Does experience matter to anyone anymore?

[Jaydynomite]

Sorry for any confusion. I'm not saying all PA students should be only an Emt or medic, those were the first things that came to mind. You could be a nurse or paramedic or something too. The point being that any medical encounter can become a medical emergency, and without experience, how would you know the way to handle the situation? Also, bodiggler's comment above kinda wraps things up nicely. Anyone can study. A GPA can't measure a person's true ability to handle a crisis, though.

[Timon]

Here is why HCE is so important:

 

HOW can anyone that HAS NEVER EVEN SEEN a patient dying/very sick, never experienced the mental/physical stress of healthcare, and never even dealt with insurance companies, POSSIBLY even know what they are getting themselves into by going straight into health care to be a PA?

 

This signle statement struck a cord with me.. I've been trying to keep my opinion to myself for many of the posts in this thread.. but here goes...

 

I'll start by saying I think HCE is important prior to entering PA school.. but not for the reason of not know what I'm doing AFTER I pass the PANCE and work as a PA or the notion that one lacks the ability to cope with and manage stressfull situations...

 

For those of you that think HCE is a must.. you shouldn't assume that those without HCE do not have real life experiences they can call on to handle seeind a "patient dying/very sick" and lack the mental/physical capacity to cope with this stress. What do you guys think everyone applying is some 22 year old that grew up privledged and both parents are executives? What little bubble did you grow up in?

 

I had no direct patient care experience when I saved my dad's life the first, second or third time after he stopped breathing.

I had no HCE when I c-spined my first person (I was 14 year old Huntington Beach Jr. Lifeguard).

I had no HCE when I performed CPR for my first time on someone.

I had no HCE the first time I saw someone die right in front of me.

I had no HCE when I was the first one on the scene after my dad had a serious stoke/heart attack and found him already in rigamortis only to have to explain to the rest of my family what happened and watching their strife and agony.

I had no HCE when I saw a car drive off the road was the only one on the scene to assist three critically injured patients by triaging and managing the scene for the 1 hour it took for EMS to arrive (one of the injured had a tree branch impaled in his femor).

All of this occured before I turned 23.

I had no HCE when my mother beat breast cancer for her first and second time and same with my grandmother.

I had no HCE as I currently watch my grandmother currently laying in her death bed the same as I did with my grandmother on my father's side.

 

Or my first day shadowing in an ER at a level 1 trauma center where a patient came in with a severe onset of shortness of breath, had to be intubated, a code was called and the patient expired.. 10 minutes later I was eating my lunch as if nothing had happened even though I had deep empathy for this patient's son who was sitting right next to me because I could relate with him having my own father pass away in front of me...

 

Guess what.. I was able to manage stress very well in those situations. I didn't feel like a fish out of water because I've been in inintense situations and know how to manage and cope with stress because of my real life experiences outside of healthcare. You think I haven't had to deal with someone or something breathing down my neck with some random deadline that was make or break? Or that I haven't lost sleep because of a real life situation?

 

How about the fact I can call on my days as a lifeguard saving people's lives and the stress with those situations?... or as a SCUBA instructor / divemaster where I've had to perform CPR and have seen some bad stuff happen to them. Or while I was underwater watching in horror as another instructor's student weights fell off at 110ft knowing full well they'd be dead by the time they hit the surface.

 

Also knowing that this could happen to me or to one of my own students and that I'm responsible for that person's life.

 

You think I have to work in healthcare to learn that insurance companies are BS and have a bunch of red tape or learn how to get around red tape? or to understand what red tape is? Or that office politics exist? Or why someone doesn't want to pay for a procedure because the insurance or managed care system felt it wasn't nescisary? How about you work at my business job and I'll show you red tape and micromanagement...

 

HCE is good.. But what schools should be emphasizing is does this person have the ability to be teachable... I don't see how working 4k+ hours as a CNA/EMT who's job scope is to only give sponge baths or assist patients get dressed or be a glorified taxi driver to the dialysis center and the care facility is more valuable than someone who has years of experience let's say as an analyst/manager or some other job that requires critical thinking and has stressfull situations.

