Why do a residency?

[jsfelder0417]

From my perspective, it was not that arcane. Giap's methods, and the way the French responded are routinely studied by military personnel. My COP had a battle plan similar to the one successfully utilized against Giap at Khe Sanh. I plan on attending an EM residency upon completion of my program. My ultimate goal being one of the leaders in a rural ED. Bassett looks good, but Arrowhead Regional is 30 mins from my home and family. I have already spent 7 years away, so I would like to return. Sure, I will concede that I will give up potential earnings, however, the documented skillset, ability to cover the wide range of ailments seen in a Level 1, and comfort in ED ops is worth the trade in my opinion. From where I am coming from prior to the PA profession (an active duty E5 medic) 52K is a lot more than i'm used to earning, so I can definitely live off of that. DPAS? The Doctor of Physician Assistant/Associate Studies? I would much rather see PA to MD/DO bridges such as the program in it's infancy over at LECOM. I know most people don't become PAs to become docs, but if you want independence and expanded scope of practice, well there's the top of the ladder. Then you negate the potential scenario that DNPs are in now.

[jsfelder0417]

From my perspective, it was not that arcane. Giap's methods, and the way the French responded are routinely studied by military personnel. My COP had a battle plan similar to the one successfully utilized against Giap at Khe Sanh. I plan on attending an EM residency upon completion of my program. My ultimate goal being one of the leaders in a rural ED. Bassett looks good, but Arrowhead Regional is 30 mins from my home and family. I have already spent 7 years away, so I would like to return. Sure, I will concede that I will give up potential earnings, however, the documented skillset, ability to cover the wide range of ailments seen in a Level 1, and comfort in ED ops is worth the trade in my opinion. From where I am coming from prior to the PA profession (an active duty E5 medic) 52K is a lot more than i'm used to earning, so I can definitely live off of that. DPAS? The Doctor of Physician Assistant/Associate Studies? I would much rather see PA to MD/DO bridges such as the program in it's infancy over at LECOM. I know most people don't become PAs to become docs, but if you want independence and expanded scope of practice, well there's the top of the ladder. Then you negate the potential scenario that DNPs are in now.

[cinntsp]

EMED writes "do you realsitically think pa's will ever be 100% independent of docs?

we report to the medical boards of each state in case you forgot. the reason docs hire pa's and not np's is that they have some degree of control and oversight over our practice. take that away and we are just np's. then docs will just hire other docs and be done with us entirely"

 

You keep saying "EMED writes" and just copying/pasting his posts but using the quote option is easier and clearer to others when reading your replies:

 

[ATTACH=CONFIG]859[/ATTACH]

[cinntsp]

EMED writes "do you realsitically think pa's will ever be 100% independent of docs?

we report to the medical boards of each state in case you forgot. the reason docs hire pa's and not np's is that they have some degree of control and oversight over our practice. take that away and we are just np's. then docs will just hire other docs and be done with us entirely"

 

You keep saying "EMED writes" and just copying/pasting his posts but using the quote option is easier and clearer to others when reading your replies:

 

[True Anomaly]

TrueAnomaly writes "If you're gonna make the decision to do a residency and take at least half the pay you otherwise could as a PA, you better make it worth your while in your learning"

 

I would add. You better make it worth your while in your learning AND YOUR RIGHT TO PRACTICE INDEPENDENTLY AND THE RIGHT TO A TERMINAL DOCTORATE WITH CLINICAL USE OF "DOCTOR" TITLE.

 

Why are so many PAs willing to give up time and treasure to simply be able to make more money for our Masters?

 

While you may view it as a slave mentality, I don't. The inherent value my residency was to me was, to be redundant, invaluable. OF COURSE employers want their employees to help make them money. What matters to ME is how confident I feel in my own abilities, and what I could do to get myself there.

 

Where we'll have to agree to disagree is that this would somehow translate into a magical "degree" bestowed upon me, and that degree being a doctorate. I fundamentally disagree with the notion of a clinical doctorate for residency training, and it mostly comes down to I believe it would create so much more confusion in the medical world than the "benefit" of my having the degree. I said this years ago on this forum when the army began handing out clinical doctorates to their PA residency graduates, and I maintain it today.

 

As far as my employers earning extra money off my added training- we're all salaried, and no one makes bonus on numbers of patients or procedures- this is both physicians and PA's.

[True Anomaly]

TrueAnomaly writes "If you're gonna make the decision to do a residency and take at least half the pay you otherwise could as a PA, you better make it worth your while in your learning"

 

I would add. You better make it worth your while in your learning AND YOUR RIGHT TO PRACTICE INDEPENDENTLY AND THE RIGHT TO A TERMINAL DOCTORATE WITH CLINICAL USE OF "DOCTOR" TITLE.

