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rev ronin

Do you REALLY want to be a PA?

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True, I think my HCE will be very helpful. But I still have 99% of medicine to learn.

 

The question is: in what way will it be helpful?

 

People say HCE is "helpful", but it's not really clear how.......

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No, you missed the point. My original statement said they bring nothing to the table as far as the didactic year...and yes they did have it more difficult during clinicals than someone who had hce as an RN. We were constantly helping them in study groups during the study year, it didn't bother us...but it was noticable, their lack of medical knowledge. We didn't blame them, but questioned the school about the choice. Figured there was someone on the app that stood out...maybe a mission trip. You didn't answer the question...when have you worked in a very rural setting??? Also when did I NOT acknowledge that there's not substitute for experience as a PA-C??? Ball is your court my friend...

 

Your impressions of how much you helped your PAS colleagues aside, the issue the OP raised is the merit of HCE and age/life experience in general in PA school acceptance and performance. There is nothing currently to suggest that low HCE correlates with poor PA school performance, PANCE rates etc.

 

 

My rural experience was in North Florida, prior to PA school. No running water and dirt poor.

 

 

It was noble of you to question your PA program on the merits of certain students being accepted. I'm sure those students appreciated your support.

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it's not "youth" that is the problem but inexperience.

23 yrs old with 5 yrs hce , a bs, community service, good gpa/gre. no problem.

23 yr old 4.0 gpa, perfect gre, no hce or relevant experience outside of school. don't pass go. don't collect 200 dollars.

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it's not "youth" that is the problem but inexperience.

23 yrs old with 5 yrs hce , a bs, community service, good gpa/gre. no problem.

23 yr old 4.0 gpa, perfect gre, no hce or relevant experience outside of school. don't pass go. don't collect 200 dollars.

 

Exactly...

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something else to confuse the issue even more....many of the "old timers" here(myself, davis, contrarian, marilyn, etc) took pance prior to 1997.

the old version of the test was MUCH harder than what folks do today. it was a week long with 3 written components and 3 practicals vs today's 3 hrs on a computer and done.

my hypothesis(which I can't prove) is that many folks who pass today's pance would fail the old version.

basically they had to dumb down the test so folks without prior hce could pass it(flame suit on).

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it's not "youth" that is the problem but inexperience.

23 yrs old with 5 yrs hce , a bs, community service, good gpa/gre. no problem.

23 yr old 4.0 gpa, perfect gre, no hce or relevant experience outside of school. don't pass go. don't collect 200 dollars.

 

This seems like a point that most can agree with, I'm sure. Perhaps it is what rev meant? Surely he wasn't intending to come across as ageist. :)

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something else to confuse the issue even more....many of the "old timers" here(myself, davis, contrarian, marilyn, etc) took pance prior to 1997.

the old version of the test was MUCH harder than what folks do today. it was a week long with 3 written components and 3 practicals vs today's 3 hrs on a computer and done.

my hypothesis(which I can't prove) is that many folks who pass today's pance would fail the old version.

basically they had to dumb down the test so folks without prior hce could pass it(flame suit on).

 

E, the issue seems to be that this proposed philosophy is exclusionary without strong basis.

I have been an advocate of HCE, but for different reasons. It makes the pre-PA aware of the medical system and how PAs function in it. Not under any idea that the experienced pre-PA is easier to train in their program. My reference is my own PA class, which had experienced students who did poorly and inexperienced students who excelled....and everything in between.

 

We have one group telling another "you're not experienced enough, you are more difficult to train, you will not be ready from day one"....sound familiar? Sounds like physician's criticisms of PAs.

 

PA education and the expected role of the PA in the workforce seems to have risen up to meet the current PA product- one that is well educated and ready to serve in the dependent role they are designed for. Clinically akin to a physician before residency.

 

I know it is not YOUR statement on this thread but to say that young or inexperienced individuals belong in med school instead of PA school seems to miss out on the way PAs are trained and used in the modern age.

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it's not "youth" that is the problem but inexperience.

23 yrs old with 5 yrs hce , a bs, community service, good gpa/gre. no problem.

23 yr old 4.0 gpa, perfect gre, no hce or relevant experience outside of school. don't pass go. don't collect 200 dollars.

 

Well said emed...well said!

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I think anyone with experience can do well in pa school regardless of age and anyone without experience, regardless of age, will have a harder time of it than if they had said experience. I think an 18 yr old starting the process should SERIOUSLY consider a career as an md/do and not shoot for pa unless they take a long view approach and say " I want to be a pa but I realize I will need to go to college for a few yrs, most likely get a bs degree, and pick up a few years of experience along the way".

