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rev ronin

Do you REALLY want to be a PA?

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Mind if I rant a wee bit here?

 

In the two years and change I've been here, I've been seeing more and more posts from new members that go something along the lines of "I want to be a PA, but how do I get HCE?" or, less commonly, "I want to be a PA, but how do I find a PA to shadow?"

 

Rather than chewing on any particular newbie, here's my generalized response:

 

1) PA is not an entry-level medical profession. It is a profession specifically crafted to take experienced providers and uplevel them. If you're not already an experienced entry-level (or higher) provider, you probably don't actually want to be a PA. You might think you want it, but how on earth can you know you want to see patients day in and day out if you've never seen a patient in your life?

 

2) HCE is not "paying your dues" or "checking a box". HCE is an integral part of the reason a pre-PA chooses to become a PA. As an EMT, I was thinking I wanted to go to Paramedic school... until I got to assist in surgery on a medical mission. If you can't point to a specific patient care experience and say "this is when I decided I wanted to practice medicine", then you probably only think you want to be a PA. If you read any of the nonsense articles that said that PA was one of the best jobs in America and that influenced your decision to seek admission to PA school, then you need to think long and hard about why you're really interested.

 

3) PA is not for the young; they belong in medical school. If you're under 25 and want to practice medicine, go to medical school. It's longer and more expensive, but it's a tried and true way for the young, malleable, and motivated to practice medicine. PA is orchestrated from the ground up to take people who have experience, adult learners, who have already demonstrated competence in limited fields to uplevel their skills and knowledge to the level needed to practice medicine, and are willing to live with de facto caps on their salary and professional respect.

 

If you do the math and the number curves, physicians more than make up for the additional cost in med school over the course of their careers, provided they start early enough. For those of you who think you can make bank right out of school AND have a comfortable, casual lifestyle you desire, you, too, don't get it.

 

4) PA is not a shortcut. Yes, the school may be shorter chronologically than med school, but that's missing out on two key things: PA school needs far more than just an undergraduate degree (see 1-3 above), and residents really do practice medicine. They do so in conditions that would draw fines if any other workers were subjected to them, for pay that is ridiculously low given their level of responsibility, but they practice medicine.

 

I love the fact that I'm in my clinical rotations now. I love the fact that at 40, there's a career option that will let me bring my existing life skills and knowledge into medicine. I make no secret of the fact that if I'd known how much more fun biological systems were than digital systems, I wouldn't have gone into IT as a first career.

 

5) If all PA programs respected points 1-4, there would be far less call for mandatory PA residencies and jobs seeking only PAs with 2+ years of experience. 2-2.5 years is not enough to take any random person off the street and shape them into a medical practitioner. If the folks selected don't have enough judgment, scientific acumen, and patient care experience to step into the role of a medical provider after the PA school length, then the selection process is wrong.

 

So by all means: those of you who have HCE, real-life experience, and the smarts to knock the science prerequisites out of the park, please come be PAs. The rest of you, who think you WANT to be PAs but are missing one or more of those three legs, don't try and shortchange the process. It should probably be harder than it is, because somehow they let me into the coolest profession on the planet.

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Well said. Unfortunately it seems like the admissions people for many programs seem to think that your views on #1 and #2 are out of date.

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I'll graduate PA school just before I turn 25... sorry to disappoint you Rev. In my future life I will go to med school to appease you-- since that is where I obviously belong.

 

Believe it or not, employers are more likely requiring 2+ years of experience in a particular field because PAs are now branching out into all specialties, though we are still trained as generalists. A 2 year training as a generalist is not enough to become proficient in any given specialty, especially when you consider the material might have only been 1-3 weeks of coursework and MAYBE 1 month of a rotation if you were lucky enough to land that rotation.

 

For anyone to think that they will be proficient in all specialties following graduation just because they worked as (fill in the blank) and are older (hence infinitely wiser apparently) is not only a stretch, but potentially dangerous to future patients.

 

I'm all for previous HCE being a requirement, but who is to say that you cannot gain this experience while in school? I had 4.5 years of experience with patients when I graduated from undergrad... it doesn't HAVE to come after school is complete. Everyone's personal and career goals will vary, who are you to decide what is right for any individual/an entire profession?

 

These boards are becoming increasingly close-minded when it comes to many things, to the point where I'm considering being done posting here. I spend more time arguing posts than learning anything at this point.

