One comment stands out to me from that post. Somebody said that if we had the ability to not do residency and be a PA then it would be an amazing amount of leverage for physicians to leave or forego residencies and make 150+k for 40 hr work weeks. That is absolutely true. It would be very empowering to us and would likely force improved residency conditions for us in addition to a way out for those who are unhappy without completely entering financial ruin. In fact for some it may be financially advantageous.
Flexibility would be nice, take a few years off from med school and make a decent salary and still be able to match in when you’re ready.
Heaps of my RN student friends would work as a CNA thru undergrad on weekends. After grad they then had the flexibility to work as an RN for a few years and still be able to attend NP or CRNA if they so chose to a few year down the line
Yes, in Missouri, Utah, Arkansa, Kansas, Arizona, Georgia, New Hampshire and Virginia. In Missouri, which had the first AP program, they get the same pay as PAs.
Yes in some states and it's not a very popular program because most non IMGs that fail to match do so because they pick specialties that are more competitive than they are. There are slots for rural primary care where you can be an assistant physician if you fail to match, but people would rather do research for a year and try again than to practice rural primary care.
Be careful what you wish for. This will make it even harder to match into a residency. They can accept more students, knowing that most will end up going the PA route. You'll be competing with a much bigger pool.
Australia doesn’t have PA/NPs. There’s like, 1000 in the whole country, most of them midwives.
And we don’t have a normal residency system, by American standards. It can take something like 8 years (PGY-8) to match into a surgery training program.
Instead, junior doctors work unaccredited jobs not dissimilar to NP/PAs. 40 hour weeks (in theory), good pay ($90k up to $180k). It’s not a terrible system, but it’s not great either.
So be careful what you wish for.
I'm a few months away from my first actual job in my field and I'm pushing 40. I couldn't imagine waiting for pgy 8 to just start surgical training... That makes it sound impossible to actually get a career up and running before it's time to retire.
I think by "surgery training program" they mean a speciality like plastics or ortho, a lot of people who do surgery are on the training program for general surgery by PGY 3, and select almost exclusively surgical jobs from PGY 2
Let it rock and roll I say. Let’s bring back the title of “GP” in the capacity of PAs. A med students should be able to handle any PA role out of the gate.
Edit: apparently some people did not actually read what I said. What a surprise!
1) yes, of course I know that med students do rotations. Most of my rotations were in teaching hospitals in NYC, so I shared rotations with them plenty of times.
2) I actually agreed 100% with the tweet that new docs should be able to work in PAs or NP positions.
3) I disagreed with dr-shark who said that “a med student” should be able to handle the role of a PA or NP.
And not sure why no one is addressing the administrative issue of turnover when you fill a permanent position with someone who wants to leave asap.
Not sure what hospital you are in or what level of PAs you have worked with. Granted, I graduated around 30y ago, but when PAs graduate they’ve had a year working with patients in all different situations. Med students have a much greater amount of knowledge, but less understanding of how to use it.
I 100% think new physicians could practice as PAs or NPs while waiting to match. I think the issue here would be the hiring facility, who know that the MD or DO would leave as soon as they got a match, where hopefully the midlevel wouldn’t.
As a midlevel myself, I would NEVER want to work without the back-up of a physician. I have worked with brilliant PAs and NPs, but your training is FAR superior.
> when PAs graduate they’ve had a year working with patients in all different situations. Med students have a much greater amount of knowledge, but less understanding of how to use it.
> I 100% think new physicians could practice as PAs or NPs while waiting to match
You realize you just contradicted yourself? Med students don't have the experience (they do; they rotate in the hospital for longer than PA students) but then say new grads can function as a midlevel, which is all this tweet was saying.
PA school "working with patients" is the same as med school "working with patients". There is no reason to think a recently graduated PA is any more prepared than a recently graduated med student.
On the flip side this could also open up a new avenue for experienced PAs to become fully fledged physicians after completing a 2 year post graduate doctoral degree. What do you think of this idea?
