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Random thoughts:

 

Dissenting voice: can you expound on your qualifications? To throw out that you are a licensed physician leaves an awful lot of unanswered questions. D.O./M.D.? Currently practicing? Specialties? Number of years out of med school?

I am  not being accusatory, actually instead I think it is excellent to have a different viewpoint.

 

I do contest your statement of "PAs have a great lifestyle"     I work anywhere from 40 to 80 hours a week, and on call 24x7 But do get 3 to 4 weeks of vacation a year (not very good for being midcareer professional), and then scraping by at well under hundred K.  I would not even want to figure out my hourly rate. There are many physicians working a lot less, getting paid a lot more.  Generalities should be avoided

 

 

 

I strongly disagree with allowing unmatched physicians to become PAs or anything similar to this. My opposition to this would diminish significantly if the AMA, the establish medical education system, and the medical system in general acknowledgment PA school is darn hard, and does indeed prequalify us, exempt us from much of med school. There is a lot of hard sciences that would still need to learn to become a physician, but we should be able to figure out what this knowledge is, teach it in a condensed format, and allow us a bridge to becoming a physician in a very quick fashion. In reality I practice as a primary care physician, I manage all aspects of my patient's care, integrate with all local specialists, and am responsible for their health and well-being. Basically if the medical establishment wants to claim that PA education is close enough to physician education that they can utilize it as a fallback for unmatched physicians than they also have to acknowledge and give us credit for attending a fair portion of Physician training, and develop a bridge program. Part of this would entail a shorter residency as well, I do not need 3+ years of supervision to do the exact same job I currently do.

 

 

 

This topic is so challenging to address, theoretically there are many issues with it, then the business side of it with each profession trying to protect itself, combined with the political side and it is almost unsolvable. I can definitively state that PAs should be given the ability to practice unrestricted as primary care providers. Specifically I mean with collaboration to a physician, should be able to sign any and all forms required in the course of a regular day, order any required tests, write any required medicine. This means that the provision of hospice, VNA services, signing of death certificates, admitting to hospitals, all need to be able to be accomplished by PAs.

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I do contest your statement of "PAs have a great lifestyle"     I work anywhere from 40 to 80 hours a week, and on call 24x7 But do get 3 to 4 weeks of vacation a year (not very good for being midcareer professional), and then scraping by at well under hundred K.  I would not even want to figure out my hourly rate. There are many physicians working a lot less, getting paid a lot more.  Generalities should be avoided

 

 

this 4 week stretch I work 48, 60, 56, and 72 hours.....no, not a great lifestyle...

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Great lifestyle is more than hours.  You can change specialties if you find someone to take you on and train you.  You make good money - often twice as much as medical residents.  Your loans are reasonable.  You make money much quicker.  Most physicians can't even afford loan payments until they are in their 30s and currently 51% of physicians are still paying off loans in their 60s.  You could reasonably start a family in your 20s if you wanted.  The job market isn't awful. You have reasonable autonomy.

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Great lifestyle is more than hours.  You can change specialties if you find someone to take you on and train you.  You make good money - often twice as much as medical residents.  Your loans are reasonable.  You make money much quicker.  Most physicians can't even afford loan payments until they are in their 30s and currently 51% of physicians are still paying off loans in their 60s.  You could reasonably start a family in your 20s if you wanted.  The job market isn't awful. You have reasonable autonomy.

Only some of your points are valid.

 

Ease in switching specialties is one of the great myths of PA practice. As you say, finding someone willing to train you is one barrier. I know of no study/review looking at it but there is incredible inertia in practice paths, and many stay in their comfort zone. I would exclude PAs who do side/perdiem work outside their primary field.

Re salary, should someone be happy or satisified because they make more than soemone in a related but different profession? Furhtermore should they be satisified to make more than a resident who hasn't reached a comparable competency level in their field? Should they NOT make MUCH more than a resident given their productivity and contribution to collections? Sorry- comparing to resident salary is too far a leap.

I will say that my loans and many of the old/older timers here are reasonable, but just as national tuition rates have skyrocketed relative to inflation, spending ability etc, younger students are getting hit- hard. For income relative to salary I'd bet many to most PAs are in a similar boat re: covering their loans.

We do get into the income stream faster than docs, true. But the doc salaries will outpace and make up the difference later (if they are in a lucrative field and not primary care/peds/other low earners).

Starting a family depends on worklife factors like hours and salary and PAs have issues with both. I don't like anedotal experience but I see plenty of pregnant residents in my career. Fortunately employers, GME included, are making accomodations for that.

 

I'd say we have considerable to great autonomy. As we should based on our training, experience, and practice model.

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Great lifestyle is more than hours. You can change specialties if you find someone to take you on and train you. You make good money - often twice as much as medical residents. Your loans are reasonable. You make money much quicker. Most physicians can't even afford loan payments until they are in their 30s and currently 51% of physicians are still paying off loans in their 60s. You could reasonably start a family in your 20s if you wanted. The job market isn't awful. You have reasonable autonomy.

