Tuesday, March 9, 2010

Interesting Ideas concerning PA evolution....

FROM a PA who went back to the Medical School, and became a physician. I don't see it happening, but interesting nonetheless.

PA’s are as diverse in personality, background and desires as the sands of the sea. A young PA will have differing opinions on various subjects than an older PA. Times change, exams change,people change but human beings are basically competative by nature. Anyone ever run a race to come in second place? My comments to you all are very contemporary, political but with “YOU” in mind. I recently spoke at a conference where a group of NP’s addressed a fellow DNP by the title Doctor. I was recently at a rural clinic where an older PA and a younger PA apparently had issues with a Doctorally trained PA using the titile “Dr.Jones the associate Physician” I didn’t have a problem with that but the two PA’s apparently did. My goodness the PA had a Doctorate degree in Public Health and 18 months of residency training under his belt and I as an MD would not insult this man, brush aside his skills and great bedside manner to consider him my assistant but rather my associate.

To the gentleman who erroneously states PA’s are not considered second class medical citizens check this out and then tell me what you think, then I will answer Daves question as to what the profession needs to do. I propose a scheme for PA’s that would answer the question of why some people got into the medical field and not the PA profession particularly. I think outside of the box so my proposals take into account the group that loves the assistant role and being supervised versus the group which recognizes the practice of medicine boils down to good training and a lot of experience, not a “HAZING” process of brutal medical school training with 3 years of inhumane residency slavery.

Proof that the medical community sees you as second class citizens.

The Michigan state medical board without letting you all know, listed podiatrists as supervising physicians of PA’s. How respected is the PA profession when foreign-trained doctors working in Federal facilities can get a PA license without any didactic or clinical training in a PA program? see


When a medical organization accepts a model of licensure that designates its practitioners as lifelong “interns/residents” needing supervision,(Post Graduate year 1/2 medical students). That profession is doomed to accept practice guidelines involving supervision by “any” independant healthcare professional, (podiatrist).

Statement by AMA to increase medical student seats to increase the primary care force. PA’s are not even considered a viable option. Physician workforce shortage: Yes, no, or maybe? e-mail story | print story In the March 2005 issue of the GME E-letter, we wrote, “It appears we are facing a national shortage of doctors. This shortage is currently confined to some regions and specialties, but the bulge of aging baby boomers threatens to widen the gap. “The Association of American Medical Colleges (AAMC) has called for a 15 percent increase in the number of medical school graduates by 2015--but that won’t solve the whole problem. We will need more GME positions as well. “To be feasible, this expansion will require removing the current caps on the number of federally funded residency positions as well as finding additional funding sources for GME. But how should these residency slots be distributed geographically and among the specialties? And how should we develop national policy on medical workforce issues such as these?”

So when a Doctor gets disciplined or has his/her license revoked and the state medical board publishes this statement;

“Dr. John doe was placed on 2 years probabtion and is prohibited from SUPERVISING PA’s and NP’s”

So when those PA’s/NP’s just lost their job because of the MD’s incompetence and the underlying tone of such statements imply that a PA/NP can’t function without the valid,unrestricted license of an MD I have 2 questions;

a) Why then do you have PA/NP licensing agencies?
B) Why take exams,do clinical rotations,take CME’s or even have conferences?

Dave it was a Doctor who created the P.A profession now the PA’s should move the profession forward by doing the following;

1) Change your title to “Associate Physician”. The word Assistant in 33 standard dictionaries means “Clerical”.

2) Create a Doctorate Associate Physician (DAP). Read the history of DO’s then you will see that this just follows an already established precedent. A DO colleague of mine once said that “MD’s may look down upon me because I am a DO but at least I’m not a PA” the DAP degree needs to be created and granted with completion of accredited postgraduate clinical residency training programs. This should be a clinical degree, and you should use a doctoral title. Optometrist,opthomologist,psychologist and psychiatrist don’t have a problem with an established precedent of “Degrees”. I suggest the following licensing scheme to keep all Associates and Assistants happy;

4 year degree, Bachelors, Associate Physician. (BAP)

7-8 Year degree,(bachelors and 3 years of additional
training) Masters, Associate Physician(MAP)

7-8 Year degree, with Post-Graduate training,
Doctorate, Associate Physician (DAP)

This would be the key in a licensing system as defined;

Distinction/educational level is clear in this scheme.BAP, MAP and DAP. The bachelors trained professionals
are the only ones that need to follow the current PA-Physician supervisory model. This would keep all the assistants happy. If you want to be an assistant then stay here. The MAP and DAP should be independant practitoners however. In this scheme a seasoned, experienced Associate Physician could actually move up the career chain after many years of practice if they choose, or 26-30 year olds fresh out of medical school residency training will become supervising Physicians of a 30 year practicing PA. Doesn’t make sense to me. I had to put a 1 year out of residency training Board certified 30 year old FP in his place because the 50 Year old PA of whom he was the supervising Physician was correct regarding the use of basal -vs- bolus insulin in a Diabetic patient. It was quite obvious this board certified rookie learned all this detail about Lantus but didn’t understand you don’t use basal insulin for Bolus random blood sugar elevations, the 50 year old PA his “assistant” knew however.

Why am I on here? I don’t want my fellow hardworking, intelligent and innovative colleagues to go through the “Hell” I went through to move away from the clinical handcuffing I went through as a PA, going through medical school, residency training only to end up doing the same thing I did day in and out but now with a title change. Now with a better income and incentive pay. With hospitalist, I don’t need to manage patients in the hospital etc.....Wake up my friends and move forward. The grass is green on your side please water it properly.

Interesting, and timely discussion....

1 comment:

Patricia Camacho said...

This is not only useful for people interest in medicine, but for any person interested. Thanks for sharing.

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