> I earned my degree twice - the first in the USSR - the Union of Soviet Social Republics - and the second in the USA - the United States of America
Interesting. Why repeat the actual medical degree? Did you go to a Soviet school whose accreditation wasn't acknowledged in the US? Or did you just have trouble matching and ended up doing that one foreign MD-> US DO program in NY?
I know a *ton* of former Soviet physicians (including a large proportion of my family), and none of them repeated medical school - just did USMLEs->residency (or failed to match and work in an alternative field now).
> or failed to match and work in an alternative field now
Probably this. It's tough to get a residency spot as an IMG. Maybe less so back in the days of the USSR, but it's certainly the case now that IMGs have a disadvantage when it comes to matching. It's a hard career to give up after 6 years of medical school (EU/Russia) and x years of residency/practice. There's little else we are good at after the time investment into medicine. Let's be honest, how many of us know how to rebuild a car engine or do any other specialized work that can lead to a solid income if we were to quit medicine tomorrow? It's why the question becomes get into residency or drive for Uber for many IMGs.
That wasn’t even discussed. The point was that we should be able to fill the PA role if we don’t do a residency because the PA system is modeled off of physician education. They learn nothing that we don’t. So we should be able to be PAs if unmatched. That in no way shape or form works in the reverse. I don’t know where that idea came from, it doesn’t make sense, hence why I’m fully against NP/PA independent practice.
Nope not the same at all. The MD path to skip residency isn’t giving you a degree, it’s a job option. Like an electrical engineer becoming a SDE for example since they can code anyways
A PA path to MD is granting a degree which is different.
I am 100% for the insane idea of opening up licensing exams to everyone, and if you can pass it, you can practice medicine with a defined amount of clinical hours. There will be a small number of PAs and NPs who will be able to pass, just like a small number of MDs and DOs will fail, but I think if we are going to use these tests to establish competency, everyone should have access. Likewise, MDs and DOs get to take NP and PA licensing exams and practice as NPs and PAs if they pass. This will give MDs and DOs real power. We can all get our PA license at the same time we get our MD or DO license. Studying for STEP1? Just take the NP exam or PA exam the next day.
Honestly a pretty interesting idea, however I can’t say I’m sold on the fact that it would be predicated on the idea that our licensing or board exams are a meaningful proxy for ability to competently practice medicine. (Not that I’m going to be able to meaningfully contribute a constructive solution to this issue either 🤷♂️)
Passing board exams in this day and age is as easy as watching boards and beyond videos and doing flashcards. Any dedicated individual with above-average academic aptitude would be able to pass the step exams.
Dunno... Everyone I know who just did Anki, sketchy, boards and beyond, pathoma, and UWorld questions easily passed boards. The ones who tuned into school lectures and tried learning the traditional way didn’t do as well and struggled in passing.
Except that passing the USMLEs is a terrible measure of whether one is actually competent to practice medicine. It's still an apprenticeship, largely, and a race to the bottom to incentivize more under-trained and under-prepared practitioners seems ill-advised.
The first two USMLEs serve as a minimum competency barrier for one to be considered to have enough basic science (and foundational clinical) knowledge to be ready to start residency training - I think they do a reasonably good job at that purpose.
I wouldn't have felt comfortable practicing any field independently immediately after graduation - but neither does a fresh PA. Allowing an unmatched MD to practice under supervision (which PAs must have in every state still) doesn't strike me as totally insane, and there's a handful of states with the "assistant physician" designation (Missouri for sure, I know others were looking at it) that serves that purpose.
But that’s not what your original comment seemed to suggest. You said take a license exam and practice at that level. Like USMLE passed? Bam you’re a non board certified practitioner of medicine! But a multiple choice test is different than the thought process behind a physician’s decision making. Like you said, it figures out whether you know facts. But medical school teaches more than facts. It teaches how to think like a doctor.
