Jump to content

If you haven't heard yet....

Recommended Posts

What needs to be done is to revive and fund GP internships, or just fund more residencies, not make them into PAs woth MD after their name by fiat

 

Sent from my PC36100 using Tapatalk 2

 

 

Share this post


Link to post
Share on other sites

AAPA needs to be pressured to step up to the plate and address this legislation. If they don't, then they need to just go away as they would effectively say we are irrelevant. I propose that all of us write them a letter asking them what their plan is to either thwart the legislation or to get us all promotions immediately with physician standing and licenses plus CMS recognition that we really are physicians.

Paula, I hope you meant this tongue-in-cheek. I wholeheartedly support PAs and have been one for most of my professional life--but PAs ARE NOT PHYSICIANS. There is a difference and it is a hard road to achieve physician status. I will never support PAs who think they are physicians and should be afforded the same rights and privileges without doing the time. I am all for advancing PA practice and scope with education, training and time in the profession, but I will not allow my significant investment of blood, sweat, tears, money and time to be so cheapened.
  • Upvote 6

Share this post


Link to post
Share on other sites
PA --> DO exists as primadonna said (and did). I find it hard to believe that most docs would oppose this if done well.
Yes, I'm well aware. But it is not an expedited process.

 

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. MorganPresidentKrispy Kreme Doughnuts, Inc.Post Office Box 83Winston-Salem, North Carolina 27102Phone: 1-336-725-2981
Fact: Jelly doughnuts are the root cause of 89% of all strife and conflict worldwide. I will not rest until these preserve filled pastries are stricken from the earth in the most delicious way possible.
  • Upvote 1

Share this post


Link to post
Share on other sites

What needs to be done is to revive and fund GP internships, or just fund more residencies, not make them into PAs woth MD after their name by fiat

Yes, but running a residency program actually costs money.  It used to be beneficial because the residents would do all the work and allow the attending to see many more patients at a quicker pace  They contributed significant value.  Now programs just hire PAs/NPs to do all their H&Ps, etc.  CMS has no extra money to give, and they are even threatening to withdraw GME funding.

 

It's much cheaper to hire 6 PAs/NPs to do your grunt work than 6 residents because you don't have to jump through all the ACGME hurdles, and that's the growing trend.  (ACGME requires Intern hour rules, educational sessions, program directors and other resident specific staff, paperwork, salary, conferences, audits and site visits, etc)  'Back in the day' residents used to be the only type of physician extenders.  Now, our healthcare system doesn't have much of a need for residents anymore.  I guess they'll just have to find something else to do?

Share this post


Link to post
Share on other sites

If anything cheapens MD education it is allowing someone to call themselves a doctor without doing a residency....the part of the training that really makes the huge difference. I would have less problems with this if they were required to pass the pance and not allowed to call themselves doctor or display MD.

 

Also, I am pretty sure Paula was not claiming PA/MD parity. It seems pretty obvious she was using that to make a point. I guess I should let her speak for herself on that though.

 

I bet those unmatched guys would be willing to do a year unpaid internship for their go licence....

 

Sent from my PC36100 using Tapatalk 2

 

 

Share this post


Link to post
Share on other sites

I bet those unmatched guys would be willing to do a year unpaid internship for their go licence....

 

Maybe, but I don't think they exist.

 

On another note, physicians don't have to do a full residency to get licensed. It's only one year in must states.

Share this post


Link to post
Share on other sites

I bet those unmatched guys would be willing to do a year unpaid internship for their go licence....

 

Maybe, but I don't think they exist.

 

On another note, physicians don't have to do a full residency to get licensed. It's only one year in must states.

Share this post


Link to post
Share on other sites

I know they don't exist and they can practice after 1 year. That is my point. If they want to make use of unmatched residents and give them a chance to practice then they SHOULD exist. It would be better for patients, the MDs, and the PAs.

 

Sent from my PC36100 using Tapatalk 2

 

 

Share this post


Link to post
Share on other sites
Guest Paula

Yes, tongue in cheek.  I am not equivalent to a physician.  PA/NP/DNP not equivalent.  I respect primadonna's blood sweat and tears and support the PA-DO bridge.  I would like to see the RESTRICTIONS to practice lifted for PAs.  Like signing my own orders for home health, PT,DME,  get HITECH funds, have insurance companies recognize us for billing, and have physician's send us back the notes from their consults....not to the SP without any acknowledgement that it is the PA who is the PCP. 

