NYT article on NPs - Doctoring, Without the Doctor

[Timon]

By that argument, how do you get a pass out of taking anything "integral" to medicine? Why avoid microbiology, embryology, biochemistry, and immunology other than you just don't need it at that level for PANCE?

Our program gave us the same PowerPoint and lecturers as our DO students for Micro, biochem, pathology (labeled as clinical genetics) and immunology. We didn't cover embryology however we did speak about it during some of our system specific lectures like cardiology, OB/GYN, pediatrics and etc. Also, our didactic program is 16 months.

 

From what I gathered, we cover most of the same stuff as our DO counterparts. The main difference I've noticed is they have an extra year of clinical rotations and they spent more time in anatomy with dissected vs we used prosected cadavers and we covered physiology and anatomy in about 5-10% less depth when comparing courses with a PA students who either changed to the DO program and to DO students who left and entered the PA program. (we also sat in the lectures and used the same cadavers with PT students).

[db_pavnp]

So your outright assertion is that you had an equivalent education in biochemistry, microbiology, and immunology education as med students?

 

I am just trying to understand clearly here as I am unsure how to interpret "given" powerpowers and same "lecturerS"...

[Timon]

I am saying that we covered the same human science material that the DO students covered with the exception of embryology, pathology and histology and at about 10% less depth.

[db_pavnp]

What program is this?  I'll ask directly.  I find your suggestion that you covered nearly all of step one implausible.

 

Edit:  Nevermind, I see the signature.

[EMEDPA]

I don't believe there are ANY PA programs in the country that cover ALL MS1 material to the same depth as med students. PA school has a lot of hybrid courses that cover a lot of what is covered in 3-4 med school classes, but not all. I don't know of a single pa program , for example that has a dedicated histology or embryology class for an entire semester with nothing else in that coursework. At Hahnemann we had a 2 semester sequence after A+P called "principles of medical science", which was a best of MS1 essentially. MS1 did immunology in 12 weeks. we did it in 2-3 lectures.

The real difference between PA and MD before the residency is the intensity of MS1. I would stack my clinicals against most med school ms3/ms4 years.

[Timon]

Again, these were just from conversations I've had with people who have been in both programs. They both agree DO is in more depth. As to the amount, they've said around 10%. Again, I'm just reporting hearsay conversations I've had.

[acozadd]

db_pavnp: Your question has changed, so which is it? First you claim PAs are avoiding those courses. Then when presented with facts claiming otherwise, your post is defensive stating that PAs are "claiming equivalent training." I did not make that claim.

 

I merely stated that my program did not "avoid" these courses. In fact, we had dedicated courses for each listed aside from biochemistry, which was incorporated into a pathophysiology course, along with being a required pre-req course to enter the program. I never claimed equivalent training, but I did state that we had the majority of the same lectures presented by the same lecturer as the med students. There were certain instances where they would breeze through a slide and say "don't worry about this, but it's there for completion sake." AKA here is the kreb cycle. If you were a med student, I'd make you memorize and then shortly forget every step like you already have in undergrad. However, in PA school we were tested not on specific steps, but general input-->output.

 

We did not fully cover the minutiae needed for step I.

[db_pavnp]

db_pavnp: Your question has changed, so which is it? First you claim PAs are avoiding those courses. Then when presented with facts claiming otherwise, your post is defensive stating that PAs are "claiming equivalent training." I did not make that claim.

 

First of all, let's be clear here - these aren't 'facts'.  Secondly, I think you are somewhat misinterpreting my intention.  I am not suggesting that PAs are avoiding those courses.  I am suggesting it is stupid for a PA to be subjected to them when, at the end of it, they take the PANCE and not step exams.  The issue has been confounded by the suggestion that PAs do, in fact, take those courses, which I simply don't find plausible.  Or if it is true, it is sadistic.

[acozadd]

Fact: Those courses were part of my schools curriculum. In those courses (The basic sciences), we generally had the same lectures given by the same lecturers as the med students at my school. Some were abbreviated from their original form. We did not cover all topics in the depth that they did, as mentioned above. If those aren't facts, what would you call them? I have no reason to lie about it...

 

At the end of the day it is about being a competent and well rounded provider, regardless of what is ultimately tested on the certification exam. Your point sheds light on the fact that perhaps the PANCE needs to be revamped, as opposed to schools cutting important coursework.

 

How do you find a PA taking mirco, immuno, etc. implausible? I find this whole conversation ridiculous. "We took these courses." ... "No you didn't."... ok?

[db_pavnp]

I am referring to step 1 material, of which you already said you did not fully cover.  I have no doubt you take some micro, etc.  Have you interpreted me as saying you literally do not take micro?

