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didymus

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  1. Time and debt are the majors reasons I'm considering it over MD/DO right now too. Making decisions for practical reasons such as these is wise. I don't think everyone should pursue the "dream" of becoming a doctor, because it just isn't financially wise for everyone, and for older students such as myself time is a huge factor in deciding what to do. Another great point here is that not everyone cares about being a dependent provider. Some people take issue with this (not being the expert, not having the final say, etc.). For those who don't care that much, being a PA would probably be a great fit.
  2. Cool story. 1. All opinions are subjective. 2. I have direct experience in healthcare, as I was the director of a health clinic for several years, and I happen to be married to an attending physician who works as faculty at a large academic center. My wife and I converse in great detail the many facets of healthcare, healthcare delivery, and so on. 3. It is possible for one to be informed on the role, scope, and contribution of PA's without having actually been one. For instance, there are experts in WWII history. Probably not one of them actually fought in WWII. Just because they weren't soldiers during, or in, the war does not mean they cannot be experts about it. Me? I'm not even claiming expertise. I'm merely commenting on information that has been observed and learned about over years, from the birds nest, as it were, as a executive healthcare administrator, the spouse of a faculty doctor, personal friend of numerous PA's, PA students, med students, residents, and attending physicians, extensive shadowing experience, and as one who can just go on the internet and simply look all of this stuff up. It's not like being a PA is some mysterious, ethereal pilgrimage that no one who hasn't done it can't possibly understand or informatively comment on. 4. Your insults, hubris, and alleged use of sarcasm (though I think you were being serious, only to claim you were being sarcastic once you were called out) in a thoughtful discussion is quite juvenile. But if you take such issue with me using memes (which, historically, are incredibly common in online message boards), I guess you also need to take it up with the more senior members of this forum who also used them in this discussion. 5. I don't snapchat. I'm in my thirties. 6. You sure have a funny way of showing that I didn't get under your skin. Such as making it seem like that is exactly what happened. 7. Is there a state where the medicolegal stipulations on PA's are different than what I cited from AAPA? Are there states where SP's are not held vicariously liable for the acts and omissions of the PA's they supervise? Are there states where PA's can practice without an SP? 8. You're right. My masters degree from The George Washington University hasn't covered the nuances of state-by-state physician assistant regulations. We just haven't had time what with the hundreds of pages and countless hours spent covering global healthcare policy, tropical disease management among developing world communities, the US healthcare system, advanced data analysis and epidemiological methods, infectious disease, and domestic and global disaster response. I'll mention to my advisor that they should really have a block on what states offer physician assistants greater scope of practice so that I can seem reputable to some dude online with a chip on his shoulder and insecurities over physicians getting paid more, and having more time for golf, than he does. You took very thoughtful, reasonable, and verifiable responses from myself and, bewilderingly, turned them into a pissing contest. That's how I know I got under your skin. What is so baffling to me is why such responses (that really are representative) were so infuriating for you. All I can think is that they poke holes in a narrative you are adamant about maintaining above all else. Anyway, the thread has gotten back to where it needs to be with the posts that followed your rant. I just couldn't let such ignorance go without a follow-up response. I will not participate further in the derailing of this thread. Onward.
  3. It is laughable for sure! I only piped up because the thread was becoming heavily one-sided, and I wanted to add a bit of balance to the points being made to the OP. When I thought I was merely conveying, in detail, information that was widely accepted (outside of this forum, of course) I got under the skin of some posters. It happens. Moving on...
  4. Yikes. Seriously, yikes. You provided an awesome example right here of not knowing enough about who you are talking to. Also, your delivery should serve as a cautionary tale of how poorly being unprofessional can make you look. It wouldn't even matter if everything you said were true (and, man, there is just so much wrong with most everything you have said in this thread), the way you write undermines any credibility you may have. And honestly, guy, listing off all of your "gold star achievements" for the world to see isn't making anyone swoon. You must not have very in-depth conversations with your spouse if she was successful (I'm assuming here, since all you said was, "She was in the stock market--whatever that means), in her field and you didn't learn anything, or at least enough to converse intelligently on what she does, what the stock market is, who is involved, how they are involved, and what, in general, it all looks like. But, then again, my knowledge of the healthcare industry doesn't just come from "being married to it," so I am able to converse at length and in great detail about it. I've worked extensively in the field, but I won't go on listing my background, as you've shown us how distasteful that can come across. All of the ax grinding going on in this thread is a sight to behold.