Share this post


Link to post
Share on other sites
Guest Paula

So PAs could go to Year 1 medschool, see if they can test out of YR 2/3 etc. and do a one year internship? Then get MD license? 

Share this post


Link to post
Share on other sites

Thank you Paula. I agree with you that arbitrary restrictions to practice must be lifted to allow the PA to practice to the full extent of his or her license. I was so frustrated with these limitations that I went back to school (yes I understand most folks cannot do this, and I have made significant personal sacrifices to do it myself). One of my goals is to be influential on the physician side to address and correct these limitations.

But no...M1 alone won't suffice lol. I did learn a whole lot more than that ????

Having said that, I haven't learned much in the past 6 mos until beginning residency. Still in orientation this past 2 wk and my brain is already being challenged! It's not even July yet and I am already tired. ????

  • Upvote 3

Share this post


Link to post
Share on other sites

So PAs could go to Year 1 medschool, see if they can test out of YR 2/3 etc. and do a one year internship? Then get MD license?

 

Nah, I think is too short. I wouldn't strenuously object to doing both years 1 and two, with 3rd year optional if you can pass all 3 steps of the nmle... I think this would shore up academic short fallings and the holes in the PA education ( both in class and in practical experience) which make in separation between medical students and PAs.

 

I wonder if, not having at least ms3 would negatively affect your ability to match. I do not see ms2 as a lot of free time to explore residencies..or to interview for them...

  • Upvote 1

Share this post


Link to post
Share on other sites

Agree with Boatswain except it's M1 that PAs don't get and need in a bridge program. M2 and PA1 are quite similar but M2 is in more depth and prepares for USMLE 1/COMLEX 1.

Honestly 3 yr flew by. It's nothing.

Indeed.  Time goes fast.  It is more the $$$$.  The program you did is not cheap, and I am sure you and your family made tremendous sacrifices.

Share this post


Link to post
Share on other sites

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.

 

I have been on this Board for many years, I have never seen someone claim that PA equals M.D. In every sense, I have heard that we are capable of performing the role of primary care provider, without being handcuffed to a single physician.  I have numerous times read and strongly agree that physician education is at a higher level than PA education. They are exposed to more, and know more, But this does not mean that we should be dependent on them. I would be very careful about stating what You think other people are saying.  

 

Does anybody on this board really think that PA equals M.D. in every sense of the word?

 

 

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.....

 

The docs have not given us an accelerated PA-->DO program. LECOM did this on its own. As well if you look you will realize that a three-year medical school is likely going to become the norm for primary care providers.  I truly don't believe that the AMA or organized medicine is going to do anything to help elevate the position of PAs. And in fact likely uses this competition, and does not want to see us advance.

Goes back to the simple business equation, limited supply allows you to charge more for your product.  Limiting the number of physicians and healthcare providers, preserves high income.

 

 

to the person working 80 hours a week at "well under 100k"  do yourself a favor and quit.

 

Hey, that's me!  Issue is I own my own practice, control my own destiny, do not have to put up with nonsense of an office or other bureaucratic issues. I get to practice medicine the way I believe, my appointments are 30 to 60 min. I see geriatric homebound patients.

There is more important things to life than money. My bills get paid, I am happy, my patients are happy, I'm providing an invaluable service to the community.

 Housecall medicine is probably the lowest paid specialty out there.   I was most miserable personally when I was making the most is a PA in emergency medicine.  

 

 

 

 

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

 

 

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.)

 

I truly believe this is the answer to a lot of questions, unfortunately it truly does not increase the number of primary care providers as you are taking a provider out of the PA pile, and putting them in the M.D./DO.  If they could come out with a reasonable time and expense bridge program I honestly would very likely accomplish it.  I do not see three years in residence education, followed by a full three-year residency, totaling six years, at an expensive $300,000-$500,000 as a reasonable bridge program.  (Three years loss of income, three years loss of retirement savings, three years at reduced income, 80+ hours a week.)

 

 

I would propose somewhere around 1.5 years academic, with 1.5 to 2 years residency.  Three to 3 1/2 years is reasonable. Much beyond this is too expensive in time and effort and expense as well as likely redundant to exactly what I accomplish right now.