 

You are confounding the issue conversationally when, on one hand, you suggest you take the same lectures by the same lecturers, however also admit you don't cover all the topics, same depth, took them over the Summer, used the same pdf's but scratched out slides, and so forth.

[FfIghter23]

I am referring to step 1 material, of which you already said you did not fully cover. I have no doubt you take some micro, etc. Have you interpreted me as saying you literally do not take micro?

 

You are confounding the issue conversationally when, on one hand, you suggest you take the same lectures by the same lecturers, however also admit you don't cover all the topics, same depth, took them over the Summer, used the same pdf's but scratched out slides, and so forth.

Dude, chill with the Step 1 comparison. Of course PAs don't study for step 1 because we don't have to take it. Do PAs still need to know some pathology, histology, embryo, etc... Yes. But if we wanted to be doctors and become basic science Jedi masters we would have gone to mes school.

 

I know PAs who have PhDs in biochemistry and some with 20 year genetics backgrounds who run circles around step 1 MS2/3/4s and they don't run around talking about how much they know.

 

Medicine is about patient care and a team based approach to the care of a patient and ive honestly never seen anyone who is puffing out their chest and sputtering off medical step 1 facts.

[tunafish]

By that argument, how do you get a pass out of taking anything "integral" to medicine?  Why avoid microbiology, embryology, biochemistry, and immunology other than you just don't need it at that level for PANCE?

you need a ton of micro for PANCE and you need a ton of micro for Fam medicine. It is just some people try to memorize that crap like Chinese characters while others try to have a logical understanding to systematization of bugs and drugs.

It is also worth noting that not everyone study to pass PANCE. Test taking and being clinician are two separate tasks. You can prep to PANCE in a matter of weeks and cram in your head all the "currant jelly poop" and "rusty color sputum" buzz words. Patients do not come with multiple choice answers on the heads and usually do not present with classic triads and pentads.  I would also hate to spend 80K on tuition if their ultimate goal for me to pass PANCE. I can spend $200, buy a Qbank and beat the living hell out of it in a month. For 80K I want something more out of my education... dunno, it is very subjective of course. 

[tunafish]

 Or if it is true, it is sadistic.

I think PA school is sadistic. Its intensity is soul crushing, depressing and takes a lot out of you. You are made to survive and hope they won't kick you out for not meeting their expectation. I think if you are direct entry level student you would be so much better in medical school: it is much more balanced environment, less stressful, more time to do soul searching, try different things and see what you like. PA is like a boot camp where you take beating everyday and no one cares how you feel. In a month you understand that crying out of self pity is no fun and really no one cares if you cry at the first place. So you pull your crap together and plow through... and then you are done!

[db_pavnp]

I think PA school is sadistic.

 

This is exactly what I am getting at.  I am stealing this notion from elsewhere on the forum, but I read it astutely observed that any PA program can achieve near 100% PANCE rates by simply flunking out anyone at remote risk.  It strikes me as educationally and intellectually lazy to subject PA students to outright med school coursework, if not outright disingenuous and abusive. 

[Boatswain2PA]

I don't know what to think when PA students take the same coursework as med students.

 

Please bear with me on this, but why would you take the same anatomy class when you will never perform surgery or work as a radiologist?

 

Do you think PANCE has the expectation that you essentially get med school level anatomy?

When you are putting in chest tubes you need to know the anatomy of the neurovascular bundles, how high the diaphragm/liver/stomach/spleen can be. When intubating you need to understand how different the glottic anatomy can be between patient populations, and PAs read their own radiology images all the time. While the radiologist is "better" at looking at the images, I have the patient in front of me.

 

And yes, I think PANCE requires "med school anatomy" level knowledge.

[coloradopa]

This is exactly what I am getting at.  I am stealing this notion from elsewhere on the forum, but I read it astutely observed that any PA program can achieve near 100% PANCE rates by simply flunking out anyone at remote risk.  It strikes me as educationally and intellectually lazy to subject PA students to outright med school coursework, if not outright disingenuous and abusive. 

It also will get the program on probation. Programs are measured on their PANCE pass rates and graduation rates. If you fail out too many thats a program problem not a student problem. ARC-PA is primarily concerned with student protections and making sure programs teach to curriculum. On the other hand if you look at NP programs you can find any number that have around a 50% graduation rate. 

[acozadd]

Boatswain2pa- I completely agree with your post. In ortho, I read 100% of my own films, and 100% of films that have been previously read by a radiologist and referred to me. I've had way too many incorrect reads come my way to blindly trust a radiologist report. Was this taught in PA school? superficially, as it was to my med student counterparts. Now I look at musculoskeletal imaging daily, and I have the benefit of knowing the mechanism of injury and anticipated injury patterns. Most trauma reads by radiologists are too generic to be useful for treatment purposes regardless.

