The Prerequisite Absurdity

[db_pavnp]

It does sound like you are making a strong argument for direct or near-direct entry PA programs, given someone has picked up 500 hours as a PCT between the ages of 18 and 24.

[SHU-CH]

It does sound like you are making a strong argument for direct or near-direct entry PA programs, given someone has picked up 500 hours as a PCT between the ages of 18 and 24.

 

That's a topic that is beaten up in multiple other threads, but here is my take (which 50% of people here will vehemently disagree with). And again, this is one person's experience at one program. We have had a ton of direct-entry students through the program, and by all available measures their performance at graduation is indistinguishable from people with substantial HCE. 

 

PA school admission decisions are very complex. You are not comparing apples to apples. You are comparing an apple to a coconut to a crescent wrench.

 

This is probably best a topic for another thread, but here is my entire personal admissions evaluation process in a nutshell:

 

1. Prove to me beyond any reasonable shadow of a doubt you will excel academically. 

2. Prove to me that you have your life together so that outside distractions will not threaten your progress.

3. Prove to me you have the heart and personality to work with people in bad situations.

4. Prove to me that you bring something to the table that will help your entire class to succeed. 

[EMEDPA]

it's not the "performance at graduation" where you see a difference. it is the "performance the first week on the job" where you see a difference. I work with and teach LOTS of new PAs. I always can tell the difference between those with significant and substantial HCE and those without. as above, 50% of folks will disagree with this. that's fine.

[SHU-CH]

it's not the "performance at graduation" where you see a difference. it is the "performance the first week on the job" where you see a difference. I work with and teach LOTS of new PAs. I always can tell the difference between those with significant and substantial HCE and those without. as above, 50% of folks will disagree with this. that's fine.

 

We survey employers of our graduates one year out from graduation. Of those who take time to respond, no difference. 

 

Give me a good, blinded study and I will be very happy to agree with you. Someone must be fishing for a dissertation topic out there. Anyone?

[EMEDPA]

We survey employers of our graduates one year out from graduation. Of those who take time to respond, no difference. 

 

Give me a good, blinded study and I will be very happy to agree with you. Someone must be fishing for a dissertation topic out there. Anyone?

maybe the ones who don't respond are the ones who are angry because they had to fire their direct entry new grads and hire experienced folks.....:)

[SHU-CH]

maybe the ones who don't respond are the ones who are angry because they had to fire their direct entry new grads and hire experienced folks.....:)

 

That may be, but I'm pretty sure I would have heard about it. The next doc I meet that is shy about sharing his opinion will be the first...

[MedicinePower]

I'm not exactly sure what you are asking. If you are asking whether I would be concerned about a student with a lot of outside obligations, the answer is yes.

 

I am having trouble exactly understanding your position and bias, so perhaps you may be able to clarify it. Do you mean to say that you would discriminate against an applicant who is currently working full-time in health care (say as an RT or RN), who is married with a family, and is taking one or two pre-req at a time (as this is what time and money allows) and instead select an applicant who is fresh out of college, has no health care experience, but was able to take 2 or 3 science courses at a time? The entire point of the PA profession was to enable those who are already working in health care to advance their training and skills, but it seems you are breaking with this history. Why? Or am I misunderstanding your position?

[PACdan]

Shouldn't employers of new grad PAs assume a learning curve for all hires regardless of previous HCE?

I mean, maybe somebody was an EMT for years, but how did that really prepare them for being a surgical PA, beyond their rotations? Unless we are just talking medical jargon, basic pt. contact skills, and being acclimated to the healthcare system. Seems like a lot of that would come from rotations as well.

Disclaimer: I'm for some HCE before PA.


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[SHU-CH]

I am having trouble exactly understanding your position and bias, so perhaps you may be able to clarify it....

 

 

I think you might have the situation reversed. If anything, I think programs with lower experience requirements are much less biased than others. Such programs have every opportunity to accept high HCE candidates and have no prejudice against candidates with low HCE but otherwise excellent credentials.

 

I will confess that our whole admissions thought process may be different than a lot of schools. For example, we do not participate in CASPA. Why? Because I have no interest in receiving 2000 applications. I am very happy to receive a couple hundred so that each one can be evaluated by a human instead of screened out by some computer algorithm. 

 

Does this method of applicant evaluation still seem biased to you?

[db_pavnp]

Evaluation of humans by humans contains bias.  However, your suggestion that a subtle preference for fresh grads as running against the grain is cleverly suggested.  I do appreciate your 1-4 and those are probably good for any applicant to any program to remain mindful of.

[MedicinePower]

I think you might have the situation reversed. If anything, I think programs with lower experience requirements are much less biased than others. Such programs have every opportunity to accept high HCE candidates and have no prejudice against candidates with low HCE but otherwise excellent credentials.

 

I will confess that our whole admissions thought process may be different than a lot of schools. For example, we do not participate in CASPA. Why? Because I have no interest in receiving 2000 applications. I am very happy to receive a couple hundred so that each one can be evaluated by a human instead of screened out by some computer algorithm. 

 

Does this method of applicant evaluation still seem biased to you?