 

Because isn't that what we are supposed to be doing as a PA? Using our critical thinking abilities to figure out a solution?

So many of those in this thread are stating "This PA without HCE is like a dear caught in headlights" and just a bunch of rubbish.. stop basing an entire profession that states PA's have lateral mobility to work in most specialties in healthcare and focusing it on emergency medicine.

 

How many primary care physicians are going to be dealing with an OB emergency (in a non rural setting)? Yet the lowest level of prehospital care EMT-B is trained on breached deliveries, nuchal cords, and fecal matter in amniotic fluid to a limited basis yet a PA is going to be clueless (from what some of you are implying) when faced with that and you make it seem like it occurs so often. Or how many surgery PA's are going to have to give a rectal exam to check for internal bleeding for a TC?

 

It seems like everyone is really fusing the need for HCE and relating it to emergency medicine PA's when they cite their example. Be fare in what examples you are using when you are making a generalization out of all the specialties fields a PA can work in, since for the most part PA's work in the fast track in the hospitals in my area and don't deal with acuity. Speaking with many physicians during my shadowing not a single one ever stated that a PA in their area even run's a code.. it's not that they couldn't take an ACLS/PALS/NRP course and know what to do but it has to do to the lack of pathophysiology taught in PA programs versus a MD/DO (as it was explained to me by ER physicians).

[GatorRRT]

PAs as well as NPs run codes at my facility. The ability to handle a code has to do with following an algorithm, not pathophysiology.

[GatorRRT]

. Life experiences have value, but I don't think your situations compare to solid HCE. As an RT at my facility, it's my job to determine if a patient looks "bad", obtain labs to confirm this, speak with the midlevel covering the patient, and help them come to an appropriate conclusion in regards to the next steps needed, up to intubation, which I do as well. There's a huge differnce between this type of thinking in a clinical setting and life guarding and being a SCUBA instructor. The ability to recognize what a "bad" patient looks like and knowing what to do isn't something you learn as a midlevel executive, it's a skill acquired by working in a health care setting. Being around patients in any capacity in an acute facility is invaluable experience to help hone these skills.

[Timon]

I understand and agree. I'm familiar with the algorithm as I've taken the ACLS/PALS courses. This what was said to my a physician for their hospital even though I disagree with their blanket statement.

[Timon]

RT is a great profession and used in so many areas of healthcare. I agree that HCE is important as I stated on numerous posts. But look specifically at what I was talking about. Stress and dealing with sick and dying as well as acuity when the profession is much more vast than that.

[mktalon]

It seems like everyone is really fusing the need for HCE and relating it to emergency medicine PA's when they cite their example.

 

You might notice that there is a correlation between those that aggressively support the value of emergency related experience and posters that are/were emt-b's or medics. No matter what you say, the posters that fall in this correlation will always return to the code situation as a good reason why somebody needs xyz high acuity experience to be a PA. All the reasoning cannot change these posters minds about the fact that suburban family practice PAs have a higher chance of pumping a chest on the side of the highway after witnessing a car accident on their way to work than they do while actually working. There are also medics and emt's that support having quality HCE, and do so in a level-headed fashion and have a reasonable opinion about why HCE is important.

[EMEDPA]

Speaking with many physicians during my shadowing not a single one ever stated that a PA in their area even run's a code.. it's not that they couldn't take an ACLS/PALS/NRP course and know what to do but it has to do to the lack of pathophysiology taught in PA programs versus a MD/DO (as it was explained to me by ER physicians).

it has nothing to do with what they were taught in school , it has to do with the comfort level of their supervisors and what they are allowed to do. we have delegated practice. we are limited not by our knowledge but by the perceptions of our supervisors.. most good em pa's work at about 50-60 % of their potential and training....I could do a lot more on a daily basis than I am "allowed to do". that's why I work 4 jobs. one pays the bills, the per diem jobs lets me have fun and do the work I was trained to do. lots of pa's work solo, run codes, do advanced procedures, etc and have never taken o-chem, biochem, etc. training and experience make a competent provider, not bookwork basic medical sciences....it's a residency that makes a doc better at something than a pa, not ms1.