  5. I guess you need to define responsibility then if you believe it is a misconception. PA's do not practice independently. Unlike NP's, PA's have someone who is responsible for them; this person is the supervising physician. I hope you would admit--and I would be surprised if you didn't--that the SP is the one who has the ultimate responsibility. Shoot, it is even made clear by AAPA: https://www.aapa.org/Workarea/DownloadAsset.aspx?id=795 (see section on Supervision) "Supervising physician should be defined as an allopathic or osteopathic physician (MD or DO) licensed to practice in the state, who accepts responsibility for the supervision of services provided by physician assistants." Just by definition alone, a physician is more responsible than the PA, as the physician is responsible for the PA. The PA is the legal responsibility of the physician, and the physician is the one who will be held legally responsible for the "act and omissions of the PA". Legally, physicians are held to a greater degree of responsibility and accountability than PA's. This is not to say PA's are not responsible, just that they have less responsibility. It's a fact. It is spelled out by AAPA, and each individual state outlines the responsibility physicians have over their PA's. In Cox v. M.A. Primary and Urgent Care Clinic, the court ruled that a supervising physician had an agency relationship with a PA and thus could be found vicariously liable for the PA’s negligence, if the negligence were proven. The court held that “as a general matter a [PA] stands in an agency relationship with his or her supervising physician when the [PA] is providing authorized medical services.” Accordingly, where a “medical doctor delegates certain responsibilities to her [PA], she remains responsible for the assistant carrying out those responsibilities in an appropriate manner,” and under such circumstances, “the [PA] occupies the role of agent and the supervising doctor occupies the role of principal.” Accordingly, in Cox, the PA was an agent of the supervising physician, and the supervising physician was subject to vicarious liability. - The Physician Assistant Licensing Act (PALA) limits the scope of PA practice and mandates a supervisory relationship with a physician licensed by the State Board of Medical Examiners. - A PA holds only a limited license and can practice only in a supervisory relationship with a plenary license holder. - The general rule is that a PA may “practice in all medical care settings, including a physician’s office, a health care facility, an institution, a veterans’ home or a private home.” Such practice is subject to the following requirement: The PA is under the direct supervision of a physician. This is all basic stuff. PA's have limited licensure, whereas physicians do not. PA's can be held legally responsible for malpractice, but when they are, the SP also can--and is--held legally responsible for the PA. When a physician is sued for malpractice, that's where it ends, because the doctor is the one ultimately responsible for the care provided. Legally speaking, one of these providers has more responsibility. I'm not sure why something that is established policy and known fact makes you cringe. I can't believe me saying something that is almost universally accepted would be controversial to you. It isn't. Even this forum is loaded with PA's explaining to the pre-PA and PA-S the limited scope of practice for PA's. Actual PA's on this very thread spoke about it, and use it as an example of why someone on the fence should go and be a doctor. There is even a veteran member of this forum who has essentially said this is the reason she went to medical school after being a PA for so many years. Again, I'm not really sure why my observations of well-established, generally uncontroversial information is causing you grief.
  6. They don't. Possibly in BFE they will, but generally, physician extenders (PA/NP) are seeing bread and butter cases to take the load off of the physicians who are better trained to see more complex medical conditions. With more groups and health systems dropping the hammer on providers to see more and more patients, doctors can't really afford to see the standard cough/cold/runny nose stuff. My experience as one who ran a primary care clinic for a few years before deciding to quit and become a clinician (PA or MD, still deciding), this is how things worked. As someone who is married to a physician, I'm aware that this is how things work at a large academic hospital as well. And even beyond primary care, PA's are not doing the exact same job as physicians in procedural specialties, either. Check out the website OR Live. Watch some surgeries where PA's are involved. There is not a PA out there doing a total hip replacement. There are PA's assisting docs with those, and, as you will see in those videos, they are mostly holding retractors and closing up after the surgery is completed (but mostly holding retractors). This is a bit of an understatement, but it's meant to make the point that PA's are not doing the same job. Rural ER? Yes, the work will mimic very closely what docs do. Metro area ER? Nope. Many (not all) PA's will be working fast track and, again, seeing bread and butter. The training of a PA doesn't really enable them to handle the complex cases without years of experience first. There are exceptions to this rule, but it is the rule. Anyway, what other masters program out there allows for such cool work and a near guarantee of $90,000 or more salary a year right out of school? Not many! Not only that, but some of the old school PA's on here may not even have a masters, but got minted back when the bachelors was the terminal degree for PA's. So these are folks with a bachelor's degree who are likely making $120,000+ There are PhD's with tenured professorships who would kill for that of pay. There are practicing lawyers sitting on $200,000 in debt making only $50,000 a year, and they have doctorates. I digress. In my opinion, this is what makes being a PA so awesome. Less school and less responsibility, with damn-respectable pay, are reasons to become a PA. Not everyone wants all that burden that doctors have. Obviously, some PA's do, and wish they would have done medical school from the get-go. I think this is probably a minority of PA's, though.