 

Except that you admit you look less favorably upon the applicant who only takes one or two pre-req courses at a time and receive an "A" than the applicant who does well while taking three science courses. The former having a tremendous about of HCE and already working in health care, the latter having none. The former being the entire reason why the PA profession was created, the latter not. So yes, it still seems biased.

[SHU-CH]

Except that you admit you look less favorably upon the applicant who only takes one or two pre-req courses at a time and receive an "A" than the applicant who does well while taking three science courses. The former having a tremendous about of HCE and already working in health care, the latter having none. The former being the entire reason why the PA profession was created, the latter not. So yes, it still seems biased.

 

I'll "admit" that I have recommended rejecting candidates with substantial life experience. And I have also rejected candidates with a near 4.0 GPA. I like to think we use a holistic evaluation during our admissions process. I do not personally believe that health care experience confers any magical benefits that cannot be outweighed by other characteristics another applicant might display. HCE is a single component of a complex evaluation. Viewed another way, when you evaluate a patient, which is more "important" - their blood pressure or their oxygen saturation? We are having a Ford vs. Chevy discussion here. 

 

Regarding your other point about fidelity to the founding philosophy of our profession, am I safe to assume you share my belief that the specialty certification examinations are a nightmare for the PA profession?

[MedicinePower]

I'll "admit" that I have recommended rejecting candidates with substantial life experience. And I have also rejected candidates with a near 4.0 GPA. I like to think we use a holistic evaluation during our admissions process. I do not personally believe that health care experience confers any magical benefits that cannot be outweighed by other characteristics another applicant might display. HCE is a single component of a complex evaluation. Viewed another way, when you evaluate a patient, which is more "important" - their blood pressure or their oxygen saturation? We are having a Ford vs. Chevy discussion here. 

 

Regarding your other point about fidelity to the founding philosophy of our profession, am I safe to assume you share my belief that the specialty certification examinations are a nightmare for the PA profession?

 

I agree that the specialty certifications are not in-line with the original goals of being a PA, but they do not completely shift the target audience of the profession from who it was originally intended to another audience altogether. I just hate to think that someone with zero HCE but high GPA would gain an acceptance over someone who has a 3.2 GPA but 10 years of HCE simply because of your courseload description.

[Z PA-C]

I agree that the specialty certifications are not in-line with the original goals of being a PA, but they do not completely shift the target audience of the profession from who it was originally intended to another audience altogether. I just hate to think that someone with zero HCE but high GPA would gain an acceptance over someone who has a 3.2 GPA but 10 years of HCE simply because of your courseload description.

So shouldn't the person with 10 years HCE and 3.2 GPA just apply to a program that focuses more on HCE? I really see no problem with programs making their requirements as specific as they want. If you don't like how that school does things don't apply there. Their program philosphy probably wouldn't suit you anyway. If you don't want to take ochem, then don't take ochem, but don't expect to get into a program where ochem is a prereq. There are plenty of schools that get applicants with a stellar academic history but have little HCE who they reject and vice versa. The nice thing about having a diverse applicant pool and a diverse program pool is that the entire spectrum of GPA vs. HCE gets a shot at getting into PA school.

 

Every niche gets filled. If HCE really is as important as everyone claims then PA grads with low HCE will theoretically have a more difficult time during clinical year and have a tougher time finding a job and that is the disadvantage.

[MedicinePower]

So shouldn't the person with 10 years HCE and 3.2 GPA just apply to a program that focuses more on HCE? I really see no problem with programs making their requirements as specific as they want. If you don't like how that school does things don't apply there. Their program philosphy probably wouldn't suit you anyway. If you don't want to take ochem, then don't take ochem, but don't expect to get into a program where ochem is a prereq. There are plenty of schools that get applicants with a stellar academic history but have little HCE who they reject and vice versa. The nice thing about having a diverse applicant pool and a diverse program pool is that the entire spectrum of GPA vs. HCE gets a shot at getting into PA school.

 

Every niche gets filled. If HCE really is as important as everyone claims then PA grads with low HCE will theoretically have a more difficult time during clinical year and have a tougher time finding a job and that is the disadvantage.

 

True that every program has a niche, but do you see a problem in the PA schools which abandon the original vision and rationale for developing the PA profession- to be a second career for those who are already working in healthcare?

[Z PA-C]

True that every program has a niche, but do you see a problem in the PA schools which abandon the original vision and rationale for developing the PA profession- to be a second career for those who are already working in healthcare?

If that is your view, then just having PA programs be at the Masters level is abandoning the original vision because these second career folks already working in healthcare now have to go back and get their bachelor's before becoming a PA.

 

But to answer your question, no I don't think that just because some programs are willing to offer acceptances to applicants that have proven themselves capable of being able to handle a rigorous course load but have less HCE are somehow making it impossible for those who decide to become a PA later in life to do so.

 

To clarify, obviously the ideal candidate should be well-rounded in all areas of the application but I disagree that just because a person is young, has a high GPA, and a smaller amount of HCE they deserve to be a PA any more or less than someone who has a great deal of HCE, lower GPA, and is persuing PA as a second career. Anyone who wants to be a PA should be given a fair evaluation and a chance to pursue this career.

