CAUTION: Hot Takes Coming Through

[PAtoMD]

13 minutes ago, CAAdmission said:

That's good. Your current effort level would not likely be successful. I think it's hilarious that top of the thread begins with "Arrogance in Medicine." 

I'm legitimately asking the question of what training is "enough" to meet the majority of medical needs of the majority of Americans. Physicians have declared themselves the final arbiters of determining what "enough" is, and they have naturally equated it with their own training. 

There's a walking colostomy bag of an FP doc that runs a blog called Authentic Medicine where he likes to lay into "midlevel practitioners." This is the guy that calls us "LELTs" - less educated, less trained. I can never get him to answer the question of why anyone should come see him. After all, he is a LELT compared to a cardiologist, a dermatologist, and orthopod, etc. His viewpoint is much like that being espoused here. 

The major training advantage docs have is the intensity of hands-on training received in a residency program. But a PA working full time will eventually catch up. And I have worked in a couple of positions where I was responsible for helping to train resident physicians. You mention DNP above. I know essentially nothing about their training, but from what I have heard it is brief and not primarily hands on. No comment. 

If you want to bridge PA to MD that's fine, but there is no way that the knowledge gap between the professions needs three years to bridge. That's absurd on it's face. 

 

Honestly, you're not changing anyone's mind either. I answered your questions and you consistently shifted goal posts, presented strawmen, and intentionally misread statements. You weren't interested in the differences. You make assertations off never even having gone through medical school. 

 

You're whole point of "why see a FM doc when you can..." statement is so silly and not even worth diving into. Again, its a logical fallacy which you fall into regularly which is why its so difficult communicating with you. 

 

Thank you for admitting physician training has advantages over PA training. 

 

I've never made the comment that the three year bridge is necessary. You made that insinuation. 

 

I've never said PA training wasn't good. I said it was different. And its okay to be different. They aren't the same careers. Never were intended to be. And that's okay. Continue to believe what you want and justify it however you wish. I hope more conversation can be had in this thread aside from us two. 

[ventana]

I love it when someone in Med school (who practiced briefly as PA) suddenly becomes expert on entire PA profession across all specialties and settings. 
 

maybe just maybe the history and pt interaction really does count and by not having “the humanity beaten out of us in residency” and not having excessive “productivity goals” placed on us actually make it easier for us “less educated” PAs to actually outperform the doc’s.   My patient panel is building rapidly do you 2 of the fully boarded FP docs not taking time to slow down and listen to their patients.  Sure they have deeper understanding of immunology and pathophys but when you don’t listen to patients or slow down you miss things irrelevant of your knowledge base.  
 

it also boggles my mind docs say we are not trained enough yet the FPS seem to think their education makes them experts in every field.  They to refer to cards renal and other specialist.  
 

my overriding belief is as follows. 
We are all part of a team.  We should all be personally and professionally 100% sole responsible for our professional practice.  We should not “fall under” any other profession. When we don’t know something we should seek out someone who does.  Either more experienced PA, doc, PA specialist, or doc specialist.   There is absolutely zero medical reason docs should control another profession.  
 

please don’t adopted the physician centric view of being the center of the medical universe.  At tel he top of the pile is AMA who’s real mission it to protect the financial well being/limit competition. Everything flies from this. 
 

we are all professionals that bring different benefits to our patients.  We should all be working on leveraging our assets to improve care to our patients.  

[Hope2PA]

To CSCS, or anyone else interested in replying.

Where were you taking your "Fluff" DMSc, don't really need to answer. I am not familiar with all programs, but there are several that are pure clinical, such as LMU who's goal, per MDs and DOs was developing program  set up to bridge PA knowledge to that of physician. No "fluff" . Physicians were on board and considering that as a step for PAs to become independent primary care providers. Unfortunately, the nurse lobbies are stronger than medical and they convened politicians that an NP with total 50 grad hours 500 clinical is better than PA with 100 grad hours , 2000 clinical, 3 years work experience then an additional 42 hours designed by physicians and managed by physicians.  That's the kind of bridge that should be considered, then add a 1 year residency and you got a darn good medical provider. I'd much prefer seeing them than the NPs we are increasingly stuck with, and yes I know there are some awesome NPs that go above and beyond their "required" education. Just as there are crappy PAs and physicians who basically stop their search for knowledge upon graduation. Many admit they don't recall or use much of what was learned in med school.  

[CAAdmission]

The original post made reference to the "unearned right" of autonomy. The underlying vibe is that there is nothing that PAs can EVER do to earn this right. 

