Scribe as HCE

[EMEDPA]

I was a PC MA for 8 years after I was a corpsman. At private offices, an MA has a lot of clinical duties and functions. That is why back office MA is a good HCE source. Pharmacology, labs, who and why to refer can/will be learned as an MA.

yup, back office MAs in many setting do quite a bit. they are a different breed than front office MAs(receptionists) who I would not recommend for pa school.

[JohnnyM2]

I would look seriously at anyone with an EM residency. You will probably find a lot of senior EM PAs with my opinions. We all come from a time when real experience was required to get into PA school.( In the late 80s I was told my years as an ER tech was not sufficient background for PA school so went to medic school and worked as a medic for 5 years). Much of the hiring in EDs is done by folks like me and will for the next 20 years.

Then I will put it this way: As a Jedi Knight, you have my admiration because you have proven yourself beyond doubt, but it is important for you to recognize that the Force may be strong in others who have not followed your path. (I just love Star Wars because it contains such good examples of leadership. I have often told my children and people who work for me, " Do or do not, there is no try." That admonition, really doesn't relate directly to this post, it's just one of my favorite lines from the movie.)

[EMEDPA]

Then I will put it this way: As a Jedi Knight, you have my admiration because you have proven yourself beyond doubt, but it is important for you to recognize that the Force may be strong in others who have not followed your path. (I just love Star Wars because it contains such good examples of leadership. I have often told my children and people who work for me, " Do or do not, there is no try." That admonition, really doesn't relate directly to this post, it's just one of my favorite lines from the movie.)

Fair enough. I wish your daughter all the best in school. If she wants to do EM, electives in EM, Peds EM, trauma, ICU, and anesthesiology will help her. I would recommend a residency for anyone looking at going into EM today. I would have done one myself if one existed when I graduated. The only one out there ( LA county/USC) had their last class the year before I graduated. I already had an application in with them and when they called me (for what I hoped was scheduling an interview) I learned they had lost their funding.

[TeacherPA]

I have one very serious question about all of this. This thread in particular seems to be suggesting that PA school is not adequate preparation for being a PA... is that what you are all trying to say?

 

I suppose this must be why they are coming up with residencies, but if PA school doesn't prepare students to be PAs adequately, then shouldn't they make it longer (say by a year) so that it does? It just seems a bit unnecessary to make people who want to pursue this career go out and get these minimum wage jobs/certifications when half of them don't get the "right" kind of experience from them. I am not saying it needs to be med school (4 years plus residency), but why not make it 3 years (1 year didactic and two clinical years) since it sounds like many people who are becoming PAs are no longer the nurses, medics, RTs of the past but people pursuing their first career or who are coming from non-medical backgrounds? 

[EMEDPA]

the trend for PA schools is increasing length. This is to make up for less HCE among applicants and new requirements for research that did not exist 20 years ago. Several programs are now 3 years with 1/2 didactic and 1/2 clinical. PA school prepares you for primary care and maybe surgery. It doesn't prepare you to hit the ground running in specialties. Prior HCE does that. A new grad today is ready to be a safe beginner in most specialties. OJT used to exist at most jobs. Today jobs that are willing to train new grads are few and far between. Most places want someone ready to "move the meat" day 1.

20 years from now PA schools will likely

1. all be 3 years long

2. award a doctorate upon completion

3. require a residency of at least 1 years duration following graduation

4. require passage of a specialty specific exam (in addition to pance). based on current trends this will likely be a CAQ exam.

 

Physicians went through all these changes over the last 100 years. it used to be one could be a physician by apprenticeship ( I have a great great grandfather who did this). then going to school was required. then doing an internship. then doing post grad training. then passing a specialty exam. Lateral mobility went away for docs. It used to be that a GP could do everything. Now a GP can barely get a job(and only in a few states) with just an internship. we are following their trajectory. it is the future and it is not avoidable. credentialing organizations, the govt. and individual hospital policies are pushing this. It's like the terminator movie series. Judgement day is coming. it can't be avoided, it can only be survived. The joint commission and press-ganey are SKYNET......:)

[Joelseff]

I have one very serious question about all of this. This thread in particular seems to be suggesting that PA school is not adequate preparation for being a PA... is that what you are all trying to say?

