winterallsummer Posted February 27, 2011 Share Posted February 27, 2011 Hello all, I have a question that I hope someone doesn't mind answering. How difficult is it to switch fields as a PA? For example, say you start off in internal medicine for 2 years, would it be easy to then switch to say neurosurgery? Or vice versa? Or what if you did oncology for 5 years, would it be possible to then switch to say pediatric? Thanks for any insight you all can offer. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted February 27, 2011 Moderator Share Posted February 27, 2011 switching to related specialties, not too tough. examples: em to fp or occ. med. fp to urgent care. switching to totally unrelated specialties, more challenging(but doable with a steep learning curve). examples: pediatrics to heme/onc. fp to ct surgery. I think like physicians, pa's are becoming more specialized. folks tend to stay in related fields and specialty cert exams will make this even more common. I think mandatory residencies are coming for anything but primary care within the next 20 yrs. Link to comment Share on other sites More sharing options...
physasst Posted February 27, 2011 Share Posted February 27, 2011 It's certainly not impossible, and research done last year showed that 47% of all PA's have switched specialties at least once in their career. From a workforce perspective, this is what makes the PA possibly the most valuable commodity. By that I mean, that if incentives, or centralized workforce planning mechanisms could be used, PA's could be guided towards areas of physician shortages. Neither MD/DO's or NP's have the flexibility that PA's have. Which is why so many at the federal level are interested in what mechanisms there are to move PA's into primary care..... Link to comment Share on other sites More sharing options...
winterallsummer Posted February 27, 2011 Author Share Posted February 27, 2011 Thanks. Yes I'm hoping that if anything, it gets easier to switch roles. I agree that this is one of the major strengths of a PA. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted February 27, 2011 Moderator Share Posted February 27, 2011 I'm hoping that if anything, it gets easier to switch roles.. it will almost certainly get more difficult. every yr there are new requirements for credentialing at hospitals in specialties, both in terms of scope of practice and individual procedures. 15 yrs ago I didn't have to document procedures to maintain eligibility to do them. now I have a threshold #/yr at some of my jobs for every procedure I do down to suturing, I+D's, and starting IV's. Link to comment Share on other sites More sharing options...
Moderator ventana Posted February 27, 2011 Moderator Share Posted February 27, 2011 pretty easy to do, but honestly I hope it gets a little harder..... after you are out for a while and realize you really know only a tiny bit it is pretty scary to go into a field you don't know squat about and be expected to perform.... I went from IM to Radiology to chronic pain to ER and back to IM/FP (sort of created my own residency over about 8-9 years) Oh yeah, did per diem in ortho as well...... Just make sure when you switch you jam every new factoid in your brain, and fall asleep on a book for the first few months of the new job and you will be fine..... it is amazing how much a good H+P is truly worth!! Link to comment Share on other sites More sharing options...
marilynpac Posted February 28, 2011 Share Posted February 28, 2011 It depends on the area where you're at. If you work near a teaching hospital then the docs don't mind teaching or "willing to train". If you live out in a rural area, docs don't always keep up or they keep up as little as required by law....they don't want to teach/train. Link to comment Share on other sites More sharing options...
Moderator ventana Posted February 28, 2011 Moderator Share Posted February 28, 2011 It depends on the area where you're at. If you work near a teaching hospital then the docs don't mind teaching or "willing to train". If you live out in a rural area, docs don't always keep up or they keep up as little as required by law....they don't want to teach/train. Not sure this is 100% true - I have run into a few of these docs and as long as I was the agressor and pretty much demanded they teach me - they would (can think of one or two that were just plan jerks though) many times (with some asking and persistance and explaining you are trying to learn) they will teach - if you have read a little bit about the Dx and management before asking them their thoughts.... have a good idea of what you are talking about and allow them a brief answer..... the rest is up to you Link to comment Share on other sites More sharing options...
merseur Posted March 1, 2011 Share Posted March 1, 2011 I thinks its doable. I started working in IM, then progressed to Urgent care to EM. Now I am doing CT surgery. Link to comment Share on other sites More sharing options...
