Jump to content

Recommended Posts

35 minutes ago, aimyhtixela said:
35 minutes ago, aimyhtixela said:

You're one of the PAs who then decided to go to medical school if I remember correctly. Just purely out of curiosity, if you were not in med school now, would you still disagree?

If I wasn't in med school, I would probably be all for PA independence. After you've gone through both, you realize the difference in knowledge of what you never come close to learning about in PA school. So my PA perspective would be based totally off ignorance and false confidence. This does not even include what I'll be doing in residency. I'm a third year now. 

31 minutes ago, dizzyjon said:

Uhh....literature to back safety issues with NP independent practice?  As a new grad and based on the individual, yes it is unsafe to be 100% on your own.  However, after time in practice and agreement by a collaborative physician (or even one day experienced peer PA) then independence can be completely safe.  We don't want to be physicians.  We want to work to our fullest extent possible.  I think our salary should be at about 80% of a physician salary in certain specialties (like FP) because that is what makes sense to me when we can't bill at 100% in some cases.  They get paid more because of extensive schooling, higher degree, higher reimbursement.  That will always be the case. 

I highly disagree that a pharm tech and a pharmacist do the same thing.  This is completely inaccurate and the complex pharmaceutical knowledge a pharmacist has is above and beyond what a pharm tech has.  You can become a pharm tech without stepping into a classroom in some states. 

1. I hope you're not saying you agree with NP independent literature, which "proves" NP and physician outcomes are the same. These studies are an absolute joke and bias, all part of the nursing propaganda. Anyone who knows anything about biostatistics and how to analyze these studies would agree.  

2. My example of pharm tech and pharmacist came from my own experience, working in retail pharmacy at 4 different locations. In the course of a day, a pharm tech will do >90% of a pharmacist job. I think you'd be shocked if you knew the lack of knowledge a retail pharmacist has in "complex pharmaceutical knowledge" Coming from a guy who is married to a pharmacist and constantly has to hang out with her pharmacist friends. But remember, I made the small example of a retail pharmacist, I'm not talking hospital, clinical, etc etc. Just as we are talking about a PA working in FP. Long story short, I don't feel PA and NP independence is safe for patients. Again, if PAs/NPs want to practice independently, and be paid closer to a physician wage, they should suck it up and go to medical school and residency. This isn't the best place for me to make those comments I realize, but its just my opinion, which in the end doesn't mean anything. 

  • Upvote 1

Share this post


Link to post
Share on other sites
33 minutes ago, Hckyplyr said:

 

Hmm...So, does your wife agree she is no smarter then a pharm tech? Please do ask and report back. I agree there is a big difference between a retail pharmacist and a clinical pharmacist. 

I'm not saying I agree with studies about independent NP practice, but asking you to provide evidence that only a physician is capable of treating patients safely and that an NP or PA is not safe.  Is this fact or opinion?  I have a PA friend in medical school right now.  She would disagree with you.  However, we agree physicians get more indepth education and residency.  

 

Share this post


Link to post
Share on other sites
1 hour ago, Hckyplyr said:

I agree with this post except for "no more doc involvement." This would just be unsafe, as it's unsafe when NPs practice independently.  If you want to be a physician, get paid like a physician and get the benefits of a physician, go to medical school. Plain and simple. But, just like our society, people want to take an easier route but still get the same benefits as others who took a harder route. I read your post about PAs should make physician salaries in primary care because "we do the same thing." Does a pharm tech in retail do the EXACT same job as the pharmacist? Yes, they do. Does that mean they should be paid a pharmacists wage, no it doesn't. I understand the argument you're trying to make, but I certainly don't agree with it. 

That comparison of a pharm tech and a pharmacist is not even the same. Who says you need to be a MD/DO to practice primary care? You could say MD/DOs are "over-trained" for primary care... I have not went to medical school so I can not comment, but I did go to a PA program that was within the school of medicine. We did a lot of the same things plus were in class a heck a lot longer than the MD students...If you compare the education of a PA to MD/DO in classroom hours and rotations, a lot of the school are less than 1 year of difference in time frame. Most PA students are in school 104 weeks where MD/DO are in school about 140-150 weeks...the difference is the residency plus MD/DOs go into more detail in biochem, molecular bio, immunology, etc...not sure if that extra 100 pages of biochem text really makes a difference (I am sure most people could not figure a way to find this answer out). I practice solo and have great outcomes, it was and is still a learning curve, but I know if you put me up to any primary care doctor my numbers and stats will be excellent...we will find all this out with the MIPS and PQRS measures. 

  • Upvote 1

Share this post


Link to post
Share on other sites
53 minutes ago, Hckyplyr said:

 

I do not want to go to medical school cause I do not think I need 9 months more of specialty rotations in peds neurosurg or plastic surgery...I am speaking for primary care providers only, we should be supervised for several years then pass a FM boards to become independent...I truly think MD/DOs are over-trained in primary care...Look at https://www.ttuhsc.edu/som/fammed/fmat/documents/FMAT_FactSheetJan2015.pdf

Read under How is the FMAT curriculum different and it will answer my above post about duration of medical school ~160 weeks for the regular 4 year program and 149 weeks for FMAT. All I am saying is the residency is what sets MD/DOs WAY apart from PAs and I respect that....but it is really necessary for primary care...? There has to be a reason why texas tech is doing this program and others...