These are all things that flashy Forbes and US News "Top 20 Best Jobs Ever!" articles cite, and everyone is like "wow, being a PA is gonna be this awesome cake-walk-medicine-cash-cow"...

 

...Then I came on here and talked with/shadowed PAs in my community...and they were all like "hahahaha, NO."

 

Just a few more weeks until school starts! : )

 

 

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Guest Paula

Great lifestyle is more than hours.  You can change specialties if you find someone to take you on and train you.  You make good money - often twice as much as medical residents.  Your loans are reasonable.  You make money much quicker.  Most physicians can't even afford loan payments until they are in their 30s and currently 51% of physicians are still paying off loans in their 60s.  You could reasonably start a family in your 20s if you wanted.  The job market isn't awful. You have reasonable autonomy.

 

Sounds like you are ready to apply for PA school. We will welcome you to the club.  

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Great lifestyle is more than hours.  You can change specialties if you find someone to take you on and train you.  You make good money - often twice as much as medical residents.  Your loans are reasonable.  You make money much quicker.  Most physicians can't even afford loan payments until they are in their 30s and currently 51% of physicians are still paying off loans in their 60s.  You could reasonably start a family in your 20s if you wanted.  The job market isn't awful. You have reasonable autonomy.

 

 

and then there is the real world

 

PAs coming out with 100-200k in debt with little hope to ever repay

having to walk around and be "dependent" on a fickle SP or worse yet the rotating SP as they all seem to come an go faster then we can count

starting a family in the 20's - unsure where this thought comes from, but I would agree we sometimes can start a family a few years earlier then say a neurosurgeon, but maybe not so much over a 3 yr residency program.  New Grad IM doc's are getting 160-200k in my area - after one year of practice they are comfortable, counting backwards this means they are comfortable and settled at about 29 or 30.  PAs tend to start PA school at about 25-26, then 2.5 years and then 1-2 years of no sh## OJT that is very hard - not as hard as a residency, but still pretty draining and stressful and not conductive to family.  All for about $85k/yr at age 28-30 - not much difference there (other then about 100k in income)

 

In some ways PAs have it A LOT worse - there are many many horror stories of a doc that just hires a  new grad PA for cheap labor, doesn't train them, lets them fail.  This is what residency prevents and assures a more standardized training (to protect society).  Hence why I think there should be a one year fellowship required for PAs.

 

Loan repayment, mine will be paid off at age 55, not that great.  Between a BS,  MBA, AAS, and MS I have well over 250,000 invested in my education.  

 

Again, not being adversarial, just wanting to point out that PAs do not have it all cushy, our stress level is high, and only getting higher.  

 

I do leave we're state of change in the medical delivery system which is never been seen before. Established PAs probably can understand this.

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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.

Or....one could say about PAs:

 

"They trained under the mentality for four years that they were going to always have a doctor to call if they need.  It's not about a knowledge divide or if they can pass the USMLE/COMLEX  It's about what profession they committed to practicing in and how they trained for it.

 

Some might fallaciously suggest that these PAs could take a few courses, the USMLE, and function as a MD.  Those few courses won't erase or reprogram the intrensic mentality that they are PAs.  Hence a myriad of issues that can and will arise when they no longer work within the parameters of a PA.

 

They long and short of it, if they want to practice as MDs, they need to go through that experience and train as one."

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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.  

 

Sooo....what is wrong with changing the American medical system in two ways:  First, you only get a medical license (and call yourself Doctor) if you finish a residency, and second, provide for TWO ways to become a Physician Assistant - Go to PA school (a condensed medical school) or graduate from a US medical school??

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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.

 

Be careful generalizing "What you guys have to say on this subject" to all PAs.  There is a vocal group on this board who consistently push for equivalency between PAs and MDs.  I have yet to find a PA in person (other than meeting some folks from here at conferences) who feel that PAs = MD.

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....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"

With the explosion of new PA programs, the changing of PA student demographics (much younger, virtually no experience), and the rapid growth of PA residencies, I think PA programs are no longer focused on preparing new PAs to be PROVIDERS (ie: relatively independent) right out of school.  

 

Yes, med schools are designed to create residents.  But as has been alluded to here earlier, the first few years out of PA school is often like a residency....gradually increasing autonomy with (hopefully!) appropriate physician oversight. 

 

If PA and NP programs are so specialized that med school graduates simply cannot possibly perform as a PA or NP, then why does the inverse not apply?  Med school is clearly the more comprehensive modality, so why do some people here think that PA graduates should be able to eventually "challenge" the USMLE/COMLEX??

 

"HOW CAN YOU EDUCATION SOMEONE AS A PHYSICIAN AND THEN HAVE THEM TAKE ON THE ROLE OF A PHYSICIAN ASSISTANT!?"  Perhaps the same way you can educate someone as a physician assistant, and then have them take on the role of a physician. 

