I would like to hear some imput from some of you Physicans out their about PA's. Are they generally seen as helpful and useful practioners or are they posing a threat?
I ask because I cannot decide between medical school or a physicans assistant program. I have young children you see and I am weighing the aspects concerning years sacrficed in comparisson to a career. I like the general concept of a PA but am unsure on the overall attitude towards them by Physicans. I want to be in medicine, I don't need to be a MD to be happy with that career path. I would be happy to be a part of a team with an overall goal of helping people.
Please comment.
| QUOTE (jrob @ Oct 30 2002, 02:15 PM) |
| I would like to hear some imput from some of you Physicans out their about PA's. Are they generally seen as helpful and useful practioners or are they posing a threat? I ask because I cannot decide between medical school or a physicans assistant program. I have young children you see and I am weighing the aspects concerning years sacrficed in comparisson to a career. I like the general concept of a PA but am unsure on the overall attitude towards them by Physicans. I want to be in medicine, I don't need to be a MD to be happy with that career path. I would be happy to be a part of a team with an overall goal of helping people. Please comment. |
Hi there,
Physicain Assistants, Nurse Practictioners and other mid-level practictioners are not threats to MDs. There is plenty or room for all of us in the delivery of healthcare to patients. At UVa, we use PAs and NPs in all aspects of our practice. They do things like doing H & P work ups on patients in clinic, assisting in the OR, coordinating services and other duties as assigned by the attendings. They are not "physician substitutes" but rather "physician extenders". Having them do most of the "scut" allows us focus on things that demand an MDs attention. They do not direct patient care but assist us in making sure that good pateint care is efficiently delivered to patients on the surgery service. In medicine, their roles are similiar.
With the Residency Review committee's regulations sharply cutting back the hours of resident physicians, NPs and PAs along with attending physicians will be taking over some of the duties that once fell to residents. As long as I have the opportunity to get plenty of OR experience, I have no problem with NPs and PAs doing some of my paperwork such as dictating charts and bookeeping orders.
PAs assist in surgery with things like harvesting the saphenous veins for cardiac bypass and other surgeries. There are far too many surgeries for all of them to be covered by a resident or intern. Having a few PAs around to cover these routine surgeries like appys and hernias works for me.
Rather than competition, these mid-level practictioners are valued members of the healthcare team. They often have more experience with a certain service and help us (the residents) as we rotate from service to service. It really helps to have some continuity, which the mid-level practictioners cheerfully provide.
Natalie
In primary care, nurse practitioners and PAs actually have more autonomy than the surgical mid-level practitioners described in Nat’s post. There are a number of potential advantages to becoming a mid-level practitioner, as well as some disadvantages. The most serious disadvantage from my point of view: You won’t get as much training, nor as much support once you do get trained. Though the lack of residency programs is appealing, my NP friends report that it can also be terrifying and/or frustrating when you’re thrown into practice without all the training and mentoring that a residency program provides. You can find some job opportunities, however, where you’ll get good on-the-job training and support; but you need to choose carefully. Finally, as you’ve already perceived, you’ll have less authority and autonomy. As far as advantages go–how does “having a life” sound? And if primary care is your interest, a recent study shows that NPs do just as well as MDs in treating a number of chronic conditions; and they often are able to have more time for their patients. If you know that primary care is your only interest (ie, you’re not interested in specializing or in becoming a research investigator), and you don’t mind always having a supervisor, the NP/PA option is hard to beat in my view. I made a more detailed comparison of the pros and cons of NP vs. MD (a choice I thought a lot about), and Mary R. also discussed her take on this, a few months ago; you might want to look for that thread as well.
As far as my own attitude about PAs and NPs, I expect that in my career as a physician, I will spend a fair amount of time supervising, teaching and mentoring mid-level practitioners; I think that they are the future of a great deal of primary care. This view is not universally held; on the other hand, those who don’t hold this view may also be less likely to hire or supervise mid-level practitioners.
Good luck!
sf/boston joe
Thanks for the input from both of you. I am difinetly totally intrested in primary care, most likely peds. I feel my biggest reason for wanting a career in medicine is the patient realtionships and the chance to help people expecially in underseved communitys. I am from montana you see, and I intend on practicing here. There are alot of problems with the health care system here due mostly to state funding. I think the PA's are the anwser in situations like this. Not all cases always demand a MD's superior expertise and knowledge and Pa seem to be a very logical way to better distrubute healthcare in communitys that do not have alot of money for healthcare.
Thanks for your input.
JROB
Yes–it sounds like being a PA or NP might be very reasonable for you. However, it will be important to think about how you’re going to get support and training in the early parts of your practice–how will you do your de facto “residency”? This will be even more important for you if you end up being the sole medical provider for miles–so if I were you I’d talk to some other Montanan mid-level practitioners about the ups and downs of the early portions of their careers, and how to avoid the downs. Make sure to talk to people who had your equivalent amount of experience before PA/NP school. Those who were nurses or military medics (as many PAs and NPs have been) before becoming mid-level practitioners are generally more confident going in.
Right now the thing that’s probably on your mind is “Can I do this?” From my experience, once you realize that the answer is “yes”, then the next question is, “Well, OK, maybe I can do the coursework, but how do I avoid killing people?” This is when the need for postgraduate training and support becomes more evident. I think that there will eventually start being some NP/PA training fellowships–if I was rich, I’d endow some right now–but right now it’s to each her/his own.
Good luck!
–sf/boston joe
Thanks again boston joe,
I still have about 3 years of cours work left to get my B.S. Right now I'm trying to find helth care experince, most PA schools demand at least 12 months. I think I am going to become an EMT, and work full time in the summers and possibly part time in the school years. I am still unsure (and proboly will be for a while) on whether I want to pursue medical school or the PA school. The EMT thing will not hurt eithier way and will leave the doors open for both. I am also going to shadow both a pediatrician and a PA in the same practice. Your absolutely right about PA's needing training like residencies. Thats seems to be alot of responsibity with very little background. (at least those 80 hr/week residencys are good for that much) I will address that when talking to any PA's I meet in the future.
All I can think about is balance. I want a balance between a rewarding and interesting career, and a family life (sports, vacations, ect) But my biggest fear is a will forever be unsatisified becasue the PA thing would not provide me with depth I want in the career.
Anyways, thanks for taking the time to write.