Why did you become a PA and not a physician?

[ventana]

Your points being mentioned, do you ever feel as though the docs for whom you work think less of your opinion because you are not "one of them?" Do THEY put you in the same category with the nurses?

 

 

few did - but then I left jobs like that - others are great and respect the experience I have and the knowledge I bring - really funny when a doc I don't know challenges a decision I have made, and when I pull out sanfords or another text saying I am praciticing the way I should there is usually a immediate and long lasting shift in their attitude towards me. However only one or two doc's that I have worked with would back me up 100% with out knowing a thing about the case - a rare but nice thing when you find it

 

 

I am pretty vocal in a dysfunctional situation on calling people out on the fact we need to practice to the best of our ability - try to be very politically correct with it and gentle but do tend to ID issues and vocalize them to a few key people.

 

 

 

and rather a PA or MD goes home on time is not a function of the degree but instead a function of the job and the person - got out 2 hours late last night....... and the doc's at my primary job tend to leave long before me......

 

 

 

And PA's can own a practice in most states.....

[Swole2112]

So, they can own a practice!? What else can they do that has them in charge?

[LESH]

Are you all happy with your decisions?

Yes. It was the best decision I ever made.

[Contrarian]

Your points being mentioned, do you ever feel as though the docs for whom you work think less of your opinion because you are not "one of them?" Do THEY put you in the same category with the nurses?

 

There are some "dismissive" docs out there.

Some feel like ONLY docs... those that completed the traditional medschool route have been adequately prepared... and should be practicing medicine. Some feel like no matter WHAT you do or know as a PA or NP... the very fact that you are not a doc automatically means that there is NO way for you to ever possibly know as much or more than ANY doc about any particular area of medicine and/or patient care.

 

These folks feel that because they are physicians, they automatically know more about emergency medicine than any active trauma Medic with 10 yrs on a bus doing inner-city, ghetto ALS GSW "hot-transports." The fact that they are immunologists, allergists, and not ed docs doesn't matter.

 

These folks have no problem dismissing the recomendations of the 20yr Derm PA or 10 yr Psych NP simply because the person is NOT a MD/DO. Quite often... these folks won't even acknowledge that NPs and PAs actually "practice medicine."

 

It is NOT unheard of where these folks will refuse to accept a referral from a NP/PA or even refuse to come to the phone when a NP/PA calls and will send a message for the NP/PA to have their SP (Doc) call.

 

Some even go so far as to openly advertise in distributed print and on their practice websites that they DO NOT use/employ NPs/PAs as a way to "improve patient care." Basically sugesting that the patient's care will be safer and better because non-physicians aren't involved.

 

These are typically either the young fresh out of training ones who still believe in the whole physician "deification" schtick or the old ones still stuck on the physician "caste" system. Often they harbor deep seated resentment about their debt load and professional "hazing" and feel like NPs and PAs took a 2 yr short-cut to do 80% of what they can.

 

Basically, neither of these folks have a firm grasp on the whole "medicine is a team sport" concept.

 

On monday, while sitting in the medical staff office surfing the internet and shooting the breeze with my supervisor... she informed me that the doc that works 4 days a month reported to her and anyone that would listen, that I "neglected" to put a newly admitted patient that was 2.5 months S/P PE on warfarin. The doc went on about how "dangerous" this was and how I needed to be educated about the correct treatment of coagulopaths. My supervisor asked her if she started the patient on warfarin and she stated that she didin't, because it was MY responsibility and if she simply did it, I wouldn't learn anything.

 

I simply started laughing, got up, walked into the nursing station, pulled the chart and picked up one of those BRIGHT ORANGE highlighters.

 

I went back in the medical staff office, sat down across the desk from my supervisor, flipped to the admitting paperwork area of the chart then started reading ALOUD... the 2 page dictated hospital report that detailed VERY CLEARLY why this non-compliant, suicidal, psychotic patient was a poor candidate for warfarin anticoagulation. While reading this... I used the BRIGHT ORANGE highlighter to illuminate the words of the 4 physicians at the hospital that basically described this patient as a living coumadin contraindication.