 

Why are so many PAs willing to give up time and treasure to simply be able to make more money for our Masters?

 

While you may view it as a slave mentality, I don't. The inherent value my residency was to me was, to be redundant, invaluable. OF COURSE employers want their employees to help make them money. What matters to ME is how confident I feel in my own abilities, and what I could do to get myself there.

 

Where we'll have to agree to disagree is that this would somehow translate into a magical "degree" bestowed upon me, and that degree being a doctorate. I fundamentally disagree with the notion of a clinical doctorate for residency training, and it mostly comes down to I believe it would create so much more confusion in the medical world than the "benefit" of my having the degree. I said this years ago on this forum when the army began handing out clinical doctorates to their PA residency graduates, and I maintain it today.

 

As far as my employers earning extra money off my added training- we're all salaried, and no one makes bonus on numbers of patients or procedures- this is both physicians and PA's.

[Gonadometrics]

You keep saying "EMED writes" and just copying/pasting his posts but using the quote option is easier and clearer to others when reading your replies:

 

[ATTACH=CONFIG]859[/ATTACH]

 

Thank you. You are right. It's much simpler to use the "Reply with quotes" button.

[Gonadometrics]

You keep saying "EMED writes" and just copying/pasting his posts but using the quote option is easier and clearer to others when reading your replies:

 

[ATTACH=CONFIG]859[/ATTACH]

 

Thank you. You are right. It's much simpler to use the "Reply with quotes" button.

[andersenpa]

This notion that the DNP and NP independence is going to drive PAs into the ground seems misguided.

First, the independence of Nonphysicians is only relevant in primary care.

Per the AAPA 31% of PAs practice in Primary Care

http://www.aapa.org/uploadedFiles/content/Research/2010%20Census%20Report%20National%20_Final.pdf

 

Second, only a small percentage of PAs or NPs enter into practice ownership (PAs) or fully independent practice (NPs). It is true that the number of states granting NP independence is growing, but so far is there any evidence that the factors which enable private practice ownership are improving? If anything, it's moving in the opposite direction. More and more private practices are being assumed by hospitals or health systems.

 

And as EMEDPA mentioned, the pushback from physicians is potent.

 

Third, look at the growth in the PA profession. I recall the last numbers I saw showing the number of practicing PAs in the US has DOUBLED to ~80000 over the past 10 YEARS. Pretty impressive growth. This is practicing PAs, not just new graduates being produced.

 

The market forces that favor the employment of PAs- cost effective care, reliable job market etc- are strong. So the gloom and doom prophecies for the PA profession don't add up, even if successes of NPs exceed the fears of PAs (and physicians!)....

 

I'm still not sure if I connect the arguments I see here with the need to awarding a degree for residency. MDs after all earn their degree prior to residency. Perhaps a better endpoint to residency would be a loosening of oversight- lesser supervisory requirements etc. EMEDPA I agree that associate will come. I hope you're correct that supervision will change to sponsorship (as we have here in WA for certified PAs)!

[andersenpa]

This notion that the DNP and NP independence is going to drive PAs into the ground seems misguided.

First, the independence of Nonphysicians is only relevant in primary care.

Per the AAPA 31% of PAs practice in Primary Care

http://www.aapa.org/uploadedFiles/content/Research/2010%20Census%20Report%20National%20_Final.pdf

 

Second, only a small percentage of PAs or NPs enter into practice ownership (PAs) or fully independent practice (NPs). It is true that the number of states granting NP independence is growing, but so far is there any evidence that the factors which enable private practice ownership are improving? If anything, it's moving in the opposite direction. More and more private practices are being assumed by hospitals or health systems.

 

And as EMEDPA mentioned, the pushback from physicians is potent.

 

Third, look at the growth in the PA profession. I recall the last numbers I saw showing the number of practicing PAs in the US has DOUBLED to ~80000 over the past 10 YEARS. Pretty impressive growth. This is practicing PAs, not just new graduates being produced.

 

The market forces that favor the employment of PAs- cost effective care, reliable job market etc- are strong. So the gloom and doom prophecies for the PA profession don't add up, even if successes of NPs exceed the fears of PAs (and physicians!)....

 

I'm still not sure if I connect the arguments I see here with the need to awarding a degree for residency. MDs after all earn their degree prior to residency. Perhaps a better endpoint to residency would be a loosening of oversight- lesser supervisory requirements etc. EMEDPA I agree that associate will come. I hope you're correct that supervision will change to sponsorship (as we have here in WA for certified PAs)!

