Should PA schools be longer?

[Guest Paula]

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.

 

First couple of years out you need a good SP. So do NPs, but some may not be required to have that kind of OJT, and that is a flaw in the NP scope of practice laws.

[TThielen]

IMO It doesn't matter what role you're in, NP, PA, DO, MD or even a surgeon, the fact of the matter is no amount of school or training will prepare you well enough to hit the ground running. Only years of experience can do that.

[jsfelder0417]

I'm with Oneal on this, a 1 year general medicine internship immediately after school. I am one of those military medics with 10,000 hours of HCE, including time in the sandbox- turned PA student types. I still plan on applying for an EM residency once I graduate. The knowledge and skills picked up during residency are worth more than the temporary pay hit for me. I am in this because I am fascinated by the human body, not because I wanted to get rich.

[EMEDPA]

I still plan on applying for an EM residency once I graduate. The knowledge and skills picked up during residency are worth more than the temporary pay hit for me. I am in this because I am fascinated by the human body, not because I wanted to get rich.

excellent plan and one I would follow as a new grad today...I still haven't ruled out doing it myself....if the stars line up just right and a program opens up near me I may very well do it still....the procedure log alone you build in a residency is priceless for future jobs.....

[discogenic]

Assuming it's true, why are schools selecting applicants who lack significant HCE? One would think these schools have their pick, what with so many applicants for so few seats. I've heard that PA school applications were up over 20% this year. Has there been some realization that prior HCE doesn't matter much?

[rev ronin]

That's easy: PANCE scores are everything to a program--who wants to go to a program who can't get students through it?--and GRE scores and GPA speak to the ability to pass a single test far more than the hours or quality of HCE does. So if one program creates better clinicians, and another programs fills itself with people with no HCE, high GPA, and high GRE... who is going to show up with a better PANCE pass rate? That's right: the one that prefers the high GPA/GRE students.

 

HCE never helped anyone pass the PANCE, did it?

[True Anomaly]

HCE never helped anyone pass the PANCE, did it?

 

Even if it did, I doubt you could actually quantify it in a study

[lovinglifefully]

New grad RNs are now doing residencies. Maybe because it's tough to find a job, maybe because hospitals realize better to get them into more training first?.

[Justeco]

I'm unsure. With Anesthesiology Assistants there is no prior healthcare experience required yet they perform at the same level as CRNAs, who through a great deal more comparatively speaking.

[LT_Oneal_PAC]

New grad RNs are now doing residencies. Maybe because it's tough to find a job, maybe because hospitals realize better to get them into more training first?.

 

These are not residencies like docs or we have. They are typical work weeks, you picked your favorite 6 specialties to work on, 6 months in length, standing literally beside the precepting nurse nearly the whole time. It's more of a way for RNs to figure out which floor they want to work on and to attract young BSN prepared nurses than anything else.

 

My old hospital had them and those coming out of "residency" had more or less the same amount a clue as any other new grad.

[LT_Oneal_PAC]

I'm unsure. With Anesthesiology Assistants there is no prior healthcare experience required yet they perform at the same level as CRNAs, who through a great deal more comparatively speaking.

 

Hard to say since CRNAs can be completely independent and fully replace anesthesiologists and AAs can only perform their duties with a anesthesiologist in the building. Also we are talking about people who learn only one specialty.

[KCMA79]

Assuming it's true, why are schools selecting applicants who lack significant HCE? One would think these schools have their pick, what with so many applicants for so few seats. I've heard that PA school applications were up over 20% this year. Has there been some realization that prior HCE doesn't matter much?

 

There are several reasons. They are chasing the Holy Grail of PA schools, PANCE pass rate. It is easier to select students using only grades/test scores. It is easier to teach the PANCE than good solid clinical medicine. Being a PA is no longer a calling, many now view it as a job with a decent salary and OK working conditions. Some of the newer schools are simply cash cows that see a chance to make money off of grad school tuition. And what better way to maintain that cash flow than select only applicants that can keep that PANCE pass rate high. An increasing number of PA faculty are PAs with little HCE coupled with limited clinical experience. Those are just a few of the reasons for programs ignoring HCE.

[LESH]

How do you think the internship/residency should work? Should it be further generalist training, or an elective specialty?

Why not both?

[Just Steve]

On the upside, those new PAs are realizing what they DON'T know and are at least trying really really hard to do right by the patient. There are a couple of options... 1. Be an air traffic controller...aka: refer every last patient that isn't a super obvious URI. This of course is doing a disservice to the patient, the insurance system, the clinic, and the provider because if they are never challenged, they will never grow. 2. Wing it. Shoot from the hip, throw narcs, NSAIDs, antibiotics, anti fungals at everything until A. the patient gets better on their own B. they get worse and you refer them C. they realize they are under the care of an idiot and leave D. they die.

