A Very Nice Article About US - Written by an MD and Physician Trainer

[jmj11]

http://drnjbmd.wordpress.com/2012/01/14/common-myths-about-physician-assistants/

[EMEDPA]

excellent! did you also post this at C1? Mittman would love this article.

[Gordon, PA-C]

In the end, the PA student will leave at the level of a PGY-1-2 resident and function at they level for most of their career while the medical student will leave at the level of a PGY-1 resident and move through residency to become an attending physician.

 

 

 

This is BS. When I graduated PA school, I was just as good as 95% of fully trained physicians. I was better than any PGY-4 or 5 or 6 that came out of my institution. And the fact of the matter is, MOST PAs are equal to physicians straight out of PA school with no residency needed.

 

 

[Boatswain2PA]

 

 

This is BS. When I graduated PA school, I was just as good as 95% of fully trained physicians. I was better than any PGY-4 or 5 or 6 that came out of my institution. And the fact of the matter is, MOST PAs are equal to physicians straight out of PA school with no residency needed.

 

 

 

Well then you are a lot better provider than I am, and a HELL of a lot better than most of my classmates who, while brilliant, had virtually no HCE beyond CNA duties.

 

Yeah, with my prior life experience I might compare my skills with a PGY 1-2, but certainly not my knowledge base. And I will never compare myself with a board certified emergency physician. Their training/education far exceeds anything PAs get.

 

But hey, while you just might walk on water, I will settle for being competent.

[rev ronin]

This article is great at correcting basic mistakes, but perpetuates some others. In family medicine, I have to fight to get to assist my supervising doc on procedures. I am expected do my own, assisted by my MA if necessary, and sew up what I biopsy. Maybe 5% of my patients see another provider I consult with, and often that other provider is a senior PA. We talk about cases before 8 AM and after 5, but during the day, we're usually too busy to chat. I call consultants, order therapy, infusions, DME, and external referrals, and, for the most part, the results come back either addressed to me or CC'ed to me, rather than the primary care physician of record. I have yet to sign a death certificate, but I expect I'll do that one within a year.

 

I actually do a LOT less "assisting" than I did envisioned. It's absolutely cool to be respected by the physicians I work with, but it's a MUCH flatter and less hierarchical model than what's described in the article.

[Guest Paula]

This article is great at correcting basic mistakes, but perpetuates some others. In family medicine, I have to fight to get to assist my supervising doc on procedures. I am expected do my own, assisted by my MA if necessary, and sew up what I biopsy. Maybe 5% of my patients see another provider I consult with, and often that other provider is a senior PA. We talk about cases before 8 AM and after 5, but during the day, we're usually too busy to chat. I call consultants, order therapy, infusions, DME, and external referrals, and, for the most part, the results come back either addressed to me or CC'ed to me, rather than the primary care physician of record. I have yet to sign a death certificate, but I expect I'll do that one within a year.

 

I actually do a LOT less "assisting" than I did envisioned. It's absolutely cool to be respected by the physicians I work with, but it's a MUCH flatter and less hierarchical model than what's described in the article.

 

You have it good, Rev. That is how it should be. I still get results back with my SP's name on them from some places and I attempt to correct it. Sometimes it works, sometimes not. In my FP we all do our own work, consult with each other when needed, and refer back to the SP with very difficult, complicated cases. My place of work sounds similar to yours.

 

The article was better than most and the author was trying to make a point that we all are to work together without false preconceived notions.

[rcdavis]

Remember.. The article was written by a vascular surgeon.

The degree of autonomy we have in great part depends on the specialty or subspecialty in which we work.

 

It is very reasonable the heirarchal model she describes is the best for her panel of patient's. In cardiovascular or neurosurgical practices, very few if any PAs carry their own panel of patients, most work in the manner she describes.

 

Less invasive practices, which cater to patients with a slightly lower degree of immediacy or urgency in their practices, and whose practices have practices which have many return visits, work well with greater autonymous PAs who reconize when things are not going as they should, and consult the SP at that point.. And carry their own panel of patients.

 

Any surgical PA recognizes the accuracy of her description...

 

Even when I was the solo SICU/CSRU night provider, I presented EACH patient I had taken care of in the unit to the morning rounding team of my SPs, residents and day PAs... As they did me when I came on. And my boss expected a call when unexpected things happened, when the chest needed to be reopened at the bedside and every time he was needed at the bedside or in the OR.

 

I think the article was complementary in the extreme.