 

She smiled... started to interrupt me but I held up a hand and stopped her...

 

I then turned to the "Physician Notes" section to MY 1.5 page admission chart note where I summarized the rational for the coumadin contraindication and then used the BRIGHT ORANGE highlighter to illuminate it.

 

I then turned to the "Physician Orders" section to MY entry where I ordered Pradaxa (dabigatran) 150mg BID... on this patient upon admission and used the BRIGHT ORANGE highlighter to illuminate it.

 

I smiled, handed her the chart and walked out of the building... but before I left, I put the BRIGHT ORANGE highlighter in the complaining doc's mailbox.

 

I won't see this doc until Friday but I'm really looking forward to it...:heheh:

 

Contrarian

 

P.s... My supervisor told me today that she doesn't think the other doc read the hospital paperwork when she did her admission on this patient, the doc didn't bother to read my note when she did her admission on this patient, and the doc didn't/doesn't know what Pradaxa (dabigatran) is.

[EMEDPA]

So, they can own a practice!? What else can they do that has them in charge?

Solo coverage of rural er's, night coverage of ICU's, military medicine(multiple settings), state dept/cia/peace corps medical officer, alaska solo/rural coverage(no doc within 6 hrs by plane in the aleutians).

[Contrarian]

Solo coverage of rural er's, night coverage of ICU's, military medicine(multiple settings), state dept/cia/peace corps medical officer, alaska solo/rural coverage(no doc within 6 hrs by plane in the aleutians).

 

Yep...

For 18months (2006 to early 2007)... my SP was in Nebraska while I was in Juba, Sudan Africa. The nearest hospital was a 3hr flight SW to Entebbe, Uganda or 2.5hrs SE to Nairobi, Kenya.

 

I had a Sat Phone that I could use to contact him if needed. I called once and spoke to the receptionist for a few minutes just to see if the phone actually worked.

[JLaur122]

I am a Pre- PA student looking for guidance. Do most PA programs NOT require O-chem? It seems like they all do (at least where I am looking in IL). Anyone have any suggestions as far as schools are concerned? I am flexible in relocating. Thanks so much.

[EMEDPA]

If you want to avoid o-chem look at older programs and non-masters programs.

[physasst]

There are some "dismissive" docs out there.

Some feel like ONLY docs... those that completed the traditional medschool route have been adequately prepared... and should be practicing medicine. Some feel like no matter WHAT you do or know as a PA or NP... the very fact that you are not a doc automatically means that there is NO way for you to ever possibly know as much or more than ANY doc about any particular area of medicine and/or patient care.

 

These folks feel that because they are physicians, they automatically know more about emergency medicine than any active trauma Medic with 10 yrs on a bus doing inner-city, ghetto ALS GSW "hot-transports." The fact that they are immunologists, allergists, and not ed docs doesn't matter.

 

These folks have no problem dismissing the recomendations of the 20yr Derm PA or 10 yr Psych NP simply because the person is NOT a MD/DO. Quite often... these folks won't even acknowledge that NPs and PAs actually "practice medicine."

 

It is NOT unheard of where these folks will refuse to accept a referral from a NP/PA or even refuse to come to the phone when a NP/PA calls and will send a message for the NP/PA to have their SP (Doc) call.

 

Some even go so far as to openly advertise in distributed print and on their practice websites that they DO NOT use/employ NPs/PAs as a way to "improve patient care." Basically sugesting that the patient's care will be safer and better because non-physicians aren't involved.

 

These are typically either the young fresh out of training ones who still believe in the whole physician "deification" schtick or the old ones still stuck on the physician "caste" system. Often they harbor deep seated resentment about their debt load and professional "hazing" and feel like NPs and PAs took a 2 yr short-cut to do 80% of what they can.

 

Basically, neither of these folks have a firm grasp on the whole "medicine is a team sport" concept.

