As I get closer to attending school I have found myself reading more and more medical blogs. I find many of them to be humorous, well-written and insightful. During my admittedly shallow investigation into these medical blogs I came across a disturbing and somewhat disheartening trend. There is a group of vocal and relatively popular blogs written by physicians and med students that go to some length to question and/or discredit the role of Physician Assistants in modern American healthcare. Their anonymous supporters chime in with an occasional ‘here-here’ and are equally, if not more so, anti midlevel. These doc bloggers point out that since PAs do not have the extensive training that a residency trained physician does, they are incapable of treating most patients, and that anyone who chooses to become a PA is lazy, not smart enough to handle any of the rigors a physician does or is simply wasting their time in such a limited and undignified role. They also argue that patients who see a PA are selling themselves short by forgoing the artistry and command of the obscure that a Physician provides and may likely fall victim to a disease or injury because their lowly PA simply couldn’t wrap their reptilian brains around a medical condition or was being a renegade by practicing outside their scope.
First I want to get the points of agreement with out of the way. PAs do not have the extensive training that physicians do. PA school is two to three years long and usually doesn’t have a residency component. The time spent in school is not nearly as long a residency trained doc. Great! While most med students have no real world experience, let alone any that would serve them in a medical field, most PA students are required to have direct patient care experience in order to gain admission to the highly competitive programs. With this medical experience often comes maturity and knowledge of how the world outside of school operates. PAs learn a great deal about the practical application of medicine during their time on the job. PAs should not operate independently. That’s why they call them Physician Assistants. The PA’s job is to assist the doc where needed, see the lesser acuity patients, free up the doc’s time to do what he/she needs to, get more patients seen and hopefully improve patient satisfaction and practice profitability along the way - under the supervision of a physician. PAs are limited in what they can do. I’ll add that PAs are also limited in what they should do. That is to say, recognizing the inherent limits of a PA, they should consult with/differ to their supervising Physician when a questionable case arises and should only operate within their scope of practice as agreed upon by the PA and their SP. However, a PA’s training allows them to diagnose and treat illness and injury, order and evaluate labs and x-rays, splint and cast fractures, repair lacerations and in most states, prescribe medications. A PA cannot perform open heart surgery (may assist however) or perform certain independent medical research, for example. Sounds good to me…..
Now, here is where I feel these doc/MS bloggers are off their nut. Some have insinuated that PAs are simply not smart enough to be a doc and are PAs because they couldn’t get into med school. What crap – all crap and absolutely no empirical proof. With all the education these folks possess, how can they still make completely unfounded and uneducated statements? It is a sad attempt to undervalue the training and intelligence PAs possess. Some doc bloggers have hinted that those in the profession are inferior or lazy for accepting the simple role of assistant when becoming an elite medical leader is possibly within their grasp. As if being a doctor is the ONLY way one can and should be able to treat the sick and injured and that anyone who attempts to do so by other means are hacks and poseurs, regardless of their education, training and commitment. This kind of attitude reinforces the not uncommon notion that doctors can be arrogant, pious and controlling tools. I imagine that since their views are so strong that these doc/MS bloggers tend to stand out. Finally, and most aggravatingly, these bloggers posit several medical scenarios that may not have a clear diagnosis or outcome and then use the rhetorical question, “what if you had this disease/injury? Would your PA discover it in time or would you die having forgone your only true salvation - being seen by a MD/DO?” They bring up fictitious scenarios where some cowboy PA operates outside of scope and harms a patient. As if only PAs were capable of such arrogance. Well, we can find numerous documented instances where doctors operated in such a way and injured or killed their patients. These pseudo scare tactics are almost silly, save their attempt to undermine the PA profession in a most classless way. These bloggers will also argue obtusely that a medical practioner with anything less than 6-8 years of medical education and residency is not only useless, but is dangerous to boot. No offense to my esteemed medical colleagues, but doctors through the centuries have led privileged and well paying careers killing countless patients, couldn’t you all use a little help? Until there is empirical proof that PAs are more dangerous or incompetent in their scope of practice than doctors, please shut your highly educated and well trained yap.