P.S. I chose not to go to medical school cause of the time that I did not want to spend in school and away from my family (I know I can get into medical school cause the admissions committee is mostly the same to the MD/PA programs, the ONLY difference was not releasing my MCAT score as I chose to go to PA school.) After the buy out of the practice, after the 1st year I will make more than most FM docs in the midwest without my MD/DO degree...plus working 35 hours a week and every weekend off...

  • Upvote 1

Share this post


Link to post
Share on other sites
2 hours ago, dizzyjon said:

Hmm...So, does your wife agree she is no smarter then a pharm tech? Please do ask and report back. I agree there is a big difference between a retail pharmacist and a clinical pharmacist. 

I'm not saying I agree with studies about independent NP practice, but asking you to provide evidence that only a physician is capable of treating patients safely and that an NP or PA is not safe.  Is this fact or opinion?  I have a PA friend in medical school right now.  She would disagree with you.  However, we agree physicians get more indepth education and residency.  

 

You've missed my entire point. Which is, just because a retail pharm tech can perform >90% of a pharmacists job DOES NOT mean they have the same breadth of knowledge, education and experience, nor does it give them the right to the same/close to the same salary as a pharmacist. Now replace the words pharm tech with PA, and pharmacist with physician.

 

2 hours ago, camoman1234 said:

That comparison of a pharm tech and a pharmacist is not even the same. Who says you need to be a MD/DO to practice primary care? You could say MD/DOs are "over-trained" for primary care... I have not went to medical school so I can not comment, but I did go to a PA program that was within the school of medicine. We did a lot of the same things plus were in class a heck a lot longer than the MD students...If you compare the education of a PA to MD/DO in classroom hours and rotations, a lot of the school are less than 1 year of difference in time frame. Most PA students are in school 104 weeks where MD/DO are in school about 140-150 weeks...the difference is the residency plus MD/DOs go into more detail in biochem, molecular bio, immunology, etc...not sure if that extra 100 pages of biochem text really makes a difference (I am sure most people could not figure a way to find this answer out). I practice solo and have great outcomes, it was and is still a learning curve, but I know if you put me up to any primary care doctor my numbers and stats will be excellent...we will find all this out with the MIPS and PQRS measures. 

Over trained? As opposed to what, adequately-trained, under-trained? I'll take over-trained all day long. Although I disagree they are over-trained. Because your PA school "did a lot of the same things" and "were in class a lot longer" means absolutely nothing. I'm not trying to be harsh, I think if you experienced med school, you would understand what I'm talking about, and would never try to make comparisons between the two. 

1 hour ago, camoman1234 said:

I do not want to go to medical school cause I do not think I need 9 months more of specialty rotations in peds neurosurg or plastic surgery...I am speaking for primary care providers only, we should be supervised for several years then pass a FM boards to become independent...I truly think MD/DOs are over-trained in primary care...Look at https://www.ttuhsc.edu/som/fammed/fmat/documents/FMAT_FactSheetJan2015.pdf

Read under How is the FMAT curriculum different and it will answer my above post about duration of medical school ~160 weeks for the regular 4 year program and 149 weeks for FMAT. All I am saying is the residency is what sets MD/DOs WAY apart from PAs and I respect that....but it is really necessary for primary care...? There has to be a reason why texas tech is doing this program and others...

P.S. I chose not to go to medical school cause of the time that I did not want to spend in school and away from my family (I know I can get into medical school cause the admissions committee is mostly the same to the MD/PA programs, the ONLY difference was not releasing my MCAT score as I chose to go to PA school.) After the buy out of the practice, after the 1st year I will make more than most FM docs in the midwest without my MD/DO degree...plus working 35 hours a week and every weekend off...

These 3 year FM track schools have been around for awhile. You do realize you have to complete a residency afterwards, right? YES, I absolutely think a residency is required for FM. Someone is NOT prepared to practice medicine after graduating med school.  If you want to take a FM boards, you should also have to take and pass the exact same tests we do, which includes (USMLE/COMLEX) Step 1, Step 2, Step 3 CK, Step 3 CS and all 10 national shelf exams to even graduate med school, then the residency boards. There should be one standard alone to be eligible, go to medical school. Why are we even debating or considering an easier route to an equal outcome? You seem to think I'm saying PAs aren't smart or competitive applicants for med school, as you felt the need to include your detailed history. I'm not saying that at all.

  • Upvote 2

Share this post


Link to post
Share on other sites

I don't think we are physicians or ever will be and comparing educations has always been a "play with the numbers" game. That said the one thing that interests me is your contention that PAs and NPs aren't safe to practice without supervision. I have been listening to physicians scream "people are gonna die" here in Texas for 20 years each time our scope grew grew a bit and , of course, it never happened.

You mentioned studies. Where are the "unsafe" studies? We are, theoretically, scientists so where is the well written peer reviewed unbiased studies showing "unsafe" or even "worse outcomes"? There aren't any. I know because each time I testified in committee I advised that the physicians were going to claim safety issues and I asked the legislators to ask for measurable proof. They did and I think we all know the out come. Further as long as NPs have had independent practice bodies should be stacking up like cord wood. At the least there should be metastudies showing how poor outcomes are comparatively. 

