because he doesn't know what he doesn't know. We are hemorrhaging money in dumb expenses while skirting compliance issues. 

 

So, advantage of corp employee status - someone else handles state regs and compliance. Downside - you are a cog in a machine and viewed as easily replaceable and paid less for doing same.

 

Advantage of solo private doc - no Press Ganey, no beancounter posse attacking your "practice patterns" and "time to door". But, doctors aren't necessarily business people (nor are PAs for that matter) but there is no one to go to with compliance concerns. And I still get paid less than I earn or deserve. 

 

Another vote for PA autonomy and the ability to bill for oneself. Might still be an employee but more on a same footing.

 

Just my old 2 cents.....

[Kaepora]

Sorry but I believe that PA schools should abandon the HCE requirement and start the enforcement of the MCAT for admission. There should be a minimum MCAT for admission to PA school perhaps 25. I would recommend 30 for average acceptance (on the old MCAT). We would attract better applicants with broader educational preparation who are able to reason well in a number of areas. If someone cannot pass organic chem, biochem, general chemistry, physical and math, I have doubts about their intellectual capacity to practice medicine.

 

I have to smile at the "I was exposed to this or that before PA school because I was a whatever."  Being exposed is not the same as being responsible for. I am exposed to a lot of NFL football on Sundays. I doubt that I could start as Quarterback for a professional team next week. The only thing relevant is the experience you gain AFTER PA school. You will do absolutely well on clinical rotations by doing what Medical student do for rotations without HCE. Study. 

 

 

I'm going to have to disagree with you on this one.  I took the MCATs.  It's a hoop to jump through and if you've taken the courses and studied in a reasonable fashion you'll do well.  And requiring a 25?  That's an awful score.  At least make it a score of 9s in each section or something.  In general a 30 is the minimum mark for hopeful medical school applicants.  Heck, a lot of PA/NP schools don't even require the GRE and many students lament about having to take that test for the ones that do.

 

I for one think prior experience (hands on - not scribing or shadowing) is a great indicator of future success and should be required across the board.  You got up each day at the crack of dawn.  Interacted with other health care professionals.  And most importantly, interacted with patients in a responsible, meaningful way.  I guarantee that a NP/PA student who was first a good ICU RN or paramedic will outperform their 21 year old classmates who had good grades and took the MCAT.

[EMEDPA]

FWIW if one has a reasonable background of HCE and life experience you can get into many DO schools with a 24 on the mcat. they are really more interested in well rounded applicants than MD schools, which are just about the #s.

[Kaepora]

I admittedly didn't look at DO schools when I was looking at medical school.  But that just goes to show that getting into medical school isn't necessarily all that difficult.  Scoring a 24 should be relatively painless.  I had friends who took the Kaplan course and everything and still didn't do well though, so who can say.  I must admit my very first question was about the nature of charged particle in an electric/magnetic field and I had a moment of panic.  Once I calmed down it wasn't terrible.

[overthehorizen]

I'm going to have to disagree with you on this one.  I took the MCATs.  It's a hoop to jump through and if you've taken the courses and studied in a reasonable fashion you'll do well.  And requiring a 25?  That's an awful score.  At least make it a score of 9s in each section or something.  In general a 30 is the minimum mark for hopeful medical school applicants.  Heck, a lot of PA/NP schools don't even require the GRE and many students lament about having to take that test for the ones that do.

 

I for one think prior experience (hands on - not scribing or shadowing) is a great indicator of future success and should be required across the board.  You got up each day at the crack of dawn.  Interacted with other health care professionals.  And most importantly, interacted with patients in a responsible, meaningful way.  I guarantee that a NP/PA student who was first a good ICU RN or paramedic will outperform their 21 year old classmates who had good grades and took the MCAT.

These are details that could be worked out. At least we can agree the requiring the MCAT for admission to PA school is a great start. MCAT scores seem to be improving with each admission cycles in some schools. Nonetheless, it seems that state schools that generally only accept in-state students will have an average MCAT between 27 and 30. Some of the state schools have a minimum 25. All of these numbers are based on the old MCAT. When you look at private schools that are more competitive (the place your parents would brag about you attending), then you are looking at average MCATs between 32 and 36. 

[Febrifuge]

Back when I was in PA school, the students had a hand in admissions interview days. We rejected a guy when we learned he had MCAT scores in the system. The professor I was working with explained that we wanted people interested in being PAs, not people who were lacking confidence in their ability to get into 4-year med school.

[overthehorizen]

Interesting. Did you forget the history of our profession? (If you are even a PA) It's built on prior healthcare experience. Pick up a book. Obviously the new programs sprouting up aren't aware of it. My program hasn't forgotten..If we replaced HCE with MCAT what's the point? Funny you mention the basic science courses and math. For most programs those are a prerequsite to even applying. It's not like there is a shortage of great applicants. It the MCAT is used why wouldn't you just go into medical school after taking the MCAT?

 

I agree that being responsible for is better than exposure. Save that for the scribes. I was responsible for a lot of patients. Combat medic/EMT/paramedic experience will always be superior experience. To say experience prior to school is irrelevant is ridiculous. It makes you a better PA AFTER school. I am sure those who have precepted students that have had quality HCE vs none can tell the difference.

 

How is Joe blow the college student that heard that being a PA sounds cool and applying better than a combat medic or an EMT with years of service that has been in the $hit and has experienced medicine? Hands down I want someone who's experienced.

 

Alas, you obviously don't like our profession. You make it abundantly clear every time you post on this forum and it's quite sad. I wonder how your patients feel..

While we owe much to the earliest PAs who started the profession, we must allow our history to fade into the past as we reinvent ourselves in a new landscape for medicine. Some of our PAs will find great joy and satisfaction in military endeavors as well as the financial rewards reaped from enlisting. However, we should keep in mind that only 0.4% percent of the American population is engaged in active military service. Of the remainder, most of whom are barely aware that America has been at war,  the majority of PAs will enter and engage in the practice of medicine in the same manner as medical students. 

[overthehorizen]

Back when I was in PA school, the students had a hand in admissions interview days. We rejected a guy when we learned he had MCAT scores in the system. The professor I was working with explained that we wanted people interested in being PAs, not people who were lacking confidence in their ability to get into 4-year med school.

This kind of thinking clings to a difference that doesn't add value. That is to say, the argument that a PA with hce is superior to an MD with residency and MCAT, USMLE 1,2,3 and ABIM is absurd. We need to abandon the idea of selling something that doesnt sell. This is why NPs are beating us to death. What Febrifuge says is that his PA program will reject a motivated applicant with superb undergraduate training because they prefer intellectually lazy and fearful applicants who cannot undertake rigorous entrance exams.