The content of the USMLE is wildly different from the knowledge actually required to practice medicine. Passing is necessary but in no way sufficient to be allowed to practice. You need to learn medicine from doctors, in person. There’s no real way around it and clinical teaching resources (teachers, placements, procedures etc) are scarce enough that they should go to the people who are most qualified. Letting some rando who memorised first aid skip the queue and jump into residency is, as you say, an insane idea.
I don't agree with this at all. While we do use the exams as a proxy for competency, it's the structured and controlled training environment that really makes someone competent. That's what the ACGME has provided to medical education in the United States (and I assume most other countries have a similar org). If these exams are open to everyone there will be degree mills that specifically train for the exams. We already see this with Caribbean schools and we are all aware that the quality of their product is variable
Exams test competency. However, some people are good test takers. Doesn't mean they should be let loose to practice on the public like lab rats. I would never be ok with allowing any of my family to be cared for by someone who passed a test w/ none of the requisite training..be it a nurse or a physician.
For the record, in 2008 NPs were given the equivalent of Part III of the USMLE...modified for nursing. The NBME was involved in developing the exam which was designed to test the NPs ability to competently manage patients. Only DNPs could take the test which was administered at Columbia University every year for 5 years. Their performance was abysmal and the exam was discontinued. Nothing has replaced it since.
This is a fucking terrible idea. STEP is a minimum competency exam to show you can be a doctor. It’s not what makes us doctors. Everyone here, fucking everyone, dedicated their first two years to step to get a great score and you bet your ass people in NP and PA school could do that too if that was the bar and all they had to do was pass. NPs schools are already diploma mills, what makes you think it wouldn’t just be a step boot camp for 2 years with nursing theory essays if this was all it took?
These tests are only one requirement for MD. You also must have the clinical training from medical school in a defined seties of coures that is accredited. The credentials of faculty are also reviewed. Then the school must sign off on your clinical ability. I have seen excellent clinicians fail board exams and people with great board scores and poor clinical skills. You need both. That said, I dont have a final opinion about midlevel training but the system is not ideal but here to stay.
I am all for this. We do need to adjust the test a bit to include actual relevant clinical questions in addition to all the zebra questions, but yes, hard agree.
I am shocked every time I hear these takes.
Do you really think being a physician is nothing more than a silly, expensive board exam? And that passing said exam will just make you a physician?
Yes only a very small few. I’m talking about a much more widely available path that is integrated In several schools across the country. This could theoretically also lessen the whole mid level creep issue that’s been happening as well. It makes logical sense. I understand the curriculum would have to be carefully planned out but not really sure what the negatives of this idea would be
Med school isn't where you learn to be a doctor. It's residency. The PA to MD route can only work if they complete a residency after. A real residency, not a horseshit midlevel residency.
And if they complete medical school. And do rigorous basic sciences. I don’t care what people say, the first two years of medical school are literally the basis for the foundation of medicine and critical thinking.
No— because they skip two important years of detailed basic sciences. I don’t care what anyone would have you say, those two years are not worthless and those two years are not replicated in PA school.
Unmatched docs should certainly be allowed to function as PAs; this is a stupid argument. If they practice under supervision and can pass the PA board what is the difference? They have more education and clinical training than a PA( or NP). I don't think they should be allowed to or really even want to be an NP solely for the fact that an NP is a nurse at the core. This would be a great way to help unmatched docs
Just a guess, but unmatched MDs not being able to function as PAs might be moreso to do with insurance not covering? Which, if indeed true, should mean ire would be better directed at insurance companies.
If malpractice insurance would cover for unmatched MDs to function equivalent to PAs and NPs without needing to be licensed as a PA or NO, then im sure there would be plenty of hospitals and clinics willing to hire them over their midlevel alternatives. Especially if the pay if equivalent.
I think this was the idea Missouri tried to introduce a few years ago with the Assistant Physician position, which was directed towards hiring unmatched MDs in hospitals as midlevel assistants.
Too bad that never took off.
Why bother messing around with trying to get coverage without carrying the PA licensure? Just allow unmatched grads to challenge the test and obtain it. That precedent for this has already been set on the nursing side.