Lastly referring to someone else's ignorance as part of your argument? Cumon.... I have learned over the years that when some either has to quote their credentials before they start or demean someone else then it means the argument doesn't stand on its own. Yes I know the definition... and the way you said it wasn't the "you can't know what you don't know" style. It was more the "I'm smarter than you" style.

  • Upvote 7

Share this post


Link to post
Share on other sites

By the hckyplyr logic, only cardiologists should treat hypertension, only urologists should treat pyelo, only GYN should treat irregular menses, only endocrinologists should treat diabetes, only ENT should treat sore throats and ear infections, and anyone outside a specialist should be supervised because they do not have the same level of training. The FM docs practicing EM in rural areas, what about them? FM practicing as inpatient hospitalists when IM has much more inpatient time? How about the more advance things that FM and IM does? Should they be doing vasectomies? Should FM be doing c-sections since they don't have nearly as much experience as an OB? They have way less experience doing scopes than a GI doc, should they be doing scopes? Should GI docs even do them because they have to call surgery to manage a perforation? There's no evidence to support this (the opposite as FM often has better outcomes than specialists), just like there is no evidence about poor outcomes with PAs. I won't say they are over trained, because I'm always trying to further my training and learn, doing a residency myself, but imposing unnecessary restrictions based on no evidence will lead to increase cost and poor medicine.

  • Upvote 7

Share this post


Link to post
Share on other sites
10 hours ago, Hckyplyr said:

You've missed my entire point. Which is, just because a retail pharm tech can perform >90% of a pharmacists job DOES NOT mean they have the same breadth of knowledge, education and experience, nor does it give them the right to the same/close to the same salary as a pharmacist. Now replace the words pharm tech with PA, and pharmacist with physician.

 

Over trained? As opposed to what, adequately-trained, under-trained? I'll take over-trained all day long. Although I disagree they are over-trained. Because your PA school "did a lot of the same things" and "were in class a lot longer" means absolutely nothing. I'm not trying to be harsh, I think if you experienced med school, you would understand what I'm talking about, and would never try to make comparisons between the two. 

These 3 year FM track schools have been around for awhile. You do realize you have to complete a residency afterwards, right? YES, I absolutely think a residency is required for FM. Someone is NOT prepared to practice medicine after graduating med school.  If you want to take a FM boards, you should also have to take and pass the exact same tests we do, which includes (USMLE/COMLEX) Step 1, Step 2, Step 3 CK, Step 3 CS and all 10 national shelf exams to even graduate med school, then the residency boards. There should be one standard alone to be eligible, go to medical school. Why are we even debating or considering an easier route to an equal outcome? You seem to think I'm saying PAs aren't smart or competitive applicants for med school, as you felt the need to include your detailed history. I'm not saying that at all.

I chose to give you my history because you are telling us to go to medical school to do the exact same job. Re-read my comment, I do understand about the residency..."All I am saying is the residency is what sets MD/DOs WAY apart from PAs and I respect that." Also, you may take the over-trained all day long, but what is the point...? More money, time, resources wasted, not enough provider, etc...All I am saying is I do the exact same job as my CP and he comes in twice a month (1/2 day) to sign charts...I am just looking at the real world and not how many test I have taken...I have not studied the Step 1, but I have Step 2, Step 3 CK and CS for studying exams in school and my boards...I would be more than happy to take those exams, but what is the point? I am not here to argue the point as I have not been through medical school nor have zero desire to waste more of my life in school for the exact same job I am doing now (family medicine). I am fine if my roofer or plumber has a masters degree, but I am sure my brother with a associates does the exact same work...Good luck in medical school and please let us know how different practice is (if you are in primary care).

  • Upvote 2

Share this post


Link to post
Share on other sites
3 hours ago, LT_Oneal_PAC said:

By the hckyplyr logic, only cardiologists should treat hypertension, only urologists should treat pyelo, only GYN should treat irregular menses, only endocrinologists should treat diabetes, only ENT should treat sore throats and ear infections, and anyone outside a specialist should be supervised because they do not have the same level of training. The FM docs practicing EM in rural areas, what about them? FM practicing as inpatient hospitalists when IM has much more inpatient time? How about the more advance things that FM and IM does? Should they be doing vasectomies? Should FM be doing c-sections since they don't have nearly as much experience as an OB? They have way less experience doing scopes than a GI doc, should they be doing scopes? Should GI docs even do them because they have to call surgery to manage a perforation? There's no evidence to support this (the opposite as FM often has better outcomes than specialists), just like there is no evidence about poor outcomes with PAs. I won't say they are over trained, because I'm always trying to further my training and learn, doing a residency myself, but imposing unnecessary restrictions based on no evidence will lead to increase cost and poor medicine.

I agree 100%, but I would say it is over-training to do the same job...I am all about furthering education as well, but where does it stop? I think a FM PA with 5 years experience can function fully without someone looking over their shoulder...I trained with a FM that did a 3 year FM residency and functioned as a OB/GYN doing colposcopies and endometrial biopies, womens health, IUDs, vaginal deliveries and C-sections at the local hospital. He did not have a OB residency, but did very well. 