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I think anyone with experience can do well in pa school regardless of age and anyone without experience, regardless of age, will have a harder time of it than if they had said experience. I think an 18 yr old starting the process should SERIOUSLY consider a career as an md/do and not shoot for pa unless they take a long view approach and say " I want to be a pa but I realize I will need to go to college for a few yrs, most likely get a bs degree, and pick up a few years of experience along the way".

 

I have to agree...and andersen, I still think about some that were in my class, wondering how they are doing as a PA b/c as a student they embarrassed many of us...nothing noble about it, but I'm sure that was your sarcasm speaking vs your head.

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The thing to keep in mind is the older you get, and the longer you practice, the less experienced everyone else seems to become. The 35 year old probably sees the 28 year old as a PA newbie with little to contribute, whereas the 55 year old looks at both of them as mere children in the grand scheme of things. There has to be a point in your life where you realize "I'm not getting any younger, but the graduating class will always be the same age" and learn to accept that new blood will not be the fall of the profession. And most of all, don't ever forget whatever roots you started from, maintaining a facade of friendliness if you must when dealing with the inexperienced. We all began by crawling.

 

I can fully appreciate where PAs came from and why they were first "created," but the fact of the matter is that the stereotypical PA student is now a 20-something with only a few years of basic experience (hello, self). Is this a fault of the student for daring to apply to school? Is it a fault of more and more programs "catering" to that crowd? Neither, it's simply something that is and if anything, it should be celebrated that young people are excited and willing to get knees deep in a fast-paced, intense medical program. Thank goodness we live in a time when there is anyone passionate about medicine, PA, MD, or otherwise, because the number of providers isn't going to improve any time soon.

 

If you're wanting the older crowd to return, to grow as a fraction of the applicant pool, then you need to advocate for their attention and knowledge aggressively. Students see PA career brochures in their college and high school programs; when was the last time any of us saw a single commercial discussing the career for the public at large? Now when did you last view one of those Johnson and Johnson nursing commercials? What media of any kind targets the 35 year old RN/EMT/engineer and says "hey, come be a PA, we need your life experience!" Unless you're already aware of the profession through previous work or taking the time to realize that person in the white coat talking to you is a PA and not MD, you're not likely to have that lightbulb moment and begin applying to school.

 

The point is, it's useless to complain about the young guns who come on here asking asinine questions that Google could have answered for them. Most who are that woefully unprepared won't follow through with the application and won't make it to the interview stage. Let the adcoms worry about weeding them out if they detect too much immaturity, and let's skip ahead to the young graduates who actually make it to the practicing stage.

 

Now if you honestly think that the young, inexperienced PAs are an immediate threat, you can do several things that will yield far more tangible results than ranting online:

- Offer to be a teacher, either unofficially in the workplace to new hires, or as a preceptor.

- See if you can be an active participant in the hiring phase so that you are one of the first judges when they enter the building. Advocate for minimum levels of experience if you feel that your unit/clinic/practice doesn't have the resources or ability to take on a fresh-off-the-press graduate.

- Try to get involved in the curriculum of nearby PA programs. What sorts of hands-on experiences could they possibly utilize that would teach better than a book? As a working PA, what things have you learned in the real world that the classroom never touched on (but is capable of doing so)?

- Simply refuse to ever be treated by one by asking how long they've practiced. (I don't actually advocate this, but for someone's sanity and feeling of security it could be necessary)

 

And to the other young students reading this thread, don't feel as though Rev Ronin, EMED, Marilyn or any of the prominent posters are personally attacking you. They aren't. I don't feel attacked. Would any of them have chosen me as a candidate for their alma mater (or current program, as some are on adcoms)? Maybe, maybe not. But I was chosen either way, and rather than sit here shouting "no fair" and defending myself like an upset child, I'm better off working toward my degree. What truly matters is that we learn as much as we possibly can and be the best damn young PAs we can possibly be, not to prove them wrong, but to keep our patients safe.

 

I'm confident enough in myself that I know if I ever cross paths with any of them in the distant future (and the PA world is small enough that it could happen), that I will be able to prove that I earned my spot and I can be a respected colleague, while still acknowledging and respecting their far greater experience. Because let's face it, all of these posters will always be older than me and will have had ample opportunity to experience more simply by virtue of time.

 

As for the anonymous poster that comes online and asks for the cheapest, quickest online chemistry course (key point: the people Rev is complaining about)? Somehow I doubt they will be able to say the same thing.

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PA education and the expected role of the PA in the workforce seems to have risen up to meet the current PA product- one that is well educated and ready to serve in the dependent role they are designed for. Clinically akin to a physician before residency.

 

.

 

maybe this is why fewer pa's are going into practices that they were intended to gravitate to originally; primary care, underserved, etc where the pa grad needs to be fairly functional from day 1 with some oversight but not presenting every case. practices like those caldje, the cableguy, and kargiver went to as new grads(rural fp and rural er).

