Do PAs go to Med School?

Noobposter · Jul 17, 2008

My sister has always scored above the 90th percentile (USMLE, board cert exam, etc) and has over 10 years of experience in her field. She has told me a number of times that she has met PA/NPs that know more than she will probably ever know. I wouldn't say it's too out there for an experienced PA/NP to second guess a young doctor still in his residency.

DocHolliday · Jul 17, 2008

It appears whoever is posing these questions is really over-stepping their bounds in regards to not only questioning your expertise, but showing you disrespect at the same time....... and especially to do it in front of the patient. I'm appalled.
Actually change an order? Not only is that disrespectful, it's absolutely wrong. I would certainly consult with either the Attending Physician and/or the Surgeon first just out of professional courtesy/respect.
Please indulge me for a little bit and I mean this with all due respect........since you say "this kind of stuff doesn't upset me"........could it really be upsetting you to the point that you are venting your frustrations about all NPs, PAs; mid-levels in general here when in reality, you should be addressing the issues in real life??
I totally can understand and relate to not wanting any type of confrontation, but it appears that the above scenarios should be addressed. Explaining the rationale behind your decisions is perfectly acceptable, but to do so because you must rationalize your decisions to their satisfaction before you act, is not.

Well, you have to admit that the anonymity of this forum does allow one to vent. I am well aware of the fact that the nurses, PA's, NP's etc. with whom I work in the hospital could make my life miserable if I upset them! I need them to do work for me, and, being a practicaly guy, I recognize the need to pick my battles. (Believe me, though, my patients' health always comes first and if ever push comes to shove, I can certainly see to it that my orders are carried out.) Besides, they all do excellent work and I'm willing to overlook things that don't get out of hand.

core0 · Jul 17, 2008

I agree.
As already mentioned, don't let the moronic postings of a few mid level morons poison your view of the whole profession.

Or maybe don't let the third hand postings from some anonymous person on the internet have any bearing on how PAs function or represent themselves in the medical workplace.

David Carpenter, PA-C

APNgonnabe · Jul 18, 2008

I have a different view on the second guessing... I truly believe that it is everyones job to watch out for the best interest of the patient. If they truly believe that there might be a better way about something they should ask you about it. Obviously not in front of pt. This would be a wonderful time for you to give the mid levels some more education and then that way they maybe able to apply that knowledge at other times in their practice and possibly better aiding the doctor.

djc1981 · Jul 18, 2008

DocHolliday,

Where do you work at? When I'm a NP I wanna work for you. You sound like nothing less than an absolute thrill in the workplace.

core0 · Jul 18, 2008

First of all to comment on the original post. PA students do not go to medical school. Less than half of PA schools are in schools that have medical schools and even within those programs many are not in the medical school. There are programs that share classes with medical students but with newer PA program requirements this has become more difficult to do. This is an easy way to explain to patients but like most easy things leads to misunderstanding.

There are a few studies that look at the contact hours of medical school. The one that I am aware of shows that for the three programs looked at in the Northwest in 1998 medical students had 2015 didactic contact hours and 2385 clinical contact hours. For comparison PA students at that time had on the average 1425 didactic contact hours and 2140 clinical contact hours. The total hours given in the report were 4500 for medical school and 3700 for PA school so from a contact hour standpoint its kind of accurate. It is misleading however and personally I would not use it.

It also goes to show the difference in education. The report divides the hours between basic science and clinical science which were about 75% and 25%. PA school is almost exactly the opposite. The real problem with this is it fails to acknowledge that physician education does not end with medical school. PAs can be licensed to practice dependent medicine after PA school. Physicians at the minimum need an intern year and realistically a residency to practice. For surgical residents in our program this translates to an additional get an additional 3050 didactic hours and 15,000 clinical hours on top of what they get in medical school. You could roughly compare PA school to the second and third years of medical school but realistically they are two seperate educational processes.

Well, you have to admit that the anonymity of this forum does allow one to vent. I am well aware of the fact that the nurses, PA's, NP's etc. with whom I work in the hospital could make my life miserable if I upset them! I need them to do work for me, and, being a practicaly guy, I recognize the need to pick my battles. (Believe me, though, my patients' health always comes first and if ever push comes to shove, I can certainly see to it that my orders are carried out.) Besides, they all do excellent work and I'm willing to overlook things that don't get out of hand.

Just a couple of points here. From your posts I am assuming that you are a resident. This is a tricky issues when working in an academic setting. Basically it depends on how the service is set up. In some programs the PAs are integrated into the residency team and take direction from the chief resident. In others they are not integrated and take direction from the attending. However, the important thing to remember is that legally we are responsible to the attending and the attending is responsible for what we do.