I'd propose this right is earned by physicians through experience gained through their residency, and not through memorizing the minutiae of the electron transport chain. And if this is the case, a PA with appropriate, documented, supervised experience should eventually also be able to gain that right. 

[Hope2PA]

Isn't it rather curious that NPs were given opportunity to take Step exam, probably to show they couldn't compare to medical training, yet PAs have never been allowed the opportunity. Let PAs take their exams and primary care board exams after X number years of supervision. What are they afraid of?   

[iconic]

I seriously don’t care if my PCP is an MD/PA/NP (quite frankly I don’t trust most medical providers at this point). My current one is an MD, however that is not something I at all considered when choosing him. The one before was an NP. And if I had to see someone in person, I would see an NP in my current city who owns his own clinic (who I see for aesthetic services) 

Edited September 8, 2022 by iconic

[kettle]

OP this is a horse ,  the one you sit upon seems quite high. Admirable you are going to medical school but you use of profanity in this post shows your true intelligence level. 

[LT_Oneal_PAC]

[newton9686]

I really do not know how this post turned into an argument between the  younger PAs going back to medical school and the OG PAs who have been practicing forever. Y’all we are better than this. What I like about this board is we are usually very supportive of each other and mainly talk shit about everyone else

As someone in medical school I can agree with both. Yes extra education is helpful. However as med students we also need to admit that a lot of the first two years of medical school is mental masturbation. Knowing the genes associated with Marfan is highly unlikely to make me a better clinician.  However I will say I am seeing some of the fruits of my labor in med school, still practicing as a PA. I will say as a PA going back to medical school I believe I am able to pick up more than the average medical school student and I have grown a fair amount as a clinician, even though I practiced for 4-5 years in hospital medicine before going back. There’s a lot more pathophysiology and understanding the why in Med School, which can be be helpful if you are like me and remember better when you understand the why. However that doesn’t downplay clinical experience and acumen that comes from years of training. But I do believe there is a sweet spot that a lot of PAs find by going back to medical school which is why we grow so much in Med School and see its value.

Also older PAs, first thank you for the path you’ve made, but don’t degrade the young people who go back, even if they have a chip on their shoulder. As you know It can be really hard especially those first 3-4 years of practice where you are still trying to learn medicine, but you are running into constant barriers, restrictions and people questioning your decisions, especially in the hospital. It can be really hard to know if you are wrong, inexperienced or just being challenged more because you don’t have the credentials. It can lead to a big chip on your shoulder and ultimately one leaving the hospital system entirely or purposely working rural as possible where you do feel appreciated. But if you truly love acute medicine it can really hard as a PA in the hospital setting when your opportunities change so drastically based on location, presence of residents or hours of the day. Or worse there is a “change in leadership” and you go from being supported with a fantastic scope to now being directly supervised and having your decisions questioned while working fast track. 

Long story short we need to all work together. One of my main goals going back to med school is to one day be in a position to help future PAs not have to go through the same crap that I have had to go through. But that also doesn’t take away from the pride I have for being one of the PAs craziest enough to go back when most if not all of us have thought about it once or twice. Now time to get back to my studies before working two shifts this weekend before my big ass test on Monday. 

 

[SedRate]

1 hour ago, newton9686 said:

Yes extra education is helpful. However as med students we also need to admit that a lot of the first two years of medical school is mental masturbation. Knowing the genes associated with Marfan is highly unlikely to make me a better clinician.

Besides me, anyone else learn this amongst other nuanced things in their PA training? My Neuro lectures were taught by a PhD neuroscientist and were extremely in depth. I felt very dumb trying to learn all that in such a short timeframe. 

I do think additional rotations beyond the one year for PA students would be helpful -- whether in the form of a residency or not. 

Anyways, thanks for your post. I found it very insightful. 

[sas5814]

Having spent years working on legislative and regulatory issues locally, at the state level and the national level I have become somewhat inured to the bickering and hyperbole and, sometimes, out right lies that get slung back and forth. I used to get mad. Now I just take note and glean what I can from the words and the attitude.

For instance we recently had a town hall type virtual meeting because leadership is appointing a new chief of staff and everyone got a chance to ask questions. I asked every candidate if they thought if it was fair and reasonable that a primary care PA who carries the exact same panel, same patients, same schedule as a physician, same acuity, were paid 40% of the physician pay. Each and every one said yes with no further explanation. From that I glean we are not valued and are considered disposable and easily replaced. My future conduct will be reflective of that.

