If you haven't heard yet....

[andersenpa]

I think it's important to consider who those unmatched doctors are.  Some are FMGs, and that's an entirely different ballgame as their programs aren't regulated like the US ones.

 

I do know of a few, I'll let you all be the judge.

 

I know of one medical student who missed a month of 4th year rotations due to personal reasons.  She graduated in July.  She was only unable to match because residencies start July 1st.  I've seen other medical students in the clinics.  They get pregnant, sick, etc just like everyone else.

 

I also know of one who was going into orthopaedics - currently one of the most competitive specialties.  He did not interview at enough programs and did not match.  His proficiency and board scores are leagues above most PCP docs, but his goal was higher and he refused to accept less.

 

Another was going into dermatology - again, a very competitive specialty.  He successfully matched derm, BUT he neglected to interview for enough preliminary year programs and didn't match.  Interviewing is a VERY expensive process for medical students.  If you drop $10,000 interviewing for dermatology, it's hard to drop another $5,000 on preliminary year programs.  Not everyone has college educated parents who have $15,000 lying around to help out.

 

I don't personally know anyone who failed to match for academic reasons, but maybe others do?  Every specialty has bad apples.  I've seen many people I would never allow to be my physician, but you can't just assume people are inept because they failed to match.

 

Case 1- if you went to school to be an MD then be a damn MD. Wait a year, do research, staff a clinic somewhere, travel the world, and match th following year. The PA profession is not a holding tank for MDs who couldn't meet their profession's timelines. 

 

Case 2- The "proficiency and board scores" is all about competition not smarts. I'd take a PCP over an orthopod on overall medical knowledge and day of the week. AND.....if he "refuses to accept less" (a bit arrogant to consider IM "less" than ortho), then why accept PA????

 

Case 3- The key word is neglect. He didn't check all his boxes. Just as in case 1- try again next time.

 

I am not ASSUMING anything, just a statement of fact that the standards for a PA license are accredited PA education and board passage.

If you are unaware, look at the hx in florida of licensing IMGs as PAs.

 

What is your background that makes you so knowledgeable about unmatched docs?

[Steve]

What part of the PA curriculum do you feel is missing from med school curricula?

We always hear how PA school is modeled after medical school - only compressed and trimmed for time. If a person is capable of passing the non-compressed medical curriculum (while spending more money and time to do so) and can demonstrate enough competency to pass the exact same certifying exam PAs have to pass, I say let them be PAs.

 

Conversely, I wouldn't mind if PAs (ideally with significant experience) were able to sit for the USMLEs.

 

I shouldn't have said "unrelated & no relationship" in my previous post, obviously the professions are tight knit and function quite similarly. My point was that they are technically 2 different professions with well defined requirements. Allowing the failed docs to encroach on the PA's wouldn't be fair to those who went through the proper process, and this is not a two way street, PA's will never be allowed to take the USMLE and then apply for residency.

[primadonna22274]

No no no no no.

728 on my COMLEX 2 (I didn't take USMLE2, ran out of money). The equivalent scaled 2-digit score is a 99 actually (not a percentile but you can think of it that way). So a pretty damn awesome score.

My PANRE in 2012 was an 800. I didn't study for that at all (I had 15 mos of med school studying and thousands of high-level test questions under my belt at that time). My point is that the clinical knowledge COMLEX 2 was a very, very similar exam of medical knowledge and decision-making to PANCE/PANRE, less the OMT of course.

On day 6 of FM residency yesterday, we took last year's ABFM in-training examination as a diagnostic. Tough questions and high-level but not that much harder than PANCE/PANRE quite honestly. I haven't studied anything since February and didn't study for this. Scored 68% which was pretty respectable for a PGY1 who hasn't learned anything new yet clinically. I think this will be about 90+ percentile if I understand the ABFM stats correctly. It's a significantly higher score than the national median for PGY3s. There's nowhere to go but up from here--so that's kinda validating.

My point: PAs have a pretty broad knowledge base and med school will deepen it, hence PAs who wish to become physicians can be expected to perform very well in medical school and in residency beyond.

 

 

 

quote name="DissentingVoice" post="172141" timestamp="1402975034"]Hey all. I was reading this post chain, and I found it very interesting. Great read, but I felt the need to comment on a few things.

