Interesting Reddit Thread

[PAtoMD]

Disclaimer: this is not my thread.

Pretty interesting / controversial thread over on reddit. What’re yalls thoughts?

 

 

[Guest UVAPAC]

Pretty stupid post.

1)  Any supervising physician and medical practice (whether a hospital or a private practice) who lets a second day graduate see "complex patients" on their second day without a physician to consult with is incompetent.  It sounds like you were thrown into a horrible situation, which is unfortunate. 

2)  "Worse than doctors and do nothing better than them" -  I have worked with numerous doctors who I believe have less medical knowledge than myself.  I have had physicians ask for help with certain procedures which they are uncomfortable with, and that I perform better than they do.  I look at us as a TEAM who both help each-other.

3)  No one in medicine knows everything.  You have to be comfortable knowing what you do/don't know and be comfortable admitting that.  I tell patient's whenever appropriate, "I do not know, let me refer you to a specialist who may be able to answer this question."  "I don't know, let me reschedule you with the medical director so you can get a second opinion."  And of course, I always continue to educate myself. 

4)  Medicine costs in this country are OUT OF CONTROL.  PA-C's and APRNs are a way to reduce cost to an extent, and we are highly valued by both private practices and hospitals. 

 

It sounds like this poster went into the wrong profession.  Go to Medical school. 

[PACJD]

"There's nothing that we do as PA's that doctors don't or can't do."

I work in a large academic hospital in NYC in CT surgery with 11 PAs. We all do vein harvesting for CABGs, know how to do them with different harvesting systems, know how to do them open/endoscopically, have the knowledge of the most updated methods of doing it. None of the surgeons know how to do it with some of the newer systems. Some have the knowledge to do it, but have no experience doing it. We teach them how to do it. We teach the residents how to do it. There was one time where there wasn't enough PAs scheduled and an emergent CABG came in. The surgeons were freaking out because they needed someone to harvest but the other surgeons didn't know how to do it. The service would fall apart if we weren't there.

This is one of many examples of what PAs in my service can do that doctors don't. In all specialities there are things that docs don't do, some major, some minor.

[kingcoffee7]

Does this guy think hospitals and private practices are walking around handing out 6 figure salaries willy-nilly? That may not be as much as the docs but come on man, that's a lot of money just to give someone to humor them. If there was no need for you they wouldn't give you any money. 

[thinkertdm]

I would imagine that's why the shadowing requirement.  If you didn't know a thing about what a PA was, maybe don't sign up, sucka.

[Guest HanSolo]

"a young and naive mind."

He seeks answers from outside, yet he already knows the truth is from within...

[Gordon, PA-C]

13 hours ago, UVAPAC said:

 

4)  Medicine costs in this country are OUT OF CONTROL.  PA-C's and APRNs are a way to reduce cost to an extent, and we are highly valued by both private practices and hospitals. 

 

I agree with everything else you said but this is incorrect IMO.  

First off, PAs should get paid the same as doctors, period.  We do exactly the same jobs they do and deserve to get paid the same.  

So I reject the premise that PAs are supposed to get paid less than MDs to save the healthcare system money.  We are not cheap substitutes for MDs.  We are equivalent medical practitioners.

[Gordon, PA-C]

12 hours ago, PACJD said:

"There's nothing that we do as PA's that doctors don't or can't do."

I work in a large academic hospital in NYC in CT surgery with 11 PAs. We all do vein harvesting for CABGs, know how to do them with different harvesting systems, know how to do them open/endoscopically, have the knowledge of the most updated methods of doing it. None of the surgeons know how to do it with some of the newer systems. Some have the knowledge to do it, but have no experience doing it. We teach them how to do it. We teach the residents how to do it. There was one time where there wasn't enough PAs scheduled and an emergent CABG came in. The surgeons were freaking out because they needed someone to harvest but the other surgeons didn't know how to do it. The service would fall apart if we weren't there.

This is one of many examples of what PAs in my service can do that doctors don't. In all specialities there are things that docs don't do, some major, some minor.

This is correct.

PAs do a lot of things that doctors can't do and frankly we are better than they are at many tasks.

