PA to MD alternative

[physasst]

I never understood people using procedures as evidence of HCE.

 

It's kind of a silly notion really. I could care less if the applicant knows how to do an LP or place a central line.

 

I can teach a monkey....(maybe a chimp) to do those things. Procedures to be honest, while fun, don't demonstrate critical thinking.

 

I am much, MUCH more concerned that an applicant knows WHY, and WHEN to do a procedure than the technique.

 

That's me though....

[physasst]

I never understood people using procedures as evidence of HCE.

 

It's kind of a silly notion really. I could care less if the applicant knows how to do an LP or place a central line.

 

I can teach a monkey....(maybe a chimp) to do those things. Procedures to be honest, while fun, don't demonstrate critical thinking.

 

I am much, MUCH more concerned that an applicant knows WHY, and WHEN to do a procedure than the technique.

 

That's me though....

[Joelseff]

I never understood people using procedures as evidence of HCE.

 

It's kind of a silly notion really. I could care less if the applicant knows how to do an LP or place a central line.

 

I can teach a monkey....(maybe a chimp) to do those things. Procedures to be honest, while fun, don't demonstrate critical thinking.

 

I am much, MUCH more concerned that an applicant knows WHY, and WHEN to do a procedure than the technique.

 

That's me though....

 

Totally agree but i must add that Any chimp can b taught as you say but developing the touch and feel takes experience. But i agree that knowing the application of a procedure/tx/test etc is more important. Which can be learned didactically (did I just make up a word lol) but i think requires some exp also to apply it.

 

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[Joelseff]

I never understood people using procedures as evidence of HCE.

 

It's kind of a silly notion really. I could care less if the applicant knows how to do an LP or place a central line.

 

I can teach a monkey....(maybe a chimp) to do those things. Procedures to be honest, while fun, don't demonstrate critical thinking.

 

I am much, MUCH more concerned that an applicant knows WHY, and WHEN to do a procedure than the technique.

 

That's me though....

 

Totally agree but i must add that Any chimp can b taught as you say but developing the touch and feel takes experience. But i agree that knowing the application of a procedure/tx/test etc is more important. Which can be learned didactically (did I just make up a word lol) but i think requires some exp also to apply it.

 

Sent from my HTC MT4GS using Tapatalk

[Guest hubbardtim48]

I understand there is a lot more to being a PA, but in EM or CCM you are dealing with a lot of respiratory problems or respiratory problems second to something else (i.e. CABG, AAA, etc). So, knowing how to wean and when to wean on a ventilator is crucial in those situations. Yes, you can have RT do most of it, but it is still nice to be able to DO it if you want to or if RT has run out of things to do then I could step in and put my 2 cents in and hopefully help the patient. You will never understand what I mean because you are not an RT and have been in dozens of situations where others can't manage the vent or need a wider knowledge base to know when to place "the patient" on a different mode or do other interventions. It all depends on the PATIENT and not what the PROTOCOL says or what the MD/DO says (that has no clue about ventilation). 99% of the time the doctor (anesth., ICU, hospitalists, etc.) will come in and put everyone on the same type of settings and same mode, not thinking about their ideal body weight, their type of surgery, past med. history (CHF, COPD, kypo, etc) or any other issue that could affect ventilation. Also, those same people usually wait wayyyyy tooooooo long to put critical patients on advanced ventilation (APRV (aka bi-vent, bi-level, duopap) VDR, independent lung ventilation, oscillator, IPV txs, etc). So, this is where my RT experience will come into play because I have had to talk physicians into letting me place patients on these types of modes and interventions because they were going downhill fast. Knowing when to start these "lung protective strategies" is key to good ventilation and being in my shoes for the past 5 years, I have seen MOST physicians not able to make these wise decisions fast enough. If you CAN do something to help a patient then why wouldn’t I use my past HCE to help others out (i.e. patients and co-workers).

[Guest hubbardtim48]