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Now if you honestly think that the young, inexperienced PAs are an immediate threat, you can do several things that will yield far more tangible results than ranting online:

- Offer to be a teacher, either unofficially in the workplace to new hires, or as a preceptor.

- See if you can be an active participant in the hiring phase so that you are one of the first judges when they enter the building. Advocate for minimum levels of experience if you feel that your unit/clinic/practice doesn't have the resources or ability to take on a fresh-off-the-press graduate.

- Try to get involved in the curriculum of nearby PA programs. What sorts of hands-on experiences could they possibly utilize that would teach better than a book? As a working PA, what things have you learned in the real world that the classroom never touched on (but is capable of doing so)?

- Simply refuse to ever be treated by one by asking how long they've practiced. (I don't actually advocate this, but for someone's sanity and feeling of security it could be necessary)

 

.

 

I'm currently doing all of these except the last one....

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something else to confuse the issue even more....many of the "old timers" here(myself, davis, contrarian, marilyn, etc) took pance prior to 1997.

the old version of the test was MUCH harder than what folks do today. it was a week long with 3 written components and 3 practicals vs today's 3 hrs on a computer and done.

my hypothesis(which I can't prove) is that many folks who pass today's pance would fail the old version.

basically they had to dumb down the test so folks without prior hce could pass it(flame suit on).

 

Certainly nobody could possibly learn the practical skill portion during their time in PA school and on clinicals... people passed these simply because ALL of them completed EVERY procedure with ease during their previous HCE...

 

I'm all for a more rigorous testing process. But what you are implying is fairly ridiculous when you break it down.

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actually the clinical exams were the easy part...the three written parts were harder; "general medical knowledge"(this is where hce helps), "primary care", and "surgery".

you had to pass all 3 practicals, the general knowledge and either primary care or surgery. most folks took both exams to improve their chances of a pass. the only folks I knew who took only a single elective exam were the surg techs who all killed the surgical exam.

what's interesting is that they changed pance to make it more like the md exam then the md exam added in a clinical component to step 2 and we didn't put the clinical portion back in.

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actually the clinical exams were the easy part...the three written parts were harder; "general medical knowledge"(this is where hce helps), "primary care", and "surgery".

you had to pass all 3 practicals, the general knowledge and either primary care or surgery. most folks took both exams to improve their chances of a pass. the only folks I knew who took only a single elective exam were the surg techs who all killed the surgical exam.

what's interesting is that they changed pance to make it more like the md exam then the md exam added in a clinical component to step 2 and we didn't put the clinical portion back in.

 

Ill admit that if the packrat is a true predictor of success on the PANCE (ie a 120 typically correlates to passing the PANCE), that is far too low of standards. Though at the same time, can a 200+ question exam really cover all that is needed to prove you are a competent provider? Unlikely. That is the role of your program (and the 2034823094 tests along the way, along with your preceptors). I'm not sure what the best testing strategy would be... a step system where you have to complete a standardized test before being able to go out on clinicals and another after the completion of clinicals? More checkpoints to ensure that the stragglers do not make it through?

 

FWIW the step 2 counts for very little in terms of medical education other than just a roadblock to pass.

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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?

 

 

I know this was several pages ago, but this really bothered me.

 

Why isn't someone who made mistakes and is now looking for their calling acceptable for other clinicians or PAs. I know MDs who had a 2.8 overall GPA, MDs who were homeless and on drugs prior to re-entering college, lawyers who originally thought being an engineer was the way to go, and a PA-S who spent a year with the FBI before taking the pre-requisites.

 

I would argue that anyone with previous life experience who has LEARNED from their mistakes is a stronger MD/DO, engineer, lawyer, accountant, PA, etc than someone who has YET to make mistakes. Especially for people who have proven through good employment and by excelling at the pre-requisites that they HAVE learned from their mistakes.

 

Aren't we a society that likes to give second chances?

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I know this was several pages ago, but this really bothered me.

 

Why isn't someone who made mistakes and is now looking for their calling acceptable for other clinicians or PAs. I know MDs who had a 2.8 overall GPA, MDs who were homeless and on drugs prior to re-entering college, lawyers who originally thought being an engineer was the way to go, and a PA-S who spent a year with the FBI before taking the pre-requisites.

 

I would argue that anyone with previous life experience who has LEARNED from their mistakes is a stronger MD/DO, engineer, lawyer, accountant, PA, etc than someone who has YET to make mistakes. Especially for people who have proven through good employment and by excelling at the pre-requisites that they HAVE learned from their mistakes.

 

Aren't we a society that likes to give second chances?