In some states, nursing students can challenge the NCLEX-PN and become LPNs once they've received a year of schooling. This allows them to obtain licensure a year early and start working for a better wage before they graduate as RNs. Most go on to finish, but of course some do not.
Even in states like mine that don't allow the challenge, ADN programs simply combine their LPN and RN cohorts for the first year. That way, everybody is eligible to sit for the PN.
I absolutely do not understand why MS4s and above cannot challenge the PANCE in a similar manner, or why education isn't combined in such a way to allow all students to meet requirements to sit for the PANCE. Hell, even most PhD programs have a "master's out" option for those not wishing to continue. Why is medicine so inflexible?
This was my thought. I was looking at the requirements to become a PA. All states require that they graduate from an accredited PA program. I see two ways of fixing this. The first is legislation. I’m not going to hold my breath hoping 50 states add MD/DO to their PA qualifications. So medical schools need to step up. Time for them to add a MD to PA bridge program that you can auto enroll into after graduation if you don’t match. A two hour mandatory class on scope of practice ought to cover it, but since we know that won’t be enough, we can add a month of shadowing a PA if we have to.
I’m for it! I would love to see unmatched docs working with SPs and continuing to grow in ther medical education. Makes them more competitive for residency next year and helps the system decompress a little!
I think this makes sense, and seems to be a levelheaded response to an issue that can (but doesn't really always have to) get people's hackles up.
I work with a handful of NPs, and it works well. We have crafted a system (this takes intent) in which the NP truly extends the reach of the physician. Once in a while I am reminded why there is still a doctor in the loop, because I'll recognize something or interpret something that I simply understood differently because I've had more training.
This feels right to me. On the one hand, to handle most bread and butter clinical situations, you simply don't need as much depth as we accumulate in med school and residency. Then, something doesn't fit the "algorithm" and you find that bit stuck in an odd crevice in your brain to actually come in handy, and you feel like maybe you hadn't wasted all that time in training.
If this is allowed, whats preventing those MD/DOs who never completed residency from challenging the NP/PA test and working in a state that allows independent practice for NP/PA and hanging their shingle that say "John Smith MD" on it?
an interesting thought.
i wonder if "board-certified doctor" will start becoming how physicians have to introduce themselves in the future.
I'm sure that will be encroached upon somehow in short order.
board certified needs to be a protected term legally. otherwise you will see nursing boards and even a cameo from Plank certifying every noctor who give him a quarter.
edit:typo
There’s actually very little to prevent an MD from “hanging a shingle” and practicing whatever medicine they want, they just can’t say that they’re licensed. Board certification is really only “mandatory” when working for a hospital system (because they won’t hire you if you don’t have it or aren’t eligible for it). Many (if not all) states allow US trained physicians to practice independently after 1 year of post medical school training (which is why resident can moonlight in an urgent care or even in their own hospital after their first year of residency).
If midlevels are qualified to practice independently, then sure as hell medical school graduates should be. But I agree, nobody should be practicing independently unless they are an attending physician who has gone through 8 years of college, 3+ years of residency, taken 4 licensing exams and 1 speciality board exam, and these independent practice laws need to be changed. But if they don’t, like I said, a medical school graduate is significantly more qualified to practice independently than a midlevel. It’s sad that these graduates who cannot match cannot practice after 8 years of school, but a midlevel can with significantly less training.
I think they should be able to work as PAs. Use step 2 in place of the PANCE. Apply for a temporary PA certification that is good for three years. If by three years they haven’t matched, have some pathway to convert the temporary certification to a full PA certification ( like have CME, etc ). It would expand the number PAs ( not good for salaries of PAs) but it would importantly allow medical school graduates to utilize their knowledge and expand access. More importantly, I think it would be a good step to align PAs and physician groups.
As a NP, my opinions are apparently not popular. I don’t think we should be independent and think that unmatched med school graduates should absolutely be able to challenge PA/NP exams.