I understand there is a lot more to being a PA, but in EM or CCM you are dealing with a lot of respiratory problems or respiratory problems second to something else (i.e. CABG, AAA, etc). So, knowing how to wean and when to wean on a ventilator is crucial in those situations. Yes, you can have RT do most of it, but it is still nice to be able to DO it if you want to or if RT has run out of things to do then I could step in and put my 2 cents in and hopefully help the patient. You will never understand what I mean because you are not an RT and have been in dozens of situations where others can't manage the vent or need a wider knowledge base to know when to place "the patient" on a different mode or do other interventions. It all depends on the PATIENT and not what the PROTOCOL says or what the MD/DO says (that has no clue about ventilation). 99% of the time the doctor (anesth., ICU, hospitalists, etc.) will come in and put everyone on the same type of settings and same mode, not thinking about their ideal body weight, their type of surgery, past med. history (CHF, COPD, kypo, etc) or any other issue that could affect ventilation. Also, those same people usually wait wayyyyy tooooooo long to put critical patients on advanced ventilation (APRV (aka bi-vent, bi-level, duopap) VDR, independent lung ventilation, oscillator, IPV txs, etc). So, this is where my RT experience will come into play because I have had to talk physicians into letting me place patients on these types of modes and interventions because they were going downhill fast. Knowing when to start these "lung protective strategies" is key to good ventilation and being in my shoes for the past 5 years, I have seen MOST physicians not able to make these wise decisions fast enough. If you CAN do something to help a patient then why wouldn’t I use my past HCE to help others out (i.e. patients and co-workers).

[LT_Oneal_PAC]

I never understood people using procedures as evidence of HCE.

 

It's kind of a silly notion really. I could care less if the applicant knows how to do an LP or place a central line.

 

I can teach a monkey....(maybe a chimp) to do those things. Procedures to be honest, while fun, don't demonstrate critical thinking.

 

I am much, MUCH more concerned that an applicant knows WHY, and WHEN to do a procedure than the technique.

 

That's me though....

 

I make the assumption if one can do those procedures they know when to use them. It's almost always apart of the training in procedures is when to recognize they are needed. People who are placing chest tubes usually aren't the type of worker that has to be told when one is needed. Someone assisting with the procedure may not, but the one's who actually do advanced procedures aren't usually just following orders.

 

I do agree with the notion that a chimp can be trained to do them, but I don't see people given skills and not knowledge.

[LT_Oneal_PAC]

I never understood people using procedures as evidence of HCE.

 

It's kind of a silly notion really. I could care less if the applicant knows how to do an LP or place a central line.

 

I can teach a monkey....(maybe a chimp) to do those things. Procedures to be honest, while fun, don't demonstrate critical thinking.

 

I am much, MUCH more concerned that an applicant knows WHY, and WHEN to do a procedure than the technique.

 

That's me though....

 

I make the assumption if one can do those procedures they know when to use them. It's almost always apart of the training in procedures is when to recognize they are needed. People who are placing chest tubes usually aren't the type of worker that has to be told when one is needed. Someone assisting with the procedure may not, but the one's who actually do advanced procedures aren't usually just following orders.

 

I do agree with the notion that a chimp can be trained to do them, but I don't see people given skills and not knowledge.

[LT_Oneal_PAC]

While I have done many procedures on my rotations, almost none of what you listed will benefit me in my career in Ortho. I dont see myself placing swans, art lines, intubating, working vents, spinal taps, MAYBE running a code but that would be a very rare occurance. In your post a few lines down you say that placing IVs, etc. are essential in getting to the next level but again I have never been asked to do this thus far and will not be asked to in my future career. So why is it that all of these things that people deem essential aren't going to help me one bit? It seems like there is a great disconnect between what some deem essential, and what actually is essential in practice, which weakens the prior HCE imo. (With that said Im all for prior HCE and feel it should be a pre-req for PA programs.. just not to the level that some of the old school members on this forum tout.)

 

I shouldn't just say things and assume people understand the meaning behind it, sorry. My point is getting use to blood and poking people. Well, besides your significant other.

[LT_Oneal_PAC]

While I have done many procedures on my rotations, almost none of what you listed will benefit me in my career in Ortho. I dont see myself placing swans, art lines, intubating, working vents, spinal taps, MAYBE running a code but that would be a very rare occurance. In your post a few lines down you say that placing IVs, etc. are essential in getting to the next level but again I have never been asked to do this thus far and will not be asked to in my future career. So why is it that all of these things that people deem essential aren't going to help me one bit? It seems like there is a great disconnect between what some deem essential, and what actually is essential in practice, which weakens the prior HCE imo. (With that said Im all for prior HCE and feel it should be a pre-req for PA programs.. just not to the level that some of the old school members on this forum tout.)

 

I shouldn't just say things and assume people understand the meaning behind it, sorry. My point is getting use to blood and poking people. Well, besides your significant other.

[whimsygirl]

...and I'll be sure to cross off that from possible places of employment once I graduate

 

That's a lot of hostility over not being able to make a vent change. We are a large academic facility that has residents floating in and out of the different units. Its a matter of safety. They are still learning vent theory. To keep some consistency only attendings and RRTs can make the actual changes.

