If you haven't heard yet....

[EMEDPA]

bio, chem, ochem, and physics were all required prerequirements for my program and they were not introductory courses. So what truly are the differences ? what is the fluff? and where are the missing links?

the difference is most of ms1 which is not covered in the vast majority of pa programs. did you have a full term each of histology, embryology, neuroanatomy, miccrobiology, etc?

most pa programs do a principles of medical science style course and cram all the really important stuff in over 2 terms instead of an entire year devoted to each subject.

[Acromion]

the issue no one has mentioned is the prior experience of the pa student which in most cases would be > than that of an md/do student. a former navy corpsman who is a pa school grad may be more competent than a new grad md student without the years of experience the pa had before starting school. granted, with the trend of pa programs to accept candy strippers as experience this will become less pronounced.

 

True, and having encountered a few MD students who have never had a JOB, let alone a health care job, I would have to agree.

[PACdan]

With the internet, traditional classes just don't make much sense anymore. I know MD students who NEVER went to class because they just watched all their lectures online, which were streamed and archived daily. Now, with sites like Dr. Najeeb or Pathoma.com, it becomes even clearer that the traditional model of education is quickly becoming outmoded. Why have a separate biochem professor for every school when you can just pay to watch lectures from the best biochem professor? Despite this, the cost of tuition just keeps going up, up, up. I guess that's one of the downsides of professional guilds: the barriers to entry allow for steep entry tolls. 

 

Granted, certain classes and labs would need to be taken in person, and there is a benefit to having a cohort, syllabus, advisors and such.  As you've said before, it's the process, not the test. However, who is to say that the PA process to MD is not equally, if not more effective? Are we really to believe that a PA who takes additional classes, perhaps part time, could not be just as competent at subjects like embryology or neuroanatomy? I think the rigor of the USMLE exams should be sufficient in determining this.

 

As a PA, I would like the opportunity to fill in some of the gaps in my knowledge, not to be a doctor, but just to be a better PA. I would also, at some point, like to teach and/or do research. People think of us as grunt workers, but in actuality we are highly educated and intellectually curious people. Having a better educated PA workforce would make us more valuable and allow us to function at a higher level. (I think I actually just made an argument for a clinical doctorate, which I have opposed in the past LOL).

 

I think Dr. Stead proposed the distance learning aspect for medical students back in the 1950's. They'd apprentice and do the didactic work by mail, until they attended school for the clinical, practicum, and procedures. And this was all long before the internet, personal computers, and digital video.

 

Of course, even those marvels can't replace being in the presence of a master of the craft for the "working with your hands" aspect. But I think you hit the nail on the head with the many courses that can be learned just as effectively via distance.

 

Education is a business; and a highly entrenched one. Go against the grain of the institution (and those who stand to lose money) and you are usually dismissed with frivolity.

[EMEDPA]

I

 

Education is a business; and a highly entrenched one. Go against the grain of the institution (and those who stand to lose money) and you are usually dismissed with frivolity.

many distance learning programs still charge > 500/unit for tuittion, many 7-900/unit.

[Acromion]

bio, chem, ochem, and physics were all required prerequirements for my program and they were not introductory courses. So what truly are the differences ? what is the fluff? and where are the missing links?

 

There's a lot, trust me. Just pick up a Step I review book and you will see. For instance, in PA school I just had to know that there's 3 pathways in the complement system: alternative, lectin, and classic. In med school, you have to memorize the entire cascade. Opening to a random page in First Aid, I see a table outlining the key differences between all the lysosomal storage diseases: the symptoms, deficient enzyme, accumulated substrate, and the type of inheritance. Same goes for the errors of inborn metabolism. Granted, med students are not expected to retain all of this, but they do get exposed to it and it is tested. It's material that I would like the opportunity to learn for my own benefit and professional development, again, not to be a doc but to advance my education.

[PACdan]

many distance learning programs still charge > 500/unit for tuittion, many 7-900/unit.

 

That's insane. Most of the information is free on the internet.

 

It's just like the textbook publishers, and their "yearly" editions... sad.

[KMD16]

on a slightly related note, very few physicians make 150k unless they work part time. the avg fp md now makes like 180-225k if I remember correctly....

You're correct. Almost wanted to respond to steve # until I saw your post. A FM friend of mine average between 300-500K/yr working smart.

