True indepent practice = go to med school. Not PA or NP school

[EMfuturePA]

While working in a big hospital I realized that almost all midlevels just follow orders from senior physicians and truly make no individual decisions. Sometimes, we come up with some great ideals but instead of getting praised these physicians dismiss them.  Recently, I came across a few urgent care centers that is run by PA's. That is the only time mid-levels seemed independent. Unless this OTP thing passes and we get more independence I don't think our profession is not that great.  I Just gotta study my butt off to get 99% on MCAT and go to NYU med for free lol.

[ohiovolffemtp]

My experience in UC and EM is different than what you describe.  The key is the high degree of variability in the amount of independence in each setting, and in many cases with each physician.  OTP is very important because it will remove artificial barriers to experienced and qualified PA's working at the top of their abilities.  

[LT_Oneal_PAC]

This is highly variable. Lots of solo PA EDs. In the military they are very independent. Plenty of CT PAs managing the post op CVICU patients. Critical care PAs in my hospital manage their own panel of patients. Other than while I’m a resident, I’ve never had or plan on having any management dictated to me unless I’m calling the consultant.

[Guest HanSolo]

17 minutes ago, EMfuturePA said:

While working in a big hospital...

Ever been anywhere else? 

[sas5814]

I agree with the variability. I worked in rural health and under served areas for many years and I often would see or speak to my SP for weeks and weeks.

Now I am in a big system and what you describe holds pretty true but the physicians are nagged just as much by rule makers and committees and policy and procedure as we are.

[thinkertdm]

In every practice, I've been pretty much independent, and not have to run patients by anyone.  Granted, it's primary care, but since everything falls back to us, it's pretty big.

I do more than fill out forms.  I have a guy I'm working up with liver cancer that has metastasized; I see and then decide what to do with chest pains, hiv patients; what anticoagulation I use for a fellow with ckd and afib.  May not be as exciting as a guy grabbing his chest and vomiting blood, but the desicions I make on a daily basis affect lives, and when I discuss with my colleagues, it's for further clarification of a process I have started, and it's rare.  I've had those md colleagues come to me on occasion as well.

Sounds like you're taking the "assistant" part too seriously.

[Lexapro]

39 minutes ago, EMfuturePA said:

While working in a big hospital I realized that almost all midlevels just follow orders from senior physicians and truly make no individual decisions. Sometimes, we come up with some great ideals but instead of getting praised these physicians dismiss them.  Recently, I came across a few urgent care centers that is run by PA's. That is the only time mid-levels seemed independent. Unless this OTP thing passes and we get more independence I don't think our profession is not that great.  I Just gotta study my butt off to get 99% on MCAT and go to NYU med for free lol.

 

Honestly I think this is just your hospital. Where I work (inpatient psychiatry) I carry my own patient load. Sure I run things by my attending sometimes but I am absolutely directing the care for my patient myself, making my own diagnoses, choosing to run my own tests, starting my own meds,  deciding whether or not to extend a hold or lift it, etc.

I just picked up a per diem gig at a PES where I am the only provider for a 24 hour shift. I will still have a doc who I can call to run things by (which I am thankful for). Jobs with autonomy are out there. This job also pays insanely well.

[EMEDPA]

I do solo, rural EM. I am the only provider in the hospital. My state has no required chart review.

That being said, it took me 15 years to get this job and the right combination of experience and training. someone in the know recently told me that 2.5% of EM PAs practice with this degree of autonomy. If you assume 10,000 EM PAs nationally that amounts to 250 PAs in the entire country.

[SoCal_PA]

Quote

Indepent

Quote

I don't think our profession is not that great

 

Good luck getting into any postgrad school bud

[mgriffiths]

3 hours ago, EMfuturePA said:

almost all midlevels just follow orders from senior physicians and truly make no individual decisions.

I work in family practice and see my own patient panel - approximately 100 patients per week with ZERO input from my collaborating physician unless I specifically go to him and ask a question.  I've personally seen him "review" my charts.  He'll "review" 20-30 per minute - I think it's pretty obvious nothing is actually being read.  He trusts my medical acumen.  Was it this way on my first day...of course not...but as I have proved myself, asked questions and actually learned I have gained trust.

But just in case the above was too technical for you - I make my own medical decisions every moment of every working day.

[jeepgirl]

3 hours ago, EMfuturePA said:

While working in a big hospital I realized that almost all midlevels just follow orders from senior physicians and truly make no individual decisions. Sometimes, we come up with some great ideals but instead of getting praised these physicians dismiss them.  Recently, I came across a few urgent care centers that is run by PA's. That is the only time mid-levels seemed independent. Unless this OTP thing passes and we get more independence I don't think our profession is not that great.  I Just gotta study my butt off to get 99% on MCAT and go to NYU med for free lol.

Are you a practicing PA? 

 

[Jkarram]

6 minutes ago, jeepgirl said:

Are you a practicing PA? 

 

On the internet, everyone is a practicing PA. 

