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"A New Type of Physician" --DMS???


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Also the DMS is not geared towards EM, but FM instead. So yes, I am not sure an EM residency would be very valuable. And I have never heard of anybody doing a FM residency... What would you do differently in a FM residency than you would working as one?

My exact sentiments. Why do a primary care residency when there are no major differences in patient outcomes for MD/DO, PA or NP as it is currently? The DMS +3yrs experience in primary care should be adequate to obtain full practice authority in primary care.

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My exact sentiments. Why do a primary care residency when there are no major differences in patient outcomes for MD/DO, PA or NP as it is currently? The DMS +3yrs experience in primary care should be adequate to obtain full practice authority in primary care.

I would totally try to do a 1 yr fellowship to sneak in the back door of EM. Ooh rah, 250 dollars an hr.

 

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If you want to practice full scope FM, a residency is needed. Many see it as just seeing clinic, which it often is in larger cities, but true FM it's OB, inpatient, smaller EM coverage, procedures like endometrial biopsy/colpo/vasectomy/flex Sig. I even know some who will do appendectomy and carpal tunnel surgeries.

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On 6/21/2017 at 10:59 PM, corpsman89 said:

Also the DMS is not geared towards EM, but FM instead. So yes, I am not sure an EM residency would be very valuable. And I have never heard of anybody doing a FM residency... What would you do differently in a FM residency than you would working as one?

A FM residency is 80 hours per week x 3 years so that equals ~ 6 years of working as a FM provider + they have case presentations (which takes lots of time and study) + talking with several other residents/fellows/attending/etc...the list goes on. I am for OPT, but I am sorry to say that working for 3-5 years does not equal a residency (even more if you are solo like I am). That strict training with tons of case presentations/study/time/talking with others is what the difference is, PLUS the crazy hours put in. I will tell you personally that I work about 31-32 hours per week, I have no one to talk to except MAs and CP comes for a few hours a month (he signs stuff and leaves), I do not go home for hours and prepare for a case presentation in the AM or read nightly...just not that same...

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This quote button doesn't work...but I'm quoting Joelseff about being under a separate board for DMS and a new profession.

 

 

I hope it wouldn't lead to creating another profession.  We don't need another medical provider profession.  Let alone an "advanced PA" that would then separate our profession.  Having more independence is awesome, but to limit it to only those who attend LMUs program is not the right way to go about it.  There needs to be additional options beyond just obtaining a $50,000 degree. 

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I hope it wouldn't lead to creating another profession. We don't need another medical provider profession. Let alone an "advanced PA" that would then separate our profession. Having more independence is awesome, but to limit it to only those who attend LMUs program is not the right way to go about it. There needs to be additional options beyond just obtaining a $50,000 degree.

I was just going by what I read from the senate bill. It specifically mentioned a separate/new license and board for DMS's. Like I stated in my post, this might be a way of circumventing the resistance from AMA etc. (though I think there will be AMA resistance to this too)...

 

It is what it is. I'm waiting to see what changes will actually come out of this. I'm being optimistic that this would be a good thing for PAs and would give us an option to advance our scope if that is what it will actually do.

 

I am actually uncertain if I would even do a DMS program since 1)it's only in Tennessee (for now) 2)it would be expensive and take some more school time which I may or may not be willing or able to do and 3) I am kind of not enjoying clinical practice now. Lol. But I think it is still a move forward.

 

Edit: I may have misread the bill and it looks like the board mentioned is the board of ME's who will govern the DMS's so it's still not governed by the PA board. So essentially a different profession...

 

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A FM residency is 80 hours per week x 3 years so that equals ~ 6 years of working as a FM provider + they have case presentations (which takes lots of time and study) + talking with several other residents/fellows/attending/etc...they list goes on. I am for OPT, but I am sorry to say that working for 3-5 years does not equal a residency (even more if you are solo like I am). That strict training with tons of case presentations/study/time/talking with others is what the difference is, PLUS the crazy hours put in. I will tell you personally that I work about 31-32 hours per week, I have no one to talk to except MAs and CP comes for a few hours a month (he signs stuff and leaves), I do not go home for hours and prepare for a case presentation in the AM or read nightly...just not that same...

We are talking about a PA specific residency (1 year).

 

I was just going by what I read from the senate bill. It specifically mentioned a separate/new license and board for DMS's. Like I stated in my post, this might be a way of circumventing the resistance from AMA etc. (though I think there will be AMA resistance to this too)...

 

It is what it is. I'm waiting to see what changes will actually come out of this. I'm being optimistic that this would be a good thing for PAs and would give us an option to advance our scope if that is what it will actually do.

