Is 2 years enough to become a competent clinician?

[PAorMDhopeful]

Hey everyone,

 

Is the two years in PA school (not on the job, sorry for the confusion with the title) enough time to feel comfortable/competent with the underlying knowledge necessary in treating patients? A patient I recently saw, once telling him I was thinking of PA school, argued that 2 years is not nearly enough time to be a competent/adequate clinician. It got me thinking that maybe he's right...how comfortable / competent can one feel upon graduating PA school after only having 12 months of book learning and 12 months of rotations (aside from the previous HCE one has had) ? It's getting me nervous that I might not feel very sure of myself making diagnoses as a PA.

[EMEDPA]

That's why prior experience is so important.

Pa is designed to be a second medical career after medic, rn, rt, etc.

Before i saw my first pt during pa school clinicals i had been working in health care seeing patients for 10 yrs already.

I would encourage those without prior experience to go the medschool route every time.

[rcdavis]

That's why prior experience is so important.

Pa is designed to be a second medical career after medic, rn, rt, etc.

Before i saw my first pt during pa school clinicals i had been working in health care seeing patients for 10 yrs already.

I would encourage those without prior experience to go the medschool route every time.

 

Ditto, double ditto.

[bgdog]

I feel comfortable and I finish at the end of the month and do indeed have a job already however...I had 45,000 hours of experience (just a rough estimate,not counting overtime), so...what they said ^^^^

[Just Steve]

Define "competent"

 

What sort of patient, in what setting? Forward operating base in the Middle East? Oil rig on the North Slope of AK? Lone provider in rural America? Family medicine clinic in a large tertiary hospital, being given 30-45 minutes to work up a head cold?

 

Sure, I can see where two years of being spoon fed hand selected patients for evaluation with the security of other providers tasked with overseeing your care may lure into into thinking "oh I got this!" But we all know once you kicked from the nest aka:graduate, it is a totally different world. If you think you can be called competent as a new grad I suggest you put down the Kool-Aid.

 

Am I confident? Heck yeah...confident I don't know squat even after having an extensive medical background before school. Will I be competent? Well that depends, as noted above.

[Hemegroup]

Also to remember ... MD/DO didactic hours are 2300 over 2 years, PA didactic hours are 2000 over 1 year. MD/DO students get breaks, PA students do not. The MD students do get to rotate more thoroughly, but the difference really lies in the residency ... which is why PA residencies can be a great asset, as can work experience after graduation ... but the more healthcare experience an individual has before PA school, the better ... it's the model that the profession was built on, not intended as a 'quick fix' alternative to medical school.

[briepm]

Just remember when you read responses OP - there are a few old school folks on this forum who repeat over and over that the only PA's worth anything (ahem) followed the exact same path that they did.

 

Many, MANY PA's graduate school without having thousands of hours of health care experience before starting, and the profession seems to be expanding, not imploding.

 

Would I trust a new grad (including myself) to fly solo right out of school with no supervision? No. Would I trust a 1st year resident to fly solo right out of school with no supervision - yikes!!! Anyone who thinks they're going to be amazing right out of school is delusional and dangerous - there is ALWAYS something to learn.

 

Anyone that makes it through PA school is incredibly smart, hard working, and has incredible drive - and clearly has learned HOW to learn. In our position, we'll always have someone to bounce ideas off of and learn from - one of the best aspects of the job, I think.

[BroncoPAS]

"Is the two years in PA school enough time to feel comfortable/competent with the underlying knowledge necessary in treating patients?"

Yes. As is with everything in life, you get out of it what you put into it.

[Acebecker]

Just remember when you read responses OP - there are a few old school folks on this forum who repeat over and over that the only PA's worth anything (ahem) followed the exact same path that they did.

 

Many, MANY PA's graduate school without having thousands of hours of health care experience before starting, and the profession seems to be expanding, not imploding.

 

Would I trust a new grad (including myself) to fly solo right out of school with no supervision? No. Would I trust a 1st year resident to fly solo right out of school with no supervision - yikes!!! Anyone who thinks they're going to be amazing right out of school is delusional and dangerous - they're is ALWAYS something to learn.

 

Anyone that makes it through PA school is incredibly smart, hard working, and has incredible drive - and clearly has learned HOW to learn. In our position, we'll always have someone to bounce ideas off of and learn from - one of the best aspects of the job, I think.

