futurePAS Posted December 16, 2012 Share Posted December 16, 2012 I'm a pre-PA, back office MA at an urgent care center that solely employs PAs with the exception of the bored SP that only shows up to countersign a couple charts here and there. We have about five PAs, most of them being fresh, new grads (graduated in 2012) working without MD presence. I'm starting to notice that a couple of the new-grads literally check Wikipedia/emedicine/epocrates/Google etc for every diagnoses and patient they see (save for the pts with common cold symptoms), and had a hard time answering the patient's questions when asked more in-depth questions. If a pt was to see them Googling their illness, they'd probably bolt. This makes me extremely nervous and apprehensive about the PA-curriculum because I feel that their training should have adequately prepared them for primary care. I blame this mostly on the absence of the SP to mentor new grads, but also feel it is irresponsible for a new grad to accept a position with no SP oversight. Thankfully, there is a seasoned PA who sometimes is there to help steer the new ones, and we don't see much of highly complicated cases. But this made me wonder: is PA school too short? Is two years enough for a new PA-C to work with autonomy? If a new PA is not ready to hit the ground running, then shouldn't they have trained longer? PAs are no longer "second careers" for seasoned paramedics or RNs, and for what its worth, most of the new grads I've encountered have extremely limited HCE (although I don't see how this plays a role in how a PA makes a Dx). Just would like to hear your thoughts. Link to comment Share on other sites More sharing options...
Administrator rev ronin Posted December 16, 2012 Administrator Share Posted December 16, 2012 More like the model being used in this clinic is, while perhaps legal, far from adequate supervision. I am a big fan of new grads working in the same office alongside experienced docs, because I have felt comfortable seeing the vast majority of patients on my own, while having freedom to seek guidance when appropriate. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted December 16, 2012 Moderator Share Posted December 16, 2012 I would be in favor of a 2 yr program for "traditional applicants" (medics/rn's/etc) and 3 yrs for folks with less than stellar experience...either that or a required internship...which is where I think we are heading anyways... Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted December 16, 2012 Moderator Share Posted December 16, 2012 More like the model being used in this clinic is, while perhaps legal, far from adequate supervision. I am a big fan of new grads working in the same office alongside experienced docs, because I have felt comfortable seeing the vast majority of patients on my own, while having freedom to seek guidance when appropriate. I agree that the vast majority of new grads should not be working unsupervised... Link to comment Share on other sites More sharing options...
futurePAS Posted December 16, 2012 Author Share Posted December 16, 2012 I would be in favor of a 2 yr program for "traditional applicants" (medics/rn's/etc) and 3 yrs for folks with less than stellar experience...either that or a required internship...which is where I think we are heading anyways... How do you think the internship/residency should work? Should it be further generalist training, or an elective specialty? Link to comment Share on other sites More sharing options...
KCMA79 Posted December 16, 2012 Share Posted December 16, 2012 As schools continue to downplay significant prior HCE the situation will only get worse. While some might be OK working unspervised the vast majority are not ready to work unsupervised right out of school. The schools just don't prepare them for the reality of this situation and fool the new grads into thinking they are. I recently encounterd 2 new grads (2012) who thought they were god's gift to medicine because they were "masters prepared". They were in an Urgent Care Center and I was there as a patient and had to advise them how to perform the procedure I was having done. I felt like I was precepting students again. Also, I have to wonder about a SP that would allow new grads to work unsupervised. There is nothing wrong with the length of the programs. The problem is with the lack of HCE and life experience of the students. For many their first job as a PA is the first real job they have ever had. IMHO Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted December 16, 2012 Moderator Share Posted December 16, 2012 How do you think the internship/residency should work? Should it be further generalist training, or an elective specialty? specialty of the pa's choice. pa internship should be the same as a physician internship in the same specialty. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted December 16, 2012 Moderator Share Posted December 16, 2012 the problem is with the lack of hce and life experience of the students. For many their first job as a pa is the first real job they have ever had. Imho ^^^^^this! Link to comment Share on other sites More sharing options...