 

The original post by Rev pretty much stated that nobody under 25 should be allowed to be in PA school... that PA school was to be reserved for those who had made mistakes early in life and are now ready to make the leap in to medicine (as if everyone needs to go through the mistake making process...). Im all for living life, but the nature of the beast in applying to PA school is that there can be over 1000 applicants for 50ish spots. In that group, you can find more than enough perfectly qualified individuals that HAVEN'T had the mistake, so why should the individual that did make these be selected above them? If these schools are comparing candidates that are squeaky clean versus those that have some blemishes on their application, I don't see where many admission boards would choose those with the blemishes in many professional programs.

 

Im all for second chances, but if you have just as many equally qualified, or more qualified individuals without the mistakes, you shouldn't jump to the top of the pile.

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acozadd- Wisdom comes from making mistakes and learning from them. A lot of people gain empathy from reaching low points in their own lives and moving on. This helps them relate to others well. Some people gain wisdom and empathy more quickly than others, so I am not saying that young people cannot have these qualities, but I do believe these qualities are very important when practicing medicine. Making mistakes and learning from them can also keep you from being quick to judge others- a mistake that can be pretty serious in medicine. If I were an adcom I think I would prefer someone who made mistakes/tried a different path in life and then chose the PA profession because then I would know they really mean it. JMO

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The original post by Rev pretty much stated that nobody under 25 should be allowed to be in PA school... that PA school was to be reserved for those who had made mistakes early in life and are now ready to make the leap in to medicine (as if everyone needs to go through the mistake making process...).

 

Really? I challenge you to find either statement in my original post.

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This is a great debate for the ages. It exactly parallels the "Should new EMT's be allowed to go to Medic school" question. I think that it is less about competent vs incompetent and more about the idea that their are tiers of competency. A couple of people touched on this but never stated it explicitly. If there are 2 new-grad PA's and one volunteered in the ER for a summer pushing stretchers (a kid in my current A+P class) and the other spent 15 years bouncing around the back of an ambulance (me) then yes there is a huge experience gap. I can read EKG's, know the difference between lido and amio, know which end of the catheter is the pointy one, etc. But where does that curve flatten out? I would think that after 5 years of work experience me and that kid from the A+P class are gonna be more or less in the same place. After 15 years that kid should be an expert and with THAT experience, he would have alot to teach ME.

 

A few people on this board talk about PA 1 and PA 2 classification when working. I think that that might be an answer.... Maybe there should be an apprentice/journeyman/master system. If you have 5-10 or more years of HCE, you can petition to test to enter that track at a higher level as a new grad where someone with no HCE could not.

 

I recently went to a cardiology conference here in Boston put on (mostly) by the faculty and attendings from the Brigham and Womens Emed department. Spending the time with and listening to how the Doc's think; What they consider important, what is a priority, the depth at which they consider differential dx, chemistry, etc was really an important lesson in this argument. I think a newbie PA with 0 HCE would have been totally lost. I was able to keep up on the 12 leads/meds/therapies, but was clearly out of my depth on chemistry/pharmokinetics/pathophys. The new Emed residents understood all the science but fell way behind on the practical application of say diuretics vs nitrates vs cpap vs bipap in heart failure. 15 years of experience as a clinician would probably trump the newbie, me, and the resident.

 

I guess it comes down to what is your vision of this field? What should you be able to do reliably on day 1 of your first job? I personally think HCE and life experience matter ALOT. The maturity, confidence, and experience bring alot to the table and many of the working PA's I know agree. The fact is that it takes balls to walk into a room where someone is REALLY ill and make a decision about how to care for them. That's somthing that people without the background (I think) don't understand. I also agree that when you dont have any experience you dont think it matters that much and when you have alot of it, you don't think there is any other way. Pilots like to say "there is a huge gap between the right seat and the left seat," ie co-pilot vs. pilot. It's easy to sit in an academic setting and say "it's obviously an MI, I'll give asa, 02, nitro, morphine" but I think when you walk into the curtain area at 3am with a patient who didn't read the textbook (atypical presentation) and you need to make the call, it gets ALOT harder.

 

I think however there is a third viewpoint in the HCE/no HCE debate; You will kick *** alot faster as a PA with alot of experience up front but after 5 or so years working in your specialty I think that difference will shrink. The problem of course is that 2 new grad PA's are providing drastically different levels of patient care and it limits consistency in the field.

 

I don't know what the answer is but I do know that I'm applying to programs at 38 with alot of experience and I hear time and time again that my cantidacy is threatened by a 23 year old with a 3.9 gpa waiting for his MCAT results who hopes that taking a CPR class will set him apart. I want this job, not because I read that it was one of the fastest growing careers, or because it's an alternative to medical school. I want it because I've spent my entire adult life working really long shifts and crafting the skills that i do have in the hopes that someday I could do more for my patients that just push more epi and drive faster so that the OTHER GUY could do what my patient needed. I want to work in a setting where my background will matter and I will have more tools to help more people become well.

 

I hope this makes sense to the guys who are doing the job.

 

Lewitt

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