 

As far as being equiv. to MD on graduation.. I graduated from a good program (GW), had a ton of preeducation experience, ((navy SS, IDT, Vietnam), and am reasonably smart, (I read the textbooks for recreation!), and yet... There is no way I honestly feel I was anywhere near an MD on graduation. Somewhere at the 10 year mark, I felt that I had elevated my capacity from PGY1-2 to that of a PGY 3. At the 20. Year mark, simple experience and exposure has elevated me to the level of.. PGY3 with a ****load of experience,

 

I reject PA to MD equivalence . I can perform equal to a GP .. Mostly, but their is no equivalence.. They simply are the total package.

 

Good as I am, I am not.

[primadonna22274]

 

 

This is BS. When I graduated PA school, I was just as good as 95% of fully trained physicians. I was better than any PGY-4 or 5 or 6 that came out of my institution. And the fact of the matter is, MOST PAs are equal to physicians straight out of PA school with no residency needed.

 

 

 

Gordon, your hubris is showing. Might want to look to that.

Would love to be a bystander while you bask in the reflection of your kool-aid pool and fall in and drown.

Sheesh.

***

On another note, nice article.

[EMEDPA]

agree with Davis. I feel like an em PGY-2 most of the time...I can(and do) run the dept by myself but every now and then it's nice to bounce something off someone with more seniority than me when I say "WTF I have never seen this before". those more senior folks used to be PAs and docs. for the most part now they are all docs, and docs older than me for the most part. I do think a good em pa knows a lot more about the practice of emergency medicine than the vast majority of docs who do not practice em. they all think of differentials within their own fields but em trained folks(both docs and pas) think across specialties. I work with a lot of fp docs who work occasionally in the e.d. Some are very good and the more time they spend there the better they are. when I work with a new grad fp doc though it's clear who knows more about the specialty.the staff knows too and they will grab the senior em pa over the locums fp md for any sick patient. I worked with an fp md a few weks ago(in theory my "supervisor" that day) who didn't know to give narcan to an aloc pt who came by ambulance then when I recommended it they asked me the dose....

there are still a few em pas out there (like Davis) who have been doing em for longer than I have that I consult with but most of my group now has less experience than I do. I stick around and they leave for more lucrative careers in other fields or retire...also I think a lot of folks now are just less passionate about em than I am and others of my generation...lots of the new grads would never consider cracking a book outside of work....I have a whole bookshelf of em and medical texts at home I look at frequently....they probably have better social lives than I do (in fact I know they do) but if I was sick I would rather see me than them...

[G. Davenport]

they probably have better social lives than I do (in fact I know they do) but if I was sick I would rather see me than them...

 

I'm pretty sure my social life was better but now I have none - 2 sets of twins ages 6 and 4. And hey, you'll be happy to see my face when you have chest pain cause you won't be able to take care of yourself. And finally, your books are outdated. Go electronic :-).

 

And one last thing. As I recall I usually called the specialist when I needed help. I know you did the same.

[EMEDPA]

your books are outdated. Go electronic :-).

 

the ones I use the most I update every year(Tarascon and Sanfords) or every edition for others.

funny story- I was working a shift with VY(now Dr. VY) a few years ago and he was going on and on about how good his phone was and how it had everything and how much my pocket guides suck. then he dropped his phone and broke it...totally inoperable...I threw my pocket tarascon on the ground, jumped up and down on it and said" Look mine still works, whose books are better now B!tch!"....:)

the best book is the one in your head....I think too many students and new pas today depend too much on their electronic peripheral brains. you need to know lot of this material, not just know where to find it....3 am, they just woke you up to see a crashing kid, peds doses for common drugs better be in your head(or at least on a card in your pocket), not in your smartphone sitting in the charger back in your call room....

[physasst]

Gordon, your hubris is showing. Might want to look to that.

Would love to be a bystander while you bask in the reflection of your kool-aid pool and fall in and drown.

Sheesh.

***

On another note, nice article.

 

Yep. Agreed. A PA with 10 or more years of experience may be very close to performing just like a residency trained, board certified physician....but a new graduate???? Man, I want some of whatever he is smoking cause that is some good sh*t. For ALL of the students reading this...this just isn't true.

[EMEDPA]

I think it is fair to say that clinically new grad pa students in primary care are at about the same level as new grad physicians(before residency). That's why they (PAs) can go right to work in an fp clinic.

the md/do folks know a lot more basic medical science but knowing more histology or biochemistry for example doesn't necessarily translate to better care for primary care patients with common issues. one can prescribe a beta blocker for htn by knowing it's indications, contraindications, mechanism of action, etc without knowing beyond a basic level on a molecular level how it works. ditto a statin. you can rx it without being able to diagram the hmg-coa reductase pathway.

I think it is fair to say that a new grad physician would perform better on an inpatient hospitalist service than a new grad pa. their raining focuses more on sick inpatients while ours focuses more on outpt primary care. it's what we drill on and what we are tested on in school.