 

I suppose this must be why they are coming up with residencies, but if PA school doesn't prepare students to be PAs adequately, then shouldn't they make it longer (say by a year) so that it does? It just seems a bit unnecessary to make people who want to pursue this career go out and get these minimum wage jobs/certifications when half of them don't get the "right" kind of experience from them. I am not saying it needs to be med school (4 years plus residency), but why not make it 3 years (1 year didactic and two clinical years) since it sounds like many people who are becoming PAs are no longer the nurses, medics, RTs of the past but people pursuing their first career or who are coming from non-medical backgrounds?

I think it's just new territory for some of the OG folks. I'm fairly new about 5 yrs out of school but went to a very old school program and HCE was not a question for any of the students that got in there. It used to be that PA was a second career in Medicine for folk who have significant HCE. It is now what LesH would call "A brave new PA world" in that our programs are accepting lower and lower HCE. I have always been an advocate for maintaining high HCE and high GPAs since the job of the PA is one not to be taken lightly by simply "checking boxes off" on the app. We should be getting the best prepared applicants for the truncated nature of PA education. Building off of HCE is how some older programs did/do it. Although I guess that is falling out of fashion and I have heard studies that stated HCE might be a hindrance...who knows?

 

To answer your question, I don't know if the schools now are inadequate to prepare PAs for PA work but I know I was ready (not saying I was independent but did not need much if any hand holding my first job out). It did require lots of self teaching after and I still read up/keep up with things that impact my practice but I was very comfortable working in Medicine and with patients because I had done it since I was 18 yrs old! I think with the new programs now a residency should be included. Even in Primary Care. I have a PA now that I have been training along with my SP for the past year. She was a new grad and had little HCE. She is pretty good. Has a good fund of knowledge but the lack of experience is evident. She, even now a year out, is gun shy about certain routine conditions/situations. To me, experience is the best teacher and should not be discounted.

[AliB]

the trend for PA schools is increasing length. This is to make up for less HCE among applicants and new requirements for research that did not exist 20 years ago. Several programs are now 3 years with 1/2 didactic and 1/2 clinical. PA school prepares you for primary care and maybe surgery. It doesn't prepare you to hit the ground running in specialties. Prior HCE does that. A new grad today is ready to be a safe beginner in most specialties. OJT used to exist at most jobs. Today jobs that are willing to train new grads are few and far between. Most places want someone ready to "move the meat" day 1.

20 years from now PA schools will likely

1. all be 3 years long

2. award a doctorate upon completion

3. require a residency of at least 1 years duration following graduation

4. require passage of a specialty specific exam (in addition to pance). based on current trends this will likely be a CAQ exam.

 

Physicians went through all these changes over the last 100 years. it used to be one could be a physician by apprenticeship ( I have a great great grandfather who did this). then going to school was required. then doing an internship. then doing post grad training. then passing a specialty exam. Lateral mobility went away for docs. It used to be that a GP could do everything. Now a GP can barely get a job(and only in a few states) with just an internship. we are following their trajectory. it is the future and it is not avoidable. credentialing organizations, the govt. and individual hospital policies are pushing this. It's like the terminator movie series. Judgement day is coming. it can't be avoided, it can only be survived. The joint commission and press-ganey are SKYNET......:)

 

I can attest to much of this.  My father was a GP, but he worked rural medicine (we lived in towns of 2-3K), usually in private practice, until very late in his career (when he was a doctor at the Quack Shack ... formally known by outsiders as the A.P.Beutel Health Center, the university's student health center).  In his busiest years he got to do it all, including open heart surgery.

 

M.D. was also the only degree he ever received ... for first few years of college he was an engineering major, best friend was pre-med, he got interested in medicine, took the pre-reqs, applied to and was admitted to medical school, but never completed any other degrees beyond high school.  

 

Can't see that happening today!  

[EMEDPA]

I think it's just new territory for some of the OG folks. I'm fairly new about 5 yrs out of school but went to a very old school program and HCE was not a question for any of the students that got in there. It used to be that PA was a second career in Medicine for folk who have significant HCE. It is now what LesH would call "A brave new PA world" in that our programs are accepting lower and lower HCE. I have always been an advocate for maintaining high HCE and high GPAs since the job of the PA is one not to be taken lightly by simply "checking boxes off" on the app. We should be getting the best prepared applicants for the truncated nature of PA education. Building off of HCE is how some older programs did/do it. Although I guess that is falling out of fashion and I have heard studies that stated HCE might be a hindrance...who knows?