[whimsygirl]

...and I'll be sure to cross off that from possible places of employment once I graduate

 

That's a lot of hostility over not being able to make a vent change. We are a large academic facility that has residents floating in and out of the different units. Its a matter of safety. They are still learning vent theory. To keep some consistency only attendings and RRTs can make the actual changes.

[GatorRRT]

No hostility intended. I'm going to PA school to increase my scope of practice as an RT, not have it limited by policy.

[GatorRRT]

No hostility intended. I'm going to PA school to increase my scope of practice as an RT, not have it limited by policy.

[GatorRRT]

I think you're just missing my point. I'm not saying I'm going to physically make every vent change I order. But if I'm in a room assessing a patient and their Sats are in the 70's, I'm increasing the FIO2 and I'll document and let RT know. Just like if I was assessing a pt with a Trach and they plugged off, I would be suctioning and trouble shooting while someone called RT. I've always been an adovacate of pt safety, which won't change, regardless of title. As for the limitation on who can touch a vent, I understand the rational, but something tells me if a hospital has a policy like that, what else would I not be able to do. Granted I'm not a PA yet, but I've been under the assumption that it should be my SP deciding my scope of practice, not hospital policy.

[GatorRRT]

I think you're just missing my point. I'm not saying I'm going to physically make every vent change I order. But if I'm in a room assessing a patient and their Sats are in the 70's, I'm increasing the FIO2 and I'll document and let RT know. Just like if I was assessing a pt with a Trach and they plugged off, I would be suctioning and trouble shooting while someone called RT. I've always been an adovacate of pt safety, which won't change, regardless of title. As for the limitation on who can touch a vent, I understand the rational, but something tells me if a hospital has a policy like that, what else would I not be able to do. Granted I'm not a PA yet, but I've been under the assumption that it should be my SP deciding my scope of practice, not hospital policy.

[LT_Oneal_PAC]

I think you're just missing my point. I'm not saying I'm going to physically make every vent change I order. But if I'm in a room assessing a patient and their Sats are in the 70's, I'm increasing the FIO2 and I'll document and let RT know. Just like if I was assessing a pt with a Trach and they plugged off, I would be suctioning and trouble shooting while someone called RT. I've always been an adovacate of pt safety, which won't change, regardless of title. As for the limitation on who can touch a vent, I understand the rational, but something tells me if a hospital has a policy like that, what else would I not be able to do. Granted I'm not a PA yet, but I've been under the assumption that it should be my SP deciding my scope of practice, not hospital policy.

 

If it's a matter of just changing O2, that's even within the scope of an RN at my hospital. I wouldn't work for a hospital that wouldn't let me change O2 either.

[LT_Oneal_PAC]

I think you're just missing my point. I'm not saying I'm going to physically make every vent change I order. But if I'm in a room assessing a patient and their Sats are in the 70's, I'm increasing the FIO2 and I'll document and let RT know. Just like if I was assessing a pt with a Trach and they plugged off, I would be suctioning and trouble shooting while someone called RT. I've always been an adovacate of pt safety, which won't change, regardless of title. As for the limitation on who can touch a vent, I understand the rational, but something tells me if a hospital has a policy like that, what else would I not be able to do. Granted I'm not a PA yet, but I've been under the assumption that it should be my SP deciding my scope of practice, not hospital policy.

 

If it's a matter of just changing O2, that's even within the scope of an RN at my hospital. I wouldn't work for a hospital that wouldn't let me change O2 either.

[Guest hubbardtim48]

I am glad your HCE is great and all, but talking over this forum, one can interpret anyway he/she wants to on how something is said. You took what I said the wrong way and I can't help that. My reasons for stating the part about MDs, DOs, CRNAs, AAs is because it shows how well RTs are needed and we do much more advanced ventilation than people know (such that even "the vent experts" can't even run it nor understand it). Also, my HCE as an asthma educator (also teach pneumonia ed, COPD ed, smoking cessation, etc) will benefit me if I want to work in an allergy/asthma clinic or any other general medicine clinic. RTs do a lot more than you could ever imagine and was trying not to act bigger and better than you, but more importantly I am trying to let others know what RTs do and how well they are needed in the health care system. RTs and PAs are underestimated and under-represented so that is my point of telling you about my past HCE because we need to let show everyone how important PAs really are and that is what I am trying to do.