guess what, you don't need that stuff even one little bit to run a code just as well or better than the avg physician....trust me on this. I have been running codes and dealing with high acuity longer than most on this board have been alive. I teach residents how to do this. their knowledge of biochem never comes into play. more often than not I have to protect patients from their mistakes.

ps : taking acls, etc has nothing to do with the ability to do things.lots of acls certified folks are clueless when the !@# hits the fan. doing things makes you a good provider.

the value of hce is to recognize the potential for badness, to be able to deal with people of all backgrounds and to tell sick from not sick from across the room. this is stuff that takes a few years to get, not 500 hrs.

[IamRRT]

Ive always STRONGLY thought that MDs should have a medical background as a requirement to med school ex: Nursing, RT.... Thats why we have so many crappy residents and MDs bc their mommy's and daddy's dished out 6 figures for med school.

 

ANYBODY CAN BE BOOK SMART, GET A 4.0 FOR A BIO UNDERGRAD DEGREE AND ACE THE MCAT. THIS DOESNT MEAN YOU CAN CRITICALLY THINK AND TREAT SOMEBODY WHOSE LIFE IS IN YOUR HANDS.

 

For example when I went through Respiratory school I had some students in my class who got accepted with 3.8s and even 4.0. They would ace the classroom lecture tests, but the moment they were put in a Moch lab or real life emergent situation they failed. BOOKSMARTS DOES NOT MEAN YOU CAN CRITICALLY THINK!!!!!

 

With that being said, MDs go through med school and never even been in a hospital. You would be amazed by some of the crap I see by even 4th and 5th year residents, even fellows at that. But I work at a major Trauma center/teaching hospital....so I see it all. Matter of fact we have new 1st year residents starting this month.. YIPPYYYYY

[GatorRRT]

Get ready for albuterol for URis, PHTN and CHF q4!

[greenmood]

A lot of people are hung up on all the new blood having HCE; I think it's come to the point where people are ashamed to say if they don't have it, and are not planning to get it. That's not the kind of atmosphere to foster - if the profession devours its young, it will never have the chance to grow and develop. That kind of dismissive attitude is insidious. The fact is that these students have been getting into PA schools on little/no experience for a while now. If there was a population of PA students graduating and heading out into the field to maim and destroy, I think we would have heard something about it.

 

I'm all for encouraging students to get experience - mine was incredibly valuable to me, and I feel like it helps me all the time in school. So I'm not saying that we should give up and abandon the effort. But lately, it seems that every single thread on this board turns into a fight about HCE. It's tiring, and I imagine it makes people reluctant to ask questions. In fact, when I saw this thread my first thought was "what the hell? experience is ALL that matters here!" I don't get the point, since it's quite clear from every other thread in this section that experience DOES matter. And with the majority of school still requiring it, it's not just the posters on here who feel that way.

 

On another note, some students at my school are looking at HCE as part of their master's research. They're comparing pre-PA healthcare experience with grades in didactic, evaluations on clinicals, PANCE scores, and first jobs after graduation, I think. I'll try to remember to post their findings next spring when we all present our projects.

[True Anomaly]

Matter of fact we have new 1st year residents starting this month.. YIPPYYYYY

 

Why now instead of July?

[IamRRT]

Lmao... Show me a resident who knows how to run a vent all around.. And I'm not just talking about changing a mode I want to know why, what, when and the advantages and disadvantages.... It's not going to happen. It's hard to find attendings that know how to work vents. I only trust a select few.

 

If you were a pt with let's say severe bilateral pneumonias, there are 2 residents treating you, both 2nd yr. One was a

Critical care RN for 3 years prior to med school. Who would you prefer???

[Just Steve]

For those of you who stand in the camp of "no experience necessary"...will you volunteer to be a surgeon's first patient? When you are post op and in pain status post knee replacement will you volunteer to be the nurse's first patient? When your mother is having a heart attack do you want her to be a brand new paramedic's first patient? If you answer yes, I question your knowledge of how things work or fail to work in medicine.

