whoRyou Posted July 21, 2014 Share Posted July 21, 2014 Snowball fights? Skiing? Building a snowman? What's not to love? I'll take the snow over earthquakes/droughts/wildfires any day :) You must understand That the touch of your hand Makes my pulse react That it's only the thrill Of boy meeting girl Opposites attract It's physical Only logical You must try to ignore That it means more than that [Chorus:] Oh what's love got to do, got to do with it What's love but a second hand emotion What's love got to do, got to do with it Who needs a heart When a heart can be broken - Tina Turner "What's LOVE Got To Do With It" http://youtu.be/TCBttS_y7lE Link to comment Share on other sites More sharing options...
Iain1028 Posted July 21, 2014 Share Posted July 21, 2014 Do Medical school Graduates get a DEA # if they haven't finished all their board steps? Link to comment Share on other sites More sharing options...
primadonna22274 Posted July 22, 2014 Share Posted July 22, 2014 Do Medical school Graduates get a DEA # if they haven't finished all their board steps?Probably yes since all of our intern class has applied for and some have received our DEA numbers in July of PGY1. None of us have yet taken step 3 and most won't until spring. Link to comment Share on other sites More sharing options...
Gordon, PA-C Posted July 28, 2014 Share Posted July 28, 2014 It is a good question, whether they ever considered better utilizing PAs and NPs rather than creating a whole new profession. Missouri has relatively restrictive code for PAs and NPs. However, it is probably a stretch to think PAs would flock to Missouri if they could open independent practice. New Mexico has had independence for NPs for almost 15 years now and they STILL cant get anybody set up rural clinics. In fact, there was a story recently about the governor of New Mexico going to Oklahoma (which does NOT have independent practice) and begging Oklahoma NPs to come to New Mexico because there werent enough NPs interested in New Mexico. Link to comment Share on other sites More sharing options...
Kwame E Posted July 28, 2014 Share Posted July 28, 2014 Geez, why is SDN why damn negative? I stopped posting there years ago because of the negativity. One guy thinks RNs and PAs are on the same level as medical assistants. Smh. Anyways, I'd like the opinions of medical school graduates on this. When they graduated medical school did they feel they could practice medicine on a primary care level? From my understanding basic clinical skills like phlebotomy, blood pressure, etc are learned the first two years. It all boils down to if these graduates are capable of practicing primary care. I personally don't like the idea (or the name lol). Link to comment Share on other sites More sharing options...
DissentingVoice Posted July 28, 2014 Share Posted July 28, 2014 Anyways, I'd like the opinions of medical school graduates on this. When they graduated medical school did they feel they could practice medicine on a primary care level? From my understanding basic clinical skills like phlebotomy, blood pressure, etc are learned the first two years. It all boils down to if these graduates are capable of practicing primary care. I personally don't like the idea (or the name lol). I've already posted a few times. Yes, I did and would have had no problem seeing patients after graduating. I would have still wanted to have backup available though for really complex or mysterious cases. (e.g. I think a medical school graduate could do basic outpatient care under supervision) I like the generic idea. Not sure I like how it's implemented, and I definitely do not support FMGs being able to do it without at least a year or two of US based residency or schooling to ensure they are qualified. Truth be told, primary care residents don't actually get that much practice in a primary care setting. Almost all residency training is inpatient with 1 afternoon a week of outpatient thanks to CMS. Link to comment Share on other sites More sharing options...
GetMeOuttaThisMess Posted July 28, 2014 Share Posted July 28, 2014 ^^^ and spread across other specialty areas as I recall from the '80's (Surg, OB-Gyn, Peds, EM, IM). Link to comment Share on other sites More sharing options...