[MedicinePower]

If that is your view, then just having PA programs be at the Masters level is abandoning the original vision because these second career folks already working in healthcare now have to go back and get their bachelor's before becoming a PA.

 

But to answer your question, no I don't think that just because some programs are willing to offer acceptance to applicants that have proven themselves capable of being able to handle a rigorous course load but have less HCE are somehow making it impossible for those who decide to become a PA later in life to do so.

 

It's not necessarily true that one needs a BA/BS before getting a masters. There are programs that will allow a practicing PA with an associates degree do a master's degree without stopping for a BA/BS.

 

I guess we will have to agree to disagree. I view PA school strictly as a second career for those already working in healthcare, as did the founders of the PA profession, and not as the first job one has in healthcare.

[Z PA-C]

I guess we will have to agree to disagree. I view PA school strictly as a second career for those already working in healthcare, as did the founders of the PA profession, and not as a the first job one has in healthcare.

Then yes we definitely disagree on this point. I don't see why someone should tell me no, PA can't be your first career, it's for old-timers only, go away.

[MedicinePower]

Then yes we definitely disagree on this point. I don't see why someone should tell me no, PA can't be your first career, it's for old-timers only, go away.

 

Why? Because the entire point of the PA profession was for those who already work in healthcare and are seeking to "upgrade". It's not meant to be a "direct entry" vocation, but I guess it is turning into that. I have no doubt that those who are directly entering PA school with little to no HCE would make fine PAs, but it still violates the entire reason why the PA profession was created. The first graduating class of PAs at Duke were all experienced corpsmen (medics, medical officers) in the military.

[Z PA-C]

Why? Because the entire point of the PA profession was for those who already work in healthcare and are seeking to "upgrade". It's not meant to be a "direct entry" vocation, but I guess it is turning into that. I have no doubt that those who are directly entering PA school with little to no HCE would make fine PAs, but it still violates the entire reason why the PA profession was created. The first graduating class of PAs at Duke were all experienced corpsmen (medics, medical officers) in the military.

I completely respect and appreciate where the PA profession came from. I do, however, disagree that the entire point of the PA profession is for people who want to "upgrade". Why is it so unbelievable that some people just know they want to be a PA and work hard to get to that point right off the bat? It is a career just like any other career, not a special club. Some people love their first career, some people don't ...let them figure that out themselves without immediately writing them off. That's just my 2 cents.

[MedicinePower]

I completely respect and appreciate where the PA profession came from. I do, however, disagree that the entire point of the PA profession is for people who want to "upgrade". Why is it so unbelievable that some people just know they want to be a PA and work hard to get to that point right off the bat? It is a career just like any other career, not a special club. Some people love their first job, some people don't ...let them figure that out themselves without immediately writing them off.

 

It's not unbelievable that some people want to start as PAs and I accept that this is the future of the profession. I suspect the logical extension of this is more PA->MD/DO programs.

[PACdan]

Well, the problem then becomes; how many years/hours define a "first" career in healthcare before becoming a PA should be permissible? 1, 2, 5, or 10 years before one can apply to PA school? What's a good about of HCE backed by supportive data? It is a rather arbitrary line at many points.

 

That's why I say "some" HCE sounds good. Enough to not be wet behind the ears, know how to interact with patients, and understand the basics of health care systems. Anything beyond that is gravy.

[db_pavnp]

The thing is, when someone who attempts a direct admit is considered a qualified applicant, but two more years of maturity and working with the degree they obtained is suggested by an adcom, they can immediately perform that.

 

When you take the 35 year old and tell them that their HCE doesn't help and their logical part-time completion of prereqs while supporting their family is "unimpressive" - they are probably done.  Picking up an extraneous masters doesn't appear to gain them much.  They can't really retake their Freshman and Sophmore years all in a big bunch to satisfy the bizarre fascination with undergrad sciences that PA programs have.  I should rephrase, they probably aren't done, they are an NP at 40.

 

I am curious what SNU-CH would advise those strong, second career applicants do to elevate their application.  What would you tell a friend of yours to do?

[rev ronin]

Why is it so unbelievable that some people just know they want to be a PA and work hard to get to that point right off the bat?

In employment discrimination against women, the term is called "glass ceiling": no matter how good you are, there is a certain point beyond which you will never be promoted because of your gender--at least in situations enforcing such discrimination.  In PAdom, it's not glass, it's concrete.  Without an MD or DO, you will never be a doctor, you will always be a non-physician provider.

 

People who are going to be doing this job for 40-50 years... who are we kidding, really?  Most people who are starting as PA-Cs in their early 20's will go on to do something else later in life.  Sure, there will probably be some, but it'll be interesting to see over time what happens.  Again, to think that people who are smart and motivated enough to get into PA school in their early 20's are going to stay in a dead-end promotional progression indefinitely is counterintuitive at best.

[db_pavnp]

I was thinking about that, too, however I simply figured the second career PA's would be retired or dead while the first career PA's moved onto their second, so it was a wash.