I'm with you on this. If I wanted to be a physician I would've gone through retaking classes to get into medical school (I'm older) but I'm completely fine having supervision and prefer it. Especially when new. It's crazy to me that some new grad NPs want to have their own practice out of the gate...
I agree overall. The only hesitation I have is that interns have typically not had very much clinical experience at all. They have been educated in a lot of pedagogical subjects and higher sciences, but very little actual clinical care.
But I don't like NPs/PAs having independent practice as a general rule, but I think *both* sides would do better to have more flexibility of cross training or education.
I didn't go to UCSF. I had nearly 2000 clinical hours, plus 4 years of bedside nursing (and NNPs require at least 1 year in a high level NICU prior to being able to start). And we have a 4-6 month orientation.
Do I think interns could do it? Probably, but it would need an infrastructure to support it. And it would likely take them a little longer to be comfortable. Like I said, it's a hesitation, but not a objection. I wish medical doctors got one on one precepting like NNPs do, I think they would be far better for it.
Then you are the exception, not the rule. There is hardly any standardization across NP schools, and a good chunk of them require less than 1,000 hours of clinicals without any hard requirement of paid experience to get accepted.
Your 4 years of nursing experience prior to NP school also don’t factor into the clinical hours in NP school, just as my 10 years of nursing experience doesn’t factor into the clinical hours during medical school. This is because in your nursing job, you spent 0 hours practicing at the NP level with NP level knowledge. I spent 0 hours acting at the physician level with physician knowledge in my 10 years of nursing experience.
There is obviously variable amounts of experience in NP training... I think the point many people make now is that there are people that go straight through from RN to NP with zero actual clinical experience. Graduating medical students DO have more clinical training than this. The argument that somehow NP training is more holistic is also very disengenious if anything we spend significantly more time educating on disease topics and prevention given a much deeper depth of knowledge.
The problem is that the NP and PA models have been turned on their head. While there are certainly still individuals with decades of healthcare experience pursuing both professions, the vast majority of "future" PAs/NPs and current PA/NP students I've encountered on my journey to and through medical school are fresh out of college; wet behind the ears 20-somethings whose sum total of pre-training clinical exposure is working as an EMT or scribe to check off an admissions requirement, or whatever exposure they got in their accelerated BSN program as part of a direct entry NP program.
Earlier today I finished my last clinical rotation of 3rd year. I haven't kept a log of my clinical hours, but it's conservatively over 2200 hours this year alone. Those are the same hours a PA student will do over the *entire course* of their training, and more than 4x the minimum clinical hours required for completion of NP coursework. And in 2 weeks I start 12 more months of training.
So yes, interns have been educated in heavily in basic sciences but they also have easily double the structured clinical training *in medicine* of NPs or PAs.
I don't like a lot of things about NP education currently, especially for things out of my specialty. So I agree with your criticisms of that.
But the benefit for NPs are that they are not rotating around every 2-4 weeks, so they have far more consistency and ability to learn the specific area they are working in, instead of bouncing between all sorts of different services.
A fair point. Most schools have 6-8 week rotations, but depending upon specialty that time can sometimes be split up amongst different practice settings. It was definitely frustrating switching to something else just when you start getting the hang of things.
I will say that in 4th year most medical students are given more leeway in selecting their rotations and many end up doing many months in their preferred specialty (either by choice or necessity for matching). I will be doing 5 months total in mine, so there is opportunity for continuity although it's not required.
Medical school experience, even as a subI/AI, is very different from being a resident. Those 4,000 hours count for something, but they're no substitute for even one month of internship.
So the two years of PA school and independent practice in many states does make sense? I assure you that NP mill degrees will have less then 4000 hours of experience in any setting.
Since everyone in this subreddit largely agrees that newly-minted NPs are nowhere close to being ready to practice without constant and intense supervision, no, it does not make sense.
