PA to MD alternative

[Veritas86]

Ok, so there's a lot of fuss going on about midlevel to MD programs. Wondering what your views on those were, should they ever come about?

 

And while I'm at it, I had a thought. A primary difference between NPs and PAs seems to be the amount of oversight. Here's the deal, why not have residency trained PAs have as little oversight as NPs?

 

Think about it. NPs tout their experience in nursing as a reason behind the lower levels of oversight by MDs. Why not PAs who have a) previous experience in healthcare either as nurses, paramedics, so forth or b) elected to do a residency have as little oversight as NPs, especially with the push toward DNP?

 

The only issue I see is the gap of residency length between MDs and PAs. Say EMPAs generally have a one year residency. Make it two years, and give the PA more autonomy.

 

Thoughts?

[Veritas86]

Ok, so there's a lot of fuss going on about midlevel to MD programs. Wondering what your views on those were, should they ever come about?

 

And while I'm at it, I had a thought. A primary difference between NPs and PAs seems to be the amount of oversight. Here's the deal, why not have residency trained PAs have as little oversight as NPs?

 

Think about it. NPs tout their experience in nursing as a reason behind the lower levels of oversight by MDs. Why not PAs who have a) previous experience in healthcare either as nurses, paramedics, so forth or b) elected to do a residency have as little oversight as NPs, especially with the push toward DNP?

 

The only issue I see is the gap of residency length between MDs and PAs. Say EMPAs generally have a one year residency. Make it two years, and give the PA more autonomy.

 

Thoughts?

[CAAdmission]

Everyone keeps talking like the PA model is somehow broken. For around forty years, we have demonstrated our ability to go into almost any medical setting and have an immediate impact on just about every marker you would care to study - outcomes, cost, patient satisfaction. Now all of a sudden we need specialty exams and residencies?

 

With the current band of imbeciles we have running the AAPA, NCCPA and ARC-PA, it isn't likely we will have a PA profession in 10 years. I'm not sure those three organizations have a functioning synaptic cleft among them.

[CAAdmission]

Everyone keeps talking like the PA model is somehow broken. For around forty years, we have demonstrated our ability to go into almost any medical setting and have an immediate impact on just about every marker you would care to study - outcomes, cost, patient satisfaction. Now all of a sudden we need specialty exams and residencies?

 

With the current band of imbeciles we have running the AAPA, NCCPA and ARC-PA, it isn't likely we will have a PA profession in 10 years. I'm not sure those three organizations have a functioning synaptic cleft among them.

[Veritas86]

I'm not so much saying that the system is broken. The current system works. It's been proven to work.

 

There is however, room for improvement. As in all things. The only issue I see with specialty training is that it takes away from what PAs were meant to be. To me, a big draw to PA is the level of adaptability. If there's a need to specialize to remain competitive, then adaptability goes out the window.

 

The other issue is that NPs are pushing for doctorates, and that's blurring the line between them and physicians. Which begs the question of how PAs will remain competitive as a career option.

[Veritas86]

I'm not so much saying that the system is broken. The current system works. It's been proven to work.

 

There is however, room for improvement. As in all things. The only issue I see with specialty training is that it takes away from what PAs were meant to be. To me, a big draw to PA is the level of adaptability. If there's a need to specialize to remain competitive, then adaptability goes out the window.

 

The other issue is that NPs are pushing for doctorates, and that's blurring the line between them and physicians. Which begs the question of how PAs will remain competitive as a career option.

[paul2834]

If my understanding is correct, the change to DNP is mostly cosmetic and the extra classes that are tacked on during the extra 2 years won't add much clinical value. I don't think the DNP will make PAs less competitive. If anything, I can see DNPs attempting to use that doctorate to bolster their wages, so why hire them when they don't have any clinical advantage over physicians and monetarily, PAs have the advantage while being just as clinically competent if not more so.

[paul2834]

If my understanding is correct, the change to DNP is mostly cosmetic and the extra classes that are tacked on during the extra 2 years won't add much clinical value. I don't think the DNP will make PAs less competitive. If anything, I can see DNPs attempting to use that doctorate to bolster their wages, so why hire them when they don't have any clinical advantage over physicians and monetarily, PAs have the advantage while being just as clinically competent if not more so.