[acozadd]

db_pavnp: Subjecting PAs to med student coursework legitimizes the PA education, and taking the coursework alongside med students encourages collaboration and discussion, which is ultimately the goal in practice. By no means is it abusive. In general, the coursework (again, we took pharm, renal, pulm, etc. with the med students) was not significantly different than any other of the other coursework experienced during PA school. It probably amounted to a few additional lectures per system, spaced out over a longer duration of time. My average on those exams was probably a few points higher compared to the PA coursework exams.

[delco714]

Boatswain2pa- I completely agree with your post. In ortho, I read 100% of my own films, and 100% of films that have been previously read by a radiologist and referred to me. I've had way too many incorrect reads come my way to blindly trust a radiologist report. Was this taught in PA school? superficially, as it was to my med student counterparts. Now I look at musculoskeletal imaging daily, and I have the benefit of knowing the mechanism of injury and anticipated injury patterns. Most trauma reads by radiologists are too generic to be useful for treatment purposes regardless.

I agree with this bud. Ct scans of abd pelvis are rough. Rads miss things relevant to me all the time. I've picked up even duplicated renal systems that we're missed before. That's very much clinically relevant! No way in hell did I get anything near the experience in PA school. And the non surgeon docs in the hospital? Internal med.. Pcp? They can't read ct scans.

 

[Joelseff]

Rads love ambiguous impressions on their reports. I always look at the film to confirm. I guess they're worried about a lawsuit that would threaten the pile of dough they roll around in between patients. Lol

 

Sent from my S5 Active...Like you care...

 

 

[db_pavnp]

re: imaging

 

This is a reason to take anatomy, not a reason to take anatomy with med students.  Secondly, as mentioned, anatomy doesn't 'really' cover imaging.

 

re: probation

 

Link to rules regarding flunking out students putting programs on probation?  I bet they are VERY lenient.  I have seen this suggested as unsupported fact too many times on the forum.  I am gonna suggest it is too easy for programs to fill up on 4.0s for this rule to be effective.

 

re: pa's taking med school courses validates pa school

 

Does your intuition suggest that to you?  Because it suggests the exact opposite to me.

[acozadd]

Re: PA's taking med school validates PA school.

 

I'm not sure how you can claim otherwise, but I am willing to hear your opinion. A common knock on "midlevel" education is that it doesn't cover topics in the same "depth" and that a "midlevel" could not survive medical school courses. If you do not take courses with med students, it becomes an opinion vs. opinion debate. But if you have taken courses with med students, you can say - as a PA I took courses alongside med students at the same depth of detail and not only did I survive but my average was significantly higher than the med student average. If you can speak on a topic with first hand experience, your opinion is now backed with substance.

[primadonna22274]

re: imaging

 

This is a reason to take anatomy, not a reason to take anatomy with med students. Secondly, as mentioned, anatomy doesn't 'really' cover imaging.

 

re: probation

 

Link to rules regarding flunking out students putting programs on probation? I bet they are VERY lenient. I have seen this suggested as unsupported fact too many times on the forum. I am gonna suggest it is too easy for programs to fill up on 4.0s for this rule to be effective.

 

re: pa's taking med school courses validates pa school

 

Does your intuition suggest that to you? Because it suggests the exact opposite to me.

Actually, anatomy now DOES cover diagnostic imaging...for at least the past 5 years and maybe more. It's a logical and integrated way to teach clinical medicine and anatomy together. My med school curriculum regularly incorporated CT, MRI and plain films on anatomy exams and continued this practice into systems-based medicine. My school's anatomy department is OUTSTANDING and they work hard to make sure we learn it (and overlearn, assuming that's possible).

When I taught PA students at MCG 6 yr ago they were getting diagnostic imaging in summer anatomy and I carried that through in their formal diagnostic imaging course (which I hope they've done away with as a standalone course because it really belongs integrated throughout each system).

 

Sent from my SAMSUNG-SM-N910A using Tapatalk

 

 

[CAdamsPAC]

ARGH!!!!!!!!! I feel like this is the PA version of "Groundhog Day" .......this subject coupled with the name game seems to be core concern of those with nothing better to do. After 12 years of HCE before PA school I know I was far more prepared than the 22 year old former Candy Striper/CNA/NA with a BA in Biology and a 3.8 GPA...........I just see patients and call in  physicians as needed......I am a PA just a guy who is smart enough to know when a patient needs to see a physician.........mostly I'm called Clark but sometimes  people call me a Physician Assistant while I try to give them the care they need.