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Or....one could say about PAs:

 

"They trained under the mentality for four years that they were going to always have a doctor to call if they need. It's not about a knowledge divide or if they can pass the USMLE/COMLEX It's about what profession they committed to practicing in and how they trained for it.

 

Some might fallaciously suggest that these PAs could take a few courses, the USMLE, and function as a MD. Those few courses won't erase or reprogram the intrensic mentality that they are PAs. Hence a myriad of issues that can and will arise when they no longer work within the parameters of a PA.

 

They long and short of it, if they want to practice as MDs, they need to go through that experience and train as one."

Sure. What's your point?

 

I wasn't making a bridge argument, I was making an argument to keep unlicensed MDs from operating as PAs.

 

 

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Sure. What's your point?

 

I wasn't making a bridge argument, I was making an argument to keep unlicensed MDs from operating as PAs.

 

It is just interesting to see some people say that PAs are close enough to MDs that they should be able to challenge the USMLE/COMLEX and become MDs, while other people say that MDs are too far away from PAs that they should NOT be able to challenge the PANCE and become PAs. 

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I think it's rational self-interest to defend one's position from intrusion, while also expanding one's interests.

 

It doesn't have to be logical to the point were you acquiesce your current domain just to gain other ground.

 

As others have said, the docs will never give up an accelerated PA to MD route, it's a seemingly mute point. But consequently there is no reason to allow the reverse; which was the origin of all this rebuffing. The rest is just theoretical posturing.

 

 

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I think it's rational self-interest to defend one's position from intrusion, while also expanding one's interests.

 

It doesn't have to be logical to the point were you acquiesce your current domain just to gain other ground.

 

As others have said, the docs will never give up an accelerated PA to MD route, it's a seemingly mute point. But consequently there is no reason to allow the reverse; which was the origin of all this rebuffing. The rest is just theoretical posturing.

 

But placing one's own interest (ie: limiting the entry to our profession) may fly in the face of what is the best for our patients and our country's healthcare system.

 

"The docs" have already given us an accelerated PA to MD (rather, DO) route.  While it certainly could be "more" accelerated, equivalency shoudl require the M2 year and a residency. 

 

Furthermore, with the recent Missouri law, this is not just theoretical posturing.  I personally agree with the intent of the law (take these highly trained med school students and let them do SOMETHING to help with our provider shortage), however the devil is in the details.....

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But placing one's own interest (ie: limiting the entry to our profession) may fly in the face of what is the best for our patients and our country's healthcare system.

 

"The docs" have already given us an accelerated PA to MD (rather, DO) route. While it certainly could be "more" accelerated, equivalency shoudl require the M2 year and a residency.

 

Furthermore, with the recent Missouri law, this is not just theoretical posturing. I personally agree with the intent of the law (take these highly trained med school students and let them do SOMETHING to help with our provider shortage), however the devil is in the details.....

Jelly doughnuts and for-profit insurance companies are bad for our patients and country's healthcare system too. But there are plenty of rising PA students, and simply opening the flood gates to unlicensed MDs (ie not "limiting entry" as you suggest) is not a guaranteed argument for improvement and may in fact prove detrimental.

 

3 years is not accelerated. Some med schools are now 3 years right off the bat.

 

The Missouri law was a bad plan. A good plan would be to increase residency openings for these poor MD grads, what they trained for.

 

- Dan, PA-S Ultranationalist

 

 

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As others have said, the docs will never give up an accelerated PA to MD route, it's a seemingly mute point. But consequently there is no reason to allow the reverse; which was the origin of all this rebuffing. The rest is just theoretical posturing.

PA --> DO exists as primadonna said (and did).  I find it hard to believe that most docs would oppose this if done well.

 

Jelly doughnuts and for-profit insurance companies are bad for our patients and country's healthcare system too. But there are plenty of rising PA students, and simply opening the flood gates to unlicensed MDs (ie not "limiting entry" as you suggest) is not a guaranteed argument for improvement and may in fact prove detrimental.

 

Dan, you can't just blame everything on jelly doughnuts, and you can't use the same doughnut argument twice in one thread.  I think it's time to constructively channel your aggression:

 

James H. Morgan

President

Krispy Kreme Doughnuts, Inc.

Post Office Box 83

Winston-Salem, North Carolina 27102

Phone: 1-336-725-2981

 

As an aside, isn't Winston-Salem a type of cigarette?  Maybe we should boycott this town?

 

It is just interesting to see some people say that PAs are close enough to MDs that they should be able to challenge the USMLE/COMLEX and become MDs, while other people say that MDs are too far away from PAs that they should NOT be able to challenge the PANCE and become PAs. 

From the other side of the table, I welcome PAs and NPs taking the USMLE.  Maybe it will be a wakeup call like the DNP exam was.  On the other hand, maybe it will be a wakeup call to MDs that they need to make their education even more rigorous.  Maybe they need to cull a few more MD by raising their own standards.  Competition refines education.  (One of the reasons I hate the idea of tenure.)

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