 

 

Many people do advocate for allowing PAs to function as full-fledged primary care providers, not that we are equal to physicians instead we possess the qualifications to accomplish the job. I really like the nursing proposals of collaborative agreements, loosely so, i.e. admitting privileges at a hospital or agreements with local physicians. This eliminates the possibility of practicing is an island, which honestly I have only seen two providers do, one was a new NP and the other old doc.  I don't believe anyone should be practicing as an island in today's medical environment.

Share this post


Link to post
Share on other sites

Paula, I hope you meant this tongue-in-cheek. I wholeheartedly support PAs and have been one for most of my professional life--but PAs ARE NOT PHYSICIANS. There is a difference and it is a hard road to achieve physician status. I will never support PAs who think they are physicians and should be afforded the same rights and privileges without doing the time. I am all for advancing PA practice and scope with education, training and time in the profession, but I will not allow my significant investment of blood, sweat, tears, money and time to be so cheapened.

 

We need to discriminate between PAs who "think they are physicians" (a phrase that has many meaning depending on the PA) and PAs who are functioning as PCPs.

The level of autonomy for these PAs in states with the more progressive supervision rules (I live in one, WA) has the PAs functioning, for all intents and purposes, as an independent PCP.

 

"Physician status" is a good term because it's so nebulous. When it comes to actual clinical practice docs and PAs are doing the same work. In some cases it's 80-90% similar and in some it's 100%.

 

Rather than looking at medical practice as a pyramid with the physician on top, it is a center with different providers arriving at it from a perimeter.

 

We could easily say that we shouldn't support a physician who thinks they are a PA. Which is true. But the pyramid mindset somehow makes that "OK".

 

Once we start using the right model then these equivalency arguments become alot easier to handle.

 

This discussion really only applies to the primary care fields.

Share this post


Link to post
Share on other sites

 

Does anybody on this board really think that PA equals M.D. in every sense of the word?

I don't because apple doesn't equal orange in every sense of the word, but they're both fruit (insert joke here!)

 

I'd say- acknowledge the differences in training, but realize what's going on out there in real primary care practice. You of all people can attest to this.

 

I'd bet that the most ardent PCP PA isn't waving the flag that "I'm equal to a physician!"....they are saying "I'm an experienced PCP PA and that qualifies me to be free of these arbitrary restrictions"...supervision, cosignature, limited scope for basic primary care services, etc. Again, I'm preaching to your choir.

Share this post


Link to post
Share on other sites

I truly believe this is the answer to a lot of questions, unfortunately it truly does not increase the number of primary care providers as you are taking a provider out of the PA pile, and putting them in the M.D./DO.  If they could come out with a reasonable time and expense bridge program I honestly would very likely accomplish it.  I do not see three years in residence education, followed by a full three-year residency, totaling six years, at an expensive $300,000-$500,000 as a reasonable bridge program.  (Three years loss of income, three years loss of retirement savings, three years at reduced income, 80+ hours a week.)

 

I would propose somewhere around 1.5 years academic, with 1.5 to 2 years residency.  Three to 3 1/2 years is reasonable. Much beyond this is too expensive in time and effort and expense as well as likely redundant to exactly what I accomplish right now.

 

I don't believe anyone should be practicing as an island in today's medical environment.

 

PCP - 4 years undergrad, 4 years medical school, 3 years residency = 11 years

Your 'accelerated pathway' - 4 years undergrad, 2 years PA, 3.5 years med school/residency = 9.5 years

 

What exactly makes the PA education system so superior that you can do the same thing in 1.5 years less?  If your accelerated pathway existed, EVERYONE would be a PA.  Doctors are reasonably smart and every single one would then do PA school instead of med school to save money and time.  We're probably competitive enough to get in

 

You complain the 3 year program is too expensive?  Welcome to the world of a physician.  I know plenty of people that have to pay back $600,000 in loans.  ($300k initial loans will have to pay back over $600k due to interest compounding).  Try going through all this.  You'll probably feel insulted as well when someone tells you your education isn't even good enough to let you work under the supervision of another physician.

 

 

Rather than looking at medical practice as a pyramid with the physician on top, it is a center with different providers arriving at it from a perimeter.

 

We could easily say that we shouldn't support a physician who thinks they are a PA. Which is true. But the pyramid mindset somehow makes that "OK".

Um...the question is not are MDs equivalent to PAs.  The question is can an unlicensed MD/DO practice under the supervision of another MD/DO who is licensed.  THAT is the question.  (I'm not trying to equate MDs to PAs.)