[cinntsp]

Ok, so there's a lot of fuss going on about midlevel to MD programs. Wondering what your views on those were, should they ever come about?

 

There is already a PA to DO program at LECOM. I'm sure more will pop up in time.

 

And while I'm at it, I had a thought. A primary difference between NPs and PAs seems to be the amount of oversight. Here's the deal, why not have residency trained PAs have as little oversight as NPs?

 

By and large, NPs and PAs have the same amount of oversight. The percentage of NPs that have their own practice is miniscule.

 

The other issue is that NPs are pushing for doctorates, and that's blurring the line between them and physicians. Which begs the question of how PAs will remain competitive as a career option.

 

It won't blur any lines as long as they aren't referring to themselves as "Dr." in a clinical setting.

[cinntsp]

Ok, so there's a lot of fuss going on about midlevel to MD programs. Wondering what your views on those were, should they ever come about?

 

There is already a PA to DO program at LECOM. I'm sure more will pop up in time.

 

And while I'm at it, I had a thought. A primary difference between NPs and PAs seems to be the amount of oversight. Here's the deal, why not have residency trained PAs have as little oversight as NPs?

 

By and large, NPs and PAs have the same amount of oversight. The percentage of NPs that have their own practice is miniscule.

 

The other issue is that NPs are pushing for doctorates, and that's blurring the line between them and physicians. Which begs the question of how PAs will remain competitive as a career option.

 

It won't blur any lines as long as they aren't referring to themselves as "Dr." in a clinical setting.

[LT_Oneal_PAC]

There is already a PA to DO program at LECOM. I'm sure more will pop up in time.

 

 

 

By and large, NPs and PAs have the same amount of oversight. The percentage of NPs that have their own practice is miniscule.

 

 

It won't blur any lines as long as they aren't referring to themselves as "Dr." in a clinical setting.

 

Right on the first one.

 

Second, they don't have the same supervision by and large. Most states require collaboration and some give complete independence. So no chart review in either of those. Owning the practice has nothing to do with the law stating how they must be supervised. The reason we aren't as unrestricted is because we answer to the medical board. They aren't about to create a monster that will take their jobs later. While we may move to a collorative model, we'll never gain independence without a bridge program. It will be even longer before we have a true bridge that takes into account our full training and not just shave a few months off med school and still have the same entrance (nodding to the mcat) and residency requirements.

 

It may not blur lines, but we should know better than any the power of rebranding.

[LT_Oneal_PAC]

There is already a PA to DO program at LECOM. I'm sure more will pop up in time.

 

 

 

By and large, NPs and PAs have the same amount of oversight. The percentage of NPs that have their own practice is miniscule.

 

 

It won't blur any lines as long as they aren't referring to themselves as "Dr." in a clinical setting.

 

Right on the first one.

 

Second, they don't have the same supervision by and large. Most states require collaboration and some give complete independence. So no chart review in either of those. Owning the practice has nothing to do with the law stating how they must be supervised. The reason we aren't as unrestricted is because we answer to the medical board. They aren't about to create a monster that will take their jobs later. While we may move to a collorative model, we'll never gain independence without a bridge program. It will be even longer before we have a true bridge that takes into account our full training and not just shave a few months off med school and still have the same entrance (nodding to the mcat) and residency requirements.

 

It may not blur lines, but we should know better than any the power of rebranding.

[cinntsp]

Second, they don't have the same supervision by and large. Most states require collaboration and some give complete independence. So no chart review in either of those. Owning the practice has nothing to do with the law stating how they must be supervised. The reason we aren't as unrestricted is because we answer to the medical board. They aren't about to create a monster that will take their jobs later. While we may move to a collorative model, we'll never gain independence without a bridge program. It will be even longer before we have a true bridge that takes into account our full training and not just shave a few months off med school and still have the same entrance (nodding to the mcat) and residency requirements.