Share this post


Link to post
Share on other sites

"If you want to be a doctor, go to medical school"

This sounds like an easy solution; logical, concise, to the point.  What this statement does not address is the reality that "getting in" is an impossibility for most PAs that have decided that choosing the PA profession, or wishing to practice at their fullest capabilities with the most autonomy, was wrong for them.  Most PAs (myself included) that have thought about going to medical school have quite an uphill battle as we have been practicing in the field for 5+ years before coming to this conclusion (me 13).  In order to be accepted, we must have up to date science prerequisites, 5+ years is too long, so basically all science courses would have to be retaken.  Right there we are looking at 1-2 years of more undergraduate school at 15 hours + per semester.  Then, we have the dreaded MCAT.  6 months of study with review course?  Take the review simultaneously with your full load of classes you must retake? Then the application...enrolment only once per year.  An individual in this position could very easily take 3-4 years before even starting med school year 1.  Don't forget to mention loss of salary for these 10-12 years, time spent away from family, the actual cost of more undergrad and medical school.  

When LCOM started, I was enthused, but couldn't fathom uprooting my family to the east.  They really (bridge programs) have not gained traction, as the idea has not spread across the US.  Further, I don't feel that this model is the optimal layout for a bridge program. (We should at very least be allotted one full year of advanced standing for our clinical clerkships in PA school).

At the end of the day, I would still like to see the physician (MD/DO/DMS(?)) be the terminal degree for PAs.  I would love to live in a world where new grads of PA school, or those that wished to continue to work as they are, dependently, continue to do so.  But physicians at large will not allow for us to have advanced standing, and if we do not stay on par with NP's, we will soon be (maybe already are as seen by some) inferior, second class "mid-level" providers.  So, we push on, we continue to evolve OTP, we come up with a viable, standardized terminal doctoral level degree; and maybe one day we will regain our footing and be on par with NP's.  Even more, if we play our cards right, we may develop a system and reputation in which we are looked at by physicians as colleagues instead of subservient allied health professionals [insert only light sarcasm].

 

  • Upvote 3

Share this post


Link to post
Share on other sites
25 minutes ago, camoman1234 said:

I agree 100%, but I would say it is over-training to do the same job...I am all about furthering education as well, but where does it stop? I think a FM PA with 5 years experience can function fully without someone looking over their shoulder...I trained with a FM that did a 3 year FM residency and functioned as a OB/GYN doing colposcopies and endometrial biopies, womens health, IUDs, vaginal deliveries and C-sections at the local hospital. He did not have a OB residency, but did very well. 

I suppose my point is that we are all training everyday. Everyday we read, learn from each patient experience, do CME, take a class or go to a conference, learn from our consults. None of us are perfect, including residency trained physicians, and won't be when we retire. Everyday is about being better than before. just like physicians, PAs who aren't trying to be better everyday will get in trouble.

to further erode the pharmacy tech vs the pharmacist argument, that is a poor analogy. The level of knowledge separating a pharm tech and a pharmacist is a far greater gap than a PA and a physician. The more like between the GP of the old days and residency trained docs of today.

  • Upvote 5

Share this post


Link to post
Share on other sites
16 hours ago, Hckyplyr said:

 

You graduated PA school in 2013 and you're now a third year medical school student. So you hardly spent two years being a PA before jumping ship. How do you know that in ~3-5 years (if you were in primary care) that you would not have reached the same knowledge and skill base as docs do (assuming of course that you studied diligently the whole time)? Why does it sound like your disagreement with PA independence is coming from you feeling like you made a mistake going to PA school so you need justification for doing the MD/DO route?

Anyway, the best of luck to you. I sure hope your Step 1 knowledge will make you a better doc in residency. 

  • Upvote 10

Share this post


Link to post
Share on other sites

One of the nicest docs I ever worked for told me he thought there was an "Arrogance 101" course somewhere in med school and some went on to the graduate program.

At this late stage of my career I guess it shouldn't surprise me but it still does when a  physician feels like he/she has to elevate themselves by belittling someone else. If you have superior knowledge and skills and have a little confidence to go with it what would the purpose be in talking down to someone?

  • Upvote 6

Share this post


Link to post
Share on other sites
12 hours ago, sas5814 said:

That said the one thing that interests me is your contention that PAs and NPs aren't safe to practice without supervision.

You mentioned studies. Where are the "unsafe" studies? 

Lastly referring to someone else's ignorance as part of your argument? 

1. I won't get started with my contention about NPs, but it has everything to do with their prereqs to get into school, curriculum in school, clinical hours, practice autonomy, lack of recert, etc. I don't think PAs have enough education training, and clinical training (form of residency) to practice independently. Years of experience isn't a good answer, because new-PAs are just dangerous, at what point with additional experience do you say, "Ok, its safe for this PA to no longer be supervised because they've practiced for X years?" There needs to be a standard, which is medical school testing, boards, residency, more boards, board certification, etc. The PANCE is not a standard of competency, as almost all PAs pass it, but it doesn't make them competent to practice alone.