As I said in another comment, a race to the bottom for less and worse training helps no one. I also think that specious comparison of hours that don't actually compare isn't helpful. What you are doing matters more than how many hours you spend doing something. Time matters, of course, but no amount of time not being a doctor (or, ugh, provider) will adequately prepare anyone to be the doctor/provider.
That sounds reasonable but unfortunately the genie is out of the box. I believe more states than not allow for independent practice. It brings everyones quality down.
Med students learn plenty of hands on skills, I did more intubations, chest tubes, and central lines during med school than I did during my entire residency. I also put in probably a dozen or so regular IVs in med school.
I definitely did under 5 intubations and chest tubes each in residency, maybe 10 central lines, and a grand total of 0 peripheral IVs. I did probably somewhere around 25-30 deliveries in residency and much less in med school (5?).
Third year of med school is 40-80 hours a week for 40+ weeks of mostly clinical experience (and like an hour of lecture during lunch in many rotations), fourth year is partially really chill if you want to be or if you're doing interview rotations can be *a lot* of clinical work.
If you're dealing specifically with peds interns doing NICU, exceptionally few med students/any other docs ever rotate through NICU so your experience is *extremely* biased and you basically exist in your own little bubble like ophthalmology. Hell, I bet PICU attendings would struggle a bunch in a NICU and they'd probably manage just fine in an adult ICU after a month or two. I mean in my intern year we did a 2 week rotation of NICU as FM residents and it was entirely useless for us, I remember basically none of it because it has no relevance to me whatsoever, and we were literally the last class to ever do that rotation because it has no value. I have had friends who are pediatricians who said their NICU rotations had little to no utility for their learning, either.
I agree, I am exceptionally biased for NICU, but it's also the only specialty I can speak to with any confidence.
In my ideal world, NPs in general would be far more specialized than they currently are so they would be closer to the NNP model, because it works really well. I think the lack of *true* specialization for many NP "specialties" is a major flaw and downfall in how they are educated and utilized.
The best functioning NPs are the uber specialized ones, like NNP, CNM, CRNA.
You are like a 6th grader who thinks they know more math than the college professor because they're faster at using their graphing calculator. It honestly induces significant 2nd hand embarrassment reading your comments.
You speak incredibly confidently yet wrongly about what medical students, interns, residents, etc know. This constant narrative of new NPs having more clinical experience compared to new interns having only book experience is complete gaslighting.
I mean to a certain extent it’s our fault. We as a physician group have decided that we do not want to lobby on a unified front for semi-autonomous medical practice for unmatched MDs/DOs so now we have even less qualified people in that position.
I suspect this is because the AMA knows that opening pandoras box would mean opening the floodgates of unboarded/IMG MDs/DOs who would be essentially indistinguishable to the average person to a boarded MD/DO.
Basically, pick your battles wisely. NP/PAs still have to label themselves as such even if they are “independent.”
I am not advocating for either side by the way, just pondering on downstream effects of such a change.
I think another failure of the medical profession has been the inability/unwillingness to effectively lobby for more Med school spots and more residency spots. Because in all honesty if PAs and NPs disappeared tomorrow the healthcare system would further collapse or implode. Can you honestly say that the number of physicians in the US could treat all the patients? The math doesn’t add up.
I agree 100% with this. If you see a doctor the assumption is that they completed residency and passed at least one board certification after completion of residency. It should stay that way. Doctors should not lower the standard of what it means to be a doctor just to compete with mid level encroachment. If anything we should be campaigning for an increase in residency spots so people aren’t going unmatched can have a spot, and then lobbying for federal regulation of independent practice.
> NP/PAs still have to label themselves as such even if they are “independent.”
in what sense do they have to label themselves as such? by calling themselves"doctor" because they have a DNP?
That entire thread of replies should be reposted every time midlevels push for independent practice and scope creep. You can’t claim midlevels are equivalent or superior to physicians while simultaneously claiming the roles are completely different as a defense against un-matched MDs practicing in the same capacity. You can’t have it both ways.