 

You seem to be implying that the required supervisory arrangement for PAs means that they get much more oversight. It's not as if 10% mandatory chart review(to give an example) skews the amount of oversight heavily in the direction of PAs, leaving NPs free to do whatever they want. I'll leave it at that until some PAs chime in so we can get it straight from the horse's mouth. I may be off base. :)

[cinntsp]

Second, they don't have the same supervision by and large. Most states require collaboration and some give complete independence. So no chart review in either of those. Owning the practice has nothing to do with the law stating how they must be supervised. The reason we aren't as unrestricted is because we answer to the medical board. They aren't about to create a monster that will take their jobs later. While we may move to a collorative model, we'll never gain independence without a bridge program. It will be even longer before we have a true bridge that takes into account our full training and not just shave a few months off med school and still have the same entrance (nodding to the mcat) and residency requirements.

 

You seem to be implying that the required supervisory arrangement for PAs means that they get much more oversight. It's not as if 10% mandatory chart review(to give an example) skews the amount of oversight heavily in the direction of PAs, leaving NPs free to do whatever they want. I'll leave it at that until some PAs chime in so we can get it straight from the horse's mouth. I may be off base. :)

[akdEM]

With the current band of imbeciles we have running the AAPA, NCCPA and ARC-PA, it isn't likely we will have a PA profession in 10 years.

 

A bit hyperbolic wouldn't you say?

[akdEM]

With the current band of imbeciles we have running the AAPA, NCCPA and ARC-PA, it isn't likely we will have a PA profession in 10 years.

 

A bit hyperbolic wouldn't you say?

[LT_Oneal_PAC]

You seem to be implying that the required supervisory arrangement for PAs means that they get much more oversight. It's not as if 10% mandatory chart review(to give an example) skews the amount of oversight heavily in the direction of PAs, leaving NPs free to do whatever they want. I'll leave it at that until some PAs chime in so we can get it straight from the horse's mouth. I may be off base. :)

 

No, you're right. The actual "supervision" that goes on is pretty equal. My point really is that a "supervisory" agreement for a PA vs a "collaborative" one for NP cause 1) more work for the doc having to sign agreement/do chart review/ect. 2) creates more unnecessary liability for the MD on the MD/PA team. 3) makes administrators think NPs are the better option because of less restrictions.

 

I've heads "don't worry there will be NP backlash," but there are plenty of docs who just want to make more money with less paperwork and liability. Hiring an NP in a state that gives them independence is a good way to do that.

 

I just want to see collaborative agreements, no MD liability, and none of these restrictions (ie in AL, PAs can't place SGC or SC lines, neither of which should be that difficult for Good PA as I've done both)

[LT_Oneal_PAC]

You seem to be implying that the required supervisory arrangement for PAs means that they get much more oversight. It's not as if 10% mandatory chart review(to give an example) skews the amount of oversight heavily in the direction of PAs, leaving NPs free to do whatever they want. I'll leave it at that until some PAs chime in so we can get it straight from the horse's mouth. I may be off base. :)

 

No, you're right. The actual "supervision" that goes on is pretty equal. My point really is that a "supervisory" agreement for a PA vs a "collaborative" one for NP cause 1) more work for the doc having to sign agreement/do chart review/ect. 2) creates more unnecessary liability for the MD on the MD/PA team. 3) makes administrators think NPs are the better option because of less restrictions.

 

I've heads "don't worry there will be NP backlash," but there are plenty of docs who just want to make more money with less paperwork and liability. Hiring an NP in a state that gives them independence is a good way to do that.

 

I just want to see collaborative agreements, no MD liability, and none of these restrictions (ie in AL, PAs can't place SGC or SC lines, neither of which should be that difficult for Good PA as I've done both)

[Veritas86]

No, you're right. The actual "supervision" that goes on is pretty equal. My point really is that a "supervisory" agreement for a PA vs a "collaborative" one for NP cause 1) more work for the doc having to sign agreement/do chart review/ect. 2) creates more unnecessary liability for the MD on the MD/PA team. 3) makes administrators think NPs are the better option because of less restrictions.

 

I've heads "don't worry there will be NP backlash," but there are plenty of docs who just want to make more money with less paperwork and liability. Hiring an NP in a state that gives them independence is a good way to do that.

 

I just want to see collaborative agreements, no MD liability, and none of these restrictions (ie in AL, PAs can't place SGC or SC lines, neither of which should be that difficult for Good PA as I've done both)

 

My point exactly.

[Veritas86]

No, you're right. The actual "supervision" that goes on is pretty equal. My point really is that a "supervisory" agreement for a PA vs a "collaborative" one for NP cause 1) more work for the doc having to sign agreement/do chart review/ect. 2) creates more unnecessary liability for the MD on the MD/PA team. 3) makes administrators think NPs are the better option because of less restrictions.