So that is a long way of saying, even in vitriol, there is truth about the speaker. We don't do a lot of vitriol here and discussion can get a bit heated but generally stay civil(ish). There is nothing wrong with disagreement. This isn't congress and there is no compromise agreement to be reached. The best we can hope for is to move the needle on beliefs a bit. That is rarely accomplished by name calling and shouting.

 

[SedRate]

1 hour ago, sas5814 said:

For instance we recently had a town hall type virtual meeting because leadership is appointing a new chief of staff and everyone got a chance to ask questions. I asked every candidate if they thought if it was fair and reasonable that a primary care PA who carries the exact same panel, same patients, same schedule as a physician, same acuity, were paid 40% of the physician pay. Each and every one said yes with no further explanation. From that I glean we are not valued and are considered disposable and easily replaced.

Do you think advancing the profession will change this? 

[sas5814]

2 minutes ago, SedRate said:

Do you think advancing the profession will change this? 

Not here. Ironically the NPs are LIPs here and they make less than I do. When I pointed out to the chief of staff they gave a new grad NP the medical director's panel and pay her less than 100k she just laughed and said "they are independent!" So their independence has permitted the org to give them a panel identical to a physician. I advised doing that to a new grad wasn't right she just shrugged.

So their independence gets them the work of a physician for garbage pay. At the same time their reason for not giving me a bonus for running a physician's team was I have to have a SP so I'm not REALLY doing the work of a physician. They have their cake and get to eat it too.

As usual the core issue wasn't patient safety, work loads, training....none of that. It always about money.

 

[PAtoMD]

5 hours ago, newton9686 said:

I really do not know how this post turned into an argument between the  younger PAs going back to medical school and the OG PAs who have been practicing forever. Y’all we are better than this. What I like about this board is we are usually very supportive of each other and mainly talk shit about everyone else

As someone in medical school I can agree with both. Yes extra education is helpful. However as med students we also need to admit that a lot of the first two years of medical school is mental masturbation. Knowing the genes associated with Marfan is highly unlikely to make me a better clinician.  However I will say I am seeing some of the fruits of my labor in med school, still practicing as a PA. I will say as a PA going back to medical school I believe I am able to pick up more than the average medical school student and I have grown a fair amount as a clinician, even though I practiced for 4-5 years in hospital medicine before going back. There’s a lot more pathophysiology and understanding the why in Med School, which can be be helpful if you are like me and remember better when you understand the why. However that doesn’t downplay clinical experience and acumen that comes from years of training. But I do believe there is a sweet spot that a lot of PAs find by going back to medical school which is why we grow so much in Med School and see its value.

Also older PAs, first thank you for the path you’ve made, but don’t degrade the young people who go back, even if they have a chip on their shoulder. As you know It can be really hard especially those first 3-4 years of practice where you are still trying to learn medicine, but you are running into constant barriers, restrictions and people questioning your decisions, especially in the hospital. It can be really hard to know if you are wrong, inexperienced or just being challenged more because you don’t have the credentials. It can lead to a big chip on your shoulder and ultimately one leaving the hospital system entirely or purposely working rural as possible where you do feel appreciated. But if you truly love acute medicine it can really hard as a PA in the hospital setting when your opportunities change so drastically based on location, presence of residents or hours of the day. Or worse there is a “change in leadership” and you go from being supported with a fantastic scope to now being directly supervised and having your decisions questioned while working fast track. 

Long story short we need to all work together. One of my main goals going back to med school is to one day be in a position to help future PAs not have to go through the same crap that I have had to go through. But that also doesn’t take away from the pride I have for being one of the PAs craziest enough to go back when most if not all of us have thought about it once or twice. Now time to get back to my studies before working two shifts this weekend before my big ass test on Monday. 

 

Well said. Good luck on your test! FBN1 gene Marfans high yield

Edited September 9, 2022 by PAtoMD

[SedRate]

3 hours ago, sas5814 said:

So their independence gets them the work of a physician for garbage pay.

Yep, and if I were a bettin' person, I'd bet PAs would be in the same boat if/when we gain independence. Sad to think about but we'll still be seen as less-than by folks like those in your example and have that uphill battle fighting for pay despite increased responsibility and liability. Sounds like the jobs I've had -- no thanks, pass. Maybe others feel differently and are willing to do more work for less.