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I too will be a PA at 24. For someone who claims to defend the profession, you ignore a lot of the advantages of it. There are many reasons I chose PA over med school, and none of them had to do with my age. What about lateral mobility, for example?

 

I realize that many of you value extensive prior HCE, and you of course have good reasons for that. But regardless of your opinions, the reality is that there is a trend toward younger PAs. Advocate for a change if you wish, but next year, if you happen to work with acozadd or myself, please remember that we have worked hard and deserve respect. For my part, I will continue my dedication to the profession and earn that respect.

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You can have lateral mobility as an FP and an IM. As for the trend of younger PAs, I agree they are younger and younger PAs have virtually nothing to bring to the table other than their high gpa...which the rest of us had too. However in my class, half young, half older and "seasoned", we were constantly helping the younger less seasoned ones to keep up...they felt like they were drowning.

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Our profession perpetually seeks evolution. Better practice legislation, stronger foothold in areas with NP competition, increased access to PA care for underserved areas, etc. There is a strong history of training experienced providers, some of whom may be restricted from entry by advancing degree requirements.

 

The presence of PAs in primary vs specialty areas has reversed over the years. Gender breakdown has changed as well. Our profession evolves, from both internal and external forces.

 

And now we have programs training relatively in- or non-experienced matriculants. Do we see any decline in program graduation or PANCE success rates?

 

The question is- what does it take to train a dependent provider? What does it take to train a dependent primary care provider? Or a dependent specialty provider?

 

It seems that as PA education has established its standards to such a specific degree that we can take all comers, from the fresh undergrad to the seasoned medic, and create PAs entering a wide array of practice areas. The profession grows.

 

The fact seems to have been established that lesser or inexperienced (#1 and 2) and young (#3) PA students are becoming successful and productive PAs. To my knowledge we don't have any measures that say that they are less successful during their education or in clinical practice than experienced, older PAs.

 

Re: residencies, the amount of experience or gray hairs a PA student carries has little bearing on the need for residencies. The majority of residencies are geared towards specialties whose breadth could not be (is not) covered in generalist PA education. Each rotation touches on the veneer of a specialty. PAs expected to perform at a competent level, even those with thousands of hrs of previous HCE, need more than 6 wks of EM to start an EM job, or 6 wks or ortho, gen surg, psych, etc. The burden of training is shifted elsewhere. This makes for more structured specialty training and more productive health systems that use postgrad trained PAs.

 

We have stressed the need to not exclude certain groups from entering PA school....yet this particular group, who has shown the ability to succeed in PA school, is dismissed. Not in line with looking at each applicant fairly/equally.

 

AndersenPA

~4000 hrs pre-PA HCE

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I believe in rev's rant he meant only to address the increasingly common attitude of some, who are in search of meeting the bare minimum requirements in order to enter this profession. It is not that all us youngins :) should not be PAs, but instead gain an idea of what the profession is before deciding on the path towards it. I too cringe when I see some of the posts titled "Minimum HCE needed?" or "Is my GRE good enough?" Most of these types of posts give an image, at least to me, of someone who is looking only to get the minimum out of this descision and not to excel. I would hope you wouldnt leave acozadd as I would believe that was not the intention of rev.

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I am sure some pre/student PA's who read the initial post will take offense, but they should step back and see the logic behind it. Good grades, and a few years of volunteer/shadow/CNA work is not only underwhelming as far as really preparing you for a medical career, but it also is not truly enough for you to find out if this is something that you think you can do for the rest of your life. And it can't be called a "trend" toward younger PA's, since that sort of implies a preference of younger over older; it's just that PA programs are popping up all over the place because the field has grown exponentially and there are more younger candidates than older.

 

None of this means that a younger PA can't be good at it, but any of you younger folks have to realize there is no substitute for experience. I would almost bet that one day when you are a seasoned PA, you would have similar feelings to the OP.

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I don't believe you can justify knocking down younger PAs with "less experience." If you work in a lot of pre-pa fields such as a CNA, med tech, or lower level EMTs do you really gain that much more insight into how to practice medicine? I'm not saying they don't help but to make the argument that they are overwhelmingly helpful would be hard pressed. I would like to think everyone has to start at some point and no PA fresh out of school will be independent right away. There is a learning curve that everyone goes through and to say young PAs do not belong is borderline ignorant.