One example is our pediatric CV team has 4 PAs and they are all better at balloon aortic valvuloplasty for aortic stenosis than the interventional cardiologists are in the cath lab.  All those cases are done by the PAs, not the MDs.

 

[Guest UVAPAC]

6 hours ago, Gordon, PA-C said:

I agree with everything else you said but this is incorrect IMO.  

First off, PAs should get paid the same as doctors, period.  We do exactly the same jobs they do and deserve to get paid the same.  

So I reject the premise that PAs are supposed to get paid less than MDs to save the healthcare system money.  We are not cheap substitutes for MDs.  We are equivalent medical practitioners.

I don't know how you can expect to get paid the same is an MD.  That is laughable.  Our schooling generally is 2.5 years for a Master's degree.  Their schooling is 4 years for MD.

After that we are able to start practicing.  If they want to be hired anywhere other than a sketchy urgent care center they have to complete a residency, which on average is 3-4 years.  During those 3-4 years they get paid $50,000 a year to work their asses off.  80-100 hour weeks (yes they have enacted laws about how many hours residents can work, however there are 1,000 ways around this), every week for 3-4 years.

Then a lot of them do a fellowship after this for an additional 2-3 years.

 

That is 4+3/4+2/3 years of training = 9-11 years of training versus 2.5 years of training (potentially more if you do a PA residency).  

 

If you want to make $300,000 - $500,000 like most MD's, go to medical school!  

 

 

I actually had a discussion with one of the physician's and with the cost of his Medical School, residency/fellowship wages... versus my 2.5 years of PA school and immediately earning $100,000 a year... it would be about year 7 into his career that he breaks even with a PA after paying off all loans, and making up wages.  

 

I would rather be a PA... just my opinion.

[MonkeyShuttle]

New to the forum and in Pre-pa status but for the sake of discussion.  

I think this article is a rant about how the individual is comparing himself way to much to others in the field.  This individual would have posted a comparing argument if they did become a doctor about how surgeons or dentist or any other specialized practice have it better. Just an opinion though.  

[PACJD]

3 hours ago, UVAPAC said:

I don't know how you can expect to get paid the same is an MD.  That is laughable.  Our schooling generally is 2.5 years for a Master's degree.  Their schooling is 4 years for MD.

After that we are able to start practicing.  If they want to be hired anywhere other than a sketchy urgent care center they have to complete a residency, which on average is 3-4 years.  During those 3-4 years they get paid $50,000 a year to work their asses off.  80-100 hour weeks (yes they have enacted laws about how many hours residents can work, however there are 1,000 ways around this), every week for 3-4 years.

Then a lot of them do a fellowship after this for an additional 2-3 years.

 

That is 4+3/4+2/3 years of training = 9-11 years of training versus 2.5 years of training (potentially more if you do a PA residency).  

 

If you want to make $300,000 - $500,000 like most MD's, go to medical school!  

 

 

I actually had a discussion with one of the physician's and with the cost of his Medical School, residency/fellowship wages... versus my 2.5 years of PA school and immediately earning $100,000 a year... it would be about year 7 into his career that he breaks even with a PA after paying off all loans, and making up wages.  

 

I would rather be a PA... just my opinion.

yea definitely agree with you.. There's no question that MDs are and should be making more, with the amount of schooling and training they go through to become specialists in the field. No one can really argue that. And the reason why the PA/NP profession is so prominent and successful now IS so hospital systems can save money, so the OP in this respect is speaking the truth. 

At the same time, PAs definitely make a healthy salary, while MDs make crazy (at times unnecessary) amounts of money. I read articles doing the math of long-term payout of PA vs MD school and the numbers were similar to yours. It would take at least 5-7 years for an MD to break even with a PA (depending on several factors of course). Obviously in the long-run MD incomes take off, but I am completely satisfied with making my six-fig salary right out of school and having a good quality of life. 

[PACJD]

1 hour ago, MonkeyShuttle said:

New to the forum and in Pre-pa status but for the sake of discussion.  