 

So will changing the education standards improve care...perhaps. Perhaps not. Anyone have a study showing patient care outcome during the days of the shorter education model where the student came from a more traditional prior HCE background vs the current education model where prior HCE is fading from requirements?

 

 

 

I can't imagine a school standing up and saying "oh no, we don't want your tuition for a third year". Instead, I would expect to see Academia shouting "of course the current program is too short" and raking in another $30,000+ per student.

[Contrarian]

Soooo....

About 3.3 yrs for the MD/DO program.

Now there is a suggestion for 3 yrs for a PA program...???

Why even bother with the latter...????

[CAAdmission]

There are three year programs around. Most applicants probably do not have the maturity and insight to recognize the benefit of more rotation experience. Applicants want instant gratification, which means a faster, cheap program.

[EMEDPA]

I'm a big fan of the usc 3 yr program for those with less experience as opposed to a standard program.

[discogenic]

Soooo....

About 3.3 yrs for the MD/DO program.

Now there is a suggestion for 3 yrs for a PA program...???

Why even bother with the latter...????

 

There are those who would still prefer to be PAs. Or at least that's what applicants are routinely telling Adcoms. :;;D:

[cinntsp]

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?

 

Mods should just move the threads to the pre-PA section as they come across them. It may help to promote a few active posters to mods to help police it a bit. Several "how are my stats?" threads and the like have started popping up on the professional board lately.

[cinntsp]

There are three year programs around. Most applicants probably do not have the maturity and insight to recognize the benefit of more rotation experience. Applicants want instant gratification, which means a faster, cheap program.

 

Sometimes it's a case of the faculty's opinion being that extending the program will not necessarily improve the student's abilities as a primary care provider. I'd love it if I had the option to extend my program for three months to squeeze in a couple of elective rotations.

[KCMA79]

I have often wished there was some sort of option for grad PAs to return to their program for a short period of time in a directed studies program for grads after several yrs out in the hinterlands. Then the reality of cost, making a living etc. smacks me in the face. I guess that's what I get for dreaming.

[andersenpa]

These PAs need more postgraduate training, not more school.

That being said the need to look something up is not an indicator of quality, as we all know PAs/docs that look things up throughout their career.

The issue is what is being looked up, and what the source is. Put it this way, use references that you would cite in court if you were sued over the patient's care. (They don't start with "wiki")

 

I'd bet that quality SP-PA collaboration for the first yr or 2 is equal to residency training in most cases. You will likely see more exotic pathology and work more intensely in residency than w/ OJT though.

 

With the increasing demands put on PCP physicians, I'd bet that they have less time to dedicate to PA training than in the past, which begs for more structured (residency) training.

[EMEDPA]

 

I'd bet that quality SP-PA collaboration for the first yr or 2 is equal to residency training in most cases. You will likely see more exotic pathology and work more intensely in residency than w/ OJT though.

I disagree. I had a great first SP with whom I worked for 2 years( he was the residency director for an md residency at the same time) but he had definite ideas about what "doctors should learn" vs "what pa's should learn". in a structured residency these would have been the same things. Igot great instruction into the care of pts with mild to moderate problems and almost no instruction into care of those with emergent problems. as I was working , and aspiring to work, as an em pa this posed a problem so I left for a job with a better scope of practice. still wish I had done the residency. I have sat down with some em pa residency grads to compare procedures logs. I have lots of low to mid level procedures( I should after all this time) while they have many more high level procedures done in just 1 yr of training. for example paracentesis. I have done it 3 times total in my entire career, limited both by opportunity at some places and SP preference at others. some em pa residents have 20+ in 1 year. ditto chest tubes, cetnral lines, etc

[andersenpa]

I disagree. I had a great first SP with whom I worked for 2 years( he was the residency director for an md residency at the same time) but he had definite ideas about what "doctors should learn" vs "what pa's should learn". in a structured residency these would have been the same things. Igot great instruction into the care of pts with mild to moderate problems and almost no instruction into care of those with emergent problems. as I was working , and aspiring to work, as an em pa this posed a problem so I left for a job with a better scope of practice. still wish I had done the residency. I have sat down with some em pa residency grads to compare procedures logs. I have lots of low to mid level procedures( I should after all this time) while they have many more high level procedures done in just 1 yr of training. for example paracentesis. I have done it 3 times total in my entire career, limited both by opportunity at some places and SP preference at others. some em pa residents have 20+ in 1 year. ditto chest tubes, cetnral lines, etc

 

 

That's why I qualified it with "quality". It's a subjective term. Having done a residency and also worked with non-residency PAs, I've seen competent PAs come from both systems. It demands the right combination of PA and doc. If the doc is differentiating "physician knowledge" and "PA knowledge", then it's not quality collaboration.