Moderator True Anomaly Posted December 16, 2012 Moderator Share Posted December 16, 2012 I'm starting to notice that a couple of the new-grads literally check Wikipedia/emedicine/epocrates/Google etc for every diagnoses and patient they see (save for the pts with common cold symptoms), and had a hard time answering the patient's questions when asked more in-depth questions. If a pt was to see them Googling their illness, they'd probably bolt. I'm gonna derail things a bit. I think to make this kind of broad statement and then jump right to "Is PA school long enough" is a bit disingenuous. You mention that these new PA's are looking up those various websites, but which EXACT websites are they looking up which EXACT details? Are they using Wikipedia to look up the latest research about appendicits, or are they using it to look for the generic name of a brand-name drug? Are they using Emedicine to view which cranial nerve innervates a certain extra-ocular muscle, or are they using it to look for length of treatment for cellulitis? Are they using other websites that have solid evidence-based data when you're not looking, or are they using apps on their phones that are derived from evidence-based data? It's incredibly vague, and without exact details as to what they're using which website and for what, makes the original question just more esoteric. It used to be that if you had holes in your knowledge, you went to the text books. Now, the amount of information has increased, and the methods of delivery has grown exponentially. Some are good, some not so much. The fact is, though, that just because information is obtained from a computer as opposed to a good ol' fashioned text book does not preclude it's credibility. Just about every medical textbook is online. And I actually carry copies of Rosen's and Roberts and Hedges (two bibles of emergency medicine) in digital format with me, and they're both available online. My point is that the devil is in the details. If a PA is solely using Wikipedia in each and every patient care decision and nothing else, then PA school failed them- but the remark should be reserved for them only. Here's the dirty little secret though- Everyone, including attendings, residents and well-seasoned PA's, will at SOME POINT use a website like Wikipedia for SOMETHING while at work. Link to comment Share on other sites More sharing options...
Moderator True Anomaly Posted December 16, 2012 Moderator Share Posted December 16, 2012 BTW- why is there a sudden predominance of pre-PA threads on the board? Is the Pre-PA board out of commission or something? If you guys are just wanting the more "experienced forum people" to read your threads....you do realize we also peruse those forums as well, right? Link to comment Share on other sites More sharing options...
rcdavis Posted December 16, 2012 Share Posted December 16, 2012 There is nothing wrong with the length of the programs. The problem is with the lack of HCE and life experience of the students. . IMHO ^^^^^^^^^^^^ I simply cannot state how much I agree with this. If we fall off the pathway to sucess... If we never achieve "physician associate" status.. This will be the primary cause. The academic circles send me data which shows equal performance of PA graduates, regardless of HCE, after 5 years of practice. To these data, I respond, how many patients, and physicians, have become soured on the whole profession, based on exposure to non hce'd junior PAs, during this 5 year hiatus? Link to comment Share on other sites More sharing options...
rcdavis Posted December 16, 2012 Share Posted December 16, 2012 BTW- why is there a sudden predominance of pre-PA threads on the board? Is the Pre-PA board out of commission or something? If you guys are just wanting the more "experienced forum people" to read your threads....you do realize we also peruse those forums as well, right? Good points in both posts. Link to comment Share on other sites More sharing options...
just_me Posted December 16, 2012 Share Posted December 16, 2012 well, in my program we have paramedics and military medics that have just hit clinicals or have gone through clinicals and luckily when you ask them how are things going, they have the stones to tell you how they really feel---common thread "you simply can't, don't, won't know everything"..... as a matter of fact, some PA-Cs posting in this thread (and that will post later) have assured many new grads of the same thing...it takes time to get to that point where youre confident in your diagnosing skills. Its always possible that they know what it is and look it up just confirm because they are scared of making a mistake because they are new and from what I have read on these boards, fear in making a mistake in medicine is something anyone can have regardless of what their background was. I have read many seasoned PA-Cs here tell new grads that uncertainty in a new grad is a good thing, its those that think they know everything that are dangerous. Fear/uncertainty can infect even the best of us, take this post for example, you fear that the programs are too short for such intense curriculum, but could it be that youre afraid that you will graduate and need to look up things just like them because you don't know everything? My opinion is solely based on posts that I have read from new grads on this board for the last several years....programs lengths are just fine. You will graduate and need to look things up; you will do it less and less as you gain more experience in whatever field you are in. Prior HCE helps, but if its not related to the field you end up in (i.e. person with OB/GYN experience going into dermatology or a respiratory therapist going into urgent care) you will have a minimal edge. There are 3 year programs and I have a feeling those grads have the same issue as new grads. If you want someone to graduate and know everything about the area they are going in, most likely a program would have to add an internship and residency but then it would just be med school--defeating the purpose. If anything, programs should introduce patient experiences/history writing/physical exam skills/and diagnosing earlier in the program and more consistently --I have to say that is one of the things I have grown to like about my program. Link to comment Share on other sites More sharing options...