[EMEDPA]

there are 4+ jobs for every pa school grad and that # should increase as baby boomers retire(and get sick) but the key is relocating to an area of need. everyone can't work in nyc and chicago....

[EMEDPA]

there are 4+ jobs for every pa school grad and that # should increase as baby boomers retire(and get sick) but the key is relocating to an area of need. everyone can't work in nyc and chicago....

[plener]

not exactly know what pa are taking about about residency--i set up my own rotations as student pa and did them and i encourage others to do the same--remember what i said before you ultimately will be doing psych--learn a lot about it

 

peter

univ oklahoma 1974

[plener]

not exactly know what pa are taking about about residency--i set up my own rotations as student pa and did them and i encourage others to do the same--remember what i said before you ultimately will be doing psych--learn a lot about it

 

peter

univ oklahoma 1974

[Febrifuge]

Peter, do you mean you had the opportunity to set up rotations, to get experience in fields you had interest in, or that you were Required to set up your own rotations? There's a world of difference. Not to mention, I graduated (um, sorry to point this out) 32 years after you did, and it seems rotations are pretty darn standardized across programs now. I did have a six-week Trauma elective, I used my connections from my old job to do my required six weeks in EM someplace great, and I got to choose my eight-week preceptorship (EM again, surprising no one).

 

There were NP students rotating through the hospital where I did Surgery. They were not allowed to approach the operating table. Observing only, they got credit for their program similar to what I was earning for mine, but the experience was miles apart. For those programs requiring an NP student to go out and find a rotation, I sort of have to wonder what value the school is providing - or how well your typical student (of any stripe) is really going to do. Coordinating clinical clerkships is a full-time job... and students need to be pushed harder, and work more, than they probably think they should.

[Febrifuge]

Peter, do you mean you had the opportunity to set up rotations, to get experience in fields you had interest in, or that you were Required to set up your own rotations? There's a world of difference. Not to mention, I graduated (um, sorry to point this out) 32 years after you did, and it seems rotations are pretty darn standardized across programs now. I did have a six-week Trauma elective, I used my connections from my old job to do my required six weeks in EM someplace great, and I got to choose my eight-week preceptorship (EM again, surprising no one).

 

There were NP students rotating through the hospital where I did Surgery. They were not allowed to approach the operating table. Observing only, they got credit for their program similar to what I was earning for mine, but the experience was miles apart. For those programs requiring an NP student to go out and find a rotation, I sort of have to wonder what value the school is providing - or how well your typical student (of any stripe) is really going to do. Coordinating clinical clerkships is a full-time job... and students need to be pushed harder, and work more, than they probably think they should.

[EMEDPA]

only a handful of pa programs in 2012 (maybe 1 or 2 like stanford) require a pa student to arrange their own rotations. I had a lot of flexibility in picking mine but chose from a large list of pre-arranged options to include trauma surg, peds em, em and em electives, inpt psych, etc

[EMEDPA]

only a handful of pa programs in 2012 (maybe 1 or 2 like stanford) require a pa student to arrange their own rotations. I had a lot of flexibility in picking mine but chose from a large list of pre-arranged options to include trauma surg, peds em, em and em electives, inpt psych, etc

[Febrifuge]

Yeah, exactly, me too. Our coordinator hustled like crazy and not every rotation was equally great, but all were decent.

[OrthoSurgeryPA]

Well as stated before by someone here on this forum (andersEnpa I believe), programs will probably lengthen in response to the shift towards admitting applicants that have no/limited HCE. This seems logical in a sense because it will take longer to train a PA from "scratch".

 

So...the question is why do a residency if you were well trained in PA school? There is no substitute for focused training. That is too say that if you attend PA school and are able to get primo rotations at the best institutions/clinics/trauma centers and the like then you may, just may be able to hit the ground running.

 

BUT, this is not guaranteed, we all know that. There is a reason med students do clerkships then internship then residency. What if as a PA-S you only spend 6 weeks at a given rotation site and after a period of adjustment to that area of medicine, you don't see much or have the opportunity to do much? Then you are off to the next rotation site and it all repeats. This is taking in to account that all the while you are still studying, prepping and attending classes as well.

 

So what's wrong with getting more focused training and improving competency and/or proficiency all the while making you more employable? I say if you want to do a fellowship/residency go for it. Just maybe consider contributing to the primary care shortages if that is the mission of your program.

FWIW.

[cinntsp]

not exactly know what pa are taking about about residency

 

http://www.appap.org/

[andersenpa]

Well as stated before by someone here on this forum (andersEnpa I believe), programs will probably lengthen in response to the shift towards admitting applicants that have no/limited HCE. This seems logical in a sense because it will take longer to train a PA from "scratch".

