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A PA I shadowed today told me I was operating out of my scope of practice as a medical assistant


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So today when I was shadowing a PA, he asked me where I was working to gain my PCE and asked me what I do there. I told him that I work as an OR clinical assistant at a pain clinic. My duties are  triage, assisting physicians with new patient visits, operating a fluoroscopic C-arm, operating an ultrasound, operating a CTEV laser, performing nerve conducting studies, assisting with EMG exams, and a couple other things. He then questioned me as to whether or not I had a certification, and then went on to say that I was operating way out of my scope of practice as a medical assistant and that PA admissions committees were going to frown on that when I end up applying or having an interview. He told me I was endangering patients by doing this. However, I work for a private practice in which a certification is not required to do all these things. It's also not a requirement by my state to be licensed in order to do these things. So I'm not sure why I was told I was operating out of my scope of practice and an endangerment to patients, and that adcoms would look down on me for doing it. I'm just doing what my job asks of me if I'm being honest. It took me 183 applications across 8-10 states to find a medical assistant job that was willing to hire someone without a MA certification or MA experience, so I'm not going to quit. I need this job in order to gain the PCE hours necessary to apply to PA school. Anyway I just wanted to get some feedback from this forum as this has gotten me exceptionally worried.

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Guest blee100

I work at a pain clinic as well as a medical assistant who not certified in the state of Florida. Under law here it perfectly fine to work as an MA without a certification. You are definitely doing way more things than I do on a daily basis. Alot of the things you are saying you do such as the nerve conduction studies are done by the actual physician. While other components like helping new patients and setting up the ultrasounds(not actually moving probe on the patient to find the muscles) and taking pictures is something I do on a daily basis. I cant see why admissions would frown on you for doing tasks that your job is requiring you to do. I can see them maybe being confused toward the business for giving you all that work. If it actually an issue they most likely would like to discuss it during the interview. 

Edited by blee100
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22 minutes ago, Aware said:

What do you mean by operating? You aren't actually doing the ultrasound/inserting the CTEV laser right? Rather you're just changing resolution, voltage, etc.?

I'm not inserting the laser. I do operate the fluoroscopic C-arm and take X-rays during interventional pain procedures and vascular surgeries. I'm usually just taking the pictures in regards to the ultrasound and making any adjustments needed within the program for the physician to have a better view.

I am traiging, collecting urine samples, performing pill counts, taking blood pressures, scribing, performing blood glucose tests, operating the fluoroscopic C-arm, and performing nerve conduction studies all by myself.

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28 minutes ago, blee100 said:

I work at a pain clinic as well as a medical assistant who not certified in the state of Florida. Under law here it perfectly fine to work as an MA without a certification. You are definitely doing way more things than I do on a daily basis. Alot of the things you are saying you do such as the nerve conduction studies are done by the actual physician. While other components like helping new patients and setting up the ultrasounds(not actually moving probe on the patient to find the muscles) and taking pictures is something I do on a daily basis. I cant see why admissions would frown on you for doing tasks that your job is requiring you to do. I can see them maybe being confused toward the business for giving you all that work. If it actually an issue they most likely would like to discuss it during the interview. 

The only procedure that MAs actually move the probe are during endovenous laser ablations where the physician is preoccupied inserting and guiding the laser. In that instance, it's usually the seasoned MAs moving the probe with physician supervision. Yet still MAs without certification.

Like I said, the PA I was shadowing today just got me extremely worried about it. So I thought it was best to come here and seek advice and opinions to help calm my nerves. After leaving that conversation with the PA I felt like I was setting myself up to be crucified by admissions committees.

Edited by Ollivander
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Guest blee100
5 minutes ago, Ollivander said:

The only procedure that MAs actually move the probe are during endovenous laser ablations where the physician is preoccupied inserting and guiding the laser. In that instance, it's usually the seasoned MAs moving the probe with physician supervision. Yet still MAs without certification.

Like I said, the PA I was shadowing today just got me extremely worried about it. So I thought it was best to come here and seek advice and opinions to help calm my nerves. After leaving that conversation with the PA I felt like I was setting myself up to be crucified by admissions committees.

tbh if you are going be questioned about it just be ready like any other question that might pop up. I had a job prior in ophthalmology where I did an extensive task where patients and PAs I shadowed asked me why I was doing a specifc task and not the doctor. So if they do ask me I'm ready to respond and turn it around and discuss my overall dedication and willingness to learn.

Good luck in this cycle!

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41 minutes ago, blee100 said:

tbh if you are going be questioned about it just be ready like any other question that might pop up. I had a job prior in ophthalmology where I did an extensive task where patients and PAs I shadowed asked me why I was doing a specifc task and not the doctor. So if they do ask me I'm ready to respond and turn it around and discuss my overall dedication and willingness to learn.

Good luck in this cycle!