 

On monday, while sitting in the medical staff office surfing the internet and shooting the breeze with my supervisor... she informed me that the doc that works 4 days a month reported to her and anyone that would listen, that I "neglected" to put a newly admitted patient that was 2.5 months S/P PE on warfarin. The doc went on about how "dangerous" this was and how I needed to be educated about the correct treatment of coagulopaths. My supervisor asked her if she started the patient on warfarin and she stated that she didin't, because it was MY responsibility and if she simply did it, I wouldn't learn anything.

 

I simply started laughing, got up, walked into the nursing station, pulled the chart and picked up one of those BRIGHT ORANGE highlighters.

 

I went back in the medical staff office, sat down across the desk from my supervisor, flipped to the admitting paperwork area of the chart then started reading ALOUD... the 2 page dictated hospital report that detailed VERY CLEARLY why this non-compliant, suicidal, psychotic patient was a poor candidate for warfarin anticoagulation. While reading this... I used the BRIGHT ORANGE highlighter to illuminate the words of the 4 physicians at the hospital that basically described this patient as a living coumadin contraindication.

 

She smiled... started to interrupt me but I held up a hand and stopped her...

 

I then turned to the "Physician Notes" section to MY 1.5 page admission chart note where I summarized the rational for the coumadin contraindication and then used the BRIGHT ORANGE highlighter to illuminate it.

 

I then turned to the "Physician Orders" section to MY entry where I ordered Pradaxa (dabigatran) 150mg BID... on this patient upon admission and used the BRIGHT ORANGE highlighter to illuminate it.

 

I smiled, handed her the chart and walked out of the building... but before I left, I put the BRIGHT ORANGE highlighter in the complaining doc's mailbox.

 

I won't see this doc until Friday but I'm really looking forward to it...:heheh:

 

Contrarian

 

P.s... My supervisor told me today that she doesn't think the other doc read the hospital paperwork when she did her admission on this patient, the doc didn't bother to read my note when she did her admission on this patient, and the doc didn't/doesn't know what Pradaxa (dabigatran) is.

 

 

It's more than just medicine.

 

I've noted that some physicians tend to think that because they have an MD or DO, that they therefore understand EVERYTHING better. I once saw an MD arguing with a seasoned public health researcher about how all of their research was wrong. Yet, he had no additional training in public health and was not involved in public health research.

 

My personal favorite is the physicians who think that they understand health care economics better than those with formal economic training. As an example, a Cardiologist was giving a presentation on economics in health care at a recent meeting I was at. He started to discuss inelasticity curves, which was okay, except he had the scoring inversed. I doubt highly that he could actually create a curve. Another meeting, the AMA treasurer was speaking about health care economics, and it was obvious that he had some rather basic economic principles at least mildly confused...not completely wrong, but if he had been speaking to a group of economists, he would have been skewered. At least he admitted his rather rudimentary knowledge.

 

Other physicians not so much. There is sometimes the prevailing thought with SOME physicians, that because they are the physician and you are the PA, they must know more about virtually EVERYTHING than you do...

 

Of course, it's a logical fallacy, but it makes dealing with them painful.....

[ventana]

There are some "dismissive" docs out there.

Some feel like ONLY docs... those that completed the traditional medschool route have been adequately prepared... and should be practicing medicine. Some feel like no matter WHAT you do or know as a PA or NP... the very fact that you are not a doc automatically means that there is NO way for you to ever possibly know as much or more than ANY doc about any particular area of medicine and/or patient care.

 

These folks feel that because they are physicians, they automatically know more about emergency medicine than any active trauma Medic with 10 yrs on a bus doing inner-city, ghetto ALS GSW "hot-transports." The fact that they are immunologists, allergists, and not ed docs doesn't matter.

 

These folks have no problem dismissing the recomendations of the 20yr Derm PA or 10 yr Psych NP simply because the person is NOT a MD/DO. Quite often... these folks won't even acknowledge that NPs and PAs actually "practice medicine."

 

It is NOT unheard of where these folks will refuse to accept a referral from a NP/PA or even refuse to come to the phone when a NP/PA calls and will send a message for the NP/PA to have their SP (Doc) call.

 

Some even go so far as to openly advertise in distributed print and on their practice websites that they DO NOT use/employ NPs/PAs as a way to "improve patient care." Basically sugesting that the patient's care will be safer and better because non-physicians aren't involved.