 

I am actually uncertain if I would even do a DMS program since 1)it's only in Tennessee (for now) 2)it would be expensive and take some more school time which I may or may not be willing or able to do and 3) I am kind of not enjoying clinical practice now. Lol. But I think it is still a move forward.

 

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I believe the bill just mentioned they would be licensed under the board of medicine, just like PAs are.

 

I think if something like this were to pass and give PAs even just a little more authority, we would see DMS programs pop up all over the place and similar legislation as well. It would catch fire. That's only if it passes and it actually gives PAs more authority.

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A FM residency is 80 hours per week x 3 years so that equals ~ 6 years of working as a FM provider + they have case presentations (which takes lots of time and study) + talking with several other residents/fellows/attending/etc...they list goes on. I am for OPT, but I am sorry to say that working for 3-5 years does not equal a residency (even more if you are solo like I am). That strict training with tons of case presentations/study/time/talking with others is what the difference is, PLUS the crazy hours put in. I will tell you personally that I work about 31-32 hours per week, I have no one to talk to except MAs and CP comes for a few hours a month (he signs stuff and leaves), I do not go home for hours and prepare for a case presentation in the AM or read nightly...just not that same...

I understand what you're saying. But, working 80hrs or 40hrs a week in a

primary care setting is the same in my opinion. Most of the cases in primary care are repetitive with a few exceptions. Ok, so you work 80hrs a week, in that time you saw 10 patients who need physicals and another provider saw 5 patients needing the same in a 40hr week, is there really a difference in expertise just because you saw 10? You can think of others commonly presenting cases in Primary care. I think quality outweighs quantity any day otherwise we wouldn't have bad doctors and amazing PAs if residency is what counts.

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I understand what you're saying. But, working 80hrs or 40hrs a week in a

primary care setting is the same in my opinion. Most of the cases in primary care are repetitive with a few exceptions. Ok, so you work 80hrs a week, in that time you saw 10 patients who need physicals and another provider saw 5 patients needing the same in a 40hr week, is there really a difference in expertise just because you saw 10? You can think of others commonly presenting cases in Primary care. I think quality outweighs quantity any day otherwise we wouldn't have bad doctors and amazing PAs if residency is what counts.

While I don't think a residency should be required for PC/FP/outpt IM, I am not against doing one. I think a residency for PC should include immersion in inpatient care where you see the worse sequela of what we see in outpt practice. That's where I see the benefit of a residency... Case presentations and noon conference I think is a tiny part of what's involved in a residency but the day to day care of the very sick would be very valuable.

 

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While I don't think a residency should be required for PC/FP/outpt IM, I am not against doing one. I think a residency for PC should include immersion in inpatient care where you see the worse sequela of what we see in outpt practice. That's where I see the benefit of a residency... Case presentations and noon conference I think is a tiny part of what's involved in a residency but the day to day care of the very sick would be very valuable.

 

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Good point Joelseff, I agree :)

 

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While I don't think a residency should be required for PC/FP/outpt IM, I am not against doing one. I think a residency for PC should include immersion in inpatient care where you see the worse sequela of what we see in outpt practice. That's where I see the benefit of a residency... Case presentations and noon conference I think is a tiny part of what's involved in a residency but the day to day care of the very sick would be very valuable.

 

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I agree! This further supports my point. Quality not quantity.

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Some of you guys seem to be rearranging the deck chairs!

 

If DMS is an independent physician that gets paid, repected, and treated like an MD, then I'm OK with the idea.  If it is just a level between a PA and an MD, then I'm not OK.  We DO NOT want a level between PAs and docs!  Right now, we're still talking about DMS being a dependent provider.  Just a fancy PA with a doctorate.  

 

All PAs want greater independence.  We don't want to be forced into a doctoral program to get it, yet still be dependent!

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Some of you guys seem to be rearranging the deck chairs!

 

If DMS is an independent physician that gets paid, repected, and treated like an MD, then I'm OK with the idea. If it is just a level between a PA and an MD, then I'm not OK. We DO NOT want a level between PAs and docs! Right now, we're still talking about DMS being a dependent provider. Just a fancy PA with a doctorate.

 

All PAs want greater independence. We don't want to be forced into a doctoral program to get it, yet still be dependent!

I agree. Then we will be called lower mid levels. Lol.

 

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We are talking about a PA specific residency (1 year).

 

 

I believe the bill just mentioned they would be licensed under the board of medicine, just like PAs are.

 

I think if something like this were to pass and give PAs even just a little more authority, we would see DMS programs pop up all over the place and similar legislation as well. It would catch fire. That's only if it passes and it actually gives PAs more authority.

