PA Turned MD Blames "Midlevels" for Devaluation of Physicians

[weezianna]

https://www.kevinmd.com/blog/2018/06/physicians-have-become-devalued-in-modern-health-care.html

In this article, a former PA, now MD, blames the "devaluation" of physicians on the use of midlevels. 

[Jkarram]

He states that any medical student graduating is vastly more prepared than a PA student graduating, but I worked with a medical student on her last day before graduation who wanted to give Ace inhibitors to a pregnant sarcoidosis pt to manage her high ACE levels so..... 

Also "anonymous author" is code for, never actually went to PA school but I want to say that I have to prove my point. 

Dude just sounds bitter. 

[EMEDPA]

FMG who didn't match....

[PAtoMD]

11 minutes ago, EMEDPA said:

FMG who didn't match....

Savage

[sas5814]

Crab bucket theory....can't elevate yourself so drag others down. Just more whining.

If he is soooooo much better than any PA why isn't he sitting on the top of the mountain? It can't be our fault...we are dangerously ignorant and therefore could not possibly under any circumstances elevate ourselves above the physician.. So let us look at the other potential problems....

Corporate medicine is broken. It is a vast systemic failure with a lot of facets. It is complicated on a good day. This gross oversimplification just speaks to how poorly he understands what he is talking about.

[Reality Check 2]

I hear bitterness and jealousy of some bizarre sort.

Would LOVE to know where he/she went to PA school and how he/she was as a student. Then what med school - US or on some island somewhere - and placement in residency,  etc.

These types of articles don't help anyone and to be anonymous doesn't lend any credibility either.

I don't have time for these types of hateful jerks at this point in my career. I DO know what I know and how to use it best to serve patients. 

Moving on.....

[EMEDPA]

18 minutes ago, Reality Check 2 said:

I hear bitterness and jealousy of some bizarre sort.

Would LOVE to know where he/she went to PA school and how he/she was as a student. Then what med school - US or on some island somewhere - and placement in residency,  etc.

These types of articles don't help anyone and to be anonymous doesn't lend any credibility either.

I don't have time for these types of hateful jerks at this point in my career. I DO know what I know and how to use it best to serve patients. 

Moving on.....

guessing he didn't match, thus his concern about pa opposition to "assistant physician" programs that would allow him to work without a license...

[ProSpectre]

22 minutes ago, EMEDPA said:

guessing he didn't match, thus his concern about pa opposition to "assistant physician" programs that would allow him to work without a license...

Unfortunately, this attitude is not uncommon on the various forums frequented by medical students and residents (usually less so by attending physicians, but obviously not unheard of). I have seen comments a number of times about how the Associate Physician idea is "better than PAs because they have at least graduated from medical school". 

Usually, I chalk it up to a misunderstanding of what PA school entails by those who have never done it, but in this case, who knows. The fact that he was a PA in the 90's and then went back to medical school long before the Associate Physician thing even existed leads me to believe that he probably is a residency-trained physician, although a bitter one who now wishes to protect his new turf. 

[kingcoffee7]

1 hour ago, ProSpectre said:

Usually, I chalk it up to a misunderstanding of what PA school entails by those who have never done it, but in this case, who knows. The fact that he was a PA in the 90's and then went back to medical school long before the Associate Physician thing even existed leads me to believe that he probably is a residency-trained physician, although a bitter one who now wishes to protect his new turf. 

 

I'm gonna agree with EMEDPA about the unmatched IMG. The assistant physician point he talked about was far too random a reason for me. I really doubt many docs even know that's a thing. 

[surgblumm]

It sounds like he was a pretty lousy PA as he did not avail himself to those assets that were available to him, like his physician, like reading studies, like reading medical literature, like going to CME meetings and conferences and furthering his education. He has more education at this point but is probably a lousy physician, making the same mistakes. In an old military slang, I would tell him to "Tell it to the Chaplain".

[LKPAC]

When this guy grows a pair and uses his name, instead of cowardly remaining anonymous, I might care about his opinion.