 

One who puts on his armor should not boast like one who takes it off.

 

Prior medical experience is crucial to hitting the ground running fresh out of PA school. Hands down I would pick someone who had better experience before school compared to someone who didn't have much - both for selection of a PA student and selection of a new hire. I had over 6000 hours (which is minimal I know) and I shudder to imagine people practicing medicine with much less than what I had. I know it can be done, so not trying to knock those who are doing it. But having a lot of experience changes your entire perspective and makes you a better clinician.

 

Andrew

[briepm]

I was merely stating that there are those on this forum that hold their experience as the ultimate standard. It can be discouraging - and clearly, many people graduate and make excellent clinicians who don't have thousands of hours, even if you can't imagine it.

 

One who puts on his armor should not boast like one who takes it off.

I had over 6000 hours (which is minimal I know) and I shudder to imagine people practicing medicine with much less than what I had.

[rev ronin]

I was merely stating that there are those on this forum that hold their experience as the ultimate standard.

 

The reason that people like you and me can even PLAY in this sandbox is because the senior PAs who say "go to med school if you don't have prior HCE" repeatedly, who did have tons of prior experience before PA school, have kicked butt, taken names, and proven the worth of the profession. Do not dare to think that you and I are as good as they are, because we're not.

 

What I bring to the table is a ton of NON-medical experience, in addition to about 3k total HCE hours prior to PA school, and with that package, I am very happy to be working in a family medicine team with a bunch of great docs and two very senior PAs. I am smart enough to know my limitations, like Just Steve points out, and I'm very happy to be seeing patients in such a setting. On average, I run one or two patients per day past a doc, and they and I are very happy with what I ask about and what I handle on my own.

[ventana]

fresh out of PA school you are good at H&P and maybe getting a Ddx working

 

you are by no means a competent great clinician!

 

If you really thing you are you are drinking some funny koolaide.....

 

honestly, you can hit the ground with your feet running, you still likely have 2 more years of hitting the books to get "comfortable" with practicing medicine.

 

 

I have worked with some newer PA's that thought they were all set - and I was always scared they would miss something (that they would not even realize as their experience is limited) or just flat out kill someone. Have seen new PA's out produce every boarded ER doc in the department and get rewarded by admin (yeah that was scary)

 

Think of PA school as punching your ticket to get on the best carnival ride there ever was, it is not the ride, is is merely the way to get on!

 

 

An for newer PA's that are going to argue that they are indeed all set - do you really think the federal gov't would sink almost a million dollars in to training every physician if they could just replace them all with PA's?

 

I am not saying a PA can not be great, but instead as a new grad you still have a lot of learning to do

 

 

 

Just think of any field, literally ANY field - would you want someone just out of school cutting your hair, doing your taxes, doing dental work, or even working on your car? Not me..... but if that same new grad had a mentor that was working with them, heck yes I would go to them!

[Hemegroup]

The reason that people like you and me can even PLAY in this sandbox is because the senior PAs who say "go to med school if you don't have prior HCE" repeatedly, who did have tons of prior experience before PA school, have kicked butt, taken names, and proven the worth of the profession. Do not dare to think that you and I are as good as they are, because we're not.

 

What I bring to the table is a ton of NON-medical experience, in addition to about 3k total HCE hours prior to PA school, and with that package, I am very happy to be working in a family medicine team with a bunch of great docs and two very senior PAs. I am smart enough to know my limitations, like Just Steve points out, and I'm very happy to be seeing patients in such a setting. On average, I run one or two patients per day past a doc, and they and I are very happy with what I ask about and what I handle on my own.

 

sounds similar, i'm currently with a long time doc and one senior pa whos been out of school i think 4 years. i had about 4k when i started pa school and also a lot of life experience. as much as i thought i know, i will always be a student. we are until the day we expire in our current forms. and they are grand forms, allowing us to reach the stars.