2. The only study I mentioned was the NP studies which tries to prove NP and physician patient outcome is equal. I don't think I need a study to prove physician patient outcome is superior to an NP, you shouldn't either. 

3. I referred to my own ignorance, no one else's. 

 

11 hours ago, camoman1234 said:

I chose to give you my history because you are telling us to go to medical school to do the exact same job. Re-read my comment, I do understand about the residency..."All I am saying is the residency is what sets MD/DOs WAY apart from PAs and I respect that." Also, you may take the over-trained all day long, but what is the point...? More money, time, resources wasted, not enough provider, etc...All I am saying is I do the exact same job as my CP and he comes in twice a month (1/2 day) to sign charts...I am just looking at the real world and not how many test I have taken...I have not studied the Step 1, but I have Step 2, Step 3 CK and CS for studying exams in school and my boards...I would be more than happy to take those exams, but what is the point? I am not here to argue the point as I have not been through medical school nor have zero desire to waste more of my life in school for the exact same job I am doing now (family medicine). I am fine if my roofer or plumber has a masters degree, but I am sure my brother with a associates does the exact same work...Good luck in medical school and please let us know how different practice is (if you are in primary care).

Seemingly, you're trying to make the argument that a physician training is not needed for family practice, and that PA alone is sufficient? Its funny, I've seen multiple comments on this board, coming from PAs that usually say something like "the extra biochem, genetics, immuno, (insert random subject here" is not necessary in the real world. Its amusing that you think PA school is enough and anything learned beyond PA school is just extraneous and irrelevant to medicine. There's some serious denial here. 

8 hours ago, wdtpac said:

 

When LCOM started, I was enthused, but couldn't fathom uprooting my family to the east.  They really (bridge programs) have not gained traction, as the idea has not spread across the US.  Further, I don't feel that this model is the optimal layout for a bridge program. (We should at very least be allotted one full year of advanced standing for our clinical clerkships in PA school).

 

 

I agree. The first two non-clinical years of school are the most essential for sure. Although you need the rotations and shelf exams to sit for Step 2. Otherwise you would be applying to residency with a Step 1 and 3, and residency programs will have a conniption because you're missing Step 2, which puts you at a huge disadvantage. Why accept a bridge student missing an essential board exam when there are tons of applicants with stellar scores, which includes their step 2 score, which demonstrates their competency. They can't just assume a PA knows it all. So long story short, you need to go through those clinical years (and shelf exams) and take Step 2.

7 hours ago, aimyhtixela said:

 Why does it sound like your disagreement with PA independence is coming from you feeling like you made a mistake going to PA school so you need justification for doing the MD/DO route?

Anyway, the best of luck to you. I sure hope your Step 1 knowledge will make you a better doc in residency. 

1. My disagreement with PA and NP independence stems from feeling a bit bitter than they want the same practice rights, compensation and benefits without having to endure the same course to get there. Not to mention my feelings on inferior education and training. The argument of "I do the same job as the doc" by no means makes you on par with knowledge and clinical outcomes.

2. I'm certain all of my steps, board certifications and residency will make me a better provider. 

 

  • Upvote 1
  • Downvote 1

Share this post


Link to post
Share on other sites

By the way, are you all saying that PAs should have independent practice rights in family practice alone, or in other areas as well?

Share this post


Link to post
Share on other sites
17 hours ago, Hckyplyr said:

By the way, are you all saying that PAs should have independent practice rights in family practice alone, or in other areas as well?

How long did you practice as a PA and in what specialty? 

  • Upvote 1

Share this post


Link to post
Share on other sites

I think it is fair to say that the expert in any field is a residency trained and boarded physician in that field.

however, I will contend that a physician acting outside their training (fp doing derm, em, gi, etc) may not be better than a pa who has done only that specialty. I know I run circles around some, but not all FP physicians working in the ER. the guys who work in clinic 5 days/week and do 1-2 shifts/month are not as good/capable/comfortable in the ER as I am after doing nothing but em for 30 years, 21 as a pa. To their credit, most of them are aware of this and ask me to run the codes, manage the airways, etc that happen at shift change.

bottom line: I would take an experienced specialty pa over a non-specialty physician working outside their area of expertise most of the time. the exceptions are folks who have become defacto specialty physicians by dedicating themselves to that new field. the fp doc who has only ever worked in a rural ER for 10+ years is an ER doc as far as I am concerned.

  • Upvote 4

Share this post


Link to post
Share on other sites
12 hours ago, Hckyplyr said:

1. I won't get started with my contention about NPs, but it has everything to do with their prereqs to get into school, curriculum in school, clinical hours, practice autonomy, lack of recert, etc. I don't think PAs have enough education training, and clinical training (form of residency) to practice independently. Years of experience isn't a good answer, because new-PAs are just dangerous, at what point with additional experience do you say, "Ok, its safe for this PA to no longer be supervised because they've practiced for X years?" There needs to be a standard, which is medical school testing, boards, residency, more boards, board certification, etc. The PANCE is not a standard of competency, as almost all PAs pass it, but it doesn't make them competent to practice alone.

2. The only study I mentioned was the NP studies which tries to prove NP and physician patient outcome is equal. I don't think I need a study to prove physician patient outcome is superior to an NP, you shouldn't either. 