[thinkertdm]

2 hours ago, SoCal_PA said:

 

Good luck getting into any postgrad school bud

Ouch!

[PACJD]

 

6 hours ago, EMfuturePA said:

I don't think our profession is not that great.

Are you a pre-PA, a PA student, or a PA-C? Cause unless you are a student or practicing PA you can't say our profession. And unless you actually work as a PA you can't really comment on how great it is. How many hospitals have you actually been in to be able to judge?

Don't mean to be a jerk, but its definitely variable in the scope of practice of each PA, dependent on speciality, location, and the hospital in general. There are definitely things about the profession that aren't great and needs to be improved. 

At the end of the day, physicians are physicians and mid-levels are mid-levels. We each have our role. There are perks, benefits, and negatives of each. Do your research and shadow if you can before you make your decision. 

[Kaepora]

That's not true at all.  The NPs that staff our ICUs are completely alone and autonomous on nights, and during the day they update the intensivist but that intensivist still relies on them a great deal.  Similarly, the PAs and NPs on the hospitalist service are quite independent.  The addendum to their H&Ps/consults usually goes "I personally saw and examined the patient and agree with the NP/PAs assessment and plan as above".  And we all know what their version of "saw and examined" means...

[BirdDogPA]

On 9/6/2018 at 12:27 PM, EMEDPA said:

I do solo, rural EM. I am the only provider in the hospital. My state has no required chart review.

That being said, it took me 15 years to get this job and the right combination of experience and training. someone in the know recently told me that 2.5% of EM PAs practice with this degree of autonomy. If you assume 10,000 EM PAs nationally that amounts to 250 PAs in the entire country.

My current solo coverage job is rural but in all honesty not crazy rural. Population in the county is probably 17k and a decent town with most medical specialties is only 30 min away. There are no physicians left in town so we do everything cover the ED and hospital. I recently got privileged to do inpatient admissions which has been an interesting experience. My point to this is its all in where you work. If PA are willing to work hard and go rural there are places with tremendous independence. 

[EMEDPA]

BirdDog- do you mind sharing what state you practice in? 

[BirdDogPA]

6 minutes ago, EMEDPA said:

BirdDog- do you mind sharing what state you practice in? 

Sure! Mississippi. 

[jmj11]

I cannot remember getting an order from a physician in over 20 years. I see my SP three times a month and he would never give me an order. It is mutual respect. He probably asks me as many questions or more than I ask him. Maybe you need to find a new job situation rather than starting over in med school. PA can be a great profession.

[Reality Check 2]

I have no idea what the OP is talking about. I haven't taken an ORDER from a physician as a PA - ummm, EVER.

I am a licensed practitioner who makes my own assessments and plans.

My SP wanders by every few weeks and is available by phone or instant message.

I brainstorm with my colleagues in my dept - MD, DO, PA, NP but I don't take orders from anyone.

It baffles me that someone thinks this is normal, acceptable or proper practice. 

My history is ER, family practice, ortho and internal medicine with some occ med thrown in over all these years. 

OP - please identify yourself - PA, pre-PA - what you are describing pretty much doesn't exist.

[EMEDPA]

33 minutes ago, BirdDogPA said:

Sure! Mississippi. 

wow, seems like things are looking up there. Mississippi used to be the worst state in the nation to practice in as a PA. 

[BirdDogPA]

4 minutes ago, EMEDPA said:

wow, seems like things are looking up there. Mississippi used to be the worst state in the nation to practice in as a PA. 

Yes sir, there are some crazy stories from how PAs used to be treated here. I've had the honor of meeting a few people with license numbers in the single digits.

Even just the past 2 years things have changed a lot! 1)We no longer have to appear before the board of medicine with letters of recommendation form physicians to get a license. 2)Milage limit is being moved from 30m to 75m. 3) I believe chart review is 10% a month with plans to move that to 20 charts or 10% whichever is lowest.  

[EMEDPA]

PAs could not be licensed at all there when I was in PA school in the early 90s if I am remembering correctly. 

[BirdDogPA]

1 minute ago, EMEDPA said:

PAs could not be licensed at all there when I was in PA school in the early 90s if I am remembering correctly. 

Yes! There is a lot of PA history in Mississippi actually. We had a school at the Universtiy of Mississippi back in the 70s, I believe they graduate maybe 2 classes. As the story goes Dr. Harding (did the first heart and lung transplant) was making rounds one morning and told one of his graduate assistants Dr. Donald Fisher (the first executive director of the AAPA) to start a PA program. Dr. Fisher spoke at my white coat ceremony and said he didn't even know what a PA was at the time. Had to go research it and call Duke to see what it was. They started the program and it was successful but then the political climate got terrible and the program lost state funding and was shut down. 

Fast forward to 2000 legislation was passed to legalize practice. It's scary and humbling at the same time to think that what I get to do today would have been considered illegal in this state just 19 years ago....

[ascites]

You want autonomy go active duty.