Why didn't anyone mention this to me before I applied to PA school?

[LOVETN]

Before applying to PA school I worked alongside a PA in family medicine for one year, I spent time shadowing an amazing PA in dermatology over 80 hours, and spoke with a military PA. Not once did anyone ever mentioned the comments they dealt with from patients or medical personnel, the fact that they had to prove themselves in order to gain respect, or what it was like during their rotations while in school because rotations was not even on my mind when I was shadowing the PAs.

Two PA's said that if they where younger they would have gone to med school and the third PA stated she was happy. When I asked the two PA's why they would go to med school their reply was, "You will learn one day if you decide to become a PA." 

I applied to PA school because I fell in love with the profession regardless what the two PAs said, I loved what the PAs did for patients, I enjoyed seeing the type of relationships a PA had with their patients, and the fact that a PA can change fields without a residency. A couple of times we dealt with patients not wanting to see PAs, but it happened very rarely.

After completing my didactic year and now on rotations. Three out of my six rotations I have been talked down to by multiple patient's being described as just the assistant and the real doctor will be in soon, SO MANY people still do not know what a PA is they confuse us for medical assistants, while in school our director constantly talked about having to prove yourself when you are working, when I rotate with medical students this is how the conversation goes. Medical personnel ask a med student, "are you a med student?" Student, "Yes." Their reply, "How awesome! What type of doctor do you want to be?" The conversation goes on. Medical personnel ask PA student, "are you a med student?" Student, "No, I am a PA student." Their reply, "Oh.." The conversation ends.

I have quickly learned the huge gap their is in our education. I was previously told by my three PA mentors before being accepted to PA school, "You will learn as much as a med student will learn up until their M3 year." Not true. This did not impact my decision in applying to PA school, but it helped me realize I was going to be able to connect the dots in a patient's health. What did I spend a large part of the time learning in school? MOST COMMONS. When I tried to understand the mechanisms of a disease I was quickly shut down by my instructor and told I was going into the WEEDS. I have been told by a couple of my physician preceptors that the down side of my profession is the huge learning gap. 

I understand I am still a student I will not know everything because it is a life long learning career, but I am saddened that my mentors never informed me of everything that came with the profession. It is their fault in no way. Maybe I did not speak with enough PAs or I did not research this forum properly or maybe I did not do enough overall research. I previously worked in the medical field over 6 years.

I am in PA school because I do not want to be a doctor and I do not want to have the final word, but the longer I spend time on my rotations the more I see the big learning gap, I am continously put down by patients, I am not acknowledged by medical personnel (I work hard and ask anyone if they need help. I do the scut work because I am their to learn and acquire any learning opportunities I can take on), and I have learned about the glass ceiling in regard to pay. I am not sure if I can handle the next 40 years of my career trying to prove myself in order to gain some form of respect. 

If anyone has any advice for this heart broken PA student I would greatly appreciate it. I continue to remind myself that it is all about perspective and want to think positive, but after today when the surgeon told the surgical tech that I could put one stitch in and as soon as the surgeon walked off the nurse immediately said NO to the surgical tech because I was just an assistant and did not need to learn how to put a stitch in. I took my tears to the bathroom and did not let anyone see. 

 

[camoman1234]

"I do not want to have the final word" I am not sure that you understand you ARE making the final decision in most cases. You need to keep trucking on and finish rotations, take boards and work a 1-2 years prior to making your decision of leaving the profession. 

[newton9686]

Stop. If you feel like there's a learning gap, go read. The only one responsible for your lack of knowledge is yourself. And who the hell cares what any other healthcare profession thinks of you. Your job is to impact the lives of patients. And I guarantee you even as a PA student you can do that. During one of my last rotations I had a woman come in with bleeding in between cycles. Who cares right? I recommended we order an ultrasound, preceptor wasn't going to initially. I recognized the endometrial stripe was too big that may preceptor missed which lead to a woman being diagnosed early with endometrial cancer. It's not because my preceptor was bad, he was awesome, but it was because I went home and read every night and I knew the presentation of endometrial cancer. This profession has a huge amount of self satisficafion but only if you put your patients ahead of yourself and you have to read. It your read and re-read every version of Case Files you can get your hands on I guarantee you will feel differently about your education and ability.