I think this article is a rant about how the individual is comparing himself way to much to others in the field.  This individual would have posted a comparing argument if they did become a doctor about how surgeons or dentist or any other specialized practice have it better. Just an opinion though.  

I have always said that people who are unhappy in the profession compare themselves way too much to MDs. Truth and reality is we aren't MDs. We do similar work but we can't think of ourselves as  "worse doctors." You can't compare 2 different professions in respect to salary, practice laws, etc. 

[sas5814]

^^ This. We are what we are. Be what you are...do what you do...find satisfaction in that. I still run into people (most lately a hospital pharmacist) who just has to put someone else "in their place" and I maintain they do it because they aren't comfortable in their own skin.

[Guest JMPA]

what do you call a doctor that graduates at the bottom of his class?

[JohnnyLAX9]

6 minutes ago, JMPA said:

what do you call a doctor that graduates at the bottom of his class?

A doctor??

[MonkeyShuttle]

I see what you did there! 

[thinkertdm]

22 hours ago, JMPA said:

what do you call a doctor that graduates at the bottom of his class?

An administrator!

[ventana]

a few thoughts

 

residents at my hospital make 55-70k (not bad)

many do only work 40-50 hours per week many weeks (not on wards/ICU) but otherwise pretty reasonable schedule

on graduation with IM they are making 200k +

 

over a career they are FAR out earning PA's by many times

 

a new grad PA is nothing like a for knoweldge level

a experienced dedicated PA with 10+years the difference is less

 

yes doc's know more (trained longer) but experienced PA's are great 

 

HAve to be very careful with the "PA"s don't know enough" logic

This logic applied to medicine means only cardiologist should treat HTN, and only ortho should treat a sprained ankle and so on....

 

Docs deserve to be the top of the pile, but PA are highly valued critical parts of the team (that should be 100% responsible for ourselves.....

 

 

[EMEDPA]

agree with above. 1st yr residents(interns) work a lot. in many specialties, after the first year they work 50-60 hr weeks. I worked in 2 places with residents and was often in the hospital more than the pgy2 and 3 residents.

[CAAdmission]

On 8/3/2018 at 10:28 AM, JMPA said:

what do you call a doctor that graduates at the bottom of his class?

Lawyer bait.

[EndBulbsOfMouse]

1 hour ago, CJAdmission said:

Lawyer bait.

Haha. Interestingly enough, the things people get sued for often has little to do with their clinical acumen.  If people like their doctor and they have a good bedside manner, they get sued less. 

[EndBulbsOfMouse]

2 hours ago, EMEDPA said:

agree with above. 1st yr residents(interns) work a lot. in many specialties, after the first year they work 50-60 hr weeks. I worked in 2 places with residents and was often in the hospital more than the pgy2 and 3 residents.

It’s very specialty dependent for sure.  Some surgery fellowships, the fellow is on call literally 24/7 for 365 days. Constantly getting bothered  all night and expected to show up 5:30am for rounds.  Interestingly, Home call doesn’t count against the 80 hour rules.  

Some other residencies or fellowships, you’re unlucky if you break 40 hours the whole year and have no home call. 

[Gordon, PA-C]

6 hours ago, EMEDPA said:

agree with above. 1st yr residents(interns) work a lot. in many specialties, after the first year they work 50-60 hr weeks. I worked in 2 places with residents and was often in the hospital more than the pgy2 and 3 residents.

ER residents have the softest schedules out of all the residencies.  They do shift work with no call responsibilities.

Obviously surgical residents work a ton more than ER residents do, and surgery residents routinely lie about their work hours so they can get more OR time and case exposure.

Even for primary care specialties like internal medicine, pediatrics, even family medicine have a lot more call responsibility and higher workload than ER residents because even on outpatient rotations they usually have some overnight call responsibility at the hospital.

At my hospital ER residents work their 12 hour shift and go home and they usually work 3-4 days a week instead of 6-7 like the other specialties.  IM and peds residents spend all day in the outpatient continuity clinic and then have to cover the hospital at night or work in the ER during the night shift.