 

I may be wrong, but isn't 800 the maximum score for PANCE? A 98 on the USMLE typically corresponded to a sub-average score overall. So...essentially you're saying you scored below average on the USMLE and the highest score possible on PANCE, so they are equivalent. That does not make sense.

 

Fortunately, USMLE did away with the two digit scoring because too many people were confusing it with percentiles. If you don't believe me, send me your three digit score, test average, and standard deviation, and I will calculate your percentile for you. 98 was typically in the 45-50th percentile range when those scores existed.

 

Awhile ago the DNPs created an exam with NBME which was essentially a watered down version of the already easy USMLE 3. Even the easier version had a 50% fail rate among NPs. Please don't be so cavalier about equating them.

 

http://www.nccpa.net/Scoring

http://www.usmle.org/announcements/?ContentId=111

http://www.amednews.com/article/20090608/profession/306089978/1/

 

That said, the 99th percentile is very impressive and something to be proud of. There's a big difference between a good score and ace-ing the test (given the ceiling effect).

 

 

Um...that depends on the school. 50 weeks M3 year and 28 weeks+ M4 year is common. That's 78 weeks of clinicals. At (a very conservative) 50 hours per week, that's 3,900 hours of pure clinical time (studying not included). Some PA-C programs have as little as 2,000 hours. M4 year also includes sub-internships which are generally where medical students progress to an intern level of functioning, and those are far more important than anything in M3 year. I wouldn't diss the physician's clinical hours. They put in a lot of work.

 

 

The us-vs-them mindset probably isn't so helpful for patients.

 

 

Also, I don't remember who said it, but the idea of unlicensed physicians having to take PANCE before acting as the "assistant physician" is probably a great idea. Also, the name "assistant physician" does suck. It's confusing at best.

[PACdan]

What part of the PA curriculum do you feel is missing from med school curricula?

We always hear how PA school is modeled after medical school - only compressed and trimmed for time. If a person is capable of passing the non-compressed medical curriculum (while spending more money and time to do so) and can demonstrate enough competency to pass the exact same certifying exam PAs have to pass, I say let them be PAs.

 

Conversely, I wouldn't mind if PAs (ideally with significant experience) were able to sit for the USMLEs.

They trained under the mentality for four years that they were going to be doctors. It's not about a knowledge divide or if they can pass the PANCE. It's about what profession they committed to practicing in and how they trained for it.

 

Some might fallaciously suggest that these unlicensed MDs could take a few PA specific courses, the PANCE, and function as a PA. Those few courses won't erase or reprogram the intrinsic mentality that they are "doctors". Hence a myriad of issues that can and will arise when they must work in the parameters of a PA.

 

The long and short, if they want to practice as a PA, they need to go through that experience and train as one.

[db_pavnp]

^^^  That just doesn't read as very convincing.  I want to believe it, though.

[DissentingVoice]

No no no no no.

728 on my COMLEX 2 (I didn't take USMLE2, ran out of money). The equivalent scaled 2-digit score is a 99 actually (not a percentile but you can think of it that way). So a pretty damn awesome score.

My PANRE in 2012 was an 800. I didn't study for that at all (I had 15 mos of med school studying and thousands of high-level test questions under my belt at that time). My point is that the clinical knowledge COMLEX 2 was a very, very similar exam of medical knowledge and decision-making to PANCE/PANRE, less the OMT of course.

On day 6 of FM residency yesterday, we took last year's ABFM in-training examination as a diagnostic. Tough questions and high-level but not that much harder than PANCE/PANRE quite honestly. I haven't studied anything since February and didn't study for this. Scored 68% which was pretty respectable for a PGY1 who hasn't learned anything new yet clinically. I think this will be about 90+ percentile if I understand the ABFM stats correctly. It's a significantly higher score than the national median for PGY3s. There's nowhere to go but up from here--so that's kinda validating.

My point: PAs have a pretty broad knowledge base and med school will deepen it, hence PAs who wish to become physicians can be expected to perform very well in medical school and in residency beyond.

 

 

Did you take USMLE I?  What was your three digit?  And 68% on ABFM ITE is approximately a 490.  That's approximately the 80th percentile.  Pretty darn good for someone just starting out, and worth being proud of.  Probably around 90th percentile for PGY-1?

