Thoughts on knowledge?

[PAstudentCanada]

An emerg physician and I were talking. She doesn't understand why in the world I would want to be a PA instead of an MD. She says "you are going to do the same job and get paid less and always have to practice according to your supervising physician's style." I then said that I get to finish school sooner, and make money sooner. But I agreed that she had a point and I said "if I become an emerg PA, after ten years of practice I will have the same skill and knowledge as most of the emerg physicians I am working with but will be paid less and, while that might bother me, I do realize that I didn't train as long as they did."

 

Then she says "you might have the same skills but you will never have the same knowledge." I was quite taken back by this. I have a degree in medical science, the didactic portion of my PA program is almost identical to that of the MD program at my school, and I intend to thoroughly read the same materials that the MD residents read (Rosen's mostly) throughout my career. How could it possibly be that after ten years I wouldn't have the same knowledge?

 

Am I wrong? Thoughts?

[bradtPA]

She is correct. We don't get the background in embryology, immunology, pathology, and other first year med school subjects that an MD does.

[SocialMedicine]

i am not saying i disagree with the emrgency doc opinion. but does any physician or PA recall the material they learned in school ten years later? It will set up a foundation for learning, and residency provides an amazing building block on that. But PAs can find ways, altho much harder, to build similar foundations.

[Contrarian]

... I said "if I become an emerg PA, after ten years of practice I will have the same skill and knowledge as most of the emerg physicians I am working with but will be paid less and, while that might bother me, I do realize that I didn't train as long as they did."

 

Then she says "you might have the same skills but you will never have the same knowledge."...

 

One reason why this statement isn't necessarily correct is that EVERYTHING taught to medstudents is in a book somewhere and I'm relatively sure that all PA-Cs can read.

 

ALL of those books can be delivered to your front door step by Amazon.com. You could be just the person who decides, as a hobby, to spend 10hrs/week... for the next 10yrs digesting everything you can concerning embryology, immunology, pathology, and other first year med school subjects that physicians are tested on.

 

Another reason her assertion is a bit short sighted is that there are plenty of PAs who's knowledge of certain aspects of medicine greatly out weigh that of the majority of the physicians they interact with daily.

 

I agree with PAMAC... she just wanted to "pigeon-hole" you and 'put you in your place' as she has no idea... or really any way of predicting what you will or will not know in 10yrs...

 

There is no way that she could predict that after finishing a Canadian PA-program, you would take a job in Australia practicing Emergency Medicine and while there, in your spare time, complete post grad certifcates/diploma in immnology, and/or post grad diploma/certificate in embyology, or pathology.

[Cdn PA Student]

The thing that makes this statement more ridiculous is that at the school PAStudentCanada and I trained at, the MD STUDENTS do NOT get those 'traditional' indepth science courses (immunology, embryology etc). Both the MDs and the PAs are taught using PBL (problem/case based learning) from essentially the same curriculum! So... I would say that at least at our school, and even on a general scale in Canada, that part of the argument is nullified. I think the residency argument has some validity though in the sense that ALL emerg residents will reach a certain threshold of knowledge (ie enough to pass the emerg boards), but not ALL ER PAs will reach that same threshold of knowledge. But that being said, I agree with Contrarian - if you want to learn, you can learn, and there is no reason you can't learn just as much about medicine as your physician counterparts. You might not get recognized for having the knowledge... but you can learn as much as you want!

[PAstudentCanada]

Yes, what Cdn PA Student and Contrarian say are of course true. I also happen to have taken pathology, embryology, endocrinology, immunology, and a whole bunch of other basic medical science stuff. Heck, I've even taught a bunch of it to M.D. students.

 

The doc's main claim wasn't regarding the basic medical sciences portion of M.D. education. Rather, she was speaking about the learning done in residency. And, as has been pointed-out. I don't see why I can't make sure I learn the same things learned in residency.

[PAstudentCanada]

On more thing, in most of my conversations with academic emerg docs, my basic medical science knowledge seems to be on par with their knowledge. The difference seems to be in them remembering specific clinically relevant things (e.g. don't give nsaids with warfarin because of inhibition of platelet aggregation). But very few of them remember/know the mechanism (inhibition of synthesis of precursors of thromboxanes).

 

The doc in question in my original post told me of the many times something "goes wrong" or is hard to figure out and she goes back to the basics of medical science to think through what could be going on. I really don't see why I, or any PA, couldn't do the same.

 

Also, my upperclasswoman makes a good point in that our school is very different form other med schools in that the hardcore basic medical science traditional curriculum so common in the USA (and somewhat common at other Canadian schools, though significantly less-so) is simply not taught. There have been many studies on how this affects performance in residency and beyond with the results being that there is no difference in performance in residency whether the physician did the innovative PBL or the traditional way. I suspect that my MD schoolmates, as well as my PA schoolmates, would pass USMLE Step 2 but would need a fair bit of prep to pass Step 1. The Canadian LMCC exam, however, I suspect would have similar pass rates for PGY1s from our school and PAs with a year or two of generalist practice under their belt. Of course, this is pure conjecture and I could be completely off-base.