[Gordon, PA-C]

This article is great at correcting basic mistakes, but perpetuates some others. In family medicine, I have to fight to get to assist my supervising doc on procedures. I am expected do my own, assisted by my MA if necessary, and sew up what I biopsy. Maybe 5% of my patients see another provider I consult with, and often that other provider is a senior PA. We talk about cases before 8 AM and after 5, but during the day, we're usually too busy to chat. I call consultants, order therapy, infusions, DME, and external referrals, and, for the most part, the results come back either addressed to me or CC'ed to me, rather than the primary care physician of record. I have yet to sign a death certificate, but I expect I'll do that one within a year.

 

I actually do a LOT less "assisting" than I did envisioned. It's absolutely cool to be respected by the physicians I work with, but it's a MUCH flatter and less hierarchical model than what's described in the article.

 

 

This is spot-on. You need to ask your MD "supervisor" why you are getting paid half of what he gets, since it is obvious you are doing the same job.

[Boatswain2PA]

you need to know lot of this material, not just know where to find it....3 am, they just woke you up to see a crashing kid, peds doses for common drugs better be in your head(or at least on a card in your pocket), not in your smartphone sitting in the charger back in your call room....

 

And this is why the physician residencies are sooo important. By the time a physician graduates from an EM residency he/she has done this dozens of times and, I'm sure, has "internalized" their memory of those doses.

 

 

This is spot-on. You need to ask your MD "supervisor" why you are getting paid half of what he gets, since it is obvious you are doing the same job.

 

Not the same education/experience, and not the same job. The MD "supervisor" spends 5-10X what you spend on malpractice insurance, partially because they are on the hook for nearly every patient you see. The MD "supervisor" spent 4 years in med school, PLUS 2-3 years in FP residency rotating through a ton of rotations that you haven't done. This puts the MD "supervisor" at the pinnacle of the profession and thus deserving of greater pay.

 

If you don't like the pay difference, then go to medical school. There are some PA to physician folks who post here...you might want to ask them how much MORE they learn in med school/residency than we learned in PA school. Even YOU might learn something if you went to medical school Gordon.

 

BTW - I am also in a job where I do very, very little "assisting". I pretty much practice autonomously, but never independently. I realize I work for the attending who is on call.

[ventana]

 

 

This is BS. When I graduated PA school, I was just as good as 95% of fully trained physicians. I was better than any PGY-4 or 5 or 6 that came out of my institution. And the fact of the matter is, MOST PAs are equal to physicians straight out of PA school with no residency needed.

 

 

 

 

if you truly believe this, you are a danger to your patients. Go back and read threads about new grads PAs. you really don't even know enough to know what you don't know.

 

Do you really think the American medical system would require 7 to 10 years of formal education and on-the-job training to become an independent medical provider i.e. Doc when this could be done in a short 28 month PA program? I am not talking down about PAs at all, just pointing out the obvious, we are in no way equal to attending the graduate, nor even dip PGY 4 or 5. It is frightening to think that there is such overconfidence in a new grad, PA. It took me almost 10 years to truly find my stride and be comfortable with people's lives in my hands.

[EMEDPA]

And this is why the physician residencies are sooo important. By the time a physician graduates from an EM residency he/she has done this dozens of times and, I'm sure, has "internalized" their memory of those doses.

 

.

this is also why

1.prior experience

2. ongoing cme and/or residencies

are important for PAs.

pretty much any former paramedic can roll out of bed and care for that crashing peds pt discussed above(at least the initial stabilization) without having gone to pa school. it's what they already did in a prior career...

[rev ronin]

I'm a HUGE fan of CME... but I think the requirements should be different the first year or two out of school. I have well over 100 hours of Cat I accumulated in 9 months, largely because I'm offered free CME at work that has very little to do with the practice of medicine. I would say more than half of my Cat I CME is about the business of medicine, to include Epic training. Much of the rest of it has been re-certifications. It's all great stuff, but really shouldn't be displacing practice-based CME.

[Boatswain2PA]

I'm a HUGE fan of CME... but I think the requirements should be different the first year or two out of school. I have well over 100 hours of Cat I accumulated in 9 months, largely because I'm offered free CME at work that has very little to do with the practice of medicine. I would say more than half of my Cat I CME is about the business of medicine, to include Epic training. Much of the rest of it has been re-certifications. It's all great stuff, but really shouldn't be displacing practice-based CME.

 

I see your point, but disagree with the need for more regulation of CME's. There is nothing preventing you from getting even more Cat 1 CMEs...ones more "medicine" oriented.

 

Some new grads may be closely supervised and need that initial "business" oriented CME.