What constitues a "Mid-level Provider"

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JPINFV

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. 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.
...because 20wk EGA pregnant females never need their hands reconstructed?

...because it's rare for medical students to not change their minds, especially during 3rd or 4th year rotations?

...because there's a certain level of knowledge that society and general medical practice expects out of all physicians?
 

jrm818

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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.

Not an expert, just did a quick google. In MA, for instance, it looks like they "provide medical services"

http://www.malegislature.gov/Laws/GeneralLaws/PartI/TitleXVI/Chapter112/Section9E

by contrast, medical students "practice medicine" http://www.malegislature.gov/Laws/GeneralLaws/PartI/TitleXVI/Chapter112/Section9A

other states look like they do refer to PAs as "practicing medicine," but under the supervision of a physician



wikipedia agrees with schulz, for what it's worth
http://en.wikipedia.org/wiki/Medical_practice
 

Simplify

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...because 20wk EGA pregnant females never need their hands reconstructed?
Are you suggesting we construct medical education around treating the outliers?


...because it's rare for medical students to not change their minds, especially during 3rd or 4th year rotations?



...because there's a certain level of knowledge that society and general medical practice expects out of all physicians?

Following this rationale should all MD's be equally well versed in zero-g medicine so in the off chance they stumble across an astronaut in space they are capable of rendering care? This is hyperbole, but my point is that medical education should reflect the bulk of the bell curve in terms of actual patient need. We have to draw the line somewhere because the current model is failing. Why not expedite the OB and the hand-surgeon's education, get them both out the door and working in half the time and treating patients. A phone call between the two providers seems like an easier means of solving your hypothetical patient's problem than extra years of education tacked on of superficially studying material that neither is really interested in.

Much in the same way that PA's are able to lateralize through different fields of medicine, shortened med tracks could also encourage providers to switch fields and prevent burnout.

And lastly, societal expectations as you describe are a piss-poor means of evaluation.
The proof should be in the pudding and evidence based medicine demands evidence based results, which at the moment are sorely lacking. What good is it to have providers well versed in the minutia of medicine when you can't get in to see them until September of 2015?
 
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rescue1

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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.

I like to think most of the hate on this thread towards mid-levels is not hate towards mid-levels in general, but on the ones that claim equivalency of education and skill with physicians.

In my experience, this is usually a Doctor of Nursing Practice vs. MD/DO debate, and PAs are usually left out of it.
 

rescue1

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Following this rationale should all MD's be equally well versed in zero-g medicine so in the off chance they stumble across an astronaut in space they are capable of rendering care? This is hyperbole, but my point is that medical education should reflect the bulk of the bell curve in terms of actual patient need. We have to draw the line somewhere because the current model is failing. Why not expedite the OB and the hand-surgeon's education, get them both out the door and working in half the time and treating patients. A phone call between the two providers seems like an easier means of solving your hypothetical patient's problem than extra years of education tacked on of superficially studying material that neither is really interested in.

I like to think the chance of a medical student changing their mind about specialties is slightly higher than the chance to practice emergent Zero-G medicine.
The fact remains that if I have a medical condition that is more serious than basic primary care stuff, I want a provider taking care of me that has way more education than he knows what to do with, not one who has taken a "streamlined and efficient" path, which is usually code for "slightly worse and slightly cheaper".

Much in the same way that PA's are able to lateralize through different fields of medicine, shortened med tracks could also encourage providers to switch fields and prevent burnout.
Yes, but unlike PAs, a physician board certified in a specialty is assumed to be able to practice with total autonomy and handle most of what patients in that specialty throw at him. When PAs and residents don't know what to do with a patient, who they gonna call? The attending physician. Also, Ghostbusters.

You don't want to call an attending that has barely more experience then the first year interns.
 

WTEngel

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This whole thread has been trolled.

Chase I appreciate the intentions, unfortunately this thing has run its course.

This thread needs to die... Probably two or three pages ago.
 
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VFlutter

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This whole thread has been trolled.

Chase I appreciate the intentions, unfortunately this thing has run its course.

This thread needs to die... Probably two or three pages ago.

I agree
 

Veneficus

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Making medical school more obtainable is not necessarily the answer. More affordable and more opportunities for loan forgiveness when choosing to pursue specialties where there is a shortage I can definitely support.

In order for this to be accomplished, the entire billing system needs to be changed. Which sooner or later it will be, but not until it has been bleed to the point where doctors have to take a loss. Like most professions, in order to deal with less pay, work hours will be reduced, and when that happens, more providers will become mandatory.

