What constitues a "Mid-level Provider"

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WTEngel

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Well, I guess I should point out that I was using a rhetorical device.

We do not agree, because I do not believe that medical education should be shorter.

No disrespect, but I think you are off base. Medical education in the US is not getting shorter anytime soon.
 

silver

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Well, I guess I should point out that I was using a rhetorical device.

We do not agree, because I do not believe that medical education should be shorter.

No disrespect, but I think you are off base. Medical education in the US is not getting shorter anytime soon.

A few schools are trialling 3 years (specifically I know NYU is for this application cycle) for some of their top performing students. Basically they are looking to integrate more basic science over the entire time and add in classes before fall of first year and summer between first and second. I also believe that the students are to go into an NYU residency so that there is a continuum of clinical training in place of part of the 4th year. As this is medicine, it is important to note that the curriculum is examined like a science. So they will be tracking the performance very closely to see if this model could be expanded.
 

BSE

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Wow, I joined here to maybe get some info on state license issues....but maybe I won't.

Explanation, I am a long time military medic/Paramedic and I will be starting PA school soon in another state. I would like to maintain my cert.

Many of you guys really have no clue as to what a PA does and how they are educated/utilized. Which I find odd being that EMS is one of the main feeders of the profession.

Honestly, I haven't seen this level hostility and blatant ego boosting since the last time I checked out SDN. Sorry admin, not an attack....just an observation.

This would like me completing PA school and starting a thread bashing paramedics. I mean...how can you teach a guy with only high school to do advanced airways....sheesh....wannabes. *I heard this statement said about my guys by an anesthesiologist.

PA's are not MD's.....they know and understand that. PA's have been around since the 60's....nothing new here. I couple of bitter medics and med student with an over-sized sense of self are not good sources of information. There are better sources for those who would really like to know. Search and you will find.

Bye.
 

usalsfyre

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I agree wholeheartedly. Medical school should be shorter. The healthcare crisis in this country and lack of providers which is slated to reach critical mass within the next decade seems to corroborate this notion as well. Longer does not always mean better, and I would argue that many med programs could trim the fat and consolidate their curriculum. The antiquated model of provider education in this country is analogous to gun fanatics claiming that the 2nd amendment is somehow still applicable in the 21'st century. Times, as they say are a changin.
:nosoupfortroll:

Modern clinical medicine is far more complicated than it has been in the past. Shortening the curriculum is a ludicrous idea.
 

silver

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Wow, I joined here to maybe get some info on state license issues....but maybe I won't.

Explanation, I am a long time military medic/Paramedic and I will be starting PA school soon in another state. I would like to maintain my cert.

Many of you guys really have no clue as to what a PA does and how they are educated/utilized. Which I find odd being that EMS is one of the main feeders of the profession.

Honestly, I haven't seen this level hostility and blatant ego boosting since the last time I checked out SDN. Sorry admin, not an attack....just an observation.

This would like me completing PA school and starting a thread bashing paramedics. I mean...how can you teach a guy with only high school to do advanced airways....sheesh....wannabes. *I heard this statement said about my guys by an anesthesiologist.

PA's are not MD's.....they know and understand that. PA's have been around since the 60's....nothing new here. I couple of bitter medics and med student with an over-sized sense of self are not good sources of information. There are better sources for those who would really like to know. Search and you will find.

Bye.

Realistically there is a huge variation education and utilization of PAs depending on school, state and place of employment.
 

Simplify

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:nosoupfortroll:

Modern clinical medicine is far more complicated than it has been in the past. Shortening the curriculum is a ludicrous idea.

It's much more complicated, but more importantly, the quantity of information itself has increased. In fact, medicine is the only field in existence where the entire "body of knowledge" doubles in 5 year increments. Think about that... every five years everything there is to know about medicines doubles, and that rate is only increasing. So the question is, is it even possible for a provider to grasp all of that information, even at a superficial level in 8 years? 12 years? 20 years? Or, as the system seems to be dictating, does it make more sense to train more intensely, in narrower scopes of practice. Honestly, why does the med student who KNOWS they want to be a hand surgeon spend all of that time learning which antibodies can cross the placental barrier? Is it good to know? In an ideal world absolutely, but pragmatically, it's antiquated. We need to refine the system and this is where "midlevels" come in. As previously mentioned many med programs are experimenting with this concept as it becomes increasingly clear that the current model is woefully inept at producing providers in the numbers we need. It's about thinking progressively and not getting entrenched in a dogmatic model of education that we are painfully outgrowing.
 

rujero

Emergency Services RN, NREMT
47
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Why would a PA choose to do primary care and take a 50% paycut when they can work in ER with ZERO extra training and make more money? Doesnt make any sense.