Moderator ventana Posted December 16, 2012 Moderator Share Posted December 16, 2012 ALL PA's should have a one year internship just like the doc's broad based, burn in the medical knowledge, and the choice of residency does not affect the job at all. Interns are just interns, short of medicine or surgery - but most fields (indlucing DO) now require a one year internship. Thiis does a couple things...... it gets us all broad based real world experience working in a hospital, it raises the bar for what a new grad posses for knowledge and skills, it forces supervision for the first year of practice, it forces compliance to the very basic tennors of medicine (lots of gray areas in medicine and as long as you stay in the accepted norm you are okay, but if you practice outside this you are not okay- and this would help teach you the norms..) I really see no down sides to this set up. We could be paid a fair living, work our butts off, get exposed to many different fields including some that are harder to gain expusure in ie RCU, ICU, CCU, SICU, psych, Geriatrics, Surg, ORtho. By having the last 3 months be "electives" you could hit the ground runnning at any new job. Honestly I think the school length is about perfect - any longer and why not go to MD/DO school, we just need a formalized OJT to learn how to apply the basics. ESP witht the new movements towards CAQ and speicialization we should have a one year intternship taught in the hospital model/setting Link to comment Share on other sites More sharing options...
Medic207 Posted December 16, 2012 Share Posted December 16, 2012 Careful what you wish for! If you require an internship then what happens if you decide to change specialties later? Will you have to do another internship? While it may be easy to dismiss this concept out of hand, there are forces that will see this as an opportunity to create new requirements, create low paying internship positions and keep the overall lock on our profession. The answer is not regulations on the PAs, the answer is to work on ways to keep the fly by night car salesman type doctor from taking advantage of new grads. Maybe PA schools should do a better job of warning the graduates not to work for a greedy multi-clinic owning doctor who sees our profession as purely a way to boost profits. Link to comment Share on other sites More sharing options...
Administrator rev ronin Posted December 16, 2012 Administrator Share Posted December 16, 2012 Careful what you wish for!If you require an internship then what happens if you decide to change specialties later? Will you have to do another internship? Sure... at about the same frequency that medical doctors are required to redo internships... which would be almost never. :-) The broad-based intern year is essentially clerkships, or rotations, with a degree and with actual responsibility. Link to comment Share on other sites More sharing options...
bgdog Posted December 16, 2012 Share Posted December 16, 2012 If a new PA is not ready to hit the ground running, then shouldn't they have trained longer? PAs are no longer "second careers" for seasoned paramedics or RNs, and for what its worth, most of the new grads I've encountered have extremely limited HCE (although I don't see how this plays a role in how a PA makes a Dx). Most schools,(RN, RT, PA, whatever) only teach the basics and how to pass the boards. The knowledge base is too broad for much in depth study in any particular specialty. You learn that on the job. If you've never done orthopedics and just had to rely on whatever you were taught in school, then you will be one looking-up mofo. Any good ortho tech will smoke any new PA or MD for that matter when it comes to knowledge of orthopedics. In the meantime, you look up what you can and punt to the guys that know when you need to. Link to comment Share on other sites More sharing options...
Guest Posted December 16, 2012 Share Posted December 16, 2012 I don't think anything is wrong with looking stuff up. I've worked with doctors who looked things up occasionally. It will never ALL be in your head. Link to comment Share on other sites More sharing options...
lovinglifefully Posted December 16, 2012 Share Posted December 16, 2012 Maybe programs should be lengthened from a rotation perspective, in the new world of PA dom. 12 months of 4-5 week rotations through everything seems a bit rushed (say what you want about NP training, at least they are forced to choose a specialty / area of practice in which their clinical training then focuses). Paramedic training and work is another story, as is the training and work a military medic, if in the right environment. Most HCE people come in with does not prepare them to be able to then hit the ground running as a PA fresh out of school (MA, CNA, Research and honestly even RN). PA school gives you a foundation of general medicine to be able to work in a highly supervised and collaborative environment as a new grad. I'd be scared to death to be in an urgent care center as a new grad with no SP on site. I would not even take a job like that. Link to comment Share on other sites More sharing options...