 

To answer your question, I don't know if the schools now are inadequate to prepare PAs for PA work but I know I was ready (not saying I was independent but did not need much if any hand holding my first job out). It did require lots of self teaching after and I still read up/keep up with things that impact my practice but I was very comfortable working in Medicine and with patients because I had done it since I was 18 yrs old! I think with the new programs now a residency should be included. Even in Primary Care. I have a PA now that I have been training along with my SP for the past year. She was a new grad and had little HCE. She is pretty good. Has a good fund of knowledge but the lack of experience is evident. She, even now a year out, is gun shy about certain routine conditions/situations. To me, experience is the best teacher and should not be discounted.

thank you.

[Lemon Bars]

When PA programs increase to three years plus a residency, and the on the job mentoring aspect disappears, then you might as well merge PA/MD programs, I think. Already there are a few three year MD programs and some calls to get rid of some pre-requisites like the second semester of organic chemistry for medical school candidates. PA programs can only raise their requirements so high before students say, "Heck with being a PA, I'll just go to medical school!"

[Guest]

I have one very serious question about all of this. This thread in particular seems to be suggesting that PA school is not adequate preparation for being a PA... is that what you are all trying to say?

 

I suppose this must be why they are coming up with residencies, but if PA school doesn't prepare students to be PAs adequately, then shouldn't they make it longer (say by a year) so that it does? It just seems a bit unnecessary to make people who want to pursue this career go out and get these minimum wage jobs/certifications when half of them don't get the "right" kind of experience from them. I am not saying it needs to be med school (4 years plus residency), but why not make it 3 years (1 year didactic and two clinical years) since it sounds like many people who are becoming PAs are no longer the nurses, medics, RTs of the past but people pursuing their first career or who are coming from non-medical backgrounds? 

They prepare you well. For example, I am very well prepared for primary care, because that was the goal of my program. I just don't want to work in primary care. Residency is more for specialized areas like surgery, ER, etc. My program was 2.5 years and it felt like enough. Three years might be a bit too long for a PA program. Maybe if they made 6 months worth of electives... 

[EMEDPA]

When PA programs increase to three years plus a residency, and the on the job mentoring aspect disappears, then you might as well merge PA/MD programs, I think. Already there are a few three year MD programs and some calls to get rid of some pre-requisites like the second semester of organic chemistry for medical school candidates. PA programs can only raise their requirements so high before students say, "Heck with being a PA, I'll just go to medical school!"

even at 3 yrs + a required residency for a yr it would still be shorter/cheaper than a 3 yr md + 3 yr residency by 2 years. That being said, given those options I would do med school.

[TeacherPA]

Sorry, didn't mean to get everyone off track of the larger discussion here! I just got sort of interested in what the future of PA programs will be with more and more applicants coming in underprepared for clinical work... maybe programs could be a combined Bachelors/Masters or could require an associates degree and 1 year of HCE or something... otherwise I don't see why many people would choose PA over MD (if it were 3 years school plus mandatory residency v med school 4 years plus variable residency). I don't know how much you get paid during a residency as a PA or MD, but I imagine the MD residents get paid more, so financially it seems like it would make a lot more sense to be an MD at that point...

 

It is interesting to think about how to keep PA school shorter than MD without sacrificing the preparedness of the applicants... I am now very interested in doing a residency when I'm done with school, thanks for the insight everyone (EMEDPA and Joelseff, in particular)!

[EMEDPA]

pa and md residencies actually pay the same at places that have both, they count the pa resident as a pgy-1 (postgrad yr 1)

[JohnnyM2]

Another way to handle this would be to merge PA and MD into a single three year program. At the end of the program you can ask to get matched into a 3+ year MD residency or punt, take the PANCE, and become a PA, including entering a one year PA residency if desired. After practicing for some years, a PA would, again, have the option to request an MD residency match in their practice specialty. There are variations on this that could also work.