 

These are typically either the young fresh out of training ones who still believe in the whole physician "deification" schtick or the old ones still stuck on the physician "caste" system. Often they harbor deep seated resentment about their debt load and professional "hazing" and feel like NPs and PAs took a 2 yr short-cut to do 80% of what they can.

 

Basically, neither of these folks have a firm grasp on the whole "medicine is a team sport" concept.

 

On monday, while sitting in the medical staff office surfing the internet and shooting the breeze with my supervisor... she informed me that the doc that works 4 days a month reported to her and anyone that would listen, that I "neglected" to put a newly admitted patient that was 2.5 months S/P PE on warfarin. The doc went on about how "dangerous" this was and how I needed to be educated about the correct treatment of coagulopaths. My supervisor asked her if she started the patient on warfarin and she stated that she didin't, because it was MY responsibility and if she simply did it, I wouldn't learn anything.

 

I simply started laughing, got up, walked into the nursing station, pulled the chart and picked up one of those BRIGHT ORANGE highlighters.

 

I went back in the medical staff office, sat down across the desk from my supervisor, flipped to the admitting paperwork area of the chart then started reading ALOUD... the 2 page dictated hospital report that detailed VERY CLEARLY why this non-compliant, suicidal, psychotic patient was a poor candidate for warfarin anticoagulation. While reading this... I used the BRIGHT ORANGE highlighter to illuminate the words of the 4 physicians at the hospital that basically described this patient as a living coumadin contraindication.

 

She smiled... started to interrupt me but I held up a hand and stopped her...

 

I then turned to the "Physician Notes" section to MY 1.5 page admission chart note where I summarized the rational for the coumadin contraindication and then used the BRIGHT ORANGE highlighter to illuminate it.

 

I then turned to the "Physician Orders" section to MY entry where I ordered Pradaxa (dabigatran) 150mg BID... on this patient upon admission and used the BRIGHT ORANGE highlighter to illuminate it.

 

I smiled, handed her the chart and walked out of the building... but before I left, I put the BRIGHT ORANGE highlighter in the complaining doc's mailbox.

 

I won't see this doc until Friday but I'm really looking forward to it...:heheh:

 

Contrarian

 

P.s... My supervisor told me today that she doesn't think the other doc read the hospital paperwork when she did her admission on this patient, the doc didn't bother to read my note when she did her admission on this patient, and the doc didn't/doesn't know what Pradaxa (dabigatran) is.

 

 

Darn that made me laugh.... gotta love calling it exactly the way you see it - this is the exact thing that experienced PA's and NP's need to do routinely to get the respect that they deserve! great Job

[browndog]

If I had to do it over again and I were 30 or younger (and had the cash).....med school. If I had to do it over again and I were over 30.... PA school.

 

But, alas, I am what I am.

[ms.targaryen]

I will be starting PA school this summer, so I can't speak to whether I'd do it again.

 

However, if this helps, my many reasons include: not wanting to spend my 30's in med school and residency, work/life balance, versatility to move between specialties, don't want to own/run a business, don't need to be "the boss," lower debt load, no MCAT, still get to practice medicine. I didn't do science in undergrad, so I actually had to take MORE prereqs to do PA school than my friends who opted for med school, but not having to take that 3rd quarter of Ochem was a definitely an appreciated bonus. My 2 cents.

[primadonna22274]

I got into PA school so I went. I was too chicken to apply to med school when I was 23, but in reality I didn't really know that I could do it until I was out in practice as a PA at 26. My first supervising physician told me in our first 2 wk together that I was wasting my talent and needed to go to medical school. I did not agree, and tried to make the best of it for more than a decade, but life is full of surprises, and here I am halfway through 2nd semester of medical school at 38.

Truly, I never had a role model for how to become a physician until my first supervising doc. I owe her so much! We didn't have any physicians in my family, and in fact nobody graduated from college before me (except that my mom did finish nursing school when I was a sophomore in college--this was a VERY big deal for our family).