[CAAdmission]

Docs spent decades acting like greedy egomaniacs. It's a shame what they did to their profession. 

[lkth487]

This assistant physician idea is terrible for the reason that it will only encourage medical school increase without a corresponding increase in residency spots.  Which shouldn't happen. Right now there's still way more residency spots than US grads, and that needs to continue to be the case.  

[ventana]

Different perspective.  

 

AMA and who ever else has a hand in training docs is fully responsible for this. 

 

I was in the group of PAs whom previously applied to medical college in an earlier life. I was white, male, late 20’s with very average numbers.  Never got in.  

The physicians have a vested interest in restricting supply of new physicians to artificially affect wages(keeping them high).  They full Well knew that but l8miting the supply of docs they can keep the salaries inflated.   So they limit the production of new docs.  Simple supply driven economics. 

 

When end I was applying to school I had honestly not heard of PA and it was before the current growth.  I would have been a damn good doc, and now I am a damn good PA that happens to have been hired into a doc job......   

 

so the oganized medicine whom is responsible for the growth of PA and NP through their restrictive practices.   

 

To prove over my point.  If they developed an MD or DO bridge program for primary care that was only a few years I predict you would see a massive shift with in a few years of pa and np getting their md/do.   

 

I am am very happy as a pa but for docs to blame us is simply wrong and shows a startling lack of business and economic knowledge. (Docs are smart in medicine, but commonly uneducated and borderline stupid in business)

 

If they are serious about taking back pcp then create 1-2 yr bridge    Otherwise sleep in the bed you made.....

 

(I only have a ba in business and mba and have owned my own practice so take my opinion with a grain of salt)

 

[lkth487]

I would be a strongly opposed to a primary care bridge program.  I'm pro bridge to a MD but not specifically primary care.  I wouldn't create a quick before bridge program that allows PAs to take the steps but I would still require the same formal residencies (in whatever field, primary care or neurosurgery).  I think MD is a general degree that denotes a generalized knowledge base and should remain as such.  

[EMEDPA]

34 minutes ago, lkth487 said:

I would be a strongly opposed to a primary care bridge program.  I'm pro bridge to a MD but not specifically primary care.  I wouldn't create a quick before bridge program that allows PAs to take the steps but I would still require the same formal residencies (in whatever field, primary care or neurosurgery).  I think MD is a general degree that denotes a generalized knowledge base and should remain as such.  

I think Ventana was talking about a shortened medschool followed by a regular residency. I could see a 2 yr program followed by a 3 yr fp residency. There used to be programs which allowed college grads to attend 4 years of medschool and 2 years of FP residency. The MS4 year was the PGY-1 year for those in the track. The track stopped in the 90s, but the grads typically had BETTER FP boards scores than typical FP residents. I think the "trial" was stopped because medschools lost a year of tuition. There are currently several 3 year primary care medschools (TX, Lecom, a NYC program, others). 

https://www.nytimes.com/2014/08/03/education/edlife/the-drawn-out-medical-degree.html

https://www.medpagetoday.com/publichealthpolicy/medicaleducation/41651

[GetMeOuttaThisMess]

My adult daughter's friend from earlier years went this path initially through Texas Tech but instead of seguing into the TT program, got into UTSW and I believe is now in her fourth year last I heard.  I wish that my daughter had followed such a path as opposed to trying to out perform the masses at UT-Austin. 

[lkth487]

Yeah I have no problem with programs like LECOM and such. I would even advocate making them shorter for PAs and count their PA school rotations plus experiences as third and fourth years and just have the basic sciences filled in. 

[lkth487]

I also then would allow people to do whatever they wanted and not restrict them to any specialty.  From FP to Radiology to Orthopedic Surgery.  In that sense, im totally for a shortened track to the MD degree rather than a shortened track to a primary care specialty. 

[hlj25950]

I too have to wonder where he got his supposed PA education.

My husband is an MD and we’ve been married since undergrad. The level of detail that we went into in my PA program was on par with the level of detail he went into in almost every area except basic sciences such as histology. When I was studying cardio and renal and pharm, etc., he was slightly shocked at the detail we went into. He has always respected PAs but probably felt that we had a more basic and surface-level understanding than we actually do.