 

COMLEX, USMLE, PANCE are all apples to oranges.  Different tests.  Personally, I think they should be opened up to other professions to take if desired the same way DOs can take the MD's USMLE.  (Though, I don't understand why MDs can't take COMLEX)  I also believe physicians should be able to take each other's board exams.  Really, it's all a big turf war, and it boils down to money.

 

Speaking of which, I remember the old MD vs DO debate.  I think it has relevance to the current issue.  

 

 

Case 1- if you went to school to be an MD then be a damn MD. Wait a year, do research, staff a clinic somewhere, travel the world, and match th following year. The PA profession is not a holding tank for MDs who couldn't meet their profession's timelines. 

 

Case 2- The "proficiency and board scores" is all about competition not smarts. I'd take a PCP over an orthopod on overall medical knowledge and day of the week. AND.....if he "refuses to accept less" (a bit arrogant to consider IM "less" than ortho), then why accept PA????

 

Case 3- The key word is neglect. He didn't check all his boxes. Just as in case 1- try again next time.

 

I am not ASSUMING anything, just a statement of fact that the standards for a PA license are accredited PA education and board passage.

If you are unaware, look at the hx in florida of licensing IMGs as PAs.

 

What is your background that makes you so knowledgeable about unmatched docs?

 

Back to that topic of money.  People fresh out of medical school have none of it.  Sure they could work in a clinic as you suggest, but as what?  A medical assistant or CNA?  You think a physician wants to be make $8/hour when they have over $10,000 in interest payments alone each year?  (That's not even capital)  Travel the world?  That requires money as well unless they're hitchhiking.  Doctors without borders?  Even that requires money.  Peace corps?  Two year commitment.

 

And yes, I haven't met a lot of surgeons who aren't arrogant.

 

He didn't just neglect to check boxes.  He made a decision about how much money he had available, and how many flight tickets he could purchase.  You make it all sound so easy.

 

But after all they're just doctors.  They don't need an income or decent life.  They're out there to serve.  

 

As for me, I'm just throwing out another point of view.  It's what I do.  :-)

[delco714]

How much time of that 3900 med school rotation hours is spent in the library at the hospital? :)

 

Steve PA-C, Maine, urologic surgery

 

 

[DissentingVoice]

How much time of that 3900 med school rotation hours is spent in the library at the hospital? :)

Very little actually.  The studying happens after hours and in the first two years.  I'm sure they squeeze in a few MKSAP questions while on call and stuck in the hospital for 16-28 hours but so do the PA students.  Like I said, PA students and M3s are fairly similar in many programs.  You try to make it sound like all medical students do is read and never practice medicine.  4th year medical students are expected to function at an intern level on some of their rotations.  That's a lot of work.

[delco714]

Hmm. I was partially joking, but on all my rotations around NYC the med students were really good at slipping away and escaping to the library. Students from good schools too. Don't take it so seriously. This thread needs to lighten up just a bit.

 

Steve PA-C, Maine, urologic surgery

 

 

[PACdan]

^^^ That just doesn't read as very convincing. I want to believe it, though.

Take an Air Force pilot and tell him he can do everything but touch the stick. Or a Navy captain, but say he can't take the wheel. Then walk away.

 

The first issue off the bat is that some (maybe all) of these "MD-PAs" would want to call them themselves doctor with pts. And frankly, pts. will be more confused about PAs in general. That alone will be a massive headache.

 

Momma always said: K.I.S.S.

 

 

Sent from the Satellite of Love using Tapatalk

 

[db_pavnp]

I will take your analogies here to heart and simply have to tell you that intuitions differ and I see no problem at all.  Smart professionals know what they are signed off on in their professional lives.  That is a part of what being an employee in healthcare is all about.

[PACdan]

I will take your analogies here to heart and simply have to tell you that intuitions differ and I see no problem at all. Smart professionals know what they are signed off on in their professional lives. That is a part of what being an employee in healthcare is all about.

I think you underestimate the power of human emotions and the investment of human ego.

 

We will have to agree to disagree.

 

But if you take young med school grads that didn't match and make them PAs overnight, I see trouble brewing. They wanted to be docs, they went to school for that, I'm sure that resentment will brew if they have to come out the other end something different.