Gordon, PA-C Posted July 30, 2014 Share Posted July 30, 2014 Truth be told, primary care residents don't actually get that much practice in a primary care setting. Almost all residency training is inpatient with 1 afternoon a week of outpatient thanks to CMS. That is not true. There's a lot more outpatient primary care work in residency than just continuity clinic. Continuity clinic is only 1/2-1 day per week, HOWEVER all of the primary care residencies are mandated by ACGME to do multiple months of dedicated 100% outpatient clinic. FM residencies are notoriously outpatient heavy, many of them do at least 15 months of clinic. Our peds residency program does 1/2 day per week x 3 years in continuity clinic and 6 months of outpatient peds clinic spread across 3 years. The rest of it is inpatient peds wards and peds subspecialty months. The peds subspecialty months are 85% outpatient and 15% inpatient. A sample 12 month peds residency schedule at our hospital looks like this: 1. PICU 2. NICU 3. Peds clinic 4. Peds cardiology 5 Peds GI 6. Peds clinic 7 Peds wards 8. Peds nephrology 9. Peds clinic 10. Peds wards 11. Peds heme/onc 12. Peds ER So that's 3 months of peds clinic x 3 years = 9 total peds clinic months, IN ADDITION to the 1/2 day of continuity clinic they do throughout the entire 3 year residency. That's a huge amount of overkill. Primary care is so easy a caveman could do it. The NPs have already proven that -- they get ZERO residency experience and get 100% independence from day #1 after graduation from NP school in some states and despite that "poor" training there hasnt been shown to be any difference in level of care given. Going to medical school (or PA school for that matter) to do primary care is a waste of time. Link to comment Share on other sites More sharing options...
JohnnyM2 Posted July 30, 2014 Share Posted July 30, 2014 . Going to medical school (or PA school for that matter) to do primary care is a waste of time. Interesting viewpoint since so many PA schools profess to focus on primary care. It would be great if schools would offer a six month (or longer) elective extended rotation in a specialty since there are so few residencies. I believe this was suggested elsewhere on the forum. Sent from my Kindle Fire HDX using Tapatalk 2 Link to comment Share on other sites More sharing options...
JohnnyM2 Posted July 30, 2014 Share Posted July 30, 2014 Primary care is so easy a caveman could do it. The NPs have already proven that -- they get ZERO residency experience and get 100% independence from day #1 after graduation.... As a caveman myself, I resent being equated with an NP. Sent from my Kindle Fire HDX using Tapatalk 2 Link to comment Share on other sites More sharing options...
Guest Paula Posted July 31, 2014 Share Posted July 31, 2014 Sigh. Why do PAs think PC is easy? Is it easy in a large metropolitan center where there are many physicians and the PAs and NPs truly only see "easy" patients? In rural care, I do it all. I must work up the patient to the nth degree and THEN refer when necessary. Rural folks just don't have the time, money, transportation and have poor health insurance that restricts them from seeing specialists.....i.e. Medicaid restrictions and the co-pays from the ACA are a deterrent. Link to comment Share on other sites More sharing options...
primadonna22274 Posted July 31, 2014 Share Posted July 31, 2014 My standard line is that anyone who thinks primary care is easy has never done it and/or does it badly. Very badly. I'm with Paula on this. Have some respect for the breadth and depth of knowledge required to do quality PC. I very nearly talked myself out of it because it was appealing to be able to specialize in something, to be expert at something, and not to have to deal with everything. Trouble is I love primary care and I love rural medicine, and outstanding primary care docs and PAs are what we NEED. We don't need all these specialists. One hospital admission where one consultant consults another and on down the line is a recipe for disaster--bad outcomes abound--when the consultants don't talk to each other and coordinate plans. Rarely does the patient leave the hospital better, and they certainly are much poorer at the end of it (or rather, we all are). The waste is tremendous. Link to comment Share on other sites More sharing options...
blueridge Posted August 19, 2014 Share Posted August 19, 2014 Michigan (and more) to follow? See the last several paragraphs: http://www.vnews.com/home/13113659-95/column-missouris-alternative-for-primary-care Link to comment Share on other sites More sharing options...
Guest Paula Posted August 19, 2014 Share Posted August 19, 2014 I saw that about Michigan. Email went out to our lobbyist about this. Our AAPA president should be worried too. Link to comment Share on other sites More sharing options...