My parents were too busy raising my 5 younger siblings on my hard-working Dad's income to advise me on college and certainly could not afford to help--at all. I have been self-sufficient since I was 17. I think my story is much more typical of PAs than physicians who quite often come from privileged backgrounds.

[IdahoPA]

^Good for you, primadonna! Just because we make one choice doesn't mean we can't make others. :) How are you liking it?

[paporzelt]

i never wanted to be an MD. As much as I adore most f the MDs i worked for, I did not envy their lives. I worked mostly in surgical specialties, and these guys worked all day, half way into the night while they were on call, plus call on weekends - they were finally done with school, but they still werent enjoying their lives. They missed anniversaries, holidays, kids soccer games...and the PAs i worked with had an amazing quality of life. They weren't on call, they got to participate in patient care, the OR, and the patients and MDs loved and respected them. Obviously this is not the case for every SP, but I'm at my first job, I work in an urgent care with about 15 PAs, 3NPs, and about 10 supervising docs, and while we see a lot more than the usual urgent care because our patient population hates the local ER and everything comes to us, even that shouldn't, I love my job. I work 34-36 hours a week (3 days), I can ask my supervising docs anything and they have no problem answering my questions and discussing patients with me, and the same goes for the PA's and NPs, and everyone really appreciates the "team work" part of medicine.

I wanted to be a bigger part of patient care, I didnt want to open my own practice, I kind of like having someone who's is still above me (it takes a little bit off my shoulders), and I dont have nearly the amount of debt my friends in medical school do.

and i would never work with/for a SP who didn't respect me or my profession.

[EMEDPA]

outside of surgical fields the avg pa works more hrs than the docs they work with.

a standard em pa schedule is around 180 hrs/mo. for around 110k/yr

a standard em md schedule is 120-130 hrs/mo for around 350k/yr

who has more free time and a better lifestyle, more time to spend with family? do the math.

[physasst]

outside of surgical fields the avg pa works more hrs than the docs they work with.

a standard em pa schedule is around 180 hrs/mo. for around 110k/yr

a standard em md schedule is 120-130 hrs/mo for around 350k/yr

who has more free time and a better lifestyle, more time to spend with family? do the math.

 

THIS^^^^

 

Plus, the PA groups are typically smaller. Which means when you have people leave for various reasons or go on leave, the impact to the rest of the group is much higher. We are constantly being asked to work 2-3 extra shifts per month cause it seems like we are always short a provider for one reason or another.

 

The physicians don't really care as long as the shifts are filled.

[EMEDPA]

THIS^^^^

 

Plus, the PA groups are typically smaller. Which means when you have people leave for various reasons or go on leave, the impact to the rest of the group is much higher. We are constantly being asked to work 2-3 extra shifts per month cause it seems like we are always short a provider for one reason or another.

 

The physicians don't really care as long as the shifts are filled.

 

agree- our group of 15 just lost a pa on short notice and we are in panic mode to cover his shifts....the docs have 35 docs to cover the # of shifts we cover with 15...now 14....at my per diem job the docs will cover for the pa's but at my primary job doesn't ever happen...

[physasst]

agree- our group of 15 just lost a pa on short notice and we are in panic mode to cover his shifts....the docs have 35 docs to cover the # of shifts we cover with 15...now 14....at my per diem job the docs will cover for the pa's but at my primary job doesn't ever happen...

 

It's even worse here.....42 docs, but only 6 PA's. We lose someone, we have only 5 other bodies to pick up the slack.....

[EMEDPA]

we staff 7 shifts/day so 14 folks means you are working at least 1/2 of the time....included in that 14 are also folks who have contracts for 10-12 shifts/mo....this happened last summer as well and I had a few months of 23+ shifts/mo...yes, it's more money and more production bonus but it's not worth it...

[FfIghter23]

outside of surgical fields the avg pa works more hrs than the docs they work with.

a standard em pa schedule is around 180 hrs/mo. for around 110k/yr

a standard em md schedule is 120-130 hrs/mo for around 350k/yr

who has more free time and a better lifestyle, more time to spend with family? do the math.