 

Have you noticed that the ratio of "no experience necessary" supporters is heavily weighted on the non practicing/non accepted/non graduated side of things? There was a poster earlier who gave all these examples of how they didn't have experience the first time they did a bunch of medical things...they may have a similar situation to you and you were singing their praises. I ask you this... Did you do the best job possible or just the best job that you knew how to at the moment? If you could go back to those scenes with more experience, do you think you would do better?

 

PA's are scrapping tooth and nail to gain micrograms of trust, respect, autonomy, and privelages. Convincing a supervising physician oa accrediting body or state medical board that a student with a year of didactic medical education and a year of rotations is on par with a physician who spent four years didactic and at least three years of rotations is a long, difficult, and never ending struggle. It does not advance the profession of PA to produce scads of graduates who believe that upon graduation they are on par with people who have already spent time in the proverbial trenches. Their naivety is palpable in their handshake and visible within their presentation.

 

I am dearly close with deep friendships with PAs who had no previous experience. They are brilliant in their field...7 years after graduation. They readily self admit that their first few years was fraught with mistakes a pnd they openly admit regret not going to school with experience.

 

Medicine is not a video game. You can't hit reset and start fresh. It is not a class that you can retake for a better grade. It is not an inconsequential event that we can shrug off and say "I'm new and still learning" Patients come to the office with the expectation of high performance from their provider. We are obligated to give them that...not to use them as a set of training wheels.

 

I believe strongly that students need to come to PA school no longer requiring those training wheels. No, I do not expect everyone to be professional racers but our future patients deserve and expect their providers to at least know what the race route looks like.

 

Yes, I realize my post rallies those who share similar opinions and alienates those with opposing views. I haven't changed any minds. I am just venting. But the time it took me to type this on my iPad gave me time to relax and not say what my "Id" really wants to say...Do your thing people, whatever that is. Thanks to the forum for letting me vent. As a guy with a deep history in medicine and a current PA student on the Dean's list at a respected school I can say I know now that I don't know squat. I pity the inexperienced student who is oblivious to their plight and feel sorrow for their patients.

[greenmood]

For those of you who stand in the camp of "no experience necessary"

But who is this? The majority of the people on this board and even in this thread have been on the same side we are... so to whom are you preaching? This is my point. We're fighting a largely won battle, at least on this board. Most of the posters on here with no experience are too cowed to admit it, and if they do take a stand (because they've been backed into a corner and baited long enough) they're eaten ALIVE. We either mock them mercilessly or guilt trip them with horrible stories about how they're going to kill people, even though (as we've pointed out) there is really no hard evidence that's the case.

 

You say (and I tend to agree) that the people who poo-poo experience are the ones who don't have any and don't even realize what they don't know. They will either learn, or they won't. I take medicine pretty seriously, but I also realize that people need room to ask questions and make mistakes without their role models dashing them on the rocks. I think people take this issue way too much to heart, as if every student without experience is a personal affront to the noble field. It's not. They just don't come from the same places we do, and they won't accept our POV if it's always presented in lecture format with little digs to make them feel bad for questioning. How many times on this board have we seen a student post her stats and ask an unrelated question... and then the first reply post is that she has ****ty HCE? I see it all the time. Is that how we would engage someone face-to-face about their journey to PA school? I hope not, but that's how it's done here. Is the way to point out a flaw in understanding to say "hey dummy, you don't even know what you don't know"? No wonder people get upset and end up defending positions that don't make any logical sense.

[Will352ns]

Umm, I forgot I even replied to this one. I was simply stating that not all HCE is equal and some is bit better suited to PA than others (Independent Military Medics).

 

The original question was does experience really matter? I took that as to mean, does it matter to the schools. I don't think it does in many programs these days. Which IMO is a shame. The concept of PA was born out of the idea of taking experienced medical personnel and elevating them to a higher standard of practice.