[lkth487]

You forget most of what you learn in med school anyway.  There is no substitute for active long term reading.  Read journals, uptodate, whatever you can get your hands on.  If you see a topic you don't understand - pick up a pathophysiology/biochem/anatomy/whatever source and read about it.  It's not some secret knowledge base that you only learn in medical school - all the information is available pretty easily.  You just have to be motivated to learn it.

Read outside your niche field too - that is very important.  If you're treating the kidneys, and the patient also has a neurological condition - read about it.  And not just a paragraph - understand the anatomy, biochem, and pathophysiology behind it.  Chances are you'll forget most of it, but so does everyone.  You'll be shocked at what you remember years down the road.  There's been so many times where I've pulled a diagnosis out of nowhere because some vague lightbulb went off in my head where it was like "yea I dont know the details but I've heard of this before".   Like, oh yea, I know you don't give dextrose in fluids to a patient with pyruvate dehydrogenase deficiency...let me look up the pathway...and it'll make sense.  And you keep building on that for the rest of your life.

You don't need medical school to give you that knowledge.

[wktk222]

It seems like the main point of concern revolves around the amount of respect you get as a PA. 

However, you must remember, respect is earned, and doesn't come automatically because of your title/position. Maybe sometimes, but I've seen arrogant doctors get fired because the nursing staff thought he was an ass. If you think your power and respect will come automatically just because you're a doctor, you're greatly mistaken. It seems like in your story that you think med students were more respected because they are a med student and is a future doctor. But as someone who worked as an er tech for multiple years, I can say that med students and residents get rolled on by the medical staff (I know, which shouldn't happen).

Don't think straight up downtalking comes just because we're PAs. Arrogance and condescending manner is not justified in any way, even if because we're PAs. No one should be getting treated this way and it's not normal. Just like if we were to be doctors, we wouldn't downtalk to PAs just because they are PAs. 

And as for the amount of information you'll learn in school, dude... learn. If you don't know something, study, that's what it means by continuing education. There's a reason why doctors consult with specialists all the time. Even if you graduate from medical school, you have residency, and fellowship. PAs schools have no residency, no fellowship and is shorter. Of course the amount of information we learn is so little compared to doctors. If you didn't know this before PA school, I don't know what to say. If you truly thought you were going to learn everything in 2 years and without residency and fellowship... wow.

[EMEDPA]

this is something many , but not all,  PAs have to deal with. sometimes it is a regional thing. seems to be more of a west coast problem than an east coast issue, but may also be facility dependent.

I have dealt with it a LOT in my career and left several jobs because of it. docs refusing to talk to PAs on the phone when it is your patient and they are the on-call consultant, etc.

I seriously looked at going back to medschool several times, even going so far as taking extra courses, etc, but life always got in the way. Don't think I was really happy as a pa until I started working solo around 5 years out of school. each job change since then has involved higher acuity and lower volume with greater responsibility, autonomy, and scope of practice. things have been really good for about a year, and am interviewing for my dream job next week. (see why I love rural EM thread for info).

best of luck whatever you decide. a few thoughts:

do a residency

work a few years as a PA.

IF you love medicine, but hate being a PA, do the 3 yr LECOM PA to physician bridge program.

[Anachronist]

(For context, former EMS, currently a scribe at a GI clinic, matriculating into a PA program next year).

It seems as though you are in a bit of a hostile environment. Try to remember that there is more than our own personal bubbles that we sometimes get lost in; use it in the future when you are dealing with new PAs, NPs, nurses, and MAs as to not pass on the treatment you've received. Use it as well when you go out looking for a job to avoid a repeat situation for yourself.