[PACProvider]

I often read strongly worded answers to questions of this type. However, they are nearly always offering opinions. What frustrates me is that members of this forum advocate evidence based medicine in their practice (as do I). However, one rarely hears someone say in response to the question about healthcare experience before PA scool, "This was studied by PA X and found A, B and C." The reason I raise this has more to do with strategy and mission than this OPs question. The D.O.'s waged a long war with the M.D.s before gaining acceptance. I know that some M.D.s still don't respect D.O.s but most regard them as equal colleagues. One criticism of D.O.s was that they have no research to support their claims. Today, PAs have the capabilities to perform research to answer these questions. It would impress others more to read the results of studies than to listen to vitrol, in my opinion. Of course, I cannot cite studies to show that people are more impressed with research than vitrol. :heheh:

[briepm]

ok, and I'm done after this - I just don't want what I said to be misrepresented.

 

J

Would I trust a new grad (including myself) to fly solo right out of school with no supervision? No. Would I trust a 1st year resident to fly solo right out of school with no supervision - yikes!!! Anyone who thinks they're going to be amazing right out of school is delusional and dangerous - there is ALWAYS something to learn.

[BroncoPAS]

fresh out of PA school you are good at H&P and maybe getting a Ddx working

 

you are by no means a competent great clinician!

 

 

Maybe YOU weren't a "competent great clinician" fresh out of PA school but others may have higher standards for themselves than the path you followed, to each his own. As I said earlier, as is everything in life...the more you put into something, the more you get out. You'd be surprised at how much each individual varies and how many talented young folks there are in this world (not me, I'm an old geezer).

[Hemegroup]

It truthfully doesn't have to do only with talent. It has much to do with experience. The more you can get before PA school the better, but if you're already in then prepare for some to come after you hit the halls.

[NAP1986]

Hey everyone,

 

Is the two years in PA school (not on the job, sorry for the confusion with the title) enough time to feel comfortable/competent with the underlying knowledge necessary in treating patients? A patient I recently saw, once telling him I was thinking of PA school, argued that 2 years is not nearly enough time to be a competent/adequate clinician. It got me thinking that maybe he's right...how comfortable / competent can one feel upon graduating PA school after only having 12 months of book learning and 12 months of rotations (aside from the previous HCE one has had) ? It's getting me nervous that I might not feel very sure of myself making diagnoses as a PA.

 

So, first off, I'm not trying offer any value judgments on what constitutes good or sufficient healthcare experience. As someone who just finished the application cycle, I can report what I have directly experienced.

 

As someone who was invited to interview at 8 PA schools this past cycle (Pace University, Marquette, LeMoyne College, Barry University, Duke University, Emory University, Trevecca Nazarene University, and Campbell University), interviewed at four (Campbell, Trevecca Nazarene, Duke, Emory), and was accepted to two (Campbell, Emory), waitlisted at one (Duke), I can tell you the demographics for incoming PA students are different from the original PAs. The average age for entering students at Duke and Emory is 26-27.

 

Whether the older PAs think it is appropriate or not, most current PA applicants/students do not see PA as a career change, but do in fact see it as a "fast-track" to medical practice and it is their first career. They are choosing it due to flexibility to change specialties, shorter time in school, and a desire to work with underserved populations in primary care. Many of the PA students I've spoken with said they knew they wanted to be a PA since high school, and many colleges are offering "Pre-PA" programs, that have HCE hours integrated to the undergraduate training.

 

Emory students have an average of 4,500 previous health care hours, which works out to be 2.5 years full-time. Most of the people I've met on interviews are EMTs, emergency room technicians, paramedics, medical assistants, physical therapy aids, dieticians, clinical research assistants, and/or exercise physiologists for 2-5 years after completing college. Here is the link to what accepted Emory PAs have done: http://emorypa.org/health_care_experience.htm

 

I came from a background as a clinical research assistant. I worked at Duke University Medical Center conducting neuropsychological assessments, clinical mood assessments, and daily life functioning assessments with geriatric patients with depression, cognitive impairment, and/or Alzheimer's disease. I have 3,000 HCE hours. I also did academic medical research. I wrote scientific papers, wrote scientific research grants, designed experiments, and analyzed data. My research used neuroimaging techniques such as functional magnetic resonance imaging (fMRI) and arterial spin labeling (ASL). I have a first-author scientific publication in a respected neuroscience journal. It seems that as there is a push for evidence-based medicine, candidates who have strong academic and research backgrounds as well as clinical experience are becoming valued.

 

I am not here to say what's "right" or "best". I am simply reporting my observations. So please, no hateful responses.