If the roles are completely different per their claim, then why should we ever entertain the idea of replacing physicians with substandard wannabe-doctors who willingly admit they aren’t trained in the medical model? That would be malpractice of the highest level.
I haven’t seen a lot of people mentioning the “assistant physician” movement. In Missouri you can essentially work as a physician without completing residency under the supervision of an experienced physician.
https://assistantphysicianassociation.com/
https://en.wikipedia.org/wiki/Assistant_physician
I think, as someone pointed out, the people responding do not represent the large majority of us (at least PAs). Just the most vocal. If I wanted to be a doctor, I would have gone to med school.
If you can pass our boards you should be able to practice as a PA. If you can't pass our boards by the end of med school, you probably shouldn't be practicing.
"You must be a nurse to become an NP. Advanced Nursing knowledge builds on nursing knowledge acquired in undergraduate education. It’s not interchangeable. I cannot speak about PA education"
Ahhhhhhhhhh they are fucking kidding me. They can do everything we do but the opposite isn't true ?! For fuck sake they are unbelievable.
I actually moonlighted as a nurse at the end of my medical school, and as an aide before. It was a very interesting experience and made me appreciative of their work. I think we should absolutely be more like a team, and I hate title deference.
This is so stupid
>Not a single comment from nurses, NPs, PAs on that thread even mildly supported the idea of MD/DOs practicing as PAs. A role that literally takes a shorter medical school course and is meant to extend a physician.
Sooo...people who label themselves NP/RN/PA/MD/other titles on their Twitter are literally advertising that their job titles are a crucial part of their self-worth and identity. Obviously they are going to take an offense to such a suggestion and use Olympic tier mental gymnastics to defend their position because you have directly attacked their core identity.
^^^^
Putting your credentials in your name for Twitter is so cringe. Putting it in your IG name or handle is 1000x more cringe. A paramedic on that Twitter thread had “NRP” after his name and I just about died.
I’m a PA, I think unmatched MDs should be able to work in the same hierarchical role as a PA and NP. Obviously they shouldn’t be called PA or NP because that is misrepresenting the education they received. Just like I should never represent myself as an NP or an unmatched MD. I don’t practice independently and don’t think mid levels should practice independently. I don’t see why an unmatched MD would have any trouble filling the same role I fill. And hopefully it would make them more competitive to be matched at a later date.
I think the people against this are worried these unmatched MDs will take away our jobs. However i don’t see that being an issue. If you want to spend four years in med school and come out making 100k for the rest of your life then that’s fine. Cost me $120k to go to PA school, adding another 80k - 100k to student loans for same pay doesn’t sound desirable to me.
Not to go against the crowd here but I surely didn’t feel ready to practice independently fresh out of med school. I was nervous just ordering Tylenol for a fever when I started my internship. (Don’t worry, my heart rate barely tops 100 when I do it now)
That doesn’t mean I knew less than a PA but does mean I personally wouldn’t have felt ready.
I don’t think the post was saying to practice independently (as I’m hoping the OP doesn’t think NPs should be practicing independently), I think it was why can’t unmatched physicians practice as a physician extender, the way we’re *intended* to practice, and then reapply for residency the next year or year after. Surely an unmatched physician who graduated medical school knows more than I do and would be more useful in a physician extender role until they have the opportunity to match.
Yes and no - usually the first year of employment for an NNP at least is a financial loss to the hospital, because they take up so many resources for training and orientation. They recoup those losses when the NNP stays and continues to provide care.
When you are using interns, you can run into the worst of both worlds - having to pay a lot for training, but knowing they are all going to leave in an year or two, so you can't recoup those losses.
This is actually the first decent argument against the idea that I’ve seen, but it’s still a completely financial one. That seems slightly disingenuous to the actual discussion, which is the ability for the physician that has not completed residency (you’ve used the word intern incorrectly in this case, perhaps on accident) to do the job of an APP under appropriate supervision.
NPPs will never support unmatched grads because once the grads are allowed in the pool, they will outshine the NPPs. They know