 

Can it be done without HCE? Sure, proven time and time again. I have no ill feeling towards the folks who pretty much went to PA right out of undergrad. I'm sure most go on to be good PA's. I just wonder what the first few years where like. Was it harder than it needed to be? Did the SPs get frustrated because there were times when the PA should have seen something that would have been pretty evident to a seasoned nurse, Independent Duty Medic, or paramedic? There is no way to really study or know this, but it seems like it should be intuitive.

 

I would love to see what the curriculum's were like in the original programs. How much time did they spend teaching things like basic exams and procedures versus the clinical sciences. Food for thought.

 

I just hope that when I turn in my application in a month my experience will help put a little bit more on the table. There are certain (many) schools that have pretty much closed the door on folks like me. I have good grades (otherwise I wouldn't even apply), but the my academic history is scattered based on what was available to me at the time and what my duties would allow me to do. There are many folks, just like me, in the same boat. This isn't a pitty party, I choose my path and accept it. I'm just glad programs like MEDEX, Utah, and Stanford still exist.

 

Does HCE matter? For a growing population of schools, no, it does not. This leads to the next possibility. Is PA now the consolation prize for pre-med students who either backed out or didn't get in. Folks could go back and forth on that for days. In the end, it doesn't matter. The requirements are there and the schools have been allowed to dictate them. We (applicants) will deal with it.

 

Good luck to all.

[medicjfitz]

I am young, white, and female that has been a paramedic for 6 years working a very underserved area called pine hills in orlando, nick named "crime hills." So if you see me doing clinicals when I eventually get to PA school will you put me in a box too? I think that the heart of this conversation is that you can't clump people together. You have good and bad in every occupation, there are good docs and bad docs, good pa's, and bad pa's, and the same goes for nurses, medics and everone else. Good healthcare experience is paramount to someone who is going to be a midlevel practitioner.

[Contrarian]

Umm.......

 

 

 

 

Ummm......

 

 

 

That horse is out the barn and dead...

 

They aren't going to suddenly start requiring experience and barring the "kids" from the profession that don't have any.

So to keep on pining away about far gone times only serves as divisive chatter.

LET IT GO people. Its done and we ain't going back...!!!

[eewee]

On another note, some students at my school are looking at HCE as part of their master's research. They're comparing pre-PA healthcare experience with grades in didactic, evaluations on clinicals, PANCE scores, and first jobs after graduation, I think. I'll try to remember to post their findings next spring when we all present our projects.

 

I actually saw some data for a school that showed PANCE scores from before and after switching to a master's degree (same program, different, more academic applicant pool) and their percentile scores increased substantially with the first chort of masters level grads. Not that the PANCE is everything. But it does suggest something to me about academic background.

 

I'm a pre-PA beginning PA school in the fall. I have never been an RN, RT, Emt, etc. Am I aware that I may have to work twice as hard as my classmates with years of experience? Certainly. Do I believe that I still might have some catching up to do when I graduate? Absolutely. But I'm not going to kill a patient because I will be aware of my limitations and I don't have a big fat ego that will inhibit me from consulting with my supervisor when necessary. Actually, I'm already looking into residency programs because I'd love that additional year of formal training. I'm a 22 year old woman. But I'm not a bimbo who thinks PA school will be a breeze just because I score high on tests and got good grades.

 

I can imagine being an older PA and seeing my profession change. That would be concerning, maybe even a little annoying that the new kids didn't have to sweat it out for 5 years as a whatever HCE to get to PA school. But really, I'm not sure there are enough of these sort of applicants to take the profession to the desired level of recognition. PA schools are increasingly accepting nearly-MD/DO level applicants. Smart, driven individuals who seem to do as well in PA education as their experienced counterparts. How can that possibly hurt the profession?

[IamRRT]

Those of you getting offended I think are failing to see the bigger picture and haven't worked as a medical professional yet. I salute everybody who wants to become a PA to help others but I 100% disagree with the requirements for admission. I think a 2 or 4 yr medical degree should be mandatory with any MD or PA degree with at least 1 yr of critical care experience. I'm sure Ill get bashed for saying that but I am also sure anybody who has worked in a hospital will agree w/me.