Share this post


Link to post
Share on other sites

PCP - 4 years undergrad, 4 years medical school, 3 years residency = 11 years

Your 'accelerated pathway' - 4 years undergrad, 2 years PA, 3.5 years med school/residency = 9.5 years

 

What exactly makes the PA education system so superior that you can do the same thing in 1.5 years less?  If your accelerated pathway existed, EVERYONE would be a PA.  Doctors are reasonably smart and every single one would then do PA school instead of med school to save money and time.  We're probably competitive enough to get in

 You complain the 3 year program is too expensive?  Welcome to the world of a physician.  I know plenty of people that have to pay back $600,000 in loans.  ($300k initial loans will have to pay back over $600k due to interest compounding).  Try going through all this.  You'll probably feel insulted as well when someone tells you your education isn't even good enough to let you work under the supervision of another physician.

 

Um...the question is not are MDs equivalent to PAs.  The question is can an unlicensed MD/DO practice under the supervision of another MD/DO who is licensed.  THAT is the question.  (I'm not trying to equate MDs to PAs.)

If someone can elaborate on this, I have heard that medical school is about 144 weeks and PA school is about 100 weeks. So, stating 2 years vs 4 years in my eyes doesn't seem correct and doesn't include breaks/time off within the curriculum. 

Share this post


Link to post
Share on other sites

This is an interesting (and concerning) bit of reading:

 

http://doctorsreadytoheal.com

 

- an excerpt, from the first post at the top of the page discussing an innovative pilot program for residencies that is endorsed by the AMA:

 

"….Many PGY-1 applicants have successfully completed Step 3 in addition to qualifying for licensure granted PGY-1 residents, and rising PGY-2s and PGY-3s with prior training could carry further responsibilities and help oversee PGY-1s, with these positions potentially funded by budget-neutral resources allocated for mid-level providers…"

Share this post


Link to post
Share on other sites

If someone can elaborate on this, I have heard that medical school is about 144 weeks and PA school is about 100 weeks. So, stating 2 years vs 4 years in my eyes doesn't seem correct and doesn't include breaks/time off within the curriculum. 

 

Here is something that boggles my mind:

My first phase of PA school is 16 months of didactic (16 months straight - part of a 28 month long program.)

The first two years of my friend's medical school  is 18 months of didactic learning (2 9-month years with the summer off.)

Share this post


Link to post
Share on other sites

Here is something that boggles my mind:

My first phase of PA school is 16 months of didactic (16 months straight - part of a 28 month long program.)

The first two years of my friend's medical school is 18 months of didactic learning (2 9-month years with the summer off.)

They aren't in classes over those summers, but are usually studying a lot for USMLE Step 1.

 

 

Sent from the Satellite of Love using Tapatalk

 

 

Share this post


Link to post
Share on other sites
PCP - 4 years undergrad, 4 years medical school, 3 years residency = 11 years Your 'accelerated pathway' - 4 years undergrad, 2 years PA, 3.5 years med school/residency = 9.5 years What exactly makes the PA education system so superior that you can do the same thing in 1.5 years less? If your accelerated pathway existed, EVERYONE would be a PA.

 

You're missing his point, this would be for PRIMARY CARE ONLY. Not everyone would be a PA, because participants would be limited to primary/family practice.

 

This would increase the PC Provider numbers, but all the other specialties are not accessible from this route, so many would stay on other tracks. Also, 4 years undergrad, 2.5 for PA (the norm now) and 3.5 med school/residency would be completely fine for a PA to bridge to a primary care physician. That's 10 years of education for a PA-C that goes back to school to get an MD compared with the 10 years that a kid from undergrad takes to complete residency in new MD curriculum. 10 = 10, hmm...

 

TL;DR summary: Ventana's plan is actually 10 years (4 UG + 2.5 PA + 3.5 MED/RES) leading to a primary care MD. But there will probably we a gap in there where the PA practices medicine for X years before the 3.5 med/res schooling. New primary care programs for MDs make higher education total 10 years (4 UG + 3 MED + 3 RES). So it's actually the same amount of training, just broken up differently. You should have no issue with it.

Share this post


Link to post
Share on other sites

I have been on this Board for many years, I have never seen someone claim that PA equals M.D. In every sense, I have heard that we are capable of performing the role of primary care provider, without being handcuffed to a single physician.  I have numerous times read and strongly agree that physician education is at a higher level than PA education. They are exposed to more, and know more, But this does not mean that we should be dependent on them. I would be very careful about stating what You think other people are saying.  