If I need to see my doctor tomorrow for strep throat, or almost any other non emergency medical problem for that matter, I would 99% of the time be seeing an NP who would test, diagnose, and prescribe meds. And I have absolutely no problem with that.

My end goal at this point is to be either an NP or PA and work as a primary care provider in pediatrics under the primary MD. I have no problem making less money than a doctor because I would not be one. And I certainly would NOT go to mid-level status to present myself as a medical doctor to my peers. Even if I got my DNP and had the right to refer to myself as a Doctor, I would never present myself as a medical one. Being an NP or a PA is a pretty big accomplishment in that of itself.

I just feel like mid level providers are a more economical option in healthcare and the several I have spoken to are confident the profession will be in higher demand over the next 10-20 years. Would it be cool to be able to say, "I'm a Doctor (MD)"? Yes it would, but I'd rather avoid the extra schooling, the malpractice stress, and the divorce rates.

-r
 
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VFlutter

VFlutter

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So this thread went downhill fast :glare: Can we please try to be a little more civil? This is not SDN.

Just because I may choose to got to CRNA/PA/NP school does not mean that I am unintelligent or that I could never get into medical school. It is a personal choice based on my factors not a back up plan because I was rejected from med school.

I understand the despise for midlevels who claim to be equivalent to MDs but do not let that create a despise for midlevels in general.
 

rujero

Emergency Services RN, NREMT
47
20
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It's much more complicated, but more importantly, the quantity of information itself has increased. In fact, medicine is the only field in existence where the entire "body of knowledge" doubles in 5 year increments. Think about that... every five years everything there is to know about medicines doubles, and that rate is only increasing. So the question is, is it even possible for a provider to grasp all of that information, even at a superficial level in 8 years? 12 years? 20 years? Or, as the system seems to be dictating, does it make more sense to train more intensely, in narrower scopes of practice. Honestly, why does the med student who KNOWS they want to be a hand surgeon spend all of that time learning which antibodies can cross the placental barrier? Is it good to know? In an ideal world absolutely, but pragmatically, it's antiquated. We need to refine the system and this is where "midlevels" come in. As previously mentioned many med programs are experimenting with this concept as it becomes increasingly clear that the current model is woefully inept at producing providers in the numbers we need. It's about thinking progressively and not getting entrenched in a dogmatic model of education that we are painfully outgrowing.

+1 This is an excellent point.
 

rujero

Emergency Services RN, NREMT
47
20
8
So this thread went downhill fast :glare: Can we please try to be a little more civil? This is not SDN.

Just because I may choose to got to CRNA/PA/NP school does not mean that I am unintelligent or that I could never get into medical school. It is a personal choice based on my factors not a back up plan because I was rejected from med school.

I understand the despise for midlevels who claim to be equivalent to MDs but do not let that create a despise for midlevels in general.

See my post above. Not everyone thinks that way. A few people may have been in that exact situation, but it doesn't represent the majority. Specific field-focused mid levels are the future of general medicine.

-r
 

Tigger

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So this thread went downhill fast :glare: Can we please try to be a little more civil? This is not SDN.

Just because I may choose to got to CRNA/PA/NP school does not mean that I am unintelligent or that I could never get into medical school. It is a personal choice based on my factors not a back up plan because I was rejected from med school.

I understand the despise for midlevels who claim to be equivalent to MDs but do not let that create a despise for midlevels in general.

This pretty much sums up my thoughts on the issue.

I do not want to be a doctor. Does that mean I cannot practice medicine?

I am not looking at the PA/NP route as a shortcut to being on par with doctors. As I said, I simply have no interest in being a doctor, but I do have an interest in practicing medicine at a higher level than what I am doing now.
 

ExpatMedic0

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Do other countries use mid level providers? They don't have them where I have been in Europe. I know Australia has masters and post graduate paramedics you could argue fit that bill
 

BSE

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Realistically there is a huge variation education and utilization of PAs depending on school, state and place of employment.

