The Prerequisite Absurdity

[WIPA-C]

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.

Thank you for this comment. A common trend on this forum is that the PA route is for people who have had a career AND if you are under a certain age, you should attend med school. I understand that the PA profession started for people who have had a career in the medical field, and will like to advance it. Since senior yr in High school, I've always wanted to become a PA one day. My brother is currently a third yr med student, and although I met the prerequisite and everything to attend med school, I still chose to PA school. During my 1st PA school interview (October, 2013), I was 20 yrs old. My interviewer struggled with the fact that I was only 20. I explained to him that being a PA is what I've always wanted and my age doesn't mean that I am unsure about this career choice. Long story short, I was rejected after that interview. I emailed him, and he told me that I "was a competitive candidate but he would like me to get more life experience, and maybe reapply in a yr or two". I couldn't believe it. How does one decide that I don't have life experience because I'm 20? I was born and raised in Nigeria, and I moved to the US when I was 15. I would love to believe that I have experienced life to some extent. moreover, how much life experience will I possibly gain within a yr or two?. Oh well, I finally got admitted into 2 programs that I really love. I can't wait to graduate in May, and start PA school in August. Yes, I will be starting PA school at 21, and I'm grateful for this wonderful opportunity!

 

p.s I worked as a CNA for 6 months,volunteered in a patient care unit at the hospital, and shadowed PAs as well

[Sirpaul1990]

When I first read Dr. Jones' article, I immediately thought about my own situation and how difficult it was to plan out my prerequisites. Texas PA prerequisites are very diverse, but I think the UT system has done a superb job of aligning them easily to see their similarities and differences.

 

http://www.cns.utexas.edu/images/CNS/Health_Professions/advising_aids/PPA_Courses-_Mar2014-032514.pdf

 

I wasn't fearful of taking organic chemistry II or biochemistry because those were already included in my biomedical engineering degree plan. Instead, I was more concerned with fitting in classes like psychology, nutrition, anatomy and microbiology. In my degree plan, we take engineering physiology, which covers concepts in much more depth with an analytical purpose and we take two semesters. Many schools I contacted accepted this credit, but a few would not. I ended up retaking an online physiology course just to apply to a few extra programs but I didn't complain one bit. Instead, I looked forward to the schools I now met the standard for and applied to those programs. In my case, I had to draw a line for how far I was going to go in completing more prerequisites, especially when I decided to apply to out of state programs. 

 

My point is that Dr. Jones is correct. There are many flaws in admission prerequisite requirements for PA programs, one of those being a somewhat lack of consistency in requirements across programs, but it's also a matter of what programs will accept and will not accept. As in my case, on a case-by-case basis schools would either accept or reject my physiology coursework after reading the syllabus. I don't believe I am alone in this matter. I also agree with PACdan that there is inconsistency in the type of coursework that is being accepted, which goes along with my second point yet again. Some students might take biochemistry at a community college where the coursework is not at a standard level, but at a "pre-introductory" level where prerequisites are not required for entrance. It's usually the case where schools have biochemistry for "science-majors" and for "non-science" majors, but how would a PA program know which you took unless it was specified on your transcript?

 

While I do believe there should be some level of standardization, I also hope that programs will allow for some variability. Without it, it would make it even more difficult to decide which programs to apply to. Sometimes when you're registering for classes, you may not get into that one class you needed to apply to PA school next semester, but instead the other upper level BIO course is open and available. It could be your saving grace.

 

I also have to disagree with some others on this thread.

• I do not endorse removing coursework from prerequisites simply because it will not be on the PANCE. I think that statement was poorly thought out and did not have the best educational future in mind for PAs. As Will352ns stated, prior coursework continues to aid students throughout their entire learning journey. That journey will not end during your PANCE, right after your PANCE, or after your 10th PANRE. As AAPA has recently stated, we're trying to bring more PAs into education and research, bringing our profession more into the published world. How could we accomplish this by retracting education and discouraging it?
• I do not encourage students to avoid schools because of prerequisites they do not have. As wutthechris said, you cannot justify telling students that PA-S going to those schools are less qualified to be PAs because they are more educated in organic chemistry, etc. A more well-rounded clinician is sought after nowadays for a reason and even if you disagree with that, you shouldn't discourage students from exceeding in all aspects of education.
• I do not believe requirements 20+ years ago are relevant to our current students interest. If they were, then they would still be the same, but they are not. While we all appreciate advice from our elder PA-Cs, advice in this area is not useful.
• Prerequisites have nothing to do with PANCE scores. If you are correlating the two, you are delusional. Secondly, if you are only worried about passing the PANCE, then you shouldn't be joining the PA profession. Yes, that is my opinion. Being a PA is not just about passing a test.
• I took organic chemistry II because I wanted to, not because I wanted to apply to medical school. Just because you achieve more, doesn't mean you have to want what everyone tells you to have (i.e. just because I had Ochem II doesn't mean I had to apply to medical school or should have). If medical school is what you want, then seek it and stop wasting time on the PA forum.
• I'm choosing not to respond to the seasoned vs. unseasoned topics above simply to avoid any more conflict over it.