Evolute Posted March 2, 2011 Share Posted March 2, 2011 I think mandatory residencies are coming for anything but primary care within the next 20 yrs. I agree, if medicine doesn’t drive this, the legal environment we live in will. Link to comment Share on other sites More sharing options...
winterallsummer Posted March 2, 2011 Author Share Posted March 2, 2011 Why do you think residencies will become a requirement? Any guesses on how long these programs will be and if they will be paid or not? Link to comment Share on other sites More sharing options...
andersenpa Posted March 3, 2011 Share Posted March 3, 2011 Why do you think residencies will become a requirement? Any guesses on how long these programs will be and if they will be paid or not? Already a push for "Certificate of Added Qualifications" (CAQ) More and more PAs going into specialties National push for "standard practices" in all aspects of medicine Credentials = approval for procedures, hospital privileges etc Probably will be like the programs now (12-18 mos, 40-60k/yr) but with more standardization with accreditation. I'm in favor of advanced formal training for specialties. It serves the PAs and practices, and thus patients. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted March 3, 2011 Moderator Share Posted March 3, 2011 already a push for "certificate of added qualifications" (caq)more and more pas going into specialties national push for "standard practices" in all aspects of medicine credentials = approval for procedures, hospital privileges etc probably will be like the programs now (12-18 mos, 40-60k/yr) but with more standardization with accreditation. I'm in favor of advanced formal training for specialties. It serves the pas and practices, and thus patients. agree with all of above. Residencies for anything except primary care will likely be the wave of the future. Link to comment Share on other sites More sharing options...
winterallsummer Posted March 3, 2011 Author Share Posted March 3, 2011 Will the addition of residencies make it easier or more difficult to switch positions as a PA, in your opinions? How practical is it for someone with a family to complete a residency? So it sounds like it will be a good thing? A big part of attraction to the PA field for me is the ability to switch specialties so I'm curious as to how this will all unravel. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted March 4, 2011 Moderator Share Posted March 4, 2011 more difficult as you will pretty much need a second residency to switch into anything except primary care. Link to comment Share on other sites More sharing options...
andersenpa Posted March 4, 2011 Share Posted March 4, 2011 We are being forced into a crossroads. Our fellow nonphysician providers, NPs have more advanced degrees and specialty designation (regardless of whether that is a good thing or not). They will be, like it or not, a yardstick against which we are measured. PAs will need some sort of credential that established a minimum skill/knowledge set. Generalist PA education is certainly not good enough in my field, CT Surgery. Clinical experience is everything. Residency training would make that easier to earn. This is more of an issue in PA fields where there is real competition from NPs. We need to look beyond remaining a jack of all trades, master of none, with all due respect to our competency based history. Link to comment Share on other sites More sharing options...
FSUnoles Posted March 4, 2011 Share Posted March 4, 2011 i agree. its only a matter of time before specialty based practice will require a residency. Since our education is based upon a medical model its only natural considering our MD counterparts require it Link to comment Share on other sites More sharing options...
winterallsummer Posted March 5, 2011 Author Share Posted March 5, 2011 Will it be practical to do a residency later in life? i.e. get out of school, go to internal medicine for 5-6 years, do a residency say for neurosurgery, do that for 10-11 years, then let's say go into psychiatry or dermatology after that? It sounds like a residency is a good thing, maybe it would make it easier in some aspect for PAs to switch? And increase competency? Is anyone looking forward to them or are you guys not? Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted March 5, 2011 Moderator Share Posted March 5, 2011 most folks will do 1 then never change specialties or if they do they will do primary care which will not require a residency. I think residency for pa's is a good thing. most folks don't switch around a lot or if they do it's to closely related fields( gi to peds gi, etc). Link to comment Share on other sites More sharing options...
winterallsummer Posted March 8, 2011 Author Share Posted March 8, 2011 Right but saying if someone DOES want to switch, is that at all pragmatic? Link to comment Share on other sites More sharing options...