Interesting statement....based on?

There are some variances in the laws that govern PA in some states. Mainly it has to do with the PA/MD relationship...supervision. There aren't too many differences in scope, but there are some. So yes, take out the word "huge" and you are correct.

There is only one governing body for PA education, the ARC-PA. Like med schools, it takes years to establish a PA program. The curriculum's all have to cover the same basic material...just the way med programs have to. There are some differences in quality of faculty and clinical sites....just like med schools. Remember, the PA profession was created by physicians....the model of school accreditation is very strict because the founding physicians (one being Dr. Eugene Steed) demanded it. Not too much has changed in the accreditation process. There really aren't any "fly-by-night" programs. Some are better than others...sure. There is no avoiding that.

One of the reasons I chose PA over NP was the standard curriculum. Not bashing NP's, but their programs have three different ways to get accredited. Too much variance.
 

BSE

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Do other countries use mid level providers? They don't have them where I have been in Europe. I know Australia has masters and post graduate paramedics you could argue fit that bill

NP's are used throughout Europe, especially in the UK. The UK is starting 2 PA programs as a test project, but they are running into funding issues...last I heard.
 

ExpatMedic0

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Only a doctor may practice medicine, correct? Practitioner is the act of unsupervised medical practice, but its not practicing medicine, correct? I am just a dumb paramedic but I remember something like that
 

ExpatMedic0

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NP's are used throughout Europe, especially in the UK. The UK is starting 2 PA programs as a test project, but they are running into funding issues...last I heard.

Interesting, we only have doctors in Denmark
 

Tigger

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Only a doctor may practice medicine, correct? Practitioner is the act of unsupervised medical practice, but its not practicing medicine, correct? I am just a dumb paramedic but I remember something like that

I don't know honestly.

When we come down hard here on people saying "don't forget, BLS before ALS!" the common response is "there is no distinction, medicine is medicine. It's a continuum."

If EMS providers, physical therapists, athletic trainers, and midlevels are not practicing medicine, then what are they doing? Try to keep that response civil please.

It's an honest question, though I understand that "practicing medicine" likely has a specific legal connotation.
 
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VFlutter

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One of the reasons I chose PA over NP was the standard curriculum. Not bashing NP's, but their programs have three different ways to get accredited. Too much variance.

I don't blame you. I would pick PA education over general NP.

In my opionion it is 1. CRNA 2. ACNP and PA 3. NP 4. CNS
 

silver

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Interesting statement....based on?

There are some variances in the laws that govern PA in some states. Mainly it has to do with the PA/MD relationship...supervision. There aren't too many differences in scope, but there are some. So yes, take out the word "huge" and you are correct.

There is only one governing body for PA education, the ARC-PA. Like med schools, it takes years to establish a PA program. The curriculum's all have to cover the same basic material...just the way med programs have to. There are some differences in quality of faculty and clinical sites....just like med schools. Remember, the PA profession was created by physicians....the model of school accreditation is very strict because the founding physicians (one being Dr. Eugene Steed) demanded it. Not too much has changed in the accreditation process. There really aren't any "fly-by-night" programs. Some are better than others...sure. There is no avoiding that.

One of the reasons I chose PA over NP was the standard curriculum. Not bashing NP's, but their programs have three different ways to get accredited. Too much variance.

Well at the most basic and non-contentious level considering there are residency programs for PAs in different specialities but it isn't a requirement, I would say a post-graduate educated PA has a huge difference in education than one who did not go through the same.

And yes scope is the same, but like I said utilization, which translated most directly into supervision (as you noted the difference).
 

JPINFV

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These are people who could of gotten into a multitude of medical programs, but again, they CHOSE PA school.

Then they need to live with the fact that their education is not the same as 4 years of medical school and 3+ years of residency (since the only place you'll find a non-specialized GP in the US is the military general medical officer), and does not prepare them for independent, non-restricted, autonomous practice.


There is actually very little "doc envy" within the profession as you see it.
Except the entire "we're just like physicians and want the same practice rights and ability to bill as physicians." Sentiments seen in this very thread.

but as they say, opinions are like :censored::censored::censored::censored::censored::censored::censored:s. A concept you are surely familiar with.

I've always found it extremely ironic when someone spouts this cliche while providing an opinion.
 
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