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I am sure some pre/student PA's who read the initial post will take offense, but they should step back and see the logic behind it. Good grades, and a few years of volunteer/shadow/CNA work is not only underwhelming as far as really preparing you for a medical career, but it also is not truly enough for you to find out if this is something that you think you can do for the rest of your life.

 

I can't see how you can be so sure what it takes for someone else to figure out what they want out of life.....

 

And it can't be called a "trend" toward younger PA's, since that sort of implies a preference of younger over older; it's just that PA programs are popping up all over the place because the field has grown exponentially and there are more younger candidates than older.

 

There are more young PAs with less HCE. The reasons why that is happening is irrelevant. Look at the those PAs and what they are doing in accredited PA programs, not the merits of why they are there.

 

None of this means that a younger PA can't be good at it, but any of you younger folks have to realize there is no substitute for experience. I would almost bet that one day when you are a seasoned PA, you would have similar feelings to the OP.

 

I'm seasoned at this point. And I have always said there is value in HCE. We need to look at HCE that is a positive when it is present, not a negative when it is absent.

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To those young'uns who're defending their choices now, come talk to me when you're my age. I have plenty of regrets from career choices I made when I was your age, including not going to medical school in the first place. Time will tell whether you end up with more regrets than I.

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We have stressed the need to not exclude certain groups from entering PA school....yet this particular group, who has shown the ability to succeed in PA school, is dismissed. Not in line with looking at each applicant fairly/equally.

Well said.

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I don't believe you can justify knocking down younger PAs with "less experience." If you work in a lot of pre-pa fields such as a CNA, med tech, or lower level EMTs do you really gain that much more insight into how to practice medicine? I'm not saying they don't help but to make the argument that they are overwhelmingly helpful would be hard pressed. I would like to think everyone has to start at some point and no PA fresh out of school will be independent right away. There is a learning curve that everyone goes through and to say young PAs do not belong is borderline ignorant.

Oh boy how wrong you are. Many PAs, fresh out are solo providers at their practice with their SP only available by phone...if lucky.

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I believe in rev's rant he meant only to address the increasingly common attitude of some, who are in search of meeting the bare minimum requirements in order to enter this profession. It is not that all us youngins :) should not be PAs, but instead gain an idea of what the profession is before deciding on the path towards it. I too cringe when I see some of the posts titled "Minimum HCE needed?" or "Is my GRE good enough?" Most of these types of posts give an image, at least to me, of someone who is looking only to get the minimum out of this descision and not to excel. I would hope you wouldnt leave acozadd as I would believe that was not the intention of rev.

 

I completely agree with his first few lines/points... but his supporting details go on to bash far more individuals than what his original argument set out to be. And as I eluded to in my post above, those that post here tend to be a very small homogenous group that has a very set idea as to what a PA should/shouldn't be, which is a bit frustrating when you don't fit that mold but have been very successful along every step of the path to be a PA. I realize my arguments will not change anyone's opinions and they just fall on the deaf ears of the few that post here... and these types of posts are coming on practically a daily basis at this point.

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Rev, you sound like a doc who is pissed about PAs/NPs showing up and "practicing medicine" without "going to med school" (aka paying their dues).

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To those young'uns who're defending their choices now, come talk to me when you're my age. I have plenty of regrets from career choices I made when I was your age, including not going to medical school in the first place. Time will tell whether you end up with more regrets than I.

 

I agree that we should all be drifters in life until at least our 30s... or until a stroke of genius strikes us and we are enlightened that 1 particular field is where we want to be for the rest of our lives.

 

I've known that medicine has been for me since my middle school days. I took a job in a hospital as soon as possible doing housekeeping type work as a freshman in high school and then into a patient care position my senior year, and held the same position throughout undergrad. I've been in and around medicine for nearly a decade, realize that I truly enjoy medicine and that even in the scut lower level jobs I didn't feel like I was going to work... it was fun. I have done enough shadowing of providers, and simply watching providers while at work to know that medicine is for me. I don't need to be 40 to realize this believe it or not.

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I just want to add that I am not trying to make the argument that HCE is not important, it is. With that said, our expectations of what experience is valuable and what isn't should change with the changing industry. Some may see the PA profession as exclusively a means to "upgrade" pre-existing providers, as it was in the beginning. Others may be seeing it, additionally, as a way to train and educate new providers in an efficient and cost effective manner, that still produces high quality mid-level practitioners. Are these mutually exclusive. Can there be more than one approach to the PA profession? I am thinking that there should be.