  7. This. I have actually ever only seen PA's bitch on here (some on SDN). I know a good number of PA's at a level of candid friendship, and they would share with me if they hated the work, and wished they had become MD/DO. Nope. Not one of them ever has said that. They love what they do, feel very well compensated for having a masters-level education, and really value that they get to do the kind of work they do at the level of training they have. It's PA's like these that make me feel like I won't regret becoming a PA instead of going to medical school (as I am weighing both at this time).
  8. Not sure where you work, but this is not how it is in any setting I've ever seen or heard about from people working directly in healthcare. The vast majority of the docs I know of work insane hours, while many of the PA's are capping out at 40. NO docs are working 2 days per week and making 6-8x what PA's are making. This is simply untrue, and just a massive exaggeration in every way. The only physicians I know who are banking big money are working like 80-hour weeks and have been in practice 20+ years (meaning they haven't ever slowed down from residency, and some are working even more hours). Often the caution to students on the fence about medical school is that they need to be prepared to be working crazy hours for the rest of their careers--especially surgeons--and to be prepared not to see their families very much. Of all the docs I know (and I know a lot of doctors) none of them fit your description of hours worked and pay earned. I'm not saying you don't work with some rich physicians, but the statistics show that it is highly uncommon for doctors to make more than $400,000 (and that most are making less than $250,000) and the number that do is shrinking all the time. The docs I know are pulling between $80-$100 per hour (and $100 per hour is near the top). The PA's I know are making between $40-$60 per hour (with $60 being at the very top). That means the physicians, with a minimum of 5 years more training are making around 25% more than PA's. You must work in a niche specialty, but I can't imagine what specialty it is for the docs to only be working 2 days a week and making that kind of money. The only doctors I know working that little are those who are mothers and want more time with their children. And they sure as hell aren't making big bucks working 0.4-0.5FTE. I know of one physician who works 0.5FTE and she makes $100,000 with no benefits. On those two days she works, she sees 30-35 patients probably, and does a lot of procedures. Those are two very long, very busy days for her. To think that if she worked the other 2 days of the week to be at 1.0FTE, and make around $200K with benefits isn't all that crazy. The 1.0FTE PA's at the practice are making $95,000-100,000+. So the physician makes, maybe, double what the PA's make. Sounds fair to me. Just to make it clear, your perspective is the exception rather than the rule. The suicide rate among physicians isn't so astronomically high that studies are done over it because doctors are overstressed from 2 days a week of work and $800,000 in income, managing their overworked PA's from a tropical vacation somewhere. The suicide rate is so high because most of them are working like dogs (30+ patients per day in outpatient settings), 5 days a week, going home to chart until 10pm, not seeing their families, taking regular call, huge responsibility and liability since theirs is often the final decision re: patient care, and, thus, the backlash is theirs when things go wrong, constantly facing reimbursement decreases (while PA's and NP's are seeing steady increases in pay), increasingly negative public perception, and so on. I am married to an attending physician who works on faculty with a residency program. I know much about the stresses of physicians, residents, and medical students. I have also spent a lot of time working with PA's. The reality is, the two jobs just aren't the same, and they really aren't even close. Maybe out in the sticks the level of responsibility mirrors that of physicians, but even there it just isn't the same--and only on forums like this have I ever seen PA's complain so much about physicians, while simultaneously pleading with others to go to med school because you regret not going. It's madness. I've been hopeful about the PA profession because my experience has been that PA's and physicians have, by and large, excellent working relationships and rapport. MD's and PA's are those guarding the gates of the medical profession against the invading NP's, who are threatening the very fabric of healthcare education and delivery. Man, some of the bitter PA's on this thread really throw a wrench into that perception. There is a huge amount of bitterness with some here, and it has definitely skewed their perception of reality. -
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