The main issue I have with making medical school "easier" to get into is that the primary public education system for the most part is very flawed, and produces students who are not ready to pursue higher academia. By proxy, universities are succumbing to the same fate, and getting a bachelors degree in the USA is not real crowning achievement anymore. The American university system is turning out a generation of "rapid access to information" students, with very little ability for synthesis and higher order reasoning. Because the answers are so easily accessible for most questions, the pursuit of scholastic excellence has been turned into little more than a quest to easily learn the material for an exam and get an A, regardless of actual retention of information.

Too late, it is already like that and not just in the US.

we will see an decrease in overall quality of medical education.

and we are.

I am all for a newly graduated doctor having some chance of receiving their degree with zero debt. I am not for allowing a generation of "is this going to be on the exam" type students into higher education.

That is what a majority of it is. Everywhere. In my opinion it has to do with the selection process. Too much focus academic selection, not enough focus on candidate selection.

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.

Actually, I think the model works very well and I actually chose to go to a place with a more traditional bent. My goal was the oldest medical school in the world, but family always pulls my strings.

As WT eluded to, it is not the classical education that is the problem. It isthe inability for a majority of people to use it. Western societies are developing ultraspecialized knowledge requirements, anthropologists and taxonomists actually renamed the species to reflect this highly techno dependant and specialized lifestyle.

Consequently, The idea of a well rounded higher education loses its appeal, but not its effectiveness.

Speaking specifically of medicine, it affects the mean level of providers by decreasing it over time. One of the things I have observed working in different medical systems, with doctors from all over the world, is that the US has a mean level, with relatively few excellent or poor providers. Whereas at least Europe and Africa have basically no mean level and providers end up in one extreme or the other. What is better is really a matter of personal choice, but it seems to be for the mean level when people are not sick and they quickly switch mindset when they or a loved one gets sick.

Just because you change something doesn't mean it changes for the better. Given the current decline of the US in all aspects of society I wouldn't consider the current change positive.

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.

This is actually happening all over the world to some degree. Several countries have included the intern year into the clinical education years with expanded responsibility and scope for the senior students. But it isn't done specifically to reduce medical school so much as it is to permit more providers entering specialty training. BUt it is much too political and convoluted to explain here.

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.

With the first part I agree, there is a lot changing and being added to medicine. It does get to the point where it is impossible to know it all. But that does not mean there is benefit in hyperspecialization along traditional medical lines.

As knowledge of medicine grows it becomes apparent that drawing lines in the sand on antiquated specialties is a problem. Recently multiple new specialties which better address specific pathologies and common treatments have emerged. Such as acute care medicine and perinatology.

As for maintaining current, that is an individual choice. About 5 years ago now the NEJM published a piece on how doctors not specifically involved in academic medicine fell into a practice rut, where even if they read about newer treatment modalities are unwilling to embrace them. 3 published studies I have personally been involved in showed a lack of knowledge and change among the participants even as new information was widely disseminated.

The lack of ability to keep up seems directly tied to the motivation of the provider, not the expanding material. I think the solution is in more selection of personality traits in medical school admissions which fosters more of an apprentice type master/student relationship as opposed to the current quantatative assessments.

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.

Too late, I despise them. Mostly for their lack of ambition and secondly for their ignorance of thinking they are equal and deserve to be. I submit when their attitude changes, so will mine.


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.

I don't really agree with this. Mostly because it is a contradiction in terms and ideas. General medicine is just that. in order to have field focused general medicine then patients would have to self refer. Which means they would have to know something about medicine. Which as demonstrated by more hyperspecialized societies in the western world is not the case.

I think the future of general medcine is basically wha US EMs accel at. Quick fixes or accurate referral. Band-aids and antibiotics as I like to say. It seems a bit cyclical because I remember the days when the GP basically handled everything except the more complex cases. I see a definate shift back to that from systems all over the world. (and I get around)

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

The UK uses NPs. From my experience there it does not seem to be working out. I heard about their pilot PA program, but I don't think it will be successful. Because of the EEA, wealthier countries like the UK have no problem picking up talent from the poorer ones. With consistent educational requirements throughout, there is no real shortage of doctors willing to work in general practice. The Swiss and the Swedish have seen the exact same.

...because 20wk EGA pregnant females never need their hands reconstructed?

...because it's rare for medical students to not change their minds, especially during 3rd or 4th year rotations?

...because there's a certain level of knowledge that society and general medical practice expects out of all physicians?

Because you cannot function as a provider unless you can recognize things out of your expertise.

The future of medical specialties is going to be driven by pathophys mechanisims, not by body area. There is already significant overlap in a number of specialties as evidence.

Look at general surgery. It no longer exists as a group of procedures, it exists only as basic surgical training.
 