I’ve rotated with medical students. I’ve answered questions that they couldn’t. Yes, doctors do go into more depth in some areas. The primary game changer, though, is the residency. That intensive and focused training for years is hard to replicate.

That isn’t to say that there aren’t shitty, terrible PAs. There are definitely shitty and terrible PAs, and there are shitty and terrible doctors.

I think it’s important for ANY medical provider to recognize their own limitations, what they don’t know, and to ask for help in areas they don’t feel confident in. You should always be learning and growing as a provider. If you think you know it all, you don’t, and I don’t care how smart you are and how long you’ve been practicing, and how much training you’ve had. There’s always something we can learn and ways to grow.

He sounds like he was a terrible PA, if he ever truly was one, and is using it as a scapegoat to further his agenda, anonymously, of course.

[EMEDPA]

5 minutes ago, lkth487 said:

I also then would allow people to do whatever they wanted and not restrict them to any specialty.  From FP to Radiology to Orthopedic Surgery.  In that sense, im totally for a shortened track to the MD degree rather than a shortened track to a primary care specialty. 

Lecomap Apap has primary care and non-primary care tracks. 1/2 the class has to agree to do primary care up front. 

[lkth487]

Yeah those types of tracks annoy me haha. Traditional med schools have them too.  I feel it puts undue pressure on people.   

[ventana]

But after just under two decades in medicine I know with out a doubt I am an internal medicine guy.  No need for matching into other specialties.  Just IM for me.  Maybe FP so I could go rural but that is it.  I saw 1 to 2 years Total, give me 8 to 10 months of the stuff I need to pass step 1 then the remaining as a fast track residency.  Okay maybe e years total. 1 academic, 2 residency.   Done.  But honestly 3 years is almost a 1/2 million in lost salary and bennies and then 150k min in school loans and I would still decline it. 

 

Okay so about that terminal doctorate with independent practice.....

[lkth487]

15 hours ago, ventana said:

But after just under two decades in medicine I know with out a doubt I am an internal medicine guy.  No need for matching into other specialties.  Just IM for me.  Maybe FP so I could go rural but that is it.  I saw 1 to 2 years Total, give me 8 to 10 months of the stuff I need to pass step 1 then the remaining as a fast track residency.  Okay maybe e years total. 1 academic, 2 residency.  

That will never happen.  Ever.  There won't be a fast track residency like that.  There might be a shortened pathway to the MD degree but a shortened residency is a complete non-starter.   MDs who want to switch residencies have to do the full amount (except intern year if they've already done one). 

[EMEDPA]

I wouldn't be surprised if the 6 yr combo programs come back

MS 1-4 with MS4=PGY1 of family med residency. with a streamlined model it could be ms1-3 then pgy 2 and 3 for 5 years total.

" in order to more efficiently and effectively increase the primary care physician supply, one area of increasing focus has been the acceleration of medical education. This acceleration of medical education has been previously attempted. In the 1980s and 1990s, approximately 25 US medical schools offered accelerated family medicine programs that allowed students to begin residency training while finishing their fourth year of medical school. Studies showed performance of students in these programs to be comparable to that of students in traditional four-year curricula in terms of standardized test results, initial resident characteristics, performance outcomes, practice choices, patient visit profiles, resident demographics, and graduate surveys.^42-46 While this particular model was eventually discontinued due to accreditation and certification concerns, the idea of an accelerated training period has recently recurred. The potential advantages of a three-year medical school curriculum, such as the new programs described above, include reduced educational debt burden and more rapid entry into clinical practice, transitional pathways into medical school for those with appropriate experiences, and redirection of the fourth year of medical school to create opportunities for enriching medical education.⁴⁷ Accelerated medical school programs that incorporate family medicine graduate training may be an attractive and feasible alternative to our current model and could potentially present an opportunity to bolster the family physician workforce. "

http://www.stfm.org/FamilyMedicine/Vol49Issue4/Carek275