[VentiMacchiato]

 Most days, I think I'm at a point where I've hit the ceiling of my profession. The next step then would be either go to med school or go to PA doctorate. The thing is, If I choose the latter, I may have a doctorate's degree but I'm still a PA and the chains made by the medical boards are still yanking be back to being a PA. The DPT, DNP, PharmD, PhD, SLPD, etc... degrees do not have those chains. So is it worth doing a PA terminal degree without autonomy?

 

Edited September 11, 2022 by VentiMacchiato

[EMEDPA]

19 minutes ago, VentiMacchiato said:

 Most days, I think I'm at a point where I've hit the ceiling of my profession. The next step then would be either go to med school or go to PA doctorate. The thing is, If I choose the latter, I may have a doctorate's degree but I'm still a PA and the chains made by the medical boards are still yanking be back to being a PA. The DPT, DNP, PharmD, PhD, SLPD, etc... degrees do not have those chains. So is it worth doing a PA terminal degree without autonomy?

 

I think I have pretty much maxed out as well. Good salary, good autonomy, do some teaching on the side with the doctorate, like who I work with and where I work. After 26 years as a PA after 10 years in EMS I am pretty happy. It does irk me to no end that a brand new 29 yr old FP doc who can't find their own ass with both hands still would get more respect their first day out of residency.....sure, they would know more than I do about primary care, but drop them in a rural ED without consultants immediately available and they would piss themselves.....and yet these are the types of folks hired at high rates of pay to cover many rural facilities.  

[CAAdmission]

10 hours ago, EMEDPA said:

sure, they would know more than I do about primary care

I would not automatically accept that as true. 

[rev ronin]

13 hours ago, VentiMacchiato said:

So is it worth doing a PA terminal degree without autonomy?

First, the terminal PA degree is a masters. The PAEA is going absolutely bonkers everytime anyone proposes otherwise, because they can't get enough faculty even with a masters'.

Having said that I'd suggest that it's "... without autonomy yet" Do not think that the DNP and NP autonomy are unrelated; having a substantial number of practitioners in a class with earned professional doctorates has been a part of their push for autonomy to date, and it will likewise be part of ours. Other debates aside, "has a doctorate" vs. "doesn't have a doctorate" is the biggest chasm in public perception, so I recommend your calculations, like mine, factor that in.

[CSCH]

Coming back to this post to remind everyone who decided I was a "young" PA with minimal experience in only one practice environment that they made that story up in their own brains. I practiced well over 5 years, I did a residency, I worked in seven different hospitals and held four different roles, I was a residency director and PA school lecturer, I worked overnight shifts in the ICU with no supervision, I performed all my own procedures, I precepted...

I'm so glad I went to med school because I am learning so much in spite of my experience and training. I had a lot of arrogance at the top of my Dunning-Kruger curve and I wanted to get treated like a doctor without doing the damn work. Well, I grew up a little and acknowledged that I didn't know what I didn't know, and I'm doing the work now.

These days I don't post on here for the old farts that live on this forum, I post for the young bucks reading and trying to make big life decisions. If you are reading this because you are a PA considering going to med school who is scrolling through this forum trying to figure it out (like I was for years), you deserve to know the full story. Feel free to reach out. I get notifications of my DMs and I have always replied through the years to the folks who have reached out after reading my residency blog.

[SedRate]

3 hours ago, CSCH said:

Coming back to this post to remind everyone who decided I was a "young" PA with minimal experience in only one practice environment that they made that story up in their own brains. I practiced well over 5 years, I did a residency, I worked in seven different hospitals and held four different roles, I was a residency director and PA school lecturer, I worked overnight shifts in the ICU with no supervision, I performed all my own procedures, I precepted...

I'm so glad I went to med school because I am learning so much in spite of my experience and training. I had a lot of arrogance at the top of my Dunning-Kruger curve and I wanted to get treated like a doctor without doing the damn work. Well, I grew up a little and acknowledged that I didn't know what I didn't know, and I'm doing the work now.

These days I don't post on here for the old farts that live on this forum, I post for the young bucks reading and trying to make big life decisions. If you are reading this because you are a PA considering going to med school who is scrolling through this forum trying to figure it out (like I was for years), you deserve to know the full story. Feel free to reach out. I get notifications of my DMs and I have always replied through the years to the folks who have reached out after reading my residency blog.

Happy to hear it's working out for you. I commend folks like you who challenge themselves and "take the leap" (in any form not just med school, such as switching specialties, trying something different, etc).

The "not knowing what you don't know" is important for everyone to come to terms with, ideally sooner rather than later. Glad to hear you're working on it. 

I wish you continued success with your journey.