Can a primary care PA ever be as skilled as an MD?

[alexamasan]

Perhaps after years (or decades) of practice, do you think that a PA in primary care can become just skilled as an MD? Or do you think a PA will always be lacking something for not going through medical school? 

[rev ronin]

2 hours ago, alexamasan said:

Perhaps after years (or decades) of practice, do you think that a PA in primary care can become just skilled as an MD? Or do you think a PA will always be lacking something for not going through medical school? 

What do you mean by 'skilled'?  FP Docs have more clerkships and residency, but PA procedural skills can certainly catch up.  The additional topics not covered or not covered as deep in PA school vs. med school--I don't know that there's any structured way to measure that without letting PAs take FP doc boards.  The one area where MDs have been shown to be superior to PAs is in diagnosing undifferentiated new illnesses correctly and rapidly, and I suspect that's tied to our shortcuts... but I would be interested to see how that played out over time.  I don't doubt experienced PAs could outperform brand new FP docs, but it would be interesting to see how common an occurrence that would be.

[Reality Check 2]

Simply - yes. 

[LT_Oneal_PAC]

I’ll straight up say it. By the time I finished my FM time in the Navy, I was better than at least some of the MDs in the office. Objectively, I had less referrals, I ordered fewer tests, I had a broader procedural skills, and patients left one MDs panel consistently to come to mine. Something I’m sure didn’t bother him in the least if it meant he got home by 4 more easily.

[BruceBanner]

It depends on what you mean by 'skilled'. I'm probably more skilled at FM procedures than any of the 12 docs I work with, but that's not because I'm some hot shot. I just had a lot of training and experience after school and became the go-to guy. Most docs I've worked with in primary care do few procedures. 

Now as far as diagnostic repertoire in the IM spectrum, the IM docs I work with are wayyyy more skilled than me. I can get by, but I have a low referral threshold with things like anemias, metabolic disorders, GI disorders, etc.

As a PA your level of skill is largely up to you and where you end up working. Residency is not built-in to our training, so we have to be assertive and seek it out on the job. There are plenty of PAs in primary care just seeing colds, rashes and sprained ankles; and there are some highly competent PAs who could stand toe-to-toe with any junior attending. 

[thinkertdm]

the post sounds like a troll or someone who hasn't bothered to do basic research on PA training.  

[alexamasan]

8 hours ago, LT_Oneal_PAC said:

I’ll straight up say it. By the time I finished my FM time in the Navy, I was better than at least some of the MDs in the office. Objectively, I had less referrals, I ordered fewer tests, I had a broader procedural skills, and patients left one MDs panel consistently to come to mine. Something I’m sure didn’t bother him in the least if it meant he got home by 4 more easily.

What do you think contributed to your success? 

[LT_Oneal_PAC]

18 minutes ago, alexamasan said:

What do you think contributed to your success? 

Great teachers. I worked at a FM residency, so there were plenty. Being in a place (military) that encouraged and allowed a broad scope. Hard work. Read a lot and listened to primary care and EM  RAP over and over. Staying late to read literature and follow up specialist charts on cases I had referred so as to prevent having to refer it again if it wasn’t necessary. Hung lots of reminders up on my wall about things I didn’t see often but didn’t need referral. I had to use vacation and days off to get out of the clinic grind and learn procedures. Took 2 weeks leave to go work with urology upstairs in the hospital and do vasectomies.

[thinkertdm]

29 minutes ago, LT_Oneal_PAC said:

Great teachers. I worked at a FM residency, so there were plenty. Being in a place (military) that encouraged and allowed a broad scope. Hard work. Read a lot and listened to primary care and EM  RAP over and over. Staying late to read literature and follow up specialist charts on cases I had referred so as to prevent having to refer it again if it wasn’t necessary. Hung lots of reminders up on my wall about things I didn’t see often but didn’t need referral. I had to use vacation and days off to get out of the clinic grind and learn procedures. Took 2 weeks leave to go work with urology upstairs in the hospital and do vasectomies.

I don't think we need to justify how we got to where we are despite not going to medical school.  We have a valid place in the healthcare delivery system, numerous studies have shown that we are just as effective in most, if not all, medical specialties.  DESPITE NOT GOING TO MEDICAL SCHOOL.  

The very nature of the question "ever be as skilled as an MD" rankled me.  It's not even a good question! 

Can a phone ever be as good despite being made by Apple?  See?  There are good phones not made by apple.  There are good phones made by apple.  No one cares as long as it does what it is supposed to do.  If the OP really wanted to know how, they can shadow.  

[CAAdmission]

20 hours ago, alexamasan said:

Perhaps after years (or decades) of practice, do you think that a PA in primary care can become just skilled as an MD? Or do you think a PA will always be lacking something for not going through medical school? 

Of course. And much less time than decades....

[LT_Oneal_PAC]

30 minutes ago, thinkertdm said:

I don't think we need to justify how we got to where we are despite not going to medical school.  We have a valid place in the healthcare delivery system, numerous studies have shown that we are just as effective in most, if not all, medical specialties.  DESPITE NOT GOING TO MEDICAL SCHOOL.  

The very nature of the question "ever be as skilled as an MD" rankled me.  It's not even a good question! 

Can a phone ever be as good despite being made by Apple?  See?  There are good phones not made by apple.  There are good phones made by apple.  No one cares as long as it does what it is supposed to do.  If the OP really wanted to know how, they can shadow.  

I agree. I initially had a long post about it but deleted. Essentially, the question should be how does one become a GOOD provider. Lots of physicians and other types suck. The question is not a good one. Can a FM physician ever be as good as a IM? It’s all relative. What makes someone good is putting in the effort and having the right opportunities.

[anowww]

@LT_Oneal_PAC, I recently finished PA school and was considering the military service as a PA or working in urgent care medicine in the civilian world. I feel like I would get more experience joining the military but am not sure. Did you have good mentors and feel like you get to see more in the military as a PA vs. the civilian world? Trying to make the best decision of which sector would give me the best tools to become an experienced PA. 

[LT_Oneal_PAC]

9 hours ago, anowww said:

@LT_Oneal_PAC, I recently finished PA school and was considering the military service as a PA or working in urgent care medicine in the civilian world. I feel like I would get more experience joining the military but am not sure. Did you have good mentors and feel like you get to see more in the military as a PA vs. the civilian world? Trying to make the best decision of which sector would give me the best tools to become an experienced PA. 

Your mileage may vary. Unquestionably you will have more opportunity to grow in the military if you are willing to put in the time and effort. I spent a great deal of time studying, taking leave so that I could work with specialists in my hospital to expand my procedure list, reviewing specialists charts and correlating with texts and literature to reduce my referral rate. You certainly will have more autonomy to practice to the top of your comfort level in the military. I had great mentors in FM, but I was at a FM residency. You could be sent to any number of clinics that may or may not have good mentors. It is most certainly going to be better than UC though, where the only option is to move the meat and make them money. 

If you want to be the best kind of PA, I do highly recommend my path of military practice and then doing a residency in a field of your choice. But I'm biased

[surgblumm]

I did it the O'Neill way" If you want to be the best kind of PA, I do highly recommend my path of military practice and then doing a residency in a field of your choice. But I'm biased " and I feel exactly the same as he is describing. Military service is one of the greatest direct care entrances into advanced practice medical care and the resources and experiences are priceless. Longevity in the military only makes your practice experiences multiply and there are always additional schools to train you new skills. It is one hell of an eadventure and simultaneously you are serving your country, preserving the fighting strength and usually have a disability check as well as some outstanding VA care in certain states and facilities.