What constitues a "Mid-level Provider"

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rescue1

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Unless you've found a doctor who just lost a huge malpractice battle, I find it very unlikely there exist physicians who dream of the healthy and high paying job of firefighter.
 

JPINFV

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"Desperately want to call themselves one"? Keep stroking your own ego, dude.

I've known or worked with many PT's, OT's, SLP's, RD's, PharmD's, NP's, CRNA's, and engineers with doctoral degrees and I don't think I've ever once heard one refer to themselves as "doctor". It's always "Hi, I'm Julie - I'm a physical therapist" or "Hi, I'm John from anesthesia".

I can find some awesome, "But I'm a doctor too!" threads over at Allnurses.com that I can link for you.

Even in states where MD supervision is required, courts typically hold responsible the person that made the mistake, not the supervising physician, who may be 20 miles away at the time of the incident.
...
That doctors are "ultimately liable" for the actions of clinicians working "under them" is an absolute myth.

I believe the term you're looking for is "vicarious liability."
 

Summit

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Unless you've found a doctor who just lost a huge malpractice battle, I find it very unlikely there exist physicians who dream of the healthy and high paying job of firefighter.

I've had more than a few docs tell me that they would have gone a different path or poo-poo any of my occasional regrets of not going their path (including one immediate family member). IMHO I think a lot of it comes from docs who got into the field in one type of medical and business environment, buying into that, and then finding the world had changed all around them so that it isn't what they expected/wanted/whatever making them feel less fulfilled or like they got the short end of the stick. I think there are plenty who are very happy and plenty who are entering now with no preconceptions that their world may change. [/babbling]
 
OP
VFlutter

VFlutter

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NPs are NOT entrepreneurs -- they are "my job is 9 to 5" nurse nonsense .

That is a pretty bold generalization to make. Maybe it is like that in your particular area but that is not representative of NPs in general. The majority of NPs I have met work long crappy hours, holidays, and are frequently on call.
 

rescue1

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Oh I've met doctors like that too. But usually those doctors wish they'd become lawyers or investment bankers. Not firemen.
Heck, in any career on the planet you're going to find people who wish they had done something else.
 

EgyptianMedic

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I have no desire to call myself a physician. Ill be completed with my PA program shortly. What confuses me is all the statements on here saying PAs are limited. It seems to me that most of those on here that have posted really have no idea about the fundamentals regarding the PA profession and its origins.

The profession, as are much of the programs mission statements, are designed to help serve rural or under served populations. The field was created to extend access to healthcare services that otherwise would not be accessible. Go to the physicianassistantforum.com and scroll through there a little bit and educate yourself rather than assuming. Many PAs work autonomously without a physician on site. That being said most programs are primary care based (not to be confused with family practice).

A PA can own their own clinic, holds a DEA C-II-V license, in some states (like CA) has to only have 10% of their chart reviewed and often times trains physicians during clinical rotations and residency. There is no exemption from liability, they can be sued independently without the doctor carrying any liability. Often times they DO carry THIER OWN mal practice insurance.

Most people I know who are PAs like myself found this career as a second calling. The love of being a business executive faded and i wanted more job reward. I am, in my own opinion, too old to go through med school and loved the level of autonomy and depth of knowledge / scope of practice I'd get as a PA so I chose this field over being a RN after being in business for over 10 years.

What most of you should recognize is that PAs are highly skilled and trained healthcare professionals that complete the same curriculum as a physician in an accelerated format and instead of doing a residency they receive on the job training. Although residency and CAQs are becoming more common place in certain specialties such as EM.

So please... Stop throwing BS out there and ASSuming. Go do your homework before you start making false statements.
 

platon20

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I have no desire to call myself a physician. Ill be completed with my PA program shortly. What confuses me is all the statements on here saying PAs are limited. It seems to me that most of those on here that have posted really have no idea about the fundamentals regarding the PA profession and its origins.

The profession, as are much of the programs mission statements, are designed to help serve rural or under served populations. The field was created to extend access to healthcare services that otherwise would not be accessible. Go to the physicianassistantforum.com and scroll through there a little bit and educate yourself rather than assuming. Many PAs work autonomously without a physician on site. That being said most programs are primary care based (not to be confused with family practice).