[cinntsp]

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.

 

So you're shifting the conversation from the PA profession belonging to those with HCE to it belonging to "old" people.  It's these 20 somethings that can invest a lot of time into the profession(and some may not, but most likely will) that will help drive its future and achieve its fullest potential.  We may not have to become docs if legislation allows us to practice at our fullest capability.

[matchb0x]

So many interesting points in this thread.  I have enjoyed reading all well thought out opinions and back and forth and applaud everyone for having a lively debate without it devolving to childish antics.

 

Some concerns for me personally:  I am so like the example put forth of the less than ideal candidate.  I am 33 hope to apply PA school in a year or two after I finish the pre-reqs and the GRE.  I already have well over 5000 hrs of HCE as a ER tech, then CNA, and now Nurse.  However, my gpa is around a 3.2 (havent submitted to CASPA yet to find the official) and it makes me nervous reading some of the things that are being said about applicants such as myself.  I had to work during my accelerated nursing program to support my family as best I could and it impacted my gpa ( a terrible decision in retrospect but you do what you do to survive and move forward).  

 

I DO work full time and I DO have a family, and I am NOT able to take 3 classes a semester in some vague hope that I will 'impress' an adcom a year from now.  I have to worry about day to day life and try to slip in one or two (big if) classes a semester while trying to pay down my debt, save for the future, continue to develop as a nurse (hoping to move from med/surge to ICU soon), and spend time with my wife and dog (ya know I'd love to have kids at some point too lol).  The idea that I might be looked down on because of this situation troubles me and makes me have doubt about my chances.  The pre-reqs will have to be paid out of pocket somehow and that in and of itself causes challenges.  

 

In the end, I KNOW that I am an excellent healthcare provider (my patients have said as much) and I know what I am getting into.  I just hope I can find at least one adcom/school/program director who will believe I am more than that a 3.2 gp and a class or two per semester risk.

[EMEDPA]

Matchbox- you are the ideal candidate for those programs that value experience. Just find and apply to those programs and don't bother applying to the others.

[rev ronin]

[...] It's these 20 somethings that can invest a lot of time into the profession(and some may not, but most likely will) that will help drive its future and achieve its fullest potential.  We may not have to become docs if legislation allows us to practice at our fullest capability.

So I should encourage them into a self-limited career in the hope that they will expend energy chafing against those goads, that will benefit themselves only minimally but might help others by their efforts to remove those limitations?  I'm sorry, but I have an ethical problem with that.

[SHU-CH]

So I should encourage them into a self-limited career in the hope that they will expend energy chafing against those goads, that will benefit themselves only minimally but might help others by their efforts to remove those limitations?  I'm sorry, but I have an ethical problem with that.

 

 

I guess along this same line of reasoning, one could argue that no one should ever be encouraged to become a paramedic or respiratory therapist because these roles are only stepping-stones to becoming a PA.  ;-)

[db_pavnp]

It is bizarre to read that PA programs are not interested in being stepping stones for additional degrees, yet foster a climate that encourages doing exactly that.

[SHU-CH]

Some concerns for me personally:  I am so like the example put forth of the less than ideal candidate...

 

I'm not sure there is such a thing as an "ideal" candidate. Or perhaps more likely, I would be too ignorant to identify one. 

 

A given candidate, at a given point in their life attends a given program at a given point in that program's history. Perhaps if the same candidate and program came together 5 years earlier of later the fit would not work. 

 

When you are ready to apply, have a conversation with the programs you are interested in and see if there is a fit. ALL programs value experience. ALL programs value good academic performance. Don't allow the preconceived notions of others limit your choices.

[cinntsp]

So I should encourage them into a self-limited career in the hope that they will expend energy chafing against those goads, that will benefit themselves only minimally but might help others by their efforts to remove those limitations?  I'm sorry, but I have an ethical problem with that.

 

Every profession is ultimately self-limiting, no?  You imply that avoiding PA school and going to med school while young is a guarantee of happiness, success, and unlimited opportunity.  If every 20-something goes to med school, who will go to PA school?  There aren't enough qualified candidates with the standards you prefer(older age, lots of HCE, and capable of succeeding in PA school) to fill the number of seats available.  