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Brandon O

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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

A PA holds a license to practice medicine (you'd have to ask someone else about NPs), just not without restriction or without oversight. How exactly the latter apply depend on the state, your role, amount of experience, and so forth.

In terms of everyday function, the best comparison might be to a resident working under his attending.
 

Trashtruck

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Lets not turn this into a debate comparing professions.

And that's EXACTLY what this turned out to be! To a five year old boy, 'Don't put your hand in there...whatever you do, don't put your hand in there'

You know exactly what's going to happen.
 

ffemt8978

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The only reason the Community Leaders have allowed this thread to go on is that there have been attempts to avoid the profession vs profession debate by some of those participating, and there is some useful information in this thread.

However, we've reached the limit of what we're going to tolerate in this thread and if there is any more of the "my career is better than yours", it will go the way of the Dodo bird.
 
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The only reason the Community Leaders have allowed this thread to go on is that there have been attempts to avoid the profession vs profession debate by some of those participating, and there is some useful information in this thread.

However, we've reached the limit of what we're going to tolerate in this thread and if there is any more of the "my career is better than yours", it will go the way of the Dodo bird.


I'm sure the majority of us share the same sentiments.
 

ExpatMedic0

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This whole thread has been trolled.

Chase I appreciate the intentions, unfortunately this thing has run its course.

This thread needs to die... Probably two or three pages ago.

Its amazing how quickly a thread will be locked if its an EMS vs Nursing debate, but as soon as the "the big boys" step up to the plate everyone just steps back. :rofl:
 

ExpatMedic0

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Veneficus

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Here are some criteria that I think are required for a group to be considered mid-level providers:

  1. Graduate level education
  2. Prescriptive authority
  3. Ability to assess, diagnose, and treat
  4. Ability to bill for services
  5. Ability to perform advanced procedures? This is questionable


So where do we set the bar or what are the minimum requirements?
Given that set of criteria I believe at this present time PA and Nurse Practitioners are the only ones who achieve all those things. I do not believe Athletic Trainers or Physical Thearpist (I could be wrong) have prescription authority.
I believe there maybe other types of mid levels (specifically advanced care paramedics and community paramedics) in other countries, but I can find not any information on there abilities to write prescriptions at the moment, only rumors.
 

BSE

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by the way this thread is all over the PA forum and people are discussing everyone's replies.
http://www.physicianassistantforum....ssion-about-midlevel-providers-at-EMTLife-com

It should also be noted some of them(the PA students) fail to realize many of them are arguing with medical students and doctors on this thread... not EMS personal.

I would dare say they do. Being a physician or med student adds zero validity to the the ignorant statements that have been said.

MD's bashing PA's because they have more education? Seriously....you want a prize? Nowhere was it said that PA's are the same as MD's. Ego......
 

NomadicMedic

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Its amazing how quickly a thread will be locked if its an EMS vs Nursing debate, but as soon as the "the big boys" step up to the plate everyone just steps back. :rofl:

Trust me. As FF has stated, the mods are watching this thread closely. And if you have questions about moderation, please contact a member of the CL team via private message and we will address your concerns.
 
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Veneficus

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ego and delusions

I would dare say they do. Being a physician or med student adds zero validity to the the ignorant statements that have been said.

MD's bashing PA's because they have more education? Seriously....you want a prize? Nowhere was it said that PA's are the same as MD's. Ego......

In my time on this board I have seen all manner of arguments for the mid level provider. Especially physician Assistants. (or arew they calling themselves associates now?)

Some of the more respected members here who have chosen a mid level path have valiently defended it posting studies from every nursing association, PA association, and all manner of biased sources.

We have had this discussion many times.

But here are some of my observations.

PAs in particular like to claim they are just as effective as MDs. They tout their economic benefits ad generally denounce medical education as wasteful excess.

But how many people see education as wasteful excess?

In this very thread, staunch supporters wonder about the history of teeth in modern medicine. Unfortunately they don't see the implications. HUman evolution is intrinsic to the practice of medicine. Unfortunately for them, they were never shown the importance.

In actual US medical practice, I often see PAs talk a tough game. But I have never seen one step up and be equal to an MD. The same talkers are the ones spouting how great the PA profession is, how they are independant, don't need oversight, fill a primary care role, etc.

I have seen the same thing on this discussion.

But I will just point out...

most of the PA propaganda is just that, kool-aid. Anyone who points out the flaws of the propaganda has an ego problem. Whether or not I have an ego problem is debatable, but I will honestly say when it comes to people who claim to be as good, who have not invested the time, money, and other sacrifices I have is a sure fire way to set me off.