For some perspective. I personally know a handful of PAs and NPs closely, some wish they had gone to med school, some do not. I also know a few MDs who have told me "If I had to do it all over again, I would have been a PA." It is different for everyone. MDs are also not immune to the ire of angry patients. I've witnessed patients accuse MDs of being "quacks," "trying to kill me," "ignoring me," etc etc ad nauseum. I've had patients tell me their PCP is an idiot, and other patients with the same PCP tell me they are amazing and that they won't do anything (procedure, change Rx, etc) without running it by the PCP first. The same is true for physicians I've worked with, some patients love them, and other patients hate (not an exaggeration) them. I've even found myself in the awkward position of having to defend physicians I work with because they have funny last names and patients who haven't even met them yet are already questioning their competence because they aren't a "Dr. Jones" or "Dr. Smith."

On the flip side, I've also gotten to experience MDs take considerable time to educate me and explain how and why they are managing a patient the way that they are. Almost every day I also get to talk with MDs, NPs, and MAs about treatments and differential diagnosis in small groups. My personal favorite is when a MD asks me, "what should we do?" I take a crack at it and explain why, they think for a moment and say "sounds good, let's go for it." or if they give me their orders and I suggest something in addition and they respond "good idea, add that."And yes, scribing, some MDs brush me off as a human recorder, but others are passionate about teaching me about medicine and sharing personal experiences and anecdotes. I've also witnessed MDs passionately support the work of the PAs and NPs at our clinic when a patient questions their competence. 

Personally, I went from knowing nothing about GI (not really an EMS focus) to being able to accurately predict the treatment for a patient at our clinic at least 50% of the time in just a few months, a few months later, I knew why those treatments were being ordered and can now explain labs, procedures, pathology, and medications in great detail and my predictive treatment is spot on 60+% of the time, all in less than a year. It just takes some time to "settle in" as it were. I also routinely watch 4th year med students stumble aimlessly trying to assess our patients, or go down a completely irrelevant rabbit hole with a patient for 30 min. 

[beattie228]

Actual PA world differs drastically from the schooling setting. Nearly all of the patients I see are perfectly happy with a PA, but that boils down to how you carry yourself and the skills you pick up during your training. At the end of the day, the patient wants to see someone who is competent, compassionate and seems to know what the hell they're doing.

 

I learned very early on to not take things personal. If a patient is MD only, I move on to the next case. MD on the phone won't take my phone call, I have the MD I'm on with call on my behalf to then state at the beginning of the call "I don't know the ins and outs for that patient, let me ask my colleague who has that information discuss that with you".

 

The trick is finding the team that accepts your role and identifying the area of medicine you want to work in. There are some areas that have a ton of autonomy (rural ED, Urgent Care, Primary to name a few) and there are others (most surgical positions, sub-specialties) where it is truly team based care with the physician counterpart playing a large role in the day-to-day management. You have to find the gig that works for you and recognize that not every position is lifelong. Doing a residency can help you to set yourself apart.

[Acebecker]

The scrub nurse was wrong and you know it.  The people who talk down to you are wrong.  The people who say we "assist" are wrong.  We are lead clinicians in most cases.  There is backup when needed for the rest.  (Here's a consoling statement: MDs are lead clinicians in most cases - there is backup for them for the rest in the form of specialist consults).

You made a choice - for most people a wise choice.  You need the conviction inside you to your very bones that you did the right thing.  Even if you later decide to go to medical school, you still did the right thing by going to PA school.  When you know it, when you know that you made the right choice and that you're going to be awesome, all the comments, side glances, and all the people who are wrong will be just that - wrong.  And you'll go through your clinic day taking excellent care of people every day and you won't give those people who are wrong any more thought.

Regarding the scrub nurse, my statement would be that the surgeon told me to put the stitches in.  If she would like, we can go discuss it with the surgeon again.  It would appear that that nurse's ego interfered with her hearing.

[Cideous]

Graduate PA school and immediately apply to medical school.  If you feel this way now, it will not get better IMO.  Only worse.  Not trying to be a fatalist, but these boards are littered with people disgruntled about medicine.  As PA's are steam rolled by the NP hoard of graduates, it will only get worse.  Just finding a job in todays market is getting harder and harder for PA's.