Justeco Posted December 16, 2012 Share Posted December 16, 2012 Does anyone have any evidence that extending the length of programs or requiring internships would produce better PAs? Link to comment Share on other sites More sharing options...
Medic207 Posted December 16, 2012 Share Posted December 16, 2012 Maybe programs should be lengthened from a rotation perspective, in the new world of PA dom. 12 months of 4-5 week rotations through everything seems a bit rushed (say what you want about NP training, at least they are forced to choose a specialty / area of practice in which their clinical training then focuses). Paramedic training and work is another story, as is the training and work a military medic, if in the right environment. Most HCE people come in with does not prepare them to be able to then hit the ground running as a PA fresh out of school (MA, CNA, Research and honestly even RN). PA school gives you a foundation of general medicine to be able to work in a highly supervised and collaborative environment as a new grad. I'd be scared to death to be in an urgent care center as a new grad with no SP on site. I would not even take a job like that. Because the focus of most PA schools is primary care. Rotations are designed to be a little if everything. PA schools should spend more time in professional development and hopefully would teach new PAs to avoid situations were there is no SP. Link to comment Share on other sites More sharing options...
CByersPAC Posted December 16, 2012 Share Posted December 16, 2012 I think the length of PA programs is fine. I think a new grad is going to have a very hard time doing good work or getting good experience working a busy urgent care without backup. "Urgent care" is deceptive - it's a mixture of trivial self-limiting illnesses and serious life-threatening illnesses, and in my experience requires . . . well, experience. :) Or good backup. REgarding looking things up, I use UpToDate pretty much daily and I've been in practice a long time. Link to comment Share on other sites More sharing options...
Moderator LT_Oneal_PAC Posted December 16, 2012 Moderator Share Posted December 16, 2012 Required general medicine internship. Additional residency specialization optional (residency being an additional 6months - 1 year depending on specialty) so for a total 3-4 years of training. Just like physicians model except abbreviated. It's still way shorter than going MD and spending minimum 7 years in training. IMO we are missing a piece of the medical model by not having it. Then we get taken more seriously when we ask for expanded practice scope AND when asking for a true MD/DO bridge, we have people hitting the ground running in primary care, no need to worry about previous HCE, still have lateral mobility, and helps in the "degree creep" battle with NPs without actually having to go to a doctorate necessitating paying more for our degree. Sure we lose a year of making more money, but you aren't paying anymore, have some salary, and can command a higher salary later than others (NPs) who can't compete with you clinically after you've just spent the last year perfecting your craft. Link to comment Share on other sites More sharing options...
Guest Paula Posted December 16, 2012 Share Posted December 16, 2012 I would like to see a third year internship or residency, and see it in primary care/family practice. The VA system has a few residency programs for PAs that are in their first or second years of operation. Does anyone know of PAs who have been in the program.. I'd like to hear their input. Also, NPs will be in the same boat as PAs when RN students go to a 4 yr. nursing program right out of High School, and then directly into an NP program. There will be no significant HCE for them, either. They will be just as lost as PAs without significant HCE. The days of the PAs and NPs with loads of HCE may be waning as the careers are seen as just that,a career. Not a calling. Careers are picked by the salaries, quality of life, cost of education, and I believe the NP/PA careers are marketed as that, not that you must have HCE. Link to comment Share on other sites More sharing options...
benny32311 Posted December 16, 2012 Share Posted December 16, 2012 I agree that the vast majority of new grads should not be working unsupervised... I was talking with my adviser today and he basically stated that it is fool hardy to not to work under a physician for at least a year when you graduate. I would concur. The small amount of time in school that I've spent, and talking to my med school friend has really shown me there is a huge difference in training. Link to comment Share on other sites More sharing options...
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