[KMD16]

There's a lot, trust me. Just pick up a Step I review book and you will see. For instance, in PA school I just had to know that there's 3 pathways in the complement system: alternative, lectin, and classic. In med school, you have to memorize the entire cascade. Opening to a random page in First Aid, I see a table outlining the key differences between all the lysosomal storage diseases: the symptoms, deficient enzyme, accumulated substrate, and the type of inheritance. Same goes for the errors of inborn metabolism. Granted, med students are not expected to retain all of this, but they do get exposed to it and it is tested. It's material that I would like the opportunity to learn for my own benefit and professional development, again, not to be a doc but to advance my education.

Spot on my friend!

 

 

[Guest JMPA]

There's a lot, trust me. Just pick up a Step I review book and you will see. For instance, in PA school I just had to know that there's 3 pathways in the complement system: alternative, lectin, and classic. In med school, you have to memorize the entire cascade. Opening to a random page in First Aid, I see a table outlining the key differences between all the lysosomal storage diseases: the symptoms, deficient enzyme, accumulated substrate, and the type of inheritance. Same goes for the errors of inborn metabolism. Granted, med students are not expected to retain all of this, but they do get exposed to it and it is tested. It's material that I would like the opportunity to learn for my own benefit and professional development, again, not to be a doc but to advance my education.

we were required to know the entire cascade by heart. I'm not trying to compare a good PA program to a poor one, i would like to know the DETAILS of what the MD has educational wise as opposed to PA. Related to an earlier post, yes I had microbiology, neuroanatomy, and histology. I will admit that the embryology was a little weak. Lets be real, whats the fluff and whats the meat and potatoes of what the PA education is missing in relation to formal medical education? I would really like to hear from someone whom is knowledgable about the details of the educational differences.

[delco714]

What about with the MD comes much higher insurance costs. I mean malpractice and life and disability. My surgeons spend my mortgage equivalent on disability and life insurance a year, likely more. And like Emed said, higher tax bracket. I know where I get the title mid level from. I make 4x as much as the office MAs, and the docs make 4x what I do. Solved! :)

[PACdan]

 

 

...I know where I get the title mid level from. I make 4x as much as the office MAs, and the docs make 4x what I do. Solved! :)

And yet, you probably have 90-100% of the same work expectations and responsibilities as the docs. Funny how that goes...

[delco714]

Well they are surgeons after all.. I take in twice my earnings for the practice, as they do as well. So at least we're keeping the ratio. My job is to make them more productive and the patients safe and happy

[stj122788]

I'm looking to get in IPAP. I've met all requirements, but i finished my 6 yeas last year and now they want me to reenlist with Army...wait a year.... and hopefully get chance to do ipap. Im so confused at this point

[FEtoPA]

I'm looking to get in IPAP. I've met all requirements, but i finished my 6 yeas last year and now they want me to reenlist with Army...wait a year.... and hopefully get chance to do ipap. Im so confused at this point

 

There is a whole forum dedicated to the military.  Maybe you should post your question there.  

 

Your post leads me to believe that you are not currently in the Army.  If that is the case, I fail to see the problem with you being required to reenlist and wait a year.  It is a very competitive process and requires a long-term commitment to the military.  A year is a small price to pay for a chance at a free BS and MPAS from a top PA school all while being paid your full salary and benefits.  

[PACProvider]

When a group is in the minority, as PAs are in legislative processes, lobbying is often going to be ineffectual. I believe we should make every legitimate effort to influence legislation in our favor but we should also start preparing a separate political organization to work "under the radar." I often think about how successful the Swift Boat Veterans for Truth were in getting their message out that Kerry was "unfit for duty." I wonder why PAs cannot form our own organization and do a hatchet job on one on these newly minted "assistant physicians." Wait for the big mistake to occur. Then develop a national messaging campaign through internet (to the public) to publicize the dangers of medical students who can't pass their board exams yet bypass licensing requirements to treat patients. Smear campaigns were invented for a reason. They give power to underdogs.They are a time honored battlefield tactic in politics. PAs need to get off the high road and start playing dirty. If we need to learn the tactics for medical smear campaigns, we can study the history of the AMA for the 70 year period that they smeared DOs.

[kittryn]

This is an email from the President of the Missouri PA Society

 

 

May 20, 2014

 

 

 

On behalf of the Missouri Academy of Physician Assistants (MOAPA), I have some unhappy news to share.

