Thoughts on the future of a Supervision and PA Education

[Contrarian]

^^^ That plus the reality that there really isn't that much difference aside from the practice of the 4th yr spent mostly studying and interviewing for residency... as evidenced by the the slowly growing trend of 3 yr Medical schools.

 

So in these places... a INTERN is simply a person on the day after being handed a diploma/MD degree at the end of their 3rd yr of medical school.

 

Broaden your mind...

[ventana]

Can we keep it on topic? SDN and Med student versus intern is a bit pointless

 

 

Interesting and entertaining to read comments

 

 

Interesting to see the #'s in the poll

 

46% say some type of post grad training year would be a reasonable idea

39% say optional would be a good option - but still an option

 

 

 

lots of debate on the finer points, but the overall point of trying to raise the bar to a much higher level taking into considering the decreasing age and experience of the average PA-S-->New PA-C

It is not even close to med school + residency to add on 12 months - 28 month school plus 12 month internship is 40 months - still well less then most med schools alone

 

BUT as EMDPA has found there is a benefit to advanced training/certification.

 

As for the thought of being comfortable with our current set up - I never have like an argument against change because it is change. We can improve, we are improving, we are gaining ground in the medical world, we are becoming the future of primary care. If a Doc is not "allowed" to become a GP anymore, and they have to go through residency (even to do JUST primary care) why do we think that we can do it with an academic program that is about 50%-70% of med school? Might is be about our pride? Do we think we are possibly better then we are? Maybe we are? Maybe primary care is not as easy as we think it is... Maybe there needs to be advanced standing in the internal medicine realm (CAQ) for those of us that are practicing at the full extent of our training...... Yes I feel my training was inadequate training to handle the profoundly complex geriatric patient when I was early in my career. Try managing 10+ meds on a complex geri patient who is having psych, cardiac, resp and mobilty issues - it is not easy and although it takes a team approach their needs to be a leader somewhere and we have to be more then an effective coordinator, we need to be able to lead others.

 

So why not have a one year internship? May professions do it, SLP have a CFY year, there is apprentice positions in many fields, engineers have it, many fields have it........

 

Really enjoying the thoughts and comments - it is an interesting thread with many different view points - thanks PAF

[sartort]

How would this be funded? Federal funding helps with residencies for physicians and has been capped for 15 years, so there's obviously no money there. Medicare spent almost 10 billion on physician residencies in 2009 alone with the cap, and the plan is to cut Medicare support for teaching hospitals by 6 billion to help with the national deficit in 2015. I definitely see advantages to additional training time because some people have complained on here about not getting enough support from their SPs when they start out and it seems a lot of people don't have a lot of HCE these days, but I just don't think it's realistic to expect that the country would pay new grads to do an additional year with the bottleneck and the fact that PAs are in high need today in many places. I think it's much more realistic that if an additional year was required it would end up costing the new grads a lot more than just a first year pay reduction.

[EMEDPA]

Places with residencies currently do it as a way to do in house recruiting. train em and keep em.

[Febrifuge]

Honestly, I favor clamping down on the experience angle. The system isn't broken, and didn't need to be fixed before PA schools started accepting kids with no experience. I'll adopt the 'grumpy old man' position and say that even though "my day" wasn't that long ago, I had over 2500 hours of paid, hands-on patient care experience and I LIKED IT.

[EMEDPA]

Honestly, I favor clamping down on the experience angle. The system isn't broken, and didn't need to be fixed before PA schools started accepting kids with no experience. I'll adopt the 'grumpy old man' position and say that even though "my day" wasn't that long ago, I had over 2500 hours of paid, hands-on patient care experience and I LIKED IT.

yeah!

emedpa-another grump who isn't that old either.

10,000 + hrs hce before becoming a pa

[ventana]

How would this be funded? Federal funding helps with residencies for physicians and has been capped for 15 years, so there's obviously no money there. Medicare spent almost 10 billion on physician residencies in 2009 alone with the cap, and the plan is to cut Medicare support for teaching hospitals by 6 billion to help with the national deficit in 2015. I definitely see advantages to additional training time because some people have complained on here about not getting enough support from their SPs when they start out and it seems a lot of people don't have a lot of HCE these days, but I just don't think it's realistic to expect that the country would pay new grads to do an additional year with the bottleneck and the fact that PAs are in high need today in many places. I think it's much more realistic that if an additional year was required it would end up costing the new grads a lot more than just a first year pay reduction.

 

thats the best part

 

all the non-teaching hospitals (at least in my area) are hurting for staff

 

it is about staff training and retention - they can afford to pay a PA $50k/yr with bennies as we are a revenue producer - and we only need a year to really get up to speed...... it only makes sense, they get to bill for the work the PA's do and at the same time train them the way they want....