 

 

Sent from the Satellite of Love using Tapatalk

 

 

[LT_Oneal_PAC]

I just don't understand how you don't match unless you're a poor candidate. There is the scramble for people who shot too high and you can always do a prelim or transitional year if you don't match categorical.

 

I would let Unmatched MDs take the PANCE after some courses and be PAs the day they let PAs take USMLE after taking the 2 semester basic sciences. If wishes and buts were candy and nuts, we'd all have a merry christmas.

[DissentingVoice]

I just don't understand how you don't match unless you're a poor candidate. There is the scramble for people who shot to high and you can always do a prelim or transitional year if you don't match categorical.

 

If they scramble, they have to pick a different residency.  I know someone who wanted to do OB/GYN, and now she's in family practice.  More competitive specialties don't always have scramble spots.  It's not like a MD/DO can just get a little work experience and then switch specialties.  Wouldn't that be wonderful.  Nope - it's another 3-8 years of residency.

 

It would be like if I said to you "hey, sorry, we have no emergency medicine PA spots, but there's this one spot in northwestern Montana as a pediatric PA.  Does that sound good to you?"  You won't have to worry about that pesky sunlight and warm weather anymore.

 

People have sick family members, personal illness, new kids, geographical ties.  It's a lot more complicated than just labeling them as terrible students.

 

Honestly, I'm not sure why anyone even goes to medical school anymore.  It's like law school.  All these young naive students go and end up working as legal assistants.  Education is a business.  Medicine is a business.  If I were to pick a clinician, I would probably be an RN, work a few years, then open an independent practice.  Otherwise, I'd probably be one of those bypass guys that run the bypass machine during open heart surgery.  They have a sweet job.  Or a PA.  Definitely not a doctor.

[LT_Oneal_PAC]

If they scramble, they have to pick a different residency. I know someone who wanted to do OB/GYN, and now she's in family practice. More competitive specialties don't always have scramble spots. It's not like a MD/DO can just get a little work experience and then switch specialties. Wouldn't that be wonderful. Nope - it's another 3-8 years of residency.

 

It would be like if I said to you "hey, sorry, we have no emergency medicine PA spots, but there's this one spot in northwestern Montana as a pediatric PA. Does that sound good to you?" You won't have to worry about that pesky sunlight and warm weather anymore.

 

People have sick family members, personal illness, new kids, geographical ties. It's a lot more complicated than just labeling them as terrible students.

 

Honestly, I'm not sure why anyone even goes to medical school anymore. It's like law school. All these young naive students go and end up working as legal assistants. Education is a business. Medicine is a business. If I were to pick a clinician, I would probably be an RN, work a few years, then open an independent practice. Otherwise, I'd probably be one of those bypass guys that run the bypass machine during open heart surgery. They have a sweet job. Or a PA. Problem is, you have to set out to be a PA from the start - unlike the DNP/CRNAs.

What? You have to set out to be a CRNA. You have to become and RN, manage to get into an ICU, work there for at least one year (more likely 2-3), maybe take extra chemistry and physics depending on the school you apply to, and then apply.

 

Secondly, people still have prelim and transitional years even if you don't scramble into the specialty of your choice. I know plenty who have medical and surgical prelim years and then do a categorical residency. Work with a guy on my last rotation who did a surgical prelim year and now is going into FM. He'll have to repeat a medicine intern year, so I imagine he did it because he didn't match categorical since he was a Caribbean grad. Other possibility is that he's a glutton for punishment. So there are plenty of options.

 

So what you're saying also is if it's due to illness or "I don't wanna move" they have a right to impose themselves on an entire profession. "Sorry everyone, this guy is having a tough time, so we all have to accommodate him." Like I said, I would be fine if it was a two Lane street, but it ain't.

[andersenpa]

Did you take USMLE I?  What was your three digit?  And 68% on ABFM ITE is approximately a 490.  That's approximately the 80th percentile.  Pretty darn good for someone just starting out, and worth being proud of.  Probably around 90th percentile for PGY-1?