A PA can own their own clinic, holds a DEA C-II-V license, in some states (like CA) has to only have 10% of their chart reviewed and often times trains physicians during clinical rotations and residency. There is no exemption from liability, they can be sued independently without the doctor carrying any liability. Often times they DO carry THIER OWN mal practice insurance.

Most people I know who are PAs like myself found this career as a second calling. The love of being a business executive faded and i wanted more job reward. I am, in my own opinion, too old to go through med school and loved the level of autonomy and depth of knowledge / scope of practice I'd get as a PA so I chose this field over being a RN after being in business for over 10 years.

What most of you should recognize is that PAs are highly skilled and trained healthcare professionals that complete the same curriculum as a physician in an accelerated format and instead of doing a residency they receive on the job training. Although residency and CAQs are becoming more common place in certain specialties such as EM.

So please... Stop throwing BS out there and ASSuming. Go do your homework before you start making false statements.


1. You do NOT complete the "same curriculum" as MDs do. Yes you get a sample of it but you dont go thru nearly the same number of clinical rotations they do, nor do you get the same exposure to subjects such as histology, embryology, etc.

2. Residency is NOT the same as "on the job" training. How many thoracotomies does an surgeon-MD in residency get vs an on the job PA? Residency training exposes you to areas of practice that you dont get "on the job" as a PA.

3. Although PAs do carry their own malpractice and it is POSSIBLE for them to be sued independent of the MD, in practice this never happens. All lawsuits involving PAs also involve their supervising physician.

4. Training physicians during residency? Thats a real laugh. I'll let you in on a little secret. Phlebotomists train physicians during residency to do blood draws too. Does that mean that they are equivalents? Of course not. Hell regular floor RNs "train" residents too. Does that mean that all floor RNs have the same capabilities as MDs?

5. This whole BS about PAs/NPs treating underserved populations is a farce. Look at the statistics -- PAs love the big cities just as much as the MDs do. Thats why New Mexico's little experiment to give NPs complete autonomy failed. It turns out the NPs wanted to live in Santa Fe and Albuquerque and work for physicians. They did NOT want to open up their own solo clinic in Portales, Roswell, or New Laguna.

6. You will never be a doctor, period. Hell you dont even get to call yourself "doctor" like the NPs do. Does it make you sad that patients will think an NP is a doctor but you cant claim it?
 

WTEngel

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that complete the same curriculum as a physician

While the course titles may be similar, I think you saying PA school is just a condensed form of medical school is an extreme over simplification.

If this was in fact true, then you would expect PAs to be able to score comparatively on the USMLE step exams, which I have seen no proof of.
 

Rialaigh

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I think, like anything else, there are wonderful really great PA's and NP and there are those who barely scratched through a second rate program. I know a girl who finished her PA at 22, Didn't do a single clinical hour in a hospital setting, and works laser hair removal 36 hours a week no weekends no holidays and makes 85k+ a year. Scary thing is she can write for controlled substances and do lots of other stuff that she was "trained" to do....

Then there are nurse practitioners who were critical care nurses or ER nurses (and damn good ones at that) for 15 years before getting their NP and I think some of them are every bit as good as most ER docs or IM docs.


They have their place in healthcare, and I do see them replacing docs in many many many fields over the next 10 years.
 

EgyptianMedic

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1. You do NOT complete the "same curriculum" as MDs do. Yes you get a sample of it but you dont go thru nearly the same number of clinical rotations they do, nor do you get the same exposure to subjects such as histology, embryology, etc.

Enough that the government allows for us to diagnose, treat, and continue with care of patients while being able to prescribe drugs including narcotics. And when PAs are working in the field they're not exposed to the same patients? Not sure what bubble you're living in.

2. Residency is NOT the same as "on the job" training. How many thoracotomies does an surgeon-MD in residency get vs an on the job PA? Residency training exposes you to areas of practice that you dont get "on the job" as a PA.

And you're speaking from first hand experience? And of course you do realize you're choosing the one specialty that PAs can only first assist in... How about all the others?

3. Although PAs do carry their own malpractice and it is POSSIBLE for them to be sued independent of the MD, in practice this never happens. All lawsuits involving PAs also involve their supervising physician.

Here's an article for you to read.
hgexperts.com/article.asp?id=5878

4. Training physicians during residency? Thats a real laugh. I'll let you in on a little secret. Phlebotomists train physicians during residency to do blood draws too. Does that mean that they are equivalents? Of course not. Hell regular floor RNs "train" residents too. Does that mean that all floor RNs have the same capabilities as MDs?