[mrsmojorisin]

PAs are already over educated for the respect/pay and in most cases responsibilities they have.

[andersenpa]

We're over educated to practice medicine?

[Joelseff]

yeah!

emedpa-another grump who isn't that old either.

10,000 + hrs hce before becoming a pa

 

I guess u can count me in the "Grumpy Old Men" club...I'm only 40 and only starting my 3rd year in practice BTW. Though I had 5 figure HCE hours pre-pa in capacities as a corpsman, lab tech, ST, and a lowly MA.

 

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[taotaox1]

So with a required internships + 2-3 years of school.... why would anyone go to PA school over MD? Especially for primary care? A 3 year MD program offers the full deal with little extra sacrifice......

[Guest JMPA]

We're over educated to practice medicine?

yes, we are over educated to practice medicine as assistants to physicians

[Guest Paula]

So with a required internships + 2-3 years of school.... why would anyone go to PA school over MD? Especially for primary care? A 3 year MD program offers the full deal with little extra sacrifice......

 

MD schools may someday get the idea that they should offer 3 year programs with a one year internship in primary care and then release the MDs to PC. They think it will be their idea. When they think it is their idea, they will sanction it as the only way to get into primary care. Then, PAs will be folded into the fray and given the MD degree because we have already done it. MD schools will take over the PA schools that are located in medical colleges and PAs schools for primary care will be a thing of the past. Only thing is we will pay a heck of a lot more money to be a MDPA and the MD guilds will reign once again. Just my demented way of thinking!

[ventana]

So with a required internships + 2-3 years of school.... why would anyone go to PA school over MD? Especially for primary care? A 3 year MD program offers the full deal with little extra sacrifice......

 

 

once again

 

PA school is 28 months - then 12 month "internship" = 40 months with 28 months tuition

Physician School is 48 months (a very few 36 months) + 36 months intern/residency = 84 months with 48 months tuition (might be only 36 if you are accelerated)

 

 

Absolute FASTEST MD/DO is 72 months and $$$$$$

PA is 40 months and $$$

 

 

They are not the same creatures - and the arguement "why don't we just all go to med school" just doesn't hold water.

 

I am NOT a doc, I am a PA and proud of it, and my school loans are FAR smaller (as is the average school loan for PA versus MD/DO)

 

 

 

 

 

Oh yeah, and I would think that those doc's that are on this board would take offense that there is "little extra sacrifice" to an extra 1-2 years of school and an extra 2-3 years of residency....

 

 

 

 

 

The point is you don't need to be a doc to be a PCP and a darn good one, but why do we as a profession think that 28 months of schooling with out any formal OJT/residency make us qualified as a new grad PA to function at ans acceptable level? I for one do not believe that a brand new grad is prepared to do this with out on site physician back up - problem is that now we ARE recognized as such and I feel we should have some type of one year internship/residency to "up the playing field" so to speak..... I believe we are very well prepared in school but as any PA can point out, book knowledge is applied knowledge are very different creatures..... and a one year "guidance" for new new grads seems only reasonable.

[andersenpa]

yes, we are over educated to practice medicine as assistants to physicians

 

PAs practice medicine, not assistance.

[EMEDPA]

I don't see pas practicing "independently" any time soon but I think our association with physicians will become more like what np's have in their non-independent states. they need to work "in collaboration" with one or more physicians which sounds much better than our current arrangement of "supervision" although in practice it basically means the same thing but the PR benefit of "collaborative practice" will go a long way towards earning us the respect we deserve for the work we have already been doing for years.

[andersenpa]

The point is you don't need to be a doc to be a PCP and a darn good one, but why do we as a profession think that 28 months of schooling with out any formal OJT/residency make us qualified as a new grad PA to function at ans acceptable level? I for one do not believe that a brand new grad is prepared to do this with out on site physician back up - problem is that now we ARE recognized as such and I feel we should have some type of one year internship/residency to "up the playing field" so to speak..... I believe we are very well prepared in school but as any PA can point out, book knowledge is applied knowledge are very different creatures..... and a one year "guidance" for new new grads seems only reasonable.

 

Do you support CAQ and how do you see it as part of your proposal?

[ventana]

amazing still that over 80% of poll people would be okay with some type of internship/residency year....

 

maybe not mandatory but at least and offering..

[EMEDPA]

Do you support CAQ and how do you see it as part of your proposal?

as an aside- a few of the newer em residencies are requiring pas to take and pass the em caq at the conclusion of the residency. I think this is where all of the residencies will be heading in the next few years.