When the kool-aid approach to convincing MDs of the value of PAs fails or is met with resistance, you never hear them speak of limitations or role on the team. You hear more entrenched delusions of grandeur.

Tell me? How many PAs have walked into their hospital administration, touted the equivalency and economic benefit and suggested hiring only PAs and decreasing the physician staff?

How many PAs are employed by physician practice groups tell those group members they have useless and wasted education and were not smart enough to go to PA school because they can do the same things?

I will venture to guess none.

I would offer the very same people and organizations spouting how great the PAs are, not coincidentally are the same ones that talked about how PAs would fill the primary care void in the US. But in a quick internet search today, even PA based websites are talking about how this didn't happen and the trend towards PA specialization is expected to continue.

Could it be that these same liars about PAs serving underserved community needs are the ones spouting the greatness of PAs?

When you look at the history of medicine, particularly that of the DO, they were first accepted by the military and the underserved populations. It is a true and tested way to break into the medical profession. But unlike PAs most DOs have more education than MDs, not less. They do not pretend they are serving some greater good that MDs are not. They get into the same specialty and high earning practices as everyone else, and are just as capable. (by the way they did meet the internationally recognized minimums)

I am not suggesting DOs and PAs are the same, as DOs and MDs are the same, but their history is applicable to this conversation.

So let's just call a spade a spade. PAs tout themselves as a cost effective, mission specific solution to healthcare. Basically moving into direct competition for money that MDs are competing for. General system healthcare dollars. By their own admission they are not flocking to serve thier underserved targets. For profit healthcare embraces lesser paid "alternatives" that can bill for the same or similar rates. With even the largest academic centers filling their halls with them.

But here is a question:

If a PAs equal to an MD, why do they accept less money?

Conversly, if a PA is not equal an MD, what gives them the right to bill equally?

What's reall vexing to me is if a healthcare organization, hospital or private practice group bills the same, why do PAs accept less salary?

It seems an aweful lot like scabs in a union shop to me.

But here is something else to think about.

When I defend my value and commitment, I am egotistical, arrogant, and ignorant.

But many people who we have never seen here before get wind of my arguments against the PA kool-aid, they are compelled to come here and offer counter-point.

I have never posted on a PA forum. I don't even look at them. They might have PA vs MD vs garbage man vs street walker arguments all year. I would never know and certainly don't feel compelled to defend my profession there.

It seems like that response is similar to religious zealots who have their faith questioned.

Could it be I question your faith? Could it be that you feel threatened somebody might actually be persuaded by my arguments as to why PAs are not equal to doctors and might then decide they will not accept PAs? What if those people are politicians? Patients? Your game would be up.

I suggest you offer such passioned and spirited defense, because the PA profession might have to answer for some of its propaganda and it can't.

Perhaps more policy makers should have this discussion?

Now I don't think I will convince my new detractors, but not everyone here is immune from rational or counter argument.

The defense of my profession is no more egotistical, arrogant, and ignorant than yours. That is simply the pot calling the kettle black.

Rather than argue with me, why not simply surround yourself with people who make you feel better by drinking the koool-aid with you and call me an fool?

"And then He said, get this, that having more education makes you a better provider and people should not pay the same for less... arrogant fool."

"I am better than thou art now; I am a fool, thou art nothing"

Wise words from one of those useless literature classes.
 
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JPINFV

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When you look at the history of medicine, particularly that of the DO, they were first accepted by the military and the underserved populations. It is a true and tested way to break into the medical profession. But unlike PAs most DOs have more education than MDs, not less. They do not pretend they are serving some greater good that MDs are not. They get into the same specialty and high earning practices as everyone else, and are just as capable. (by the way they did meet the internationally recognized minimums)

I am not suggesting DOs and PAs are the same, as DOs and MDs are the same, but their history is applicable to this conversation.

I think what's even more important than the recent history is the reason for founding and early history. PAs were created specifically to help physicians. osteopathy (later "osteopathic medicine") was founded as an alternative to traditional medicine at a time when traditional medicine was almost as dangerous as what it was trying to cure. It would have been extremely easy for osteopathy to go down the same path as chiropractors (and arguably A.T. Still wanted us to go down that path). However, as medicine became more science based, we started to adopt and integrate it. In addition, yes, it wasn't just lip service we paid as a early profession to undeserved communities. Even now, just looking at where the DO schools are and where our residencies are shows a significant concentration outside of the big cities... where most MD schools are expected to show up.

It also helps when we put our money were our mouth is. It's hard to justify that DOs are significantly different when one state once changed all of their DOs to MDs for a fee and a Saturday class. It's hard to justify DOs are significantly different from MDs when plenty of DO students take and pass the USMLE.
 
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