Here's an interesting read if you got the time. content.healthaffairs.org/content/14/2/181.full.pdf

5. This whole BS about PAs/NPs treating underserved populations is a farce. Look at the statistics -- PAs love the big cities just as much as the MDs do. Thats why New Mexico's little experiment to give NPs complete autonomy failed. It turns out the NPs wanted to live in Santa Fe and Albuquerque and work for physicians. They did NOT want to open up their own solo clinic in Portales, Roswell, or New Laguna.

I plan on working in a rural area so I guess I'm the exception right?

6. You will never be a doctor, period. Hell you dont even get to call yourself "doctor" like the NPs do. Does it make you sad that patients will think an NP is a doctor but you cant claim it?

You would need to lack self confidence to require to be addressed as Dr in order to help those in need. I could care less... Ill introduce myself by my first name and correct those who call me Doctor. I don't care for a title.. I never went around with the degree creep or title creep in my previous endeavors.
 
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EgyptianMedic

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I think, like anything else, there are wonderful really great PA's and NP and there are those who barely scratched through a second rate program. I know a girl who finished her PA at 22, Didn't do a single clinical hour in a hospital setting, and works laser hair removal 36 hours a week no weekends no holidays and makes 85k+ a year. Scary thing is she can write for controlled substances and do lots of other stuff that she was "trained" to do....

Then there are nurse practitioners who were critical care nurses or ER nurses (and damn good ones at that) for 15 years before getting their NP and I think some of them are every bit as good as most ER docs or IM docs.


They have their place in healthcare, and I do see them replacing docs in many many many fields over the next 10 years.

Most PA programs require paid healthcare experience with direct patient contact. Unfortunately some schools focus more on high grades and don't require HCE like western university and USC. This trend is something that erks PAs today.
 

JPINFV

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What most of you should recognize is that PAs are highly skilled and trained healthcare professionals that complete the same curriculum as a physician in an accelerated format and instead of doing a residency they receive on the job training. Although residency and CAQs are becoming more common place in certain specialties such as EM.


While I'll often find myself on rotation with other PA students, the difference between the depth and breadth of the fund of knowledge between the 2nd year PA students and 3rd year medical students is rather staggering. It's not the same curriculum, just in an accelerated format. If it was, then all of medical school would be 2 years with no need for a residency. There's a reason residency (and don't compare PA residencies to medical residencies, they're not the same) and 4 years of medical school are required to practice independently, it's because medicine isn't easy and there aren't any shortcuts.
 

JPINFV

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Enough that the government allows for us to diagnose, treat, and continue with care of patients while being able to prescribe drugs including narcotics. And when PAs are working in the field they're not exposed to the same patients? Not sure what bubble you're living in.

Go over to the specialty forums at forums.studentdoctor.net and post in one of the specialties that you treat the same patients as the physicians. I'm sure the attendings will get a rather good laugh at that. The more complex patients are going to be treated by the physicians, not the mid-levels. Furthermore, for the surgical PAs, how often are they the primary surgeon? First assist? Sure (heck, interns and medicals students can first assist). Primary surgeon doing operations from open to close? Nope.



And you're speaking from first hand experience? And of course you do realize you're choosing the one specialty that PAs can only first assist in... How about all the others?

Ok... Emergency medicine then. EM residencies are 3-4 years. Here's an 18 month residency for PAs. Are you telling me that PAs can master all of emergency medicine in half the time as physicians?

http://www.uihealthcare.org/GME/ResProgHome.aspx?pageid=231957&taxid=226453

Some how I doubt the emergency PAs are treating the severe sepsis or the undifferentiated respiratory failure or altered mental status patients unless they're in a single coverage spot in the middle of no where that can't attract emergency physicians.
 

JPINFV

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Most PA programs require paid healthcare experience with direct patient contact. Unfortunately some schools focus more on high grades and don't require HCE like western university and USC. This trend is something that erks PAs today.


Go Western U!


HCE isn't going to make up for the lack of preclinical education that physicians go through.
 

EgyptianMedic

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While I'll often find myself on rotation with other PA students, the difference between the depth and breadth of the fund of knowledge between the 2nd year PA students and 3rd year medical students is rather staggering. It's not the same curriculum, just in an accelerated format. If it was, then all of medical school would be 2 years with no need for a residency. There's a reason residency (and don't compare PA residencies to medical residencies, they're not the same) and 4 years of medical school are required to practice independently, it's because medicine isn't easy and there aren't any shortcuts.