[Just Steve]

Is it expected that a non sports playing person can attend a training camp and then walk onto a professional sports team and function at the level of their teammates? Can a newly graduated recruit leaving boot camp go off and lead a fire team in live combat? Can the shift supervisor successfully replace the general manager at a moments notice? Does anyone actually feel comfortable taking their critically ill child/loved one to the newest provider in the ER?

 

Why not? Could it be that they lack experience and need more time in that role to develope competency?

 

 

Iatrogenic deaths or untoward outcomes are heavily under reported for several reasons. Among those include 1. No one wants that blame. 2. Administrations don't want that press about their facility. 3. Our peer group will cover for one another 4. The untoward outcome will be blamed on other co morbid factors. Using patient satisfaction surveys are ineffective tools as well because patients don't know what they don't know. If I sell you a bottle of snake oil and do so in a manner where you feel great about the experience, does that make me a good clinician? No. It makes me a good BS'r. But ask the patient and they will sing my praises.

 

 

How can a new student or recent graduate understand the impact of the lack of previous experience when they have no comparison? Clarity may come in a retrospective moment and I hope they reflect back for a moment and think..."I understand now" But until they flail and see the result of their lack of experience, you won't really get it.

[physasst]

Is it expected that a non sports playing person can attend a training camp and then walk onto a professional sports team and function at the level of their teammates? Can a newly graduated recruit leaving boot camp go off and lead a fire team in live combat? Can the shift supervisor successfully replace the general manager at a moments notice? Does anyone actually feel comfortable taking their critically ill child/loved one to the newest provider in the ER?

 

Why not? Could it be that they lack experience and need more time in that role to develope competency?

 

 

Iatrogenic deaths or untoward outcomes are heavily under reported for several reasons. Among those include 1. No one wants that blame. 2. Administrations don't want that press about their facility. 3. Our peer group will cover for one another 4. The untoward outcome will be blamed on other co morbid factors. Using patient satisfaction surveys are ineffective tools as well because patients don't know what they don't know. If I sell you a bottle of snake oil and do so in a manner where you feel great about the experience, does that make me a good clinician? No. It makes me a good BS'r. But ask the patient and they will sing my praises.

 

 

How can a new student or recent graduate understand the impact of the lack of previous experience when they have no comparison? Clarity may come in a retrospective moment and I hope they reflect back for a moment and think..."I understand now" But until they flail and see the result of their lack of experience, you won't really get it.

 

The problem being the incredible variability in patient presentations. It would be nice if they all read the textbooks, and knew to present with exactly THESE symptoms, etc. That's not medicine. The reason it is called the PRACTICE of medicine is because it is just that.....practice. Every day I am confronted with difficult to sort out complicated spine presentations. It's not straightforward. I can usually figure them out, but only because I have well over a decade of experience. As a new grad? No way. Is that an altered AMR? maybe, Is that some neural inflammation on their brachial plexus MR?

 

Real medicine outside of classroom is not straightforward....a lot of it is judgment calls. Those judgment calls are informed by experience. This is why residencies are so absolutely imperative for physicians. Judgment comes from wisdom, and wisdom comes from the combination of knowledge (which a new grad has) and experience....(which they do not)....

[Hemegroup]

Judgment comes from wisdom, and wisdom comes from the combination of knowledge (which a new grad has) and experience....(which they do not)....

 

It also helps to have a Littmann Electronic stethoscope ... had a pediatric patient sent back from surgery by the Anesthesiologist stating a heart murmur ... doh! Turned up the volume, turned the little guy in a few positions, ruled it out and sent him back. Good equipment is everything.

[ventana]

caution - - - -

 

murmurs can come and go - don't be overconfident on a single exam

 

surgery can be a very stressfull time on the heart - and to have a flow murmur that is not heard at rest would be of concern - why not order a simple transthoracic US to put the issue to rest - after all another provider did indeed hear a murmur (unless you think they were lying about what they heard) and the cost of missing something as sig as this is pretty high in a peds patient

 

again - experience counts..... if it were me (and it is not) if a NA or other provider heard a murmur I would do more then listing a single time in the office and rule it out. Especially as a fairly new PA versus a likely very established anesthesia team......(guess on my behalf)

 

 

high morbidity/mortality and settlements on missed murmurs when sudden death follows in peds - read the medical legal journals to see this.