That's a great approach to take on it! I really appreciate your feedback as that helps me better prepare myself for the obstacle should it arise. Thanks! Are you applying this cycle as well?

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13 hours ago, blee100 said:

I work at a pain clinic as well as a medical assistant who not certified in the state of Florida. Under law here it perfectly fine to work as an MA without a certification. You are definitely doing way more things than I do on a daily basis. Alot of the things you are saying you do such as the nerve conduction studies are done by the actual physician. While other components like helping new patients and setting up the ultrasounds(not actually moving probe on the patient to find the muscles) and taking pictures is something I do on a daily basis. I cant see why admissions would frown on you for doing tasks that your job is requiring you to do. I can see them maybe being confused toward the business for giving you all that work. If it actually an issue they most likely would like to discuss it during the interview. 

Just cause they "require" it does not mean it is safe nor smart by the MA. You may think you "can" do this job, but if/when you get into PA school and start seeing how much you really do not know then you might regret "treating" all these patients. If I was on a ADCOM that would be my question on why did you not know/questioned/stop doing those task that you might not think you were trained for. That is a huge red flag for myself and that is what PAs are known for, they are known for asking for help when they need it, not just acting like they know what they need to know. We are dependent providers, so if you do not have sense to stop what you are doing now if it truly is doing procedures then I would NOT accept you to a PA program as what in the hell would you do as a PA? You are not qualified to perform a nerve conduction study.

Your comment: "It took me 183 applications across 8-10 states to find a medical assistant job that was willing to hire someone without a MA certification or MA experience, so I'm not going to quit. I need this job in order to gain the PCE hours necessary to apply to PA school." Makes me very worried as you are just looking at yourself and getting into PA school. You seem like you are not willing to quit this job for any reason even if it is unsafe for the patients. 

You need to learn boundaries very quickly or you will find yourself in a law suit one day down the road if this truly is your attitude. If you want real experience then go to become a RN, RRT, EMT-P. All you newer pre-PAs just want into school the quickest, easiest route and I know you will suffer without proper experience in the real world. I just hate when all you pre-PAs say you need HCE and want to do the easiest, quickest, and IMO not real HCE (very low level) which I don't think will really help you as a PA. My RRT experience helps me daily as a PA. If I just moved a xray arm or drew blood, that does not help me when I need to make a decision if this patient is sick or not sick. Good luck and think real hard about your patients as one day you will most likely be a patient as well. 

Edited by camoman1234
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Guest blee100
9 hours ago, camoman1234 said:

Just cause they "require" it does not mean it is safe nor smart by the MA. You may think you "can" do this job, but if/when you get into PA school and start seeing how much you really do not know then you might regret "treating" all these patients. If I was on a ADCOM that would be my question on why did you not know/questioned/stop doing those task that you might not think you were trained for. That is a huge red flag for myself and that is what PAs are known for, they are known for asking for help when they need it, not just acting like they know what they need to know. We are dependent providers, so if you do not have sense to stop what you are doing now if it truly is doing procedures then I would NOT accept you to a PA program as what in the hell would you do as a PA? You are not qualified to perform a nerve conduction study.

Your comment: "It took me 183 applications across 8-10 states to find a medical assistant job that was willing to hire someone without a MA certification or MA experience, so I'm not going to quit. I need this job in order to gain the PCE hours necessary to apply to PA school." Makes me very worried as you are just looking at yourself and getting into PA school. You seem like you are not willing to quit this job for any reason even if it is unsafe for the patients. 

You need to learn boundaries very quickly or you will find yourself in a law suit one day down the road if this truly is your attitude. If you want real experience then go to become a RN, RRT, EMT-P. All you newer pre-PAs just want into school the quickest, easiest route and I know you will suffer without proper experience in the real world. I just hate when all you pre-PAs say you need HCE and want to do the easiest, quickest, and IMO not real HCE (very low level) which I don't think will really help you as a PA. My RRT experience helps me daily as a PA. If I just moved a xray arm or drew blood, that does not help me when I need to make a decision if this patient is sick or not sick. Good luck and think real hard about your patients as one day you will most likely be a patient as well. 

I get where you are coming from on some components especially in terms of understanding boundaries. All of the tasks I do are the norm at my jobs which means The job description of all the jobs I take follow up with other facilities that providing this same position. If I ever feel uncomfortable I discuss it right away with management or the physician. In terms of you saying individuals such as myself are working toward finding the easiest routes of patient care may be true for other but not in my case. I've spent hours with an ophthalmologist who graduated from John Hopkins and Yale. He spent hours discussing exactly how everything works in terms of the retina. Components include even giving us weekly exams to make sure we were actually obtaining the information we were given.  If you do not pass these exams you would be fired. I don't find spending a significant amount of hours outside of work studying including my normal studying schedule as easy at all.  I'll make sure if a ADCOM brings it up that I disclose components of my task are shown at multiple facilities throughout my area and how in the state of Florida they do not require certification. Now in terms of this individual with the nerve conduction studies, I disclosed earlier that at my facility as an MA I am nowhere near the area where they do those studies. My job now at the pain clinic is as well in the norms of multiple pain clinics in my area in terms of drawing of medication, setting up procedures, and doing vitals. 