3. I referred to my own ignorance, no one else's. 

 

Seemingly, you're trying to make the argument that a physician training is not needed for family practice, and that PA alone is sufficient? Its funny, I've seen multiple comments on this board, coming from PAs that usually say something like "the extra biochem, genetics, immuno, (insert random subject here" is not necessary in the real world. Its amusing that you think PA school is enough and anything learned beyond PA school is just extraneous and irrelevant to medicine. There's some serious denial here. 

I agree. The first two non-clinical years of school are the most essential for sure. Although you need the rotations and shelf exams to sit for Step 2. Otherwise you would be applying to residency with a Step 1 and 3, and residency programs will have a conniption because you're missing Step 2, which puts you at a huge disadvantage. Why accept a bridge student missing an essential board exam when there are tons of applicants with stellar scores, which includes their step 2 score, which demonstrates their competency. They can't just assume a PA knows it all. So long story short, you need to go through those clinical years (and shelf exams) and take Step 2.

1. My disagreement with PA and NP independence stems from feeling a bit bitter than they want the same practice rights, compensation and benefits without having to endure the same course to get there. Not to mention my feelings on inferior education and training. The argument of "I do the same job as the doc" by no means makes you on par with knowledge and clinical outcomes.

2. I'm certain all of my steps, board certifications and residency will make me a better provider. 

 

1.1To your first point, isn't that all residency is, supervision for a period of time? You don't have to be board certified to practice. I've known some physicians practicing who could NOT pass their specialty board. Heck, there are still people who after finishing a transitional year and couldn't match, out there practicing at little po-dunk ERs, with all the rights and privileges afforded to a full fledged physician. Are you irritated they got an easy way out? Are you irritated at the people that got into Howard With a lesser GPA and MCAT than you? They got it easier. Are you mad at FPs that do OB without and OB fellowship? Are you mad at people who went to the Caribbean? Should the people who skated in Med school and go to a poor residency not have the same rights and pay as you?

1.2 There are a lot of things we didn't think we needed to study in medicine. We didn't study packing or antibiotics in I&D for decades, because duh. Then we did and guess what, packing and antibiotics most often isn't needed.

all those science courses you mentioned aren't just debunked by PAs, but physician's as well. If it is important to clinical practice, why isn't it mandated that all practicing medicine be retested on it at some point, who have CME dedicated solely to advancements in biochemistry. You know the answer. It isn't relevant.

2.1 me personally, I don't want your money. I make plenty as it is. Keep it. I don't want to say I'm more or equally educated than a residency trained physician. What I want is to say, here is what I've been trained to do, and I should be able to do it without arbitrary rules binding me. I did a vasectomy the other day. That patient gets a hematoma or site infection, how is chart review at the end of the month (in particular for me it may not even be reviewed by a physician or at all because in the military we all only have 10 charts reviewed per month and Physicians/PAs/NPs randomly review each other without regard to educational level, I agree with this model because everyone should be reviewed for best practice not just PAs) going to help that patient? 

Point is, I should have a scope of practice (the breadth of which we can debate) that solely belongs to me and done without any outside approval from another profession. Floor nurses have that, why shouldn't we?

2.2 I'm sure residency will make you better. I'm sure a residency would make anyone better, though maybe not to the same degree with a new grad vs. experienced provider. Let's be clear though, step does not make you better. The step exam is a motivator for you to study, which if you had done anyway would made you equally better with or without the exam. If you feel it's only about showing a level of competency and not about the learning, how do you feel about PAs challenging the test? I imagine you think one should have to go to Med school. We come to my final point. It's not about how good someone is, how hard they work, how much experience they have. For you, it's about "It was done to me this way, so you should to." The same mentality that leds to hazing in the military and poor treatment of interns that causes them to jump off the hospital roof.

  • Upvote 8

Share this post


Link to post
Share on other sites
14 hours ago, Hckyplyr said:

1. I won't get started with my contention about NPs, but it has everything to do with their prereqs to get into school, curriculum in school, clinical hours, practice autonomy, lack of recert, etc. I don't think PAs have enough education training, and clinical training (form of residency) to practice independently. Years of experience isn't a good answer, because new-PAs are just dangerous, at what point with additional experience do you say, "Ok, its safe for this PA to no longer be supervised because they've practiced for X years?" There needs to be a standard, which is medical school testing, boards, residency, more boards, board certification, etc. The PANCE is not a standard of competency, as almost all PAs pass it, but it doesn't make them competent to practice alone.

2. The only study I mentioned was the NP studies which tries to prove NP and physician patient outcome is equal. I don't think I need a study to prove physician patient outcome is superior to an NP, you shouldn't either. 

3. I referred to my own ignorance, no one else's. 

 

Seemingly, you're trying to make the argument that a physician training is not needed for family practice, and that PA alone is sufficient? Its funny, I've seen multiple comments on this board, coming from PAs that usually say something like "the extra biochem, genetics, immuno, (insert random subject here" is not necessary in the real world. Its amusing that you think PA school is enough and anything learned beyond PA school is just extraneous and irrelevant to medicine. There's some serious denial here. 

