Hmmmmm

Below is a post I put up this time last year. It came after I read some physician bloggers comments about how midlevels simply don't stack up to the care required by many patients. I amde some minor adjustments to the post below to make it read better this time around, but the changes are minor. I should have documented the offending blogs but I think white coat and panda bear were two of them - not sure about white coat though and I don't feel like searching their archives now.

Why the Mid-Level Hate, Docs?

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 health care. 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 of physician training 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 that these patients 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 extensive 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 any medication. 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/Med School 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 with absolutely no 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 among the crowd. 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 patient. 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 medical colleagues, but doctors through the decades have led oft-esteemed and privlegded lives killing countless patients, couldn’t you all use a little help? Until there is scientific 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 health insurance industry and try to make due as a PA.