 

COMLEX, USMLE, PANCE are all apples to oranges.  Different tests.  Personally, I think they should be opened up to other professions to take if desired the same way DOs can take the MD's USMLE.  (Though, I don't understand why MDs can't take COMLEX)  I also believe physicians should be able to take each other's board exams.  Really, it's all a big turf war, and it boils down to money.

 

Speaking of which, I remember the old MD vs DO debate.  I think it has relevance to the current issue.  

 

 

 

Back to that topic of money.  People fresh out of medical school have none of it.  Sure they could work in a clinic as you suggest, but as what?  A medical assistant or CNA?  You think a physician wants to be make $8/hour when they have over $10,000 in interest payments alone each year?  (That's not even capital)  Travel the world?  That requires money as well unless they're hitchhiking.  Doctors without borders?  Even that requires money.  Peace corps?  Two year commitment.

 

And yes, I haven't met a lot of surgeons who aren't arrogant.

 

He didn't just neglect to check boxes.  He made a decision about how much money he had available, and how many flight tickets he could purchase.  You make it all sound so easy.

 

But after all they're just doctors.  They don't need an income or decent life.  They're out there to serve.  

 

As for me, I'm just throwing out another point of view.  It's what I do.  :-)

Throwing points out there doesn't make them valid.

 

The PA profession is NOT beholden to unmatched MDs. If their financial planning didn't work out like they want then find a way to make it work. Credit cards and short term loans exist for a reason. There is no deserved sympathy because someone's residency plans didn't work out.

Maybe a PA applicant should be able to apply to med school if they didn't get into PA school? Just waive the MCAT if they didn't take it since the PA applicant neglected to take it/couldn't afford it.

 

Are you a PA? Declare yourself.

[DissentingVoice]

The PA profession is NOT beholden to unmatched MDs. If their financial planning didn't work out like they want then find a way to make it work. Credit cards and short term loans exist for a reason. There is no deserved sympathy because someone's residency plans didn't work out.

Maybe a PA applicant should be able to apply to med school if they didn't get into PA school? Just waive the MCAT if they didn't take it since the PA applicant neglected to take it/couldn't afford it.

The big question is this:  "Is a newly minted physician capable of acting as a physician extender under the supervision of a licensed physician?  If so, what license should s/he operate under."  I feel the answer to the first question may be yes.  New interns teach PA students and M3s after all (among other providers).  It has nothing to do with a PA except job competition.  As for the second question, I feel it should be a unique license as an NP is different than a PA license.  I also feel the term "physician assistant" is, at best, confusing.

 

And a PA probably can get into medical school without the MCAT the same way MD/JD/PHDs can pursue graduate degrees w/o the GRE.  PAs have already proven themselves.

[andersenpa]

The big question is this:  "Is a newly minted physician capable of acting as a physician extender under the supervision of a licensed physician?  If so, what license should s/he operate under."  I feel the answer to the first question may be yes.  New interns teach PA students and M3s after all (among other providers).  It has nothing to do with a PA except job competition.  As for the second question, I feel it should be a unique license as an NP is different than a PA license.  I also feel the term "physician assistant" is, at best, confusing.

 

And a PA probably can get into medical school without the MCAT the same way MD/JD/PHDs can pursue graduate degrees w/o the GRE.  PAs have already proven themselves.

Are you a PA

[Guest Paula]

A newly minted physician operates under a physician license. I thought once the med student has passed their 4 years of med school they can now call themselves doctor.  Do they have an MD/DO license that is provisional until residency if over?  Are newly minted physicians able to practice independently after their transitional year?  They could in the past......At least the physician I work with does.  He is a GP who finished a transitional year, said screw it, and went on to practice medicine as a GP.  This was in 1989.  

[DissentingVoice]

Are you a PA

Friends with PAs, yes.  Personally a PA, no.  You guys have a good lifestyle.  But...I really want to know what you guys have to say on this subject in particular.

 

A newly minted physician operates under a physician license. I thought once the med student has passed their 4 years of med school they can now call themselves doctor.  Do they have an MD/DO license that is provisional until residency if over?  Are newly minted physicians able to practice independently after their transitional year?  They could in the past......At least the physician I work with does.  He is a GP who finished a transitional year, said screw it, and went on to practice medicine as a GP.  This was in 1989.  