I agree. The first two non-clinical years of school are the most essential for sure. Although you need the rotations and shelf exams to sit for Step 2. Otherwise you would be applying to residency with a Step 1 and 3, and residency programs will have a conniption because you're missing Step 2, which puts you at a huge disadvantage. Why accept a bridge student missing an essential board exam when there are tons of applicants with stellar scores, which includes their step 2 score, which demonstrates their competency. They can't just assume a PA knows it all. So long story short, you need to go through those clinical years (and shelf exams) and take Step 2.

1. My disagreement with PA and NP independence stems from feeling a bit bitter than they want the same practice rights, compensation and benefits without having to endure the same course to get there. Not to mention my feelings on inferior education and training. The argument of "I do the same job as the doc" by no means makes you on par with knowledge and clinical outcomes.

2. I'm certain all of my steps, board certifications and residency will make me a better provider. 

 

Studies show the safe outcomes...enough said...

Share this post


Link to post
Share on other sites

  You're right everyone. Hell, I don't even know why medical school exists, because anything not taught in PA school is useless and a waste of time. Who would know better than the PAs here,  who never went to medical school and saw the difference for themselves. They should definitely close all med schools, and just give independent practice rights to PAs and NPs to handle everything, the "studies" prove that its safe after all. I think its crazy that a physician who went through a more grueling education, boards and residency could even think they would be a better provider. Those physicians are so delusional. 

  Its pointless for me to continue to debate and respond to some of these asinine statements, I'm comforted in knowing that no matter how much you think you deserve the same practice rights and benefits, it just ain't gunna happen. Even if it did happen for some crazy reason, patients would still choose to see the physician 9/10 times. I always said that when I'm a physician I'd hire a PA any day over a NP, because I'm one myself and I know what we have to go through compared to NP school, but after this thread and seeing how many are in complete denial and can't even admit a residency trained physician is a superior clinician (in most cases, because this board has some great PAs), I'm really reconsidering that thought. 

Share this post


Link to post
Share on other sites
17 hours ago, Hckyplyr said:

1. My disagreement with PA and NP independence stems from feeling a bit bitter than they want the same practice rights, compensation and benefits without having to endure the same course to get there. Not to mention my feelings on inferior education and training. The argument of "I do the same job as the doc" by no means makes you on par with knowledge and clinical outcomes.

So you regret going to PA school because of inferior education and training. I'm sorry that your PA school education was that inadequate. PA programs aren't perfect and you should have known that there is still a lot to be learned after the program. If you feel so strongly about the shortcomings of your institution then reach out to your program and help out. But you probably think you're better than that.

Where are these clinical outcomes you speak of that show APPs are not on par with docs?

One of the pathways in early stages of conception right now for possible PA independence is LMU's DMS program. That's one or two years of didactic and a year of clinical rotations in PA school, three years of experience in FM/IM/EM as a pre-req to enter the program, followed by two years of core science and medical modules plus a clinical residency. Is that enough education for you? Probably not, because you keep boasting the value of all the tests you have to "endure."

Quote

2. I'm certain all of my steps, board certifications and residency will make me a better provider. 

Give me a break. We all know that med students forget most of what was in Step 1 by the time they have to take Step 2. The Step series is meant to put a number on your application so residencies can compare you against other applicants. Another time it will probably come up is if you were getting pimped. Do you seriously believe that eight-hour exams make better providers? 

A year or so as a practicing PA and a few years as a medical student and now all of a sudden you are an expert. Your posts exude so much arrogance that for a second there I thought I was on the wrong forum. Have you heard of SDN?

  • Upvote 2

Share this post


Link to post
Share on other sites

Hckyplyr,

I'm not sure there is an argument that a new graduate PA is on par or superior to a residency trained physician in FP; you will get no argument from me.  I will however, contest a seasoned PA reaches that point with experience and time.  My first 6 years in practice I worked 40+ per week in a clinic setting, 4-5 inpatient, and 15-30 moonlighting in the ER (not fast track).  During that time, my learning curve was about as steep as one could imagine, and I remained dedicated to the mantra of life long learning and self education.  So, do I think my clinic skill set is equal to a family practice physician after 13 years?  You better believe it, and so do the 2 physicians that I employ at my clinics (yes I am the owner, 4 RHC's) as well as the other physicians that work with me in our communities.  The real problem that exists in my opinion, is the path for a PA to achieve that level of competence is not standardized and that is something we as a profession need to focus on for the next 10 years.  What the answer is to that, I do not know.  A formalized residency program just for PAs that awards a doctoral degree? Bridge program that truly gives credit for previous educational experience?  Build OTP through the states that allows a path, at the practice level, to which one is practicing autonomously?????

Not that your opinions are not valued here, they are, and you make some good points.  I just feel that given your situation and current station, the majority are truly biased for the most part.

  • Upvote 2

Share this post


Link to post
Share on other sites
15 hours ago, dizzyjon said:

How long did you practice as a PA and in what specialty? How did your employment end? 

How long have you been a physician?.....oh wait....you aren't 

Just trying to vet you as a reputable source on PA and Physician practice. 

Not sure if I'm just reading this wrong, but how about we have some personal/professional respect here.  Hockey is a PA, and in med school.  