[Jdabrowski]

As far as the nurse issue, you stand your ground. If they don't let you do something because "you're just a PA student" You tell the preceptor. Myself personally I would have told her "yes you will let me to the stich, because that is what I am here for, that is what the surgeon instructed you to do,  and I'm paying for this rotation". A program I interviewed with told us they only send students to one rotation at a Level 1 trauma place if they can hold their ground to the med students personality wise. Sometimes we need to hold our own.

[Marinejiujitsu]

The good thing as a PA, you start as scum but you can only go up. Physician start with the utmost respect and it's easy for them to lose it.

I'd rather get, "You should have been a doctor", rather than "This guy should have never became a doctor. "

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[LT_Oneal_PAC]

6 minutes ago, Marinejiujitsu said:

The good thing as a PA, you start as scum but you can only go up. Physician start with the utmost respect and it's easy for them to lose it.

I'd rather get, "You should have been a doctor", rather than "This guy should have never became a doctor. "

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I’d rather just start out with it and keep it.

[Marinejiujitsu]

I’d rather just start out with it and keep it.

Unfortunately, that's not the real world. Your patient care is sometimes subjective. Some of the lowest patient satisfaction scores are associated with the best providers, but the highest are sometimes associated with the crappiest.

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[Dabba]

Currently finishing my didactic portion of school.

I'm sorry that your professors did not put emphasis on phys and pathophys. Ours did, and while some of my classmates prefer to commit things to memory, I know that understanding what is actually going on will go so much further. As others have said, read read read while youre still in school and fill in any gaps you dont feel comfortable with.

PAs can get a lot of flak that is not deserved, but I view it as a reason to learn enough to know more than any docs who may look down their nose at you. Yeah, you may have to bust your butt to do that, but its only good for you and your patients.

Also, I grew up in a huge suburban area, but my program is in a very rural town, and I am likely going to stay in a rural area so I can learn and do more and have more independence... and if I decide to go back, I feel I'd have more to offer and have a better chance at autonomy. 

[UGoLong]

No one can take away your self-respect without your permission. And no one is ultimately in charge; everyone has a boss.

Now, finish what you started and then see where you are. Changing your mind in the middle isn't a good idea.

[LT_Oneal_PAC]

4 hours ago, Marinejiujitsu said:

Unfortunately, that's not the real world. Your patient care is sometimes subjective. Some of the lowest patient satisfaction scores are associated with the best providers, but the highest are sometimes associated with the crappiest.

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I’m not sure what that has to do with price of tea in China. 

 

It it is the real world. Plenty of doctors walk in with respect and continue to earn it from their colleagues and patients. I will say I rather have earned respect than have it given undeservingly, but lots of people don’t have to pick. A simple solution is just don’t work in places that don’t see your value.

 

OP, this is probably more because you are a student. I’ve seen it happen and had it happen to me. Don’t let unhappy people make you unhappy.

 

Though I do agree with the second statement. Studies have shown that high patient satisfaction scores are associated with poor outcomes.

[Marinejiujitsu]

I’m not sure what that has to do with price of tea in China. 
 
It it is the real world. Plenty of doctors walk in with respect and continue to earn it from their colleagues and patients. I will say I rather have earned respect than have it given undeservingly, but lots of people don’t have to pick. A simple solution is just don’t work in places that don’t see your value.
 
OP, this is probably more because you are a student. I’ve seen it happen and had it happen to me. Don’t let unhappy people make you unhappy.
 
Though I do agree with the second statement. Studies have shown that high patient satisfaction scores are associated with poor outcomes.

True. My point is, respect as a PA usually only gets better. Don't worry about it OP.

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[Wish1pa]

I am sorry to hear you are not getting a great education and have crappy rotations. This was not the case for me, my courses were VERY in depth as far as pathophysiology and my rotations for the most part everyone was supportive and I got to do alot, If they aren't teaching you enough, like others have said, read. They are teaching you enough to pass your boards and you'll continue to learn and gain experience as you work. I am a PA of 4 years and still look things up on uptodate all the time and ask my supervising physicians for help on things or their clinical opinion. As for the respect factor, I do encounter patients that don't want to see me occasionally but I just move on. Its annoying but it is what it is. I do worry that you entering your career with these feelings is not going to improve as being a health care provider is not easy and you really have to love what you to to succeed in my opinion. Most PAs I know are very happy and don't regret it.