[Guest UVAPAC]

2 Experiences from my clinical rotations...

1)  Internal Medicine residents "saw patients for 40 hours a week" but they did not consider any charting, presentations, ground rounds, etc as time working.  Therefore when it was all said and done they were working 80+ hour weeks.  I know I would come in to the hospital around 6:00am as a student and stay till 5:00-6:00pm, and every single time the residents were there before me, and went home after me.  

2) Surgical rotation:  Residents literally  would spend the night in the hospital.  They would show up around 4:30am to start pre-rerounding, and literally stay until 6am the next day.  The residents expected us to be there as long as them.  There were numerous times I was up for 32 consecutive hours in surgeries, evaluating patients for surgery, and doing post-operative visits.  As a PA student on my surgical rotation, I would estimate I was in the hospital 72-80 hours a week for 6 consecutive weeks.  The residents also got treated like crap by the attending physicians... "You are not meant to be a surgeon" "You do not have the hands of a surgeon" "How do you expect to do surgery" "Maybe you should consider a different specialty" and watch them literally tear up in front of others...

 

Again for 50-70K a year, no thank you.  

 

[jk5142]

On 8/2/2018 at 11:21 PM, Gordon, PA-C said:

I agree with everything else you said but this is incorrect IMO.  

First off, PAs should get paid the same as doctors, period.  We do exactly the same jobs they do and deserve to get paid the same.  

So I reject the premise that PAs are supposed to get paid less than MDs to save the healthcare system money.  We are not cheap substitutes for MDs.  We are equivalent medical practitioners.

"This is correct.

PAs do a lot of things that doctors can't do and frankly we are better than they are at many tasks.

One example is our pediatric CV team has 4 PAs and they are all better at balloon aortic valvuloplasty for aortic stenosis than the interventional cardiologists are in the cath lab.  All those cases are done by the PAs, not the MDs."

 

 

 

The views that you express here seem quite ludicrous. While some of these statements may be true, it is important to contextualize them in order to prevent them from being misleading. I would like to evaluate some of your statements and would be genuinely interested in your response. 

I was not aware that PAs could perform (?independently) BAV, assuming this is so, I can imagine that the possibility would exist that some PAs possess technical skills "in performing the procedure"  (?inflating a balloon across the aortic valve) that may be on par with some physician colleagues. With that being said, a few questions I would have are :

-do these  PAs evaluate patients for appropriateness of therapy for palliation, staging (bridge to more definitive transcatheter intervention (TAVR etc), or ?other indications

-do they review history, imaging, US/echo studies, and cath reports) to determine whether they may be a candidate?

-do they then independently formulate the plan for the procedure (decide which aortic balloon size to use, etc) and perform it without input from a supervising/collaborating physician?

-do they also possess the skills and knowledge to manage (nonsurgically of course) any potentially catastrophic complications that may occur during or immediately afterwards? 

-also do you feel your statements would hold true if you were to correct for the  # of times said procedure was performed by generic intvn cards guy  so that the PAs #s were equal to the cards guy/girl?

 ** also I would be careful when making statements based on your personal experience with 1, 4, 16 or some other limited number of interactions with physicians, to make the statement "we are better than they are" unless you feel your n is sufficiently powered to be able to make the broad statement (from what little I remember from stats class). 

And when making these types of statements we should try to be aware of potential biases that may invalidate our claims. Try to remember/clarify who/what we are comparing. To keep it "fair", I would say try to make the comparison thinking that a PA with some arbitrary ranking of skill/medical knowledge in the 80 percentile among other PAs in her/his field is compared with the interventional cardiologist in the same percentile bracket amongst her/his own peers. 

With all that being said-I would think that your statements above are not entirely accurate and probably misleading (at least based on my interpretation of what you were trying to say). 

So please, please be careful when making comparative statements. Especially when they involve us PAs, as expressing views that are not accurate or misleading probably lead to animosity (somewhat justified) from some physicians towards us as an entire group/profession (because they are also allowing the same conscious or unconscious biases to affect their opinions). 

 

Sorry for the long post but it's something that's always bugged me when I read these types of arguments/statements online regarding all areas of life/medicine/sports/whatever. 

 

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