JohnnyM2 Posted August 19, 2014 Share Posted August 19, 2014 . The next step is allowing them to sit for the fp boards after a few years without residency That would be a real travesty. A medical Residency (which, I think, is hospital based) is supposed to ensure that residents learn important skills by getting exposed to a wide variety of patients with a wide variety of medical issues. it would be possible, in some FM environments, to spend a couple of years without the same exposure as a hospital resident. Link to comment Share on other sites More sharing options...
primadonna22274 Posted August 19, 2014 Share Posted August 19, 2014 ABFM boards are quite strict about who is eligible to sit for them. I do not ever foresee an opportunity for a non-residency trained family physician to "challenge" these boards. The list of requirements is long and arduous. Successful completion of residency from an accredited program. Passing step 3 USMLE or COMLEX. Meeting all the milestones established by ABFM/AAFP and recommendation for graduation by your residency program director. (these became much more detailed and specific just this year, yay class of 2017!!) Full unrestricted physician license. Adequate documented numbers of patient encounters for a broad range of diagnoses, in different settings, for all ages, including procedures. It's not a guarantee for anyone and some PGY3s do fail. I am confident that ABFM won't allow itself to be cheapened by permitting APs to challenge the exam. There are too many measures already in place to prevent that. I have no such guarantees about ACOFP but I'm not in an osteopathic FM program so I don't know their requirements as well. Link to comment Share on other sites More sharing options...
Guest Paula Posted August 19, 2014 Share Posted August 19, 2014 It's nice to have primadonna's perspective of the arduous nature and requirements of residency. Makes me appreciate the residency trained physicians. Helps me to understand the physician perspective. Makes me wonder about the GP tho. Link to comment Share on other sites More sharing options...
primadonna22274 Posted August 20, 2014 Share Posted August 20, 2014 Oh yeah I forgot to mention passing the ABFM exam aka the actual boards ???? Link to comment Share on other sites More sharing options...
Contrarian Posted August 21, 2014 Share Posted August 21, 2014 A resurgence of the GP/GMO...??? Link to comment Share on other sites More sharing options...
Boatswain2PA Posted August 22, 2014 Share Posted August 22, 2014 Sigh. Why do PAs think PC is easy? Is it easy in a large metropolitan center where there are many physicians and the PAs and NPs truly only see "easy" patients? In rural care, I do it all. I must work up the patient to the nth degree and THEN refer when necessary. Rural folks just don't have the time, money, transportation and have poor health insurance that restricts them from seeing specialists.....i.e. Medicaid restrictions and the co-pays from the ACA are a deterrent. I don't think it's easy. I much prefer the ED where if you are really sick I either fix your problem or stabilize you for admission/transfer, and if you are not sick (rash, sore knee, sore shoulder, back pain, coughed twice last week, etc), then I just send you back to your primary doc and hope to never see you again. Link to comment Share on other sites More sharing options...
Guest Paula Posted August 22, 2014 Share Posted August 22, 2014 I don't think it's easy. I much prefer the ED where if you are really sick I either fix your problem or stabilize you for admission/transfer, and if you are not sick (rash, sore knee, sore shoulder, back pain, coughed twice last week, etc), then I just send you back to your primary doc and hope to never see you again. Yeah, and the person that came to you for the cough is there because I didn't give em the "effn ZPack" ...or so my patient told me today after I told him he had a cold. Oh well you will see him tonight! LOL! Link to comment Share on other sites More sharing options...
Joelseff Posted August 22, 2014 Share Posted August 22, 2014 Yeah, and the person that came to you for the cough is there because I didn't give em the "effn ZPack" ...or so my patient told me today after I told him he had a cold. Oh well you will see him tonight! LOL!I think I saw the same guy today! Except he was a lady! Lol Link to comment Share on other sites More sharing options...
Boatswain2PA Posted August 22, 2014 Share Posted August 22, 2014 It's a VIIIIRRRUUUUUSSSS!!!!!!! lol No, but really....I don't mind these guys in the ED. They're not going to die anytime soon and I can pawn them back to you in about 90 seconds if I"m using T-sheets. It's a bigger problem if I'm in a place using Cerner which takes me 12 minutes to document an otitis media in an adult. Link to comment Share on other sites More sharing options...
Ryanviola Posted August 22, 2014 Share Posted August 22, 2014 It is great to know that the assistant physician law has passed. Link to comment Share on other sites More sharing options...
Ryanviola Posted August 22, 2014 Share Posted August 22, 2014 It is great to know that the assistant physician law has passed. Link to comment Share on other sites More sharing options...
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