[EMEDPA]

Every profession is ultimately self-limiting, no?  You imply that avoiding PA school and going to med school while young is a guarantee of happiness, success, and unlimited opportunity.  If every 20-something goes to med school, who will go to PA school?  There aren't enough qualified candidates with the standards you prefer(older age, lots of HCE, and capable of succeeding in PA school) to fill the number of seats available.  

some might argue that there are too many seats then....if the requirement to be a pilot was 10,000 hrs as a copilot and only 500 people/year met that criteria would it be ok to then lower the # to 1000 hours(or no hours) just to fill the # of pilot slots? that is basically what the pa profession has done by accepting folks without adequate hce and saying "well, it's ok they got a A in ochem after all...."

there are plenty of great PA school applicants out there with quality hce. the problem is once you value gpa>hce any clown with a 3.5 gpa as a bio major can get a seat over a seasoned 10 yr paramedic or RN with a 3.3 which is just wrong in my opinion. I take students both from programs that require extensive hce and those that require none. those from low/no hce program require a lot more handholding than folks who started pa school knowing how to read an ekg, understand common lab values, know common medications, etc.

[SHU-CH]

there are plenty of great PA school applicants out there with quality hce. the problem is once you value gpa>hce any clown with a 3.5 gpa as a bio major can get a seat over a seasoned 10 yr paramedic or RN with a 3.3 which is just wrong in my opinion. I take students both from programs that require extensive hce and those that require none. those from low/no hce program require a lot more handholding...

 

How much handholding? 10 years worth?

 

If they spend 2 years getting "caught up" to a former paramedic (which I sincerely doubt would be necessary) they will still probably have a much longer career taking care of sick people than someone who enters the career at a much older age.

 

Once you value HCE over GPA any clown with a pulse and body heat that worked as a CNA or EMT can get a seat over an applicant with a 160 IQ. And who defines "adequate" HCE? A nurse is not an EMT is not a CNA is not an RT.

[EMEDPA]

How much handholding? 10 years worth?

 

If they spend 2 years getting "caught up" to a former paramedic (which I sincerely doubt would be necessary) they will still probably have a much longer career taking care of sick people than someone who enters the career at a much older age.

 

Once you value HCE over GPA any clown with a pulse and body heat that worked as a CNA or EMT can get a seat over an applicant with a 160 IQ. And who defines "adequate" HCE? A nurse is not an EMT is not a CNA is not an RT.

I'm not talking about admitting folks with gpas of 2.5. I'm talking about >3.0. That's a B avg, defined as "very good". it's easy to get a 3.8 if all you have to do is school. I'm much more impressed with full time work, 2 classes at a time, raising kids, and a 3.3.

there are programs out there that take folks both with low gpas AND no experience. I REALLY am not a fan of those programs.

a cna with a 4.0 gpa will never get caught up to a paramedic in the field of em unless they do an em residency. I work with lots of folks in em and many >20 years as em pas without residencies still are not as good as the former medics 5 years out of school. Unless you have been a medic or er nurse or RT you just won't get a chance to master the material that they already know unless you do a residency. I work with some otherwise fine em pas who didn't have significant prior experience who have NEVER intubated, put in an IO run a code, cardioverted,, etc. It's a catch-22. to do something in many places today you have to prove that you can already do it. They are great at the low to medium acuity pts but once a really sick pt shows up a doc(or more experienced pa with significant experience) has to step in and take over. That's just the way it is. the days of SPs taking the time to actually teach new grads are gone in almost every location aside from the solo doc practice. the reality for most PAs today is that almost everything they do as new grads will be self taught, and many things just can't work that way. you can't just say one day " I think I will try to intubate this critical pt with a book open next to me". doesn't work that way. This is why PAs in the future will be required to do a residencies. we are graduating a product today that is not as good as it was 15-20 years ago.

[WIPA-C]

knowing how to read an ekg, understand common lab values, know common medications, etc.

I am a Biology major, and I learned how to read EKG,AND I also have some knowledge about how medications work (from taking human physiology, Animal physiology and Advanced human physiology). Now, I cannot compare my knowledge on those materials to an RN's knowledge, but at least I have a good understanding that I can build on while attending PA school. Rome wasn't built in one day (While attending PA school, I might need to work harder than "experienced" RNs or parademics, but I am willing to do so without whining about it)..

[EMEDPA]

I am a Biology major, and I learned how to read EKG,AND I also have some knowledge about how medications work (from taking human physiology, Animal physiology and Advanced human physiology). Now, I cannot compare my knowledge on those materials to an RN's knowledge, but at least I have a good understanding that I can build on while attending PA school. Rome wasn't built in one day (I might need to work harder than "experienced" RNs or parademics, but I am willing to do so without whining about it)..