http://www.healthbeatblog.org/2008/06/the-silence-sur.html
Here’s why I wanted to become a PA and not a doctor. At this point in my life I have neither the time, energy nor resources to tackle med school. It is difficult - not impossible, but it takes more time than I care to give. Nor I do desire to be burdened with the additional debt and lack of free time that becoming a physician requires. I’ll have a loan of $60k plus when I am done - that is already too much in my opinion. I also have a young son I’d like to see grow up. Being a PA will allow me see patients, learn and grow as a clinician, have a comfortable income and see my family often.
So, I’ll gladly take my BA, MHA, 15 years of experience as an EMT and 10 years in the insurance industry and try to make due.
10 comments:
I concur, I myself have been debating between medical school or becoming a P.A.-I am in my early twenties and I just can't seem to justify taking out so many loans for school when insurance companies actually pay doctors so little. Time is money and money is time...
I haven't ever read that PAs can't do independent medical research. Could you explain what PAs can and cannot do in research?
Many thanks!
THANK YOU, THANK YOU, THANK YOU for writing this.
I found this post after having a particularly bad day in which an older, white MD first told me I needed a "reality check" when he thought I wanted to go to medical school, then a "why bother?" when I corrected him that I wanted to become a PA. I too, have had roughly 15 years experience as a Medical Assistant in a inpatient unit of a hospital.
This gave me clarity, and inspiration to continue on my journey towards PA school.
Annon#2 - as in independent research for drug and equipment manufacturers. I may do all research I want but there is strict control on who will pay me to do it.
Sheida - we all deal with small sample sizes in our personal interactions but I work several docs whose children are PAs and they feel it is a smart choice to become a PA on a cost-benefit basis. On an absolute, personal basis there will many who feel their path is the only way. To admit that there are easier or more enjoyable routes, perhaps signals poor judgement and creates envy on their behalf. Or maybe these kinds of people must feel superior to others. If they weren't docs they'd be micro-managing office supervisor, a controlling foreman or the professor who took pride in every drop from their class. It sucks but every profession had this type of person. It just so happens that doctors have been held in higher esteem historically.
As a PA from a multi-physician family, including my father, their answer has always been simple as to why I did not go the MD / DO route.
When patients ask my father why I didn't follow in his footsteps his answer is simple, "Because he is the smart one."
As far as the medical system in this country I am not so sure any profession in the medical field is necessarily a good one. Not any more. Not lately.
The issue I find is most PAs are constantly demeaning, condescending and try to make up for their insecurities by terrorizing a first year intern who has "no life experience" as you so intelligently asserted with no empirical evidence yourself. The second residents are through their first year of residency, most of us have enough to handle what comes our way, because the level and rigor of residency training is beyond the time, energy and dedication that you can fathom. Which you also admitted you do not have. This is not an MD/PA fight. Y'all are out of the league for a fight. The issue is attitude adjustments OF PAs and knowing your place, limits, and live with your choices in life as many MDs have. As for the above comments on the "type of person" doctors are - we didn't take into account the cost/benefit bullshit that PAs love to pride themselves on. We just did what we wanted to do. And that was maximizing our compssion with our intellect, dedication and drive. So SOMEONE has to be the doctor. The resentment of PAs runs deep and that has no bearing on MDs whatsoever. If your patients ask you ignorant questions about Med school, don't take it out on your supervisors.
I personally am tired of going to doctors' offices only to find that there are no doctors there. PA's have far less medical training than doctors do, period. Nothing anyone says changes that fact. I recently went to urgent care where a PA informed me, after a 20-second examination, that a recent diagnosis made by a board-certified emergency medicine physician was incorrect. He refused to listen to most of what I had to say and would not look at my medical records. I am grateful there are people out there willing to give years of their lives while going in debt in order to become physicians.
Perfectly appropriate to judge an entire profession of your sample size of 1, Anonymous
Post a Comment