 

I've heads "don't worry there will be NP backlash," but there are plenty of docs who just want to make more money with less paperwork and liability. Hiring an NP in a state that gives them independence is a good way to do that.

 

I just want to see collaborative agreements, no MD liability, and none of these restrictions (ie in AL, PAs can't place SGC or SC lines, neither of which should be that difficult for Good PA as I've done both)

 

My point exactly.

[Veritas86]

Also, just a thought on the matter, but what do you think the biggest problem in healthcare is?

 

My thing is apathy. Top to bottom. From old crusty MDs who don't think there should be programs to bridge between midlevel and physician to patients whom you can't save from themselves.

 

It's not the financial matters of healthcare than need reform, to me. I think its the educational system first and foremost.

 

Here's a suggestion. Offer PAs who have so much experience, MCE, whatever, to shave off some of the didadic and clinical time of med school. This would be completely optional, same way with masters to PhDs in research and academia. If you want to learn more, you should be able to without starting the entire process over, to me.

 

Edit: Looked into LECOM. It's interesting, but it still takes 3 years. I think feasibly it could be shorter, especially for PAs who are already residency trained being able to take off some clinical time.

 

I think its a great thing though. Even as a DO school, there will be a precedent set, and there's a possibility MD schools, especially with a lot of the new schools popping up are going to want in on that action.

 

To me, its a lot better choice practice wise than the DHSc.

[Veritas86]

Also, just a thought on the matter, but what do you think the biggest problem in healthcare is?

 

My thing is apathy. Top to bottom. From old crusty MDs who don't think there should be programs to bridge between midlevel and physician to patients whom you can't save from themselves.

 

It's not the financial matters of healthcare than need reform, to me. I think its the educational system first and foremost.

 

Here's a suggestion. Offer PAs who have so much experience, MCE, whatever, to shave off some of the didadic and clinical time of med school. This would be completely optional, same way with masters to PhDs in research and academia. If you want to learn more, you should be able to without starting the entire process over, to me.

 

Edit: Looked into LECOM. It's interesting, but it still takes 3 years. I think feasibly it could be shorter, especially for PAs who are already residency trained being able to take off some clinical time.

 

I think its a great thing though. Even as a DO school, there will be a precedent set, and there's a possibility MD schools, especially with a lot of the new schools popping up are going to want in on that action.

 

To me, its a lot better choice practice wise than the DHSc.

[EMEDPA]

 

Edit: Looked into LECOM. It's interesting, but it still takes 3 years. I think feasibly it could be shorter, especially for PAs who are already residency trained being able to take off some clinical time.

 

To me, its a lot better choice practice wise than the DHSc.

 

lecom is as short as is allowed to maintain accreditation as a u.s. med school. I talked to their director about this.

a DO and a DHSc are fundamentally different in that the DO is clinical and full time and a DHSc is academic and part time. different degrees for different purposes. (and yes, I am in a DHSc program because I need to work and can't afford the million dollar opportunity cost to go to medschool at this point in my life. wish I could).

[EMEDPA]

 

Edit: Looked into LECOM. It's interesting, but it still takes 3 years. I think feasibly it could be shorter, especially for PAs who are already residency trained being able to take off some clinical time.

 

To me, its a lot better choice practice wise than the DHSc.

 

lecom is as short as is allowed to maintain accreditation as a u.s. med school. I talked to their director about this.

a DO and a DHSc are fundamentally different in that the DO is clinical and full time and a DHSc is academic and part time. different degrees for different purposes. (and yes, I am in a DHSc program because I need to work and can't afford the million dollar opportunity cost to go to medschool at this point in my life. wish I could).

[LT_Oneal_PAC]

lecom is as short as is allowed to maintain accreditation as a u.s. med school. I talked to their director about this.

a DO and a DHSc are fundamentally different in that the DO is clinical and full time and a DHSc is academic and part time. different degrees for different purposes. (and yes, I am in a DHSc program because I need to work and can't afford the million dollar opportunity cost to go to medschool at this point in my life. wish I could).

True, med school must be a minimum of three years according to WHO, but they could still let the MCAT thing go.