I'm sure you will do well. best of luck.

[WIPA-C]

I'm sure you will do well. best of luck.

Thanks!!

[SHU-CH]

. I work with some otherwise fine em pas who didn't have significant prior experience who have NEVER intubated, put in an IO run a code, cardioverted,, etc. 

 

Most of the procedures you are citing are very algorithmic things. You think these are hard to learn? You seem to discount the ability of a motivated practitioner to go out an pursue these things. In some respects, the sicker a patient is in terms of cardiovascular issues, the easier they are to care for because things can become very ACLS cookbook.

 

The tricky patients are those with things like vague abdominal pain. And with all due respect, medics do not know how to work this up any better than anyone else.

[PACdan]

the problem is once you value gpa>hce any clown with a 3.5 gpa as a bio major can get a seat over a seasoned 10 yr paramedic or RN with a 3.3 which is just wrong in my opinion.

 

 

Once you value HCE over GPA any clown with a pulse and body heat that worked as a CNA or EMT can get a seat over an applicant with a 160 IQ. And who defines "adequate" HCE? A nurse is not an EMT is not a CNA is not an RT.

 

Hey now guys, I've had the good fortune to spend some time with Dr. Hunter "Patch" Adams, and let me tell you that clowning can be very beneficial in medicine!

[EMEDPA]

Most of the procedures you are citing are very algorithmic things. You think these are hard to learn? You seems to dicount the ability of a motivated practitioner to go out an pursue these things. In some respects, the sicker a patient is in terms of cardiovascular issues, the easier they are to care for because things can become very cookbook.

 

The tricky patients are those with things like vague abdominal pain. And with all due respect, medics do not know how to work this up any better than anyone else.

true, but they can recognize subtle signs of sick vs not sick from the door that take years for others to pick up on.

I see folks wheeled down the hallway to fast track rooms past oblivious staff/providers when it is obvious to me that they are 2 minutes from being dead.

[EMEDPA]

Hey now guys, I've had the good fortune to spend some time with Dr. Hunter "Patch" Adams, and let me tell you that clowning can be very beneficial in medicine!

ok, I'm jealous. he's one of my personal heroes. him and dr. paul farmer.

[EMEDPA]

I wanted to address something else here. the whole idea of the non-hce folks getting "caught up" with the  hce folks.

so it's ok to be sub-par for the first year or 2 or 3? what about patients the first week after graduation? do they not matter?

"time to get caught up" is just another way of saying "learning things you should have known before starting pa school".

I don't think it's fair to those early patients to made avoidable mistakes on them just because you didn't want to take a few years to get meaningful hce before pa school.

[SHU-CH]

true, but they can recognize subtle signs of sick vs not sick from the door that take years for others to pick up on.

I see folks wheeled down the hallway to fast track rooms past oblivious staff/providers when it is obvious to me that they are 2 minutes from being dead.

 

 I know. I have have cared for patients with anaphylaxis in fast track. Do you know who dumped them there? Nurses with over 20 years experience working in the ED!

 

Can you explain this phenomenon? It seems that if a nurse showed up to your program with 20 years experience you could not admit her fast enough.

[PACdan]

ok, I'm jealous. he's one of my personal heroes. him and dr. paul farmer.

 

He went to med school at my alma mater and comes back often for seminars and activities. He's a great guy, deeply personal with everyone he meets and really is all about making that connection, he truly practices human medicine.

 

Question though EMED, how do you reconcile the notion of the 5 year medic who attends PA school and then chooses a completely different line of PA work after (non-EM)? How did that HCE prepare him for the trials of oncology, ortho, IR, or FM? Can we not change our fields, because that seems to be a implication of said argument. Obviously some things will carry over, but one's previous HCE might not dictate their future PA career choice. I'm certainly not interested in surgery.

[EMEDPA]

any significant hce teaches you:

how to deal with people

medical terminology

sick vs not sick

pharmacology

basic procedures used in all fields

the culture of medicine, what the roles of all the players are, etc

a little bit about a lot regarding disease in general

 

these things are of value in ANY field.

[SHU-CH]

so it's ok to be sub-par for the first year or 2 or 3? what about patients the first week after graduation? do they not matter?

"time to get caught up" is just another way of saying "learning things you should have known before starting pa school".

I don't think it's fair to those early patients to made avoidable mistakes on them just because you didn't want to take a few years to get meaningful hce before pa school.

 

 

I'm confused - so your skills are not any better now than they were the week after graduation? Or are you saying PA school should be 20 years long?

;-)