They can call themselves a doctor because they have an MD/DO.  They are not immediately licensed.  It's just like with a PA/NP/EMT/ST/PT/OT/etc.  Licensing depends on the state and can only be applied for once the prerequisites are met.  MD/DO prerequisites vary by state.  (http://www.fsmb.org/usmle_eliinitial.html for details)  Most states require 1-3 years of post medical training to obtain a full license.  Sometimes they require more for IMGs.  Once an MD/DO has a full license, s/he can technically practice any kind of medicine.  So an individual that just finished a medicine preliminary in Virginia could legally perform surgery if s/he could find a patient willing to allow it and pay for it.  (As well as an insurance company willing to pay the liability)

[lov2xlr8]

DissentingVoice, what are you!? So we can have an idea of where you're coming from.

[MedicalRN]

This is absolutely ridiculous.

 

The argument some are using is that because PA school is "modeled" after medicine, someone who completes medical school but no residency is no different from PA. That's complete BS.

 

PA school is designed to educate someone who is ready to be a provider when they graduate. The professors, the clinical instructors - they all know that there will be no residency after for the student to "sharpen" their skills. The program is DESIGNED so that the PA does NOT NEED a residency after graduation. The goal of the program is to CREATE A PROVIDER.

 

Medical schools are designed to prepare A RESIDENT. Medical schools spend more time teaching theory and "exposing" students to things, knowing that the details will be hammered out later in residency. The goal is entirely different. Medical schools ARE NOT preparing entry level providers. Medical students cannot practice medicine in this country because their program is designed to be school + residency. Cutting off half and saying "well it's still longer than a PA goes to school, so I should be allowed to function like a PA" is utterly ridiculous.

 

PA and NP schools have their own criteria, their own licensing exams, and their own safeguards in place to ensure competent providers. The programs are designed to create providers who will function in the role as they are educated - aka, an NP is educated as an NP, a PA as a PA.

 

HOW CAN YOU EDUCATION SOMEONE AS A PHYSICIAN AND THEN HAVE THEM TAKE ON THE ROLE OF A PHYSICIAN ASSISTANT!? The potential for role confusion is astronomical. They have not been trained to be "PAs without supervision" they have been trained to be physicians. Their knowledge of what to do in X situation was predicated on the fact that once they are in X situation they will be full fledged physicians who have completed residencies. It's like having someone go to school to be an RN and then giving them a job as a Radiology Tech - "well, it's still healthcare, and the program is just as long"

[DissentingVoice]

Lov, I'm a licensed physician. Though, I know many people that faced this problem.

 

MedicalRN, you do realize interns function under a special license with the supervision of a physician? They routinely make hard decisions and tell the attending 12 hours later particularly if overnight. They do this already. They also teach medical students, PAs, and RNs when they have time.

[DissentingVoice]

And interns are, after all, freshly graduated physicians. Medical students are trained for this level of autonomy in the M4 year.

[MedicalRN]

Lov, I'm a licensed physician. Though, I know many people that faced this problem.

 

MedicalRN, you do realize interns function under a special license with the supervision of a physician? They routinely make hard decisions and tell the attending 12 hours later particularly if overnight. They do this already. They also teach medical students, PAs, and RNs when they have time.

 

DissentingVoice - interns function within the confines of a residency program. These programs have strong oversight and are designed to train the new graduate as they become a full-fledged physician. There are safeguards in place, for example, NPs/PAs and RNs at night that have 20+ years experience and know to ignore certain orders from the new intern, or "suggest" an alternative course. These programs are designed with the idea that the intern is inexperienced, and precautions are taken.

 

This bill allows these physicians sans residency to go work out in rural environments with no oversight. There is no formal residency program keeping them in check. There are no safeguards. They just get to go out and work in a clinic, perhaps entirely on their own. What's worse, at least a patient know when they are getting a PA or NP by the nametag. This half educated physicians will be able to write MD after their names legally.

 

How you can think this is okay is beyond me. It looks bad for physicians as well, as patients realize even the ivory tower of medicine has cracks. The arguement that PAs and NPs are dangerous because of their lack of standardization and training loses all of its teeth when patients find out that the MD boards are allowing physicians to practice without the required training.

 

Soon the counter to "Your NP may have graduated from an online school" will be "Your MD may not have matched into residency"