 

Would you let somebody drive a semi truck before they know how to drive a pick-up truck? Sounds ridiculous but its the same sh*t!

 

I also think thats why NPs maybe be a little more respected than PAs bc they are REQUIRED to have an RN degree first... Its called experience.

[mktalon]

Those of you getting offended I think are failing to see the bigger picture and haven't worked as a medical professional yet. I salute everybody who wants to become a PA to help others but I 100% disagree with the requirements for admission. I think a 2 or 4 yr medical degree should be mandatory with any MD or PA degree with at least 1 yr of critical care experience. I'm sure Ill get bashed for saying that but I am also sure anybody who has worked in a hospital will agree w/me.

 

 

I also think thats why NPs maybe be a little more respected than PAs bc they are REQUIRED to have an RN degree first... Its called experience.

 

So I just want to be clear about where you stand. Do you think that a family practice nurse that has been working for ten years and wants to become a family practice PA should have to quit his/her job to go work in critical care for a year in order to be accepted?

[EMEDPA]

So I just want to be clear about where you stand. Do you think that a family practice nurse that has been working for ten years and wants to become a family practice PA should have to quit his/her job to go work in critical care for a year in order to be accepted?

nope. ten years as an rn works for me just fine.

[EMEDPA]

my wife(an artist) would have an easier time getting into medschool (md anyway) than I would. she was a bio major and took all the ochem, etc but has not 1 second of medical experience. I have good grades and lots of experience but no ochem or biochem. I would do lecom if they got rid of the mcat requirement. they already will waive a few chem courses...( I have physics, genetics, stats, etc to sub....)

[IamRRT]

s

I think the new reality as far as health care experience is concerned is that it's fast becoming the case that increased hce isn't going to save people from past poor grades. Those who veered into alternate fields because they didn't have the marks to go into being a provider, and used their alternate field as their consolation prize are going to have to look at PA school like they would medical school. My wife is in an in demand allied health field and has perfect grades, extracurriculars, background, and diversity. She could apply to pa school this month and get interviews at probably anywhere (doesn't have any interest in it though). Folks like her can hold their own when it comes to academics, and I think that's the new paradigm of achievement at a lot of the programs that are shifting to the masters degree. Yeah, the history of the PA field was based on hce, but the history of medicine was based on Galen and bloodletting, which meant there was a lot of room to evolve. It's going to be the masters degree of medicine (albeit without the seamless bridge.... Yet). Those who want a bridge should welcome the masters and the recruitment of Pre med style kids, history of the profession be damned. It just seems like more of a legit sell to the academics in medicine if it follows that path. But yeah, the days of screwing up academically and expecting salvation through hce might be behind us, unless that attempt at recovery is as intense as what you'd put into getting into medical school after a poor showing in undergrad. It's tough. I'd have an easier time getting into dental school than PA school.

 

Sigh...And thats exactly my point. Like I previously stated bookwork has little to do with critical thinking. Some can link it but 50% cannot, this statistic is coming from my experience. You dont have your notebook or textbook with you in a code or trauma. "Grades" mean something but I think schools(MD,PA) are putting way to much emphasizes on academics alone.

 

If I was choosing between two students applying to PA school, student A, three yrs as an ICU RN with a 3.1, or student B, no HCE with a 3.8. I would 85% of the time accept student A into my school. Experience in invaluable, it separates the people who "want" to practice and the people who were "meant" to practice. Now Im sure since I am writing this some people think I have a low GPA which I dont, I have a science GPA of 3.7, which that GPA includes the marks from my Respiratory Therapy program, which my no means was easy. So before you state that the only ones who think HCE should be mandatory are "those that screwed up academically", know the real facts. I think most people screwed up in college at some point. But at the end of the day its all about politics and cash flow.

[Bodiggler]

Umm yeah they do. Their 3rd and 4th year of med school is clinical rotations...