 

A legislative proposal that we have been monitoring since the start of the legislative session has passed the state legislature. Senate Bill 716 is a comprehensive bill amending several public health laws, including one which has the potential to confuse patients, health systems and other providers. This particular amendment contains language authorizing the Board of Healing Arts to license physicians, unable to find a residency match, as “assistant physicians,” practicing within the confines of a collaboration agreement with a physician, and restricted to providing primary care services in rural and underserved areas. Further, the language within SB 716 contains a provision which states that “An assistant physician shall be considered a physician assistant for purposes of regulations of the Centers for Medicare and Medicaid Services (CMS).”

 

MOAPA worked with our lobbyist, Jorgen Schlemeier, to oppose the “assistant physician” language within this bill. This language was authored by Representative Fredericks, who has been a friend to PAs, and was supported by the Missouri State Medical Association or the Missouri Association of Osteopathic Physicians and Surgeons.

 

You may ask why MOAPA has not previously informed our PA colleagues of this bill. When this provision was initially introduced it was thought to be highly unlikely to pass. The proposal seemed to be in opposition to the high educational standards set for physicians. AAPA staff and our lobbying team continued to monitor activity on the legislation, which inexplicably began to move aggressively in the last week of the legislative session. The language moved from one legislative bill, to several, to finally settle in SB 716, which passed on Friday, May 16.

 

We will be in contact with you within the week to inform you of MOAPA’s next steps and potential efforts to seek a veto on this bill. To complicate the situation, SB 716 contains several positive public health measures such as extending Medicaid benefits to pregnant women and flu immunizations for hospitalized seniors. As a result, MOAPA must tread very carefully, upholding the standards of our profession while also considering the health and well-being of our patients, who may benefit from other positive aspects of this legislation.

 

Please also share this information with your physician colleagues, as they may not be aware of this provision which will negatively impact their profession.

 

Thank you again for your continued assistance and commitment to our profession. Please watch your email for further updates!

 

Regards,

Paul Winter, PA-C

MOAPA President

 

Paul Winter MOAPA President

 

 

News from the President of the Missouri PA society.

 

 

it's not good because the assistant physicians will ALWAYS get preferential treatment over PAs. we are being so marginalized....

[primadonna22274]

I'm skeptical about the APs, but your argument that med students who can't pass board exams is false. You don't graduate med school without passing steps 1 and both parts of step 2. Step 3 is taken as soon as the day after graduation and usually during intern year and must be passed by the end of 2nd year to be promoted in residency. My program requires that we take it by end of intern year and can't be promoted unless we pass it. A permanent unrestricted license in any state requires passing step 3 plus completion of at minimum PGY1.

Gotta keep y'all honest ????

[PACProvider]

I'm skeptical about the APs, but your argument that med students who can't pass board exams is false. You don't graduate med school without passing steps 1 and both parts of step 2. Step 3 is taken as soon as the day after graduation and usually during intern year and must be passed by the end of 2nd year to be promoted in residency. My program requires that we take it by end of intern year and can't be promoted unless we pass it. A permanent unrestricted license in any state requires passing step 3 plus completion of at minimum PGY1.

Gotta keep y'all honest

I am aware of your transition from PA-C to MD. Congratulations on your success. I must disagree with your last statement about "keeping y'all honest." What I advocate is a political fight outside the statehouse. The truth is irrelevant now. I encourage you to look at "The DOs : Osteopathic Medicine in America" by Norman Gevitz. Get a glimpse of the dishonest corrupt and sometimes illegal behavior of the AMA and MDs used against DOs. It worked. Now the same AMA and MDs (and DOs) are using their tactics against PAs. Truth doesn't matter any more. I argue that we need a 527 organization that can start smearing people for our political advantage. PAs are in a battle for their lives. I could care less about "truth" at this point. If the enemy is a terrorist, then the rules of war have been abandoned. Anything goes.

[PACdan]

^^^ I believe Prima went to DO school, from what I've read.

 

That is a horrible strategy that could backfire. It's basically fighting fire with fire and then we all burn regardless. Letting the very small minority of US med school grads without a residency placement practice as APs is not a concern. They wouldn't put a dent in PA opportunity.