2 hours ago, camoman1234 said:

Studies show the safe outcomes...enough said...

The studies suck.  Enough said.

56 minutes ago, Hckyplyr said:

  You're right everyone. Hell, I don't even know why medical school exists, because anything not taught in PA school is useless and a waste of time. Who would know better than the PAs here,  who never went to medical school and saw the difference for themselves. They should definitely close all med schools, and just give independent practice rights to PAs and NPs to handle everything, the "studies" prove that its safe after all. I think its crazy that a physician who went through a more grueling education, boards and residency could even think they would be a better provider. Those physicians are so delusional. 

  Its pointless for me to continue to debate and respond to some of these asinine statements, I'm comforted in knowing that no matter how much you think you deserve the same practice rights and benefits, it just ain't gunna happen. Even if it did happen for some crazy reason, patients would still choose to see the physician 9/10 times. I always said that when I'm a physician I'd hire a PA any day over a NP, because I'm one myself and I know what we have to go through compared to NP school, but after this thread and seeing how many are in complete denial and can't even admit a residency trained physician is a superior clinician (in most cases, because this board has some great PAs), I'm really reconsidering that thought. 

Hcky - you're on a PA board which comes with its inherent bias'.  I think I read something the other day that the majority of PAs don't agree with independent practice, but can't remember where I read that.  

When you're the doc, hire the PA over the NP.  You know the training is much, much better.

That being said, there are a lot of good arguments made here for expanded scope of practice/reduction of stupid bureaucratic hurdles for PA practice.  

16 minutes ago, aimyhtixela said:

So you regret going to PA school because of inferior education and training. I'm sorry that your PA school education was that inadequate. PA programs aren't perfect and you should have known that there is still a lot to be learned after the program. If you feel so strongly about the shortcomings of your institution then reach out to your program and help out. But you probably think you're better than that.

Where are these clinical outcomes you speak of that show APPs are not on par with docs?

One of the pathways in early stages of conception right now for possible PA independence is LMU's DMS program. That's one or two years of didactic and a year of clinical rotations in PA school, three years of experience in FM/IM/EM as a pre-req to enter the program, followed by two years of core science and medical modules plus a clinical residency. Is that enough education for you? Probably not, because you keep boasting the value of all the tests you have to "endure."

Give me a break. We all know that med students forget most of what was in Step 1 by the time they have to take Step 2. The Step series is meant to put a number on your application so residencies can compare you against other applicants. Do you seriously believe that eight-hour exams make better providers? 

A year or so as a practicing PA and a few years as a medical student and now all of a sudden you are an expert. Your posts exude so much arrogance that for a second there I thought I was on the wrong forum. Have you heard of SDN?

How about some personal and professional respect for a fellow PA, especially one who is med school.  Your attitude toward him is demeaning and (should be) unacceptable on these boards.

13 minutes ago, wdtpac said:

Hckyplyr,

I'm not sure there is an argument that a new graduate PA is on par or superior to a residency trained physician in FP; you will get no argument from me.  I will however, contest a seasoned PA reaches that point with experience and time.  My first 6 years in practice I worked 40+ per week in a clinic setting, 4-5 inpatient, and 15-30 moonlighting in the ER (not fast track).  During that time, my learning curve was about as steep as one could imagine, and I remained dedicated to the mantra of life long learning and self education.  So, do I think my clinic skill set is equal to a family practice physician after 13 years?  You better believe it, and so do the 2 physicians that I employ at my clinics (yes I am the owner, 4 RHC's) as well as the other physicians that work with me in our communities.  The real problem that exists in my opinion, is the path for a PA to achieve that level of competence is not standardized and that is something we as a profession need to focus on for the next 10 years.  What the answer is to that, I do not know.  A formalized residency program just for PAs that awards a doctoral degree? Bridge program that truly gives credit for previous educational experience?  Build OTP through the states that allows a path, at the practice level, to which one is practicing autonomously?????

Not that your opinions are not valued here, they are, and you make some good points.  I just feel that given your situation and current station, the majority are truly biased for the most part.

We are all biased, including the posters who ridicule those of us who are against independent practice.

Hcky - I agree with you.  Want to be a nurse?  Go to nursing school.  Want to be a PA?  Go to PA school.  Want to have a license to practice medicine independently?  Go to medical school. 

We all knew what a PA was when we submitted our program applications.  While I agree we need to remove unnecessary regulatory burdens, I think EVERY patient deserves to have a BC physician somehow involved in their care ("involved in their care" could include knowing they were seen by a PA whom the BC physician personally knows is competent).

  • Upvote 4

Share this post


Link to post
Share on other sites

Join the conversation

You can post now and register later. If you have an account, sign in now to post with your account.

Guest
Reply to this topic...

×   Pasted as rich text.   Paste as plain text instead

  Only 75 emoji are allowed.

×   Your link has been automatically embedded.   Display as a link instead

×   Your previous content has been restored.   Clear editor

×   You cannot paste images directly. Upload or insert images from URL.


×
×
  • Create New...

Important Information

Welcome to the Physician Assistant Forum! This website uses cookies to ensure you get the best experience on our website. Learn More