The second point is that as a PA we need to have a plastic style of medicine. What this means is that we have to anticipate how the attending will want this done. As a physician you are developing your own style. When a PA or NP questions or suggests something, they may be saying that Dr. X will want it done this way. They may also have experience outside of surgery that suggests there are better ways of doing things. There are many ways to some things in medicine.

Finally you discussed NP/PAs cancelling orders. Again I can't speak for what happens in your institution but this is part of the passive/aggressive game that gets played here. What should happen in a true consultive environment is that only the admitting service should write orders. In most of the places I have been the consulting services also write orders sometimes cancelling our orders. I don't have any heartburn if this is part of what we asked them to consult for but its bad form when its something else that we are working up. For example if we see a patient and we need an MRI and your service has ordered a CT to evaluate the same problem, I'll cancel your order and write for the MRI. I always call whomever wrote the order and tell them to make sure they didn't want it for something else. On the other hand if the NPs/PAs on your service are changing your orders without the attending telling them to you should address this with your attending.

David Carpenter, PA-C

DocHolliday · Jul 18, 2008

DocHolliday,
Where do you work at? When I'm a NP I wanna work for you. You sound like nothing less than an absolute thrill in the workplace.

I don't own the practice. But you're right, I am an absolute thrill to work for.

jfk6668 · Jul 20, 2008

Why do you talk about "indulging their fantasy that you should explain things"......

I hate how MDs believe that people are questioning their authority when we ask them why they order something....Hello God Complex.....

I'm an RN and my education is limited....If I have a question it's because I don't know, not because I want to tell the doctor what to do..... I would hope doctors would want to take every opportunity to educate their staff.....it's makes for better patient care

DocHolliday · Jul 21, 2008

Why do you talk about "indulging their fantasy that you should explain things"......
I hate how MDs believe that people are questioning their authority when we ask them why they order something....Hello God Complex.....
I'm an RN and my education is limited....If I have a question it's because I don't know, not because I want to tell the doctor what to do..... I would hope doctors would want to take every opportunity to educate their staff.....it's makes for better patient care

Hold on there. Don't jump to conclusions.

I am exceptionally generous when it comes to passing on whatever knowledge I have to the mid-levels with whom I work. I am a firm believer that it makes my job easier by having those around me know as much as possible.

Any nurse, PA, NP, or even assistants who asks me about a subject will get from me as detailed an answer as they desire (and as I'm capable of giving).

There is a difference, however, between asking and questioning. And you don't need to be a psychologist to know which one you're receiving.

Pmdc · Jul 22, 2008

"I hate confrontation in the workplace, so I usually just indulge their fantasy that I am required to explain my decisions to them, and just go ahead and explain my decisions to them."

I have to admit, I'm just an emergency nurse and firefighter/paramedic, but none of my fantasies involve an MD explaining their actions to me. I have, on occasion, questioned orders that didn't seem appropriate such as inappropriate dosages, paralytics without sedation/analgesics, etc., as I'm sure most of us have . Believe me, it was not about my or the MD's ego. It's not about me, or you for that matter. It was simply to protect the patient.

I realize that the MD spent way more time in school than I, but I also realize that they are human and that it's impossible to know everything about everything. DocHolliday spoke of those 80 hour weeks during residency. I would think that one might need members of their team watching out for them when they are near that 80th hour. Very bad things can happen when the team becomes complacent. If we rely solely on that one person's judgment simply because he/she has the highest level of education, then we are not acting as advocates for our patients.

It's okay to be proud of your accomplishments. It really sounds as though you have done very well. I just don't understand the apparent need to beat everyone else down.

cherrysky · Jul 24, 2008

I'm a doctor, and let me tell you this: If I caught the PA in my office misrepresenting her training to my patients like that, I'd personally see to it that she was let go. If I owned the practice, I'd fire her on the spot.
Boy, I'm learning a lot about mid-level providers by reading the posts on this forum. I always knew that they had a hang-up about not being doctors. I was unaware that this hang-up was so extensive that they'd try and fool patients into thinking they were pseudo-doctors.
What the PA told you mother was patently untrue. Not only is PA school half the duration of medical school--meaning that they don't cover the breadth of medical topics covered my medical students, the topics PA schools do cover in the two years are not even covered in the same level of detail.

To be honest you just sound like someone that is attempting to show off on a nursing forum. If you dislike mid levels (a title I have no problem with) so much, then why do you spend so much time posting on a nursing forum?

I will however mention that I'm impressed that you were humble enough to let on that you do not own the practice in which your work---I would have expected you to fabricate something much more grandiose :)

For anyone else that is falling for this person's delusions, go check out the rest of his posts. All of them are demeaning, he even says in one post that nursing school is a joke. Does anyone on here really believe that any doctor would be so petty to spend his free time on a nursing forum trying to degrade people?

It's good that you have such an active imagination about your "medical career" though.

Much love.