Edited by blee100
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2 hours ago, blee100 said:

I get where you are coming from on some components especially in terms of understanding boundaries. All of the tasks I do are the norm at my jobs which means The job description of all the jobs I take follow up with other facilities that providing this same position. If I ever feel uncomfortable I discuss it right away with management or the physician. In terms of you saying individuals such as myself are working toward finding the easiest routes of patient care may be true for other but not in my case. I've spent hours with an ophthalmologist who graduated from John Hopkins and Yale. He spent hours discussing exactly how everything works in terms of the retina. Components include even giving us weekly exams to make sure we were actually obtaining the information we were given.  If you do not pass these exams you would be fired. I don't find spending a significant amount of hours outside of work studying including my normal studying schedule as easy at all.  I'll make sure if a ADCOM brings it up that I disclose components of my task are shown at multiple facilities throughout my area and how in the state of Florida they do not require certification. Now in terms of this individual with the nerve conduction studies, I disclosed earlier that at my facility as an MA I am nowhere near the area where they do those studies. My job now at the pain clinic is as well in the norms of multiple pain clinics in my area in terms of drawing of medication, setting up procedures, and doing vitals. 

That is great and all, but you learn all about the retina in PA school. The HCE I am speaking of is when you walk into a room, can you tell if that patient is sick or not and have the past HCE such as RN, RRT, Paramedic to assess this patient and know what to do next? That comes with time and being an MA or phlebotomist will not teach you that. Now for the pre-PAs that were SLPs, PTs, ATs, OTs, RDs, etc that is higher level education (degree), but you do not get those critical thinking skills from those positions. I know many people that were PTs, OTs, ATs, etc and GREAT PAs, but their assessment skills were formed over school plus some time in the field. That is why the PA profession was found from army medics as they had those type of skills already. You can teach almost anyone about the anatomy of the eye, but you cannot teach someone in the same time frame if that child is "sick" or not (i.e. has that look, FLK (funny looking kid)).  

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Agree with above. I would extend that list to include some long-time ER techs. I was a paramedic and had the sick/not sick down before PA school, but I have worked with some ER techs and had some as students who were pretty good in that dept as well. 10 years as an ER tech in a busy trauma ctr and you can figure out sick/not sick from the door. a medic/rn/rt can do more about it, but at least the tech can see it. many can not.

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Guest blee100
1 hour ago, camoman1234 said:

That is great and all, but you learn all about the retina in PA school. The HCE I am speaking of is when you walk into a room, can you tell if that patient is sick or not and have the past HCE such as RN, RRT, Paramedic to assess this patient and know what to do next? That comes with time and being an MA or phlebotomist will not teach you that. Now for the pre-PAs that were SLPs, PTs, ATs, OTs, RDs, etc that is higher level education (degree), but you do not get those critical thinking skills from those positions. I know many people that were PTs, OTs, ATs, etc and GREAT PAs, but their assessment skills were formed over school plus some time in the field. That is why the PA profession was found from army medics as they had those type of skills already. You can teach almost anyone about the anatomy of the eye, but you cannot teach someone in the same time frame if that child is "sick" or not (i.e. has that look, FLK (funny looking kid)).  

Ah ok. Apologize for the confusion. I have personally shadowed PAs who have told me they were medical assistants in their undergraduate before they applied to PA school. They seem perfectly fine in terms of treating their patients now. Plus their multiple schools who don't even require any health care experience. So maybe PA schools are adjusting it overall curriculum for the newer generation of PAs coming in? I'm not exactly sure but thanks for the info. My epidemiology professor an actual ADCOM for the PA program at my school so this would be a great discussion to further with him!

Edited by blee100
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OP has an important question about whether or not the work he or she is doing is legal. This is a complicated question that cannot be easily answered by the average forum reader. Laws governing this type of work are state specific and this position sounds very unique. States can be very selective about the work and duties that they allow or disallow to be taught to non-medical / non-nursing staff. Discovering the answer to this will require you do some digging into your local laws.

I think the PA you shadowed has done you a great favor by asking this question to prepare you for future discussions, but they are quite possibly speaking out of turn to flatly suggest these procedures (non-invasive?) are outside of your scope of practice. Case in point, MAs etc typically do not have a state sanctioned "scope of practice" or a true license, so it is a big misleading to refer to this issue as "scope" at all.

This position sounds unique and a great opportunity assuming that the tasks you are performing may be delegated to you. I would embrace it and I presume you will not have an issue finding PA programs who also consider it very highly. Do prepare yourself for questions about the legality of the procedures. PAs must be knowledgeable about scope of practice issues and someone on any given adcom is likely considering this angle.

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