 

 

 

 

excellent example of how experience really is highly valuable.

[chickitabanana]

Hey everyone,

 

Is the two years in PA school (not on the job, sorry for the confusion with the title) enough time to feel comfortable/competent with the underlying knowledge necessary in treating patients? A patient I recently saw, once telling him I was thinking of PA school, argued that 2 years is not nearly enough time to be a competent/adequate clinician. It got me thinking that maybe he's right...how comfortable / competent can one feel upon graduating PA school after only having 12 months of book learning and 12 months of rotations (aside from the previous HCE one has had) ? It's getting me nervous that I might not feel very sure of myself making diagnoses as a PA.

 

I don't think PA school is enough for anyone to be a "fully competent" clinician, but I do think that 12 (or more, depending on your program) months of rotations is enough to get someone comfortable working in the field. It provides a foundation of knowledge that you can build off of. (Remember, medicine is constantly changing and thus, is a profession of lifelong learning, whether you're PA, MD, or DO. That's why we all have to log CME and re-certify with boards). Most jobs I've interviewed for have an "orientation" period for new grads where you're paired with a senior PA until he/she feels you are competent enough to be left to treat patients on your own. No one I know started the first day of their new job solo, did an overnight shift alone, etc. Most of my classmates have commented that they're "learning so much" every day at their first job. Keep in mind that medical school is not enough to become fully competent either -- which is why there are residency requirements. However, if an intern in July walks into a room saying "Hi I'm Dr. Smith" no patient will question it or be concerned. (Yet, these Drs. are freshly out of med school and have 3-10 years of additional training before they are allowed to be 100% on their own and unsupervised as an attending). At my program, the medical students have about 3-4 more months of clinical training in school vs. the PA students upon graduation. (Also, keep in mind, hardly any of them have HCE equivalent to what the PA students enter with). The medical students at my program also only have about 15 months of classroom education over two years (vs. PA students 12 months). Remember, medical school is longer because the learning is spread over four years vs. the intense 2-3 years of PA school. Did the patient you spoke with really know anything about PA school? Or did you just tell him it's 12 months of classroom and 12 months of clinicals and make his judgement off that? Does he know anything about medical school either? Even when I was in PA school there were A LOT of people (friends/family/medical student colleagues) who didn't really "get" how intense PA school is, especially the fact that it is not like "normal" grad school. There's no summer off, there's no winter break, there aren't classes from 9-12 MWF and then 10-12 and 2-6 Tuesday and Thursday. It's full time, 40+ hours/wk in the classroom and then after you leave class you go home/to the library and study until bed, wake up, repeat. We were tested with exams EVERY WEEK which were equivalent to "final exams" on whatever body system/physiology concept etc. There was a total of 6 weeks off during didactic year. During the 15 months of clinical year I only had 2 weeks of REAL vacation (as in, NOTHING school related to do) and it was only because I finished my thesis early and was able to take half of the month devoted to my thesis off.

 

Since your username is PAorMDhopeful I'm assuming you're contemplating both careers. I think if you sat down and put MD and PA school curriculum side by side you'd see they aren't much different. When new MD grads enter residency they have more seasoned residents and attendings working with them to teach them all that they still don't know (despite being able to use the Dr. title). I think the same is true for new PA grads. No one expects you to know "everything" as soon as your graduate. There are PAs you will work with that will teach you on the job and the beauty of the PA profession is that your SP is available for consult if you feel uncomfortable with a certain patient you're treating. I agree with the others that no one should graduate PA school thinking they know everything. If you have the opportunity to speak to medical residents I think you'll find that when they first start off in residency they don't feel 100% sure of everything they're doing either. (Haven't you heard the phrase "Don't get sick in July?" :) )

[Gordon, PA-C]

(Also, keep in mind, hardly any of them have HCE equivalent to what the PA students enter with)

 

 

This is not true. It was true 10 years ago, but this is no longer the case. PA schools by and large have abandoned the idea of only accepting students with significant HCE. I precept both MD and PA students and 3 different schools and neither group has significant HCE

[Joelseff]

This is not true. It was true 10 years ago, but this is no longer the case. PA schools by and large have abandoned the idea of only accepting students with significant HCE. I precept both MD and PA students and 3 different schools and neither group has significant HCE

 

Sad

 

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