 

SO, EMEDPA... will this^^^ always be the case? or are the salaries of PA's going to keep going up while the salaries of MD's goes down w/ the new health laws/insurance/and such?

 

a local rural ER in North Texas that I am familiar with... just recently went from 9 Doc's and 3 PA's/NP's to 4 Doc's and 8 PA's/NP's with the mid-levels getting an almost 15% raise because of added responsibility and the Doc's taking a hit to their salary.

 

The trend definitely seems to be in the PA's favor nowadays... but will that last? and at what point do the MD's put their foot down? or is everything going to be controlled by new health laws, the government, hospital admins trying to save a buck, and such?

[EMEDPA]

that is the question of the decade...don't know...but in vague terms if docs take a big salary hit they will pass it on to the pa's who work with them...

[treejay]

Many people claim that docs go into grossly more debt than PA students, but I'm not yet convinced. My PA school is 2.5 years. Med school is 4 years, only 1.5 years more.. After med school, I'm under the impression that residents earn 45k/year. That's enough to live on, certainly well more than I currently live on as a student. When alls said and done 3 years later (in the shortest residency), that doc will be earning 3 times the PA student (most specialties outside primary care I would think. Take EM for example). Sure, they're rough calculations if you'd even call them that. I recognize that you have to pay interest all the while on the loans. But the numbers still seem obvious in docs favors. The arguement of the vastly greater amount of debt an MD student has to take on doesn't pencil out in my head. Seems to me if you're reasonably financially prudent like many are advocating our federal government to be, you could live and even service your debt (at least interest) during an MD residency, making your total debt load only 1.5 years more than a PA student. Seems negligable if this is one's main deterrant of pursing the MD/DO path. I bring this up because I'm willing to be swayed so bring it on...

[burnpac]

I became a PA because going to medical school wasn't even in the realm of the possible for me and my family.

 

I never even aspired to a career in medicine until I was exposed to it as a EMT. I dropped out of HS my junior year and was a terrible student. I finished my GED at a local community college, and got the only job I could find in my Sierra community working at a gas station that had a tow truck and an ambulance. It was then that I found my calling.

 

I remember pumping gas in 1975 into the suburban of a Dr. Ted Werning, orthopedic surgeon, who single handedly and against fierce medical society opposition (what?! non doctors starting IVs and intubating patients in the field? Heresy!), started the first paramedic program in Modesto CA in the early '70s. He encouraged me to become a paramedic, and I did (Stanilaus Co. Paramedic class of '77). That is when I got my academic legs; when I found something that I wanted to learn. I was an honor student from then on.

 

I never even heard of physician assistants, but the Stanford PA Program started a satellite at Modesto JC, and some of my paramedic peers were going on to this program. I though, why not? I didn't want to be a paramedic for the rest of my life working 72 hrs/wk at minimum wage. I had no PA role models; I just took a leap of faith.

 

I failed at the first admission attempt due to my previously poor academic performance, and spent the next year working FT and going to school FT to get the grades I needed to get in. I was admitted to class of 1981. At that time, much training was under the Health Manpower Training Act, and I had the good fortune to be trained as a PA without paying any tuition.

 

My wife and I come from working middle class roots, and we both are the first people in our respective families to complete college degrees. Without the financial aid, I would have never become a PA, or probably any other type of professional. I know now that I would have made a good physician, but feel extremely fortunate and happy to be a PA at this time of professional growth and emergence. Becoming a physician is not impossible for my children, thanks to the PA profession!

[acozadd]

A lot of my decision making had to do with time (I will graduate in a few months just before my 25th birthday), debt (I will come out of PA school with debt in the upper 20K range, friends in the med program at my school will come out with 260K.. at 6.8-8.9% interest... yikes), ease of entering competitive specialties, etc. I have many interests outside of medicine, and wanted to be able to enjoy the better half of my 20s and 30s as opposed to completing a surgical residency without a life. The decision comes with some trade-offs but I'm just fine with that.

 

EMED- was o chem really THAT intimidating that it influenced your entire career path? TBH o-chem was one of the easier chem courses, not sure where it gets it's bad reputation from. Ironically, it is now required for many/most PA programs.