[SoCal_PA]

Interesting. In my 1.5 years of rotations in school, I was never once put down. Best of luck

[LOVETN]

Thank you to every person who has replied to my post and thank you for sharing your experiences. 

I will continue to read every night as I have been doing and have ordered extra books online. I will finish PA school and look forward to practicing as a PA. The love I have for patients is what got me in this field and it is the one thing I look forward to every time I step foot in an exam room.

[Joelseff]

Your instructors discouraged you from learning the mechanisms of disease? That's weird. Learning "most commons" is ok but you should learn the mechanisms. Now, I don't think you need to go too deep (like molecular level etc.) but learning the basic mechanism of disease allows you to know in theory why a treatment will work, course of DS, symptomatology etc.

 

My first few years I got the "just a PA" feeling from some colleagues but most saw my worth and now all but a couple of docs I work with, I feel, see me as a colleague. You just have to keep studying and drive yourself. They, typically, don't know the depth of our education and training so when you practice you have to earn that respect. Keep learning. Wish you the best.

 

 

 

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[Dabba]

17 hours ago, LOVETN said:

Thank you to every person who has replied to my post and thank you for sharing your experiences. 

I will continue to read every night as I have been doing and have ordered extra books online. I will finish PA school and look forward to practicing as a PA. The love I have for patients is what got me in this field and it is the one thing I look forward to every time I step foot in an exam room.

I recommend Harrison's if you have accessmedicine. We've had to teach ourselves a lot and it's a good source if you're okay with basic physio.

 

Acessmedicine is pretty great.

[greenmood]

On 12/2/2017 at 7:41 AM, LOVETN said:

Thank you to every person who has replied to my post and thank you for sharing your experiences. 

I will continue to read every night as I have been doing and have ordered extra books online. I will finish PA school and look forward to practicing as a PA. The love I have for patients is what got me in this field and it is the one thing I look forward to every time I step foot in an exam room.

Good. I say this with encouragement and positivity: grow a thicker skin. Earn the respect of your patients. You're in charge of your own learning as a professional. It'll be great.

[jwells78]

On 11/29/2017 at 7:00 PM, LOVETN said:

 

 

There is just so much wrong with this post.  I laced this reply with a healthy dose of honesty.  Dont let ot hurt your feelings.

1. You come on a PA board and toss out remarks that could be construed as condescending, blaming others for your lack of understanding of OUR profession.

Mistake #1.  

2. Some people dont know who PA's are;  get over it.

3. Depending on your background/experience, you will NOT come out of PA school with the same education as a 3rd year MS.  That is fallacy.

A PA student is the sum of his/her previous  experience, augmented by a crash course in Medicine over 24 months;  if (A PA student) has minimal HCE and goes to PA school, they will have a large hill to climb out of school.

If your instructors are steering you away from "going into the weeds" of disease processees, they are failing you, period.  If you want to discuss disease process, pm me and we will go over whatever you want together.

4. If your physician preceptors are telling you the downfall of your profession is the knowledge gap, then go out and learn.  Nobody can stop you from learning.  Prove them wrong.  Have the answer when the question is asked;  impress them.

5. You say you are continuously put down by patients;  and you describe being offended when people dont acknowledge you as an expert in medicine or treat you the same as your medical resident counterpart.  This sounds like a personal problem to me.

You want respect?  Demand it.  How do you do that?  You be better, smarter, faster, more thorough and have better bedside manner than everyone around you.  You come up with an articulate, witty response to the questions: "whats a PA?" And "when will you be a doctor?"

6.  You WILL have the final word in care; get ready for it and dont fail your patients or your colleagues.

7. Took your tears to the locker room?!!

You shouldve stuck those pickups right up that nurses a$$.  Dont let old hags in the OR push you around, stand up for yourself.   Keep your chin up, look them right in the eye and tell them to go pound sand when they pull that shit.