 

Does anybody on this board really think that PA equals M.D. in every sense of the word?

 

The docs have not given us an accelerated PA-->DO program. LECOM did this on its own. As well if you look you will realize that a three-year medical school is likely going to become the norm for primary care providers.  I truly don't believe that the AMA or organized medicine is going to do anything to help elevate the position of PAs. And in fact likely uses this competition, and does not want to see us advance.

Goes back to the simple business equation, limited supply allows you to charge more for your product.  Limiting the number of physicians and healthcare providers, preserves high income.

Perhaps suggesting some think PA = MD was the wrong word, but there are several people who post that they do THE SAME THING as MD, and infer that they need no level of mandated supervision. Some have even suggested we should get paid the exact same since they do the exact same job. To me that is part of the natural human ego to think of one as equal to another.

 

I agree there are groups of physicians who do not want us to grow, likely because they feel we are a threat.  Conversely there certainly were physicians involved with the stand-up, and acceptance, of the LECOM program. 

Share this post


Link to post
Share on other sites

Perhaps suggesting some think PA = MD was the wrong word, but there are several people who post that they do THE SAME THING as MD, and infer that they need no level of mandated supervision. Some have even suggested we should get paid the exact same since they do the exact same job. To me that is part of the natural human ego to think of one as equal to another.

 

I agree there are groups of physicians who do not want us to grow, likely because they feel we are a threat.  Conversely there certainly were physicians involved with the stand-up, and acceptance, of the LECOM program. 

I wouldn't say "PA=MD" but there are PAs (experienced) who are just as qualified and competent as physicians.

I don't believe that's an arguable point. Again, this only applies to primary care.

 

Give a primary care PGY1 3 years to train

Give a PA more than double that- 8 years, to be sure- and see what the final products are.

  • Upvote 1

Share this post


Link to post
Share on other sites

Here is something that boggles my mind:

My first phase of PA school is 16 months of didactic (16 months straight - part of a 28 month long program.)

The first two years of my friend's medical school  is 18 months of didactic learning (2 9-month years with the summer off.)

Mine was:

M1:  9 months

M2:  9 months 

USMLE I - 1 month (We literally study full time for one month for this test)

M3:  12 months (minus 2 weeks vacation)

USMLE II - 2 weeks

M4:  9 months

Total:  40 months = 3 1/3 years

 

That's still 43% more time training than your program.

Some PA schools are shorter than yours as well.  (Some are longer; I respect that)

 

TL;DR summary: Ventana's plan is actually 10 years (4 UG + 2.5 PA + 3.5 MED/RES) leading to a primary care MD. But there will probably we a gap in there where the PA practices medicine for X years before the 3.5 med/res schooling. New primary care programs for MDs make higher education total 10 years (4 UG + 3 MED + 3 RES). So it's actually the same amount of training, just broken up differently. You should have no issue with it.

 

I'm not a fan of the 3 year MD programs.  They're new.  I don't think anyone has even graduated from one yet.  You're comparing a longer PA program to the absolute shortest (and untested) MD program.  Yes, I have a problem with it the same way I frown on the 3 year MD programs.

 

I wouldn't say "PA=MD" but there are PAs (experienced) who are just as qualified and competent as physicians.

I don't believe that's an arguable point. Again, this only applies to primary care.

 

 

Everyone keeps saying xyz can handle primary care (implying that it's simple).  Here's the thing about primary care - it encompasses every area of medicine.  Sure, anyone can look on uptodate and figure out how to treat a cough.  It's rarely the obvious that's missed.  Will you find SLE, Marfans, etc?  If not, your patient will suffer.  Will you misdiagnose hemochromatosis as diabetes and not realize it until cirrhosis develops?  The importance of a strong, general education in primary care seems to be fading as PCPs are being pushed into the role of a referral robot.

Share this post


Link to post
Share on other sites

Join the conversation

You can post now and register later. If you have an account, sign in now to post with your account.

Guest
Reply to this topic...

×   Pasted as rich text.   Paste as plain text instead

  Only 75 emoji are allowed.

×   Your link has been automatically embedded.   Display as a link instead

×   Your previous content has been restored.   Clear editor

×   You cannot paste images directly. Upload or insert images from URL.


×
×
  • Create New...

Important Information

Welcome to the Physician Assistant Forum! This website uses cookies to ensure you get the best experience on our website. Learn More