 

The trouble comes if states adopt and legitimize APs AND allow foreign trained physicians without US residency to come and practice as APs indefinitely. People take inferior schooling (compared to US standards) in foreign countries with the hope of leaving and making more elsewhere. The doctor flight is so endemic that some countries, like Ghana, have created what is essentially the PA profession so that they know those individuals won't leave to practice medicine elsewhere, as they can't.

 

I say let APs exist for US trained med school grads, but not as a pathway to permanent practice for foreign physicians. Other countries don't allow or easily allow US physicians to come practice (try to take your MD or DO to Japan), why should we have this "express" route for FMGs? If they can gain a residency, great. At least with the US med school grads, we know exactly how they have trained.

 

Don't fight the docs, work with them. I have a hunch that many would not want to deal with tens of thousands of FMG-APs comparing themselves to physicians and in time wanting equal everything.

 

[GetMeOuttaThisMess]

OK, I'm in another one of my "moods".  Can we not all get the darn phrase correct?  It is "I couldn't care less", or "I could NOT care less", not "I could care less".  It would make the argument much more effective.  This ranks right up there with affect and effect.  This now puts the anus on others to get it right (OK, if you listen to sports talk radio leader in the DFW area you will know that I phrased this last statement correctly, even though the correct grammar would be "onus").

[Guest Paula]

Honestly, If the AP profession is extended as a permanent designation then PA schools and MD/DO schools should just merge.  PAs become the next APs and can jump off the train and work permanently in the underserved rural and urban areas.  Then, if they so desire, must match for a residency within 3 years or so and finish it out to be able to explore other areas of practice and board certification. 

 

PAs become APs or Physician Associates.  All PAs who have at least 10 years of experience are grandfathered in as APs as of the start date of the new nationwide legislation.  We are afforded full rights and responsibilities as the DO/MD within whatever area of expertise we have and SOP.  We must still do the MOC stuff we do now.

 

Why not?  University PA programs that are associated with a medical school are the first ones to convert to this new model.  FMGs who want this must still attend PA or AP school in order to gain the designation.

 

Is it time to merge the three professions yet?  

[primadonna22274]

I am a DO and I know Norman Gevitz's book well. I also know he was quite willing to spin facts against MDs in a letter last year to protest the AOA-ACGME residency merger (Google that if interested...there's a telling thread on SDN about it). Separatists want to remain separate. I've never been keen on that particular camp.

Paula, I like the stem cell notion as well, but there is a distinct problem in that many PA programs are not affiliated with medical schools. I went to Pacific University in Oregon. It's a very good PA program that is community-based. It would fold if required to merge with a med school. This would be sad. Are there alternatives? Probably, although I'm not sure what they might be.

[Guest Paula]

A satellite school for the medical profession connected with the state medical school?  Designate the PAs schools without the med school affiliation as satellites of the state  medical university?

 

I don't know the answers either but the stem cell concept could work if all the medical professions who are licensed to practice medicine actually could learn to work together to solve the problems.  The territories and boundaries will be difficult to break. 

[primadonna22274]

Wouldn't work at Pacific--less than an hour away from the state medical school OHSU which has its own PA program. Perhaps if they wanted to join up with the new osteopathic school (which is a Western U satellite, which also has its own PA program in CA, but not in Oregon)...but it's difficult to merge schools that have competing interests and are not affiliated to begin with. Maybe competing interests isn't an accurate term as both programs have a rural underserved mission, but they are disconnected geographically and academically.

[PACProvider]

Your/our PA education isn't equivalent to MD. It just isn't. Again it's not about you. If you feel that's a flippant attitude, well then ok. I'm flippant.

 

 

 

Sent from my iPhone using Tapatalk

I am surprised at how unwilling Lipper is to strongly advocate for the PA profession. He seems to approach these issues as if he works for his father who is a doctor. Does Lipper operate under the same constraints as the rest of the PA profession. Regardless, Lipper fails to recognize that PAs can successfully close the education gap that MD graduates enjoy when they are newly minted MDs. Unfortunately, PAs don't have the chance to shut the mouths of these arrogant docs by kicking their ass$s on the USMLE which is something most PAs can do. I laugh regularly at docs who presume their intellect is superior because they spent one extra year shopping for residencies and traveling around the country going on interviews. I am already outperforming and have outclassed many physicians in our workplace with many years of experience. Lipper has a confidence problem. He will never beat the docs (intellectually) in his practice if he maintains this defeatist attitude.