 Your quote from above: "What would you do differently in a FM residency than you would working as one?" Even if your comparing FM PA residency to working as a PA it is the same, more hours, more structure, more studying, case presentations, etc. There is a lot more difference than you think.   

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We are talking about a PA specific residency (1 year).

 

 

I believe the bill just mentioned they would be licensed under the board of medicine, just like PAs are.

 

I think if something like this were to pass and give PAs even just a little more authority, we would see DMS programs pop up all over the place and similar legislation as well. It would catch fire. That's only if it passes and it actually gives PAs more authority.

While I don't think FM residency is as tough as the other guy (I work in one and they are often home before me), there is a lot to be learned in the off service rotations. Though I think a PA FM residency would have to be 1.5 years like many of the ED residencies because of the breadth of what you do. Case presentations? Meh. I've seen their presentations. I could do it in 30mins to an hour.
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I don't know if anyone has asked this question in this way, but which program would you recommend if you were doing it only for personal vanity and no professional value? My point is, I will be at retirement age by the time I finish and I can't see any professional value (unless it could land me a volunteer position overseas). I have two sons with PhDs and two more children working on doctorates so it would be fun to join them in a terminal degree.

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Some of you guys seem to be rearranging the deck chairs!

 

If DMS is an independent physician that gets paid, repected, and treated like an MD, then I'm OK with the idea. If it is just a level between a PA and an MD, then I'm not OK. We DO NOT want a level between PAs and docs! Right now, we're still talking about DMS being a dependent provider. Just a fancy PA with a doctorate.

 

All PAs want greater independence. We don't want to be forced into a doctoral program to get it, yet still be dependent!

I see your point.

 

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Some of you guys seem to be rearranging the deck chairs!

 

If DMS is an independent physician that gets paid, repected, and treated like an MD, then I'm OK with the idea.  If it is just a level between a PA and an MD, then I'm not OK.  We DO NOT want a level between PAs and docs!  Right now, we're still talking about DMS being a dependent provider.  Just a fancy PA with a doctorate.  

 

All PAs want greater independence.  We don't want to be forced into a doctoral program to get it, yet still be dependent!

I see your point here as well. However, as I said before, if we only wait for something perfect to come down the line, it simply wont happen. This is step forward, not perfect, but a step forward. With this win, gaining full practice authority is that much easier for the legislature to make happen. It makes it that much easier for the public to understand, it softens the blow a bit.

 

Basically, you can't jump straight to the top of the ladder, you have to go rung by rung.

 

BUT, if this doesn't pass, or PAs don't embrace this then when are we going to get on board with a name change? I personally THAT is our biggest hurdle to gaining full practice authority. As trivial as it may sound, it really is one our biggest downfalls.

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I am not sure how I feel about this. Do we really need "a new type of physician"? In my opinion, if you really want to invest your time in further education and gain full autonomy - just go to med school. I am sure most of us aware of LECOM's bridge and there are few 3 year MD programs around the country. Just my two cents.


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2 hours ago, Moonchi said:

I am not sure how I feel about this. Do we really need "a new type of physician"? In my opinion, if you really want to invest your time in further education and gain full autonomy - just go to med school. I am sure most of us aware of LECOM's bridge and there are few 3 year MD programs around the country. Just my two cents.


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Maybe because we may not want or can't stop working to "just go to med school" due to family, age, whatever. Also, would it not discount the education and work we already put in to have to start over? I know med school curriculum is more than PA school but how much more? What do we need to add to our existing knowledge or education to get to the MD/DO stage? At my office I am working at least at the same level as the docs as far as acuity of pts, pt load, etc. They consult me on some things like ortho, GI, HIV etc where I have a little more experience than they do and by the same token, i consult them on things I am not as familiar with.  In my opinion, a true "bridge" program should take these things into account.  Going back to med school should not be the only option unless you are saying PA education is of not much value compared to med school. 

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13 hours ago, Moonchi said:

I am not sure how I feel about this. Do we really need "a new type of physician"? In my opinion, if you really want to invest your time in further education and gain full autonomy - just go to med school. I am sure most of us aware of LECOM's bridge and there are few 3 year MD programs around the country. Just my two cents.


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I think most PAs would agree with you. However, sadly we are facing more and more competition from NPs. They are even beginning to encroach on areas where PAs are the dominant provider (surgery, Ortho, EM, Derm, etc.) In my area, one major hospital system doesn't even hire PAs, only NPs.

The DMS is an unfortunate step that PAs will eventually take to advance our profession to keep up with NPs. They are leaving us behind as far as advancement and we need to think fast in order to keep up. Something like the DMS and a name change will be essential to our survival.

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