[Guest hubbardtim48]

I am glad your HCE is great and all, but talking over this forum, one can interpret anyway he/she wants to on how something is said. You took what I said the wrong way and I can't help that. My reasons for stating the part about MDs, DOs, CRNAs, AAs is because it shows how well RTs are needed and we do much more advanced ventilation than people know (such that even "the vent experts" can't even run it nor understand it). Also, my HCE as an asthma educator (also teach pneumonia ed, COPD ed, smoking cessation, etc) will benefit me if I want to work in an allergy/asthma clinic or any other general medicine clinic. RTs do a lot more than you could ever imagine and was trying not to act bigger and better than you, but more importantly I am trying to let others know what RTs do and how well they are needed in the health care system. RTs and PAs are underestimated and under-represented so that is my point of telling you about my past HCE because we need to let show everyone how important PAs really are and that is what I am trying to do.

[LT_Oneal_PAC]

I am glad your HCE is great and all, but talking over this forum, one can interpret anyway he/she wants to on how something is said. You took what I said the wrong way and I can't help that. My reasons for stating the part about MDs, DOs, CRNAs, AAs is because it shows how well RTs are needed and we do much more advanced ventilation than people know (such that even "the vent experts" can't even run it nor understand it). Also, my HCE as an asthma educator (also teach pneumonia ed, COPD ed, smoking cessation, etc) will benefit me if I want to work in an allergy/asthma clinic or any other general medicine clinic. RTs do a lot more than you could ever imagine and was trying not to act bigger and better than you, but more importantly I am trying to let others know what RTs do and how well they are needed in the health care system. RTs and PAs are underestimated and under-represented so that is my point of telling you about my past HCE because we need to let show everyone how important PAs really are and that is what I am trying to do.

 

After reading all that, nope I pegged it right the first time. None of what you have said about yourself has anything to do with how much RTs are needed and even less (if anything) to do with PAs. Nice try at turning this into about you again. I'm done hearing it, finding the ignore button.

 

Back to the topic, the law is three years minimum for med school, which I believe is a rule set by WHO. What would it take to change this for say the PA who has been in FP for 10 years and wants to do FP as an MD?

[LT_Oneal_PAC]

I am glad your HCE is great and all, but talking over this forum, one can interpret anyway he/she wants to on how something is said. You took what I said the wrong way and I can't help that. My reasons for stating the part about MDs, DOs, CRNAs, AAs is because it shows how well RTs are needed and we do much more advanced ventilation than people know (such that even "the vent experts" can't even run it nor understand it). Also, my HCE as an asthma educator (also teach pneumonia ed, COPD ed, smoking cessation, etc) will benefit me if I want to work in an allergy/asthma clinic or any other general medicine clinic. RTs do a lot more than you could ever imagine and was trying not to act bigger and better than you, but more importantly I am trying to let others know what RTs do and how well they are needed in the health care system. RTs and PAs are underestimated and under-represented so that is my point of telling you about my past HCE because we need to let show everyone how important PAs really are and that is what I am trying to do.

 

After reading all that, nope I pegged it right the first time. None of what you have said about yourself has anything to do with how much RTs are needed and even less (if anything) to do with PAs. Nice try at turning this into about you again. I'm done hearing it, finding the ignore button.

 

Back to the topic, the law is three years minimum for med school, which I believe is a rule set by WHO. What would it take to change this for say the PA who has been in FP for 10 years and wants to do FP as an MD?

[andersenpa]

Re procedures...

Sorry folks but ""any chimp" cannot be taught to do procedures well.

You can easily teach someone to do something to get it done, but it takes talent and (dare I say) intellect to skillfully perform procedures. They're not all chip shots.

 

Anyone who says otherwise 1) hasn't done enough procedures or 2) hasn't done any challenging ones.

[andersenpa]

Re procedures...

Sorry folks but ""any chimp" cannot be taught to do procedures well.

You can easily teach someone to do something to get it done, but it takes talent and (dare I say) intellect to skillfully perform procedures. They're not all chip shots.

 

Anyone who says otherwise 1) hasn't done enough procedures or 2) hasn't done any challenging ones.

[LT_Oneal_PAC]

Re procedures...

Sorry folks but ""any chimp" cannot be taught to do procedures well.

You can easily teach someone to do something to get it done, but it takes talent and (dare I say) intellect to skillfully perform procedures. They're not all chip shots.

 

Anyone who says otherwise 1) hasn't done enough procedures or 2) hasn't done any challenging ones.

 

I would say that was formerly true, but today with ultrasound, ct, video laryngoscopes, vein finders, it's not as true. Now getting things done the old fashioned way (like a central line without US or a swan without CT) then yes, I agree. However, more and more it's becoming standard to does these things with more tools. Not that I agree with it.

 

I still believe though one is not taught to do these procedures or trusted to do them independently without critically thinking and without being taught how to do them without technological assistance.