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To those young'uns who're defending their choices now, come talk to me when you're my age. I have plenty of regrets from career choices I made when I was your age, including not going to medical school in the first place. Time will tell whether you end up with more regrets than I.

 

Are you truly unaware of how many doctors have regrets about THEIR career choice?

 

Doctors who wish they had done PA school vs. PAs who wish they had done med school...that's a stat I'd love to see compared.

 

I honestly cannot see how you can reconcile these contradictions:

 

PA school is not a shortcut ----> but if you're YOUNG, do medical school instead.

Young folks just don't know what they want to do with their life ----> go to medical school instead.

 

Medical school is a long road that entails an avalanche of debt. It's not something you glibly recommend to people who, in the same breath, you say do not understand whether they really want to practice medicine.

 

I don't view PA school as some sort of "second best." In my opinion, it is a valid profession in and of itself, and it's not simply something you do because medical school was "too long." That's like saying schoolteachers are shortchanging themselves by not becoming college professors.

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Understand that I've never said that young people can't get good HCE. But even if you start too early, it's hard to get 40 years of life experience packed into 25 years. Never underestimate the value of seeing people you know and love die and/or have kids of their own. Buying a house, starting a business, having hobbies, raising kids... there are so many life stages that you simply can't have gone through by you're 20's--certainly many that are incompatible with putting together the kind of portfolio that would lead to PA school admission.

 

One of the biggest values of PAs over MDs is the value of life lived before or in addition to medicine which brings empathy and authenticity to patient interactions. MDs, like young graduate students in general, have historically been socially retarded by staying isolated in a relatively homogenous environment. One of the valuable things about PAs is that it was historically OK for them to have lived life, made mistakes, and learned things on the way. A 25 year old PA or a 30 year old MD are both equally likely to be ill-equipped to connect on a human level with the patients who need that connection the most: the poor, the illiterate, the medically uneducated who place an unreasonable amount of faith in the advice they get from medical providers.

 

You can't put life in a book, take it in a pill, or watch it on a training video. Life comes with living it, and I firmly believe that the PAs who've earned the profession its reputation as better able to connect with patients than physicians did so on the basis of their own humanity and life experiences, not because they were trained better in school to do a patient interview or because they are allotted more time on the schedule to talk to patients.

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Understand that I've never said that young people can't get good HCE. But even if you start too early, it's hard to get 40 years of life experience packed into 25 years. Never underestimate the value of seeing people you know and love die and/or have kids of their own. Buying a house, starting a business, having hobbies, raising kids... there are so many life stages that you simply can't have gone through by you're 20's--certainly many that are incompatible with putting together the kind of portfolio that would lead to PA school admission.

 

One of the biggest values of PAs over MDs is the value of life lived before or in addition to medicine which brings empathy and authenticity to patient interactions. MDs, like young graduate students in general, have historically been socially retarded by staying isolated in a relatively homogenous environment. One of the valuable things about PAs is that it was historically OK for them to have lived life, made mistakes, and learned things on the way. A 25 year old PA or a 30 year old MD are both equally likely to be ill-equipped to connect on a human level with the patients who need that connection the most: the poor, the illiterate, the medically uneducated who place an unreasonable amount of faith in the advice they get from medical providers.

 

You can't put life in a book, take it in a pill, or watch it on a training video. Life comes with living it, and I firmly believe that the PAs who've earned the profession its reputation as better able to connect with patients than physicians did so on the basis of their own humanity and life experiences, not because they were trained better in school to do a patient interview or because they are allotted more time on the schedule to talk to patients.

 

There are several blatant stereotypes to address in this post, but just a few general comments.

1) Personality and social competence can be assessed in an interview far better than by checking an age and mortgage.

2) Being able to connect with a patient will be largely based on the individual... it's not like someone hits a magic age where they suddenly can connect.

3) The PA profession should not be for the individual that made mistakes and is now looking for their calling. This isn't acceptable for other clinicians, what makes you think it is acceptable for the PA profession without even backing up the statement?

4) Your entire first paragraph is completely irrelevent to success in PA school, so why should all of that be needed for acceptance into a PA program? I can tell you that those who did not make it through my program had these things going for them...

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