Correct me if I'm wrong, but a physician technically only has to complete a 1 year residency to practice (specifically primary care). Additionally don't PAs who do residencies do so along side of their MD/DO counterparts?

Times are changing. You can complete medical school in 3 years.

usatoday30.usatoday.com/news/education/2010-03-25-medical-school-early_N.htm

physiciansnews.com/2009/11/05/lecom-develops-a-3-year-medical-school-curriculum-to-encourage-primary-care-careers/


Don't get me wrong MDs/DOs get paid the big bucks for a reason but given time and experience I would expect the margin for being able to handle the same patient cases and complexity to level out or at least narrow to a point that it would be negligible.
 
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JPINFV

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Correct me if I'm wrong, but a physician technically only has to complete a 1 year residency to practice. Additionally don't PAs who do resudencies do so along side of their MD/DO counterparts?
Good luck getting insurance companies to reimburse you, med mal coverage, or hospital practice rights without completing a residency. It's like saying you can drive with a drivers license, but that doesn't mean you automatically get a car to drive around in either.

Again, 1.5 year residency does not equal a 3-4 year residency.

Times are changing. You can complete medical school in 3 years.

usatoday30.usatoday.com/news/education/2010-03-25-medical-school-early_N.htm

physiciansnews.com/2009/11/05/lecom-develops-a-3-year-medical-school-curriculum-to-encourage-primary-care-careers/
Ah, LECOM. Read the fine print there. Primary care only, linked match, very little electives, and essentially no vacation. It's not a model that's going to gain traction outside of very specific areas with very specific residency linkages. There's a reason there's no special line of people jumping at the chance of a 3 year track.
 

Brandon O

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You would need to lack self confidence to require to be addressed as Dr in order to help those in need. I could care less... Ill introduce myself by my first name and correct those who call me Doctor. I don't care for a title.. I never went around with the degree creep or title creep in my previous endeavors.

I think this is a bigger part of the issue than most people will admit. Many people who become an MD, DO, or PA are as interested in the resulting letters as in the resulting care or education.
 

Veneficus

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Don't get me wrong MDs/DOs get paid the big bucks for a reason but given time and experience I would expect the margin for being able to handle the same patient cases and complexity to level out or at least narrow to a point that it would be negligible.

This is what a lot of PAs I have encountered think. But it is seriously flawed.

A PA will never be able to handle the complex cases of a physician specialist.

I'll explain it like this:

A PA basically is like a musician that learns to play an instrument without knowing how to read music or music theory. They can play some tunes, they may even be very good at playing those tunes, but it doesn't mean they will be able to understand, and therefore play the most complex music. They will never be the conductor, and they will never be recognized as capable as a doctor by the international community of medicine.

Which means all they really are is a master of a more advanced protocol set with an absentee medical director.

Whether you like titles or not. Whether you agree with titles or not, they demonstrate that you have met the minimum standards required to do certain things.

You find a shortcut in PA school, good for you. Make your money. But don't expect equaity from those who did do it from the ground up, put forth the sacrifces of medical school, and earned that title.

Nobody who is part of medicine will ever see you as capable as a doctor. The only people who do are other PAs and patients who wouldn't know a good doctor from a bad one anyway.

Legal quackery is all it is. Only the people in the military and North Americaare dumb enough to not see it for what it is. It is like taking pride in being a snake oil salesman.


I think this is a bigger part of the issue than most people will admit. Many people who become an MD, DO, or PA are as interested in the resulting letters as in the resulting care or education.

There are many. Many more who do it for the money. But if you really have dedication to medicine, you become a doctor. Though the way recognized for centuries. With all the associated costs. A shortcut isn't going to make you an expert. That shortcut will never make you a player on the world stage. Which means you will be relegated to being a lesser player in the worst medical system in the entire developed world. Operating under direction or in a place where you are simply better than nothing that wishes they had a doctor.

You can disagree, you can tell me I'm wrong, you can present your biased and flawed research and tell me how PAs tricked somebody into paying the same as a doctor, but in the end, maybe in 5 years, maybe in 10, you will hit the cieling. It will not be glass.

Fair warning.
 
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