 

So...the question is why do a residency if you were well trained in PA school? There is no substitute for focused training. That is too say that if you attend PA school and are able to get primo rotations at the best institutions/clinics/trauma centers and the like then you may, just may be able to hit the ground running.

 

BUT, this is not guaranteed, we all know that. There is a reason med students do clerkships then internship then residency. What if as a PA-S you only spend 6 weeks at a given rotation site and after a period of adjustment to that area of medicine, you don't see much or have the opportunity to do much? Then you are off to the next rotation site and it all repeats. This is taking in to account that all the while you are still studying, prepping and attending classes as well.

 

So what's wrong with getting more focused training and improving competency and/or proficiency all the while making you more employable? I say if you want to do a fellowship/residency go for it. Just maybe consider contributing to the primary care shortages if that is the mission of your program.

FWIW.

 

Because most specialties are not represented by the mandatory clinical rotations. AND, if you are fortunate to set up an elective rotation (I didn't have the option as a student) you only get 4-6 weeks at most?

 

Residency provides in depth exposure over a prolonged time period (1 yr) which reinforces knowledge that would otherwise be heard/seen once then lost if you are doing a one month elective in Neurosurg or CTS for example.

 

PA school trains the generalist PA. Residency trains the specialist PA.

[OrthoSurgeryPA]

PA school trains the generalist PA. Residency trains the specialist PA.

 

Well stated.

I was fortunate to attend a program that allowed my to do rotations at specialty areas and sub-specialties. Also did Trauma and Orthosurg with FM residents at a Level I Trauma Center. These were all set up by my program.

Did they make me a better generalist PA? Yes, because I understand what is best handled at the primary care level and how and what needs to be referred to a spec (but only after an appropriate w/u).

Maybe a more appropriate question is for whom is a residency beneficial? The answer of course is that everyone would benefit from more extensive, focused training BUT that some may actually need it based on their future practice goals.

I can only imagine how steep the learning curve must be during PA school for a person that "volunteered at a clinic 2 days/week" or has no significant HCE. The first few years of practice must be brutal for some depending on the dynamics of their training curriculum and clinical rotations. Yes we all have a learning curve but again, it only stands to reason that those that have strong prior HCE and the optimal didactic/clinical training as a PA-S are going to be stronger "new grads". We have all seen the job listings that state "will train the right person".

 

Again FWIW.

[kargiver]

Couple of points I want to address here...

 

First, E is probably right. Independent practice will likely not be achieved by PAs during the current career times of those over 40. Is it something that may come in the future? Perhaps. The demographics of the boomers aging, demands on administrative time of physicians and the inevitable conflict that is coming between the docs and the NPs may just let it happen. It will require significant political will and a cadre of leadership that does not currently exist at the national level. Until this changes, we will be LUCKY to get a name change in place in the next 3-5 years.

 

Second, the value of residencies to is to teach those without prior experience before coming to PA school the skill set necessary to perform OTJ. This is applicable across all specialties but is meaningless in the realm of primary care. For example, the average medic with 5 years of SOLID 911 experience has the skill set, sans U/S and central lines, to be dropped into any acute care setting and start taking care of people. Add the primary care training of PA school and you have a solid knowledge base from which to spring into an EM slot. This is not so for the current crop of young 20-somethings right out of college and into PA school. They need a year to garner the necessary skills to work in a specialty environment. In an environment where medical dollars are at a premium, wasting a year to teach a newbie who is going to leave after 7 months is valuable to no one.

 

Also, the average residency trained PA, at best, has 4-4.5 years of post-bac training that is directly applicable to the clinical arena (24-30 months PA program, 1-1.5 years residency - yes, I know there are two year residencies out there...). This is still not enough to warrant the granting of independent practice when one considers that in the medical model, the average doctor (the standard for independent practice) has 4 years of medical school and AT LEAST 3 years of residency training (more likely 4-7) + fellowship. It is still apples and oranges when comparing the professions. Demanding parity as a "buy-in" to doing a residency is farcical on its face.

 

Finally, the reality is that the average student entering PA school is getting younger, experience is less common, and a lot of the outside realities of practicing medicine independent of PA practice have not changed. Litigation continues to be a major problem, PA programs are pumping out, IMHO, a less-polished product compared to even 10 years ago, and the docs are noticing it. Residencies will continue to expand as the market forces dictate it. It would behoove us as a profession to harness this now, standardize it, and put out a superior product. When that happens, you have a chip at the table to play. Otherwise, we DO leave our future in the hands of others and that does not give me a warm and fuzzy feeling...

 

G

[EMEDPA]

Damn, that may be the best post ever written on the pa forum. you should run for some kind of office....