Moderator ventana Posted March 8, 2011 Moderator Share Posted March 8, 2011 i think residency should be a requirement - but only 12 months for a speciality and broad requirements i.e. medicine/peds to cover all out patient medicine clinics, surgery to cover any surgical speciality, maybe ortho and psych too. Only 4 different areas and cover most areas 8 months of 'basics' then 4 months of 'electives' which would be the area you want to enter Link to comment Share on other sites More sharing options...
coloradopa Posted March 9, 2011 Share Posted March 9, 2011 most folks will do 1 then never change specialties or if they do they will do primary care which will not require a residency.I think residency for pa's is a good thing. most folks don't switch around a lot or if they do it's to closely related fields( gi to peds gi, etc). Actually in my opinion this is incorrect. If you look at the AAPA data 20% of PAs change jobs every year. Sixty percent of those stay in the same field while forty percent chose another field (by fields the AAPA defines this as Primary care, surgery and other). If you crunch the numbers that means 8% of PAs change fields every year. The biggest movement is from PC to other fields. The least movement is out of surgery. Whether 8% per year is a "large" amount is a matter of definition. But its the equivalent of all of Ortho PAs changing specialties every year. Link to comment Share on other sites More sharing options...
v_chicky Posted March 9, 2011 Share Posted March 9, 2011 interesting that primary care is somehow seen as "easy." i often ponder if ortho or the like would be easier, just have to know bones and joints. not bones, psych, GI, urology, peds, endo, derm, cardio, wound care, bs-sifting, plus the art of completing 5 tons of HMO/medicaid paperwork at the end of everyday. though i suppose one could argue that pa students get more of this "basic" info in school, while they are not exposed to much of the particulars of CTS or the like. if we are going to have to specialize... why become a pa instead of doc? Link to comment Share on other sites More sharing options...
andersenpa Posted March 9, 2011 Share Posted March 9, 2011 Actually in my opinion this is incorrect. If you look at the AAPA data 20% of PAs change jobs every year. Sixty percent of those stay in the same field while forty percent chose another field (by fields the AAPA defines this as Primary care, surgery and other). If you crunch the numbers that means 8% of PAs change fields every year. The biggest movement is from PC to other fields. The least movement is out of surgery. Whether 8% per year is a "large" amount is a matter of definition. But its the equivalent of all of Ortho PAs changing specialties every year. If most PAs are leaving PC, then most likely they will still only need to do one residency and stick with it. We can all agree that a PC residnecy is not needed since this is the basis of general PA education. Of those 40% who change specialties, if most are going PC -> surg/etc, they would do their one residency and be done with postgrad training. Link to comment Share on other sites More sharing options...
andersenpa Posted March 9, 2011 Share Posted March 9, 2011 interesting that primary care is somehow seen as "easy." i often ponder if ortho or the like would be easier, just have to know bones and joints. not bones, psych, GI, urology, peds, endo, derm, cardio, wound care, bs-sifting, plus the art of completing 5 tons of HMO/medicaid paperwork at the end of everyday. though i suppose one could argue that pa students get more of this "basic" info in school, while they are not exposed to much of the particulars of CTS or the like. if we are going to have to specialize... why become a pa instead of doc? Well we already do specialize, we just don't formalize it with postgrad. The equation is still 2+1 for PAs vs 4+ 3 (or 4 or 5.....plus fellowship) for docs. You're adding 12-18 mos extra for PA residency at about 50% the pay of an equivalent regular job. This extra requirement might weed out those PAs who are less committed to the specialty. I understand it's still a barrier but we should weighh the effect of those barriers against the drain on productivity and efficiency of practices who are trainig new grad PAs.....as well as the added reputation specialty PAs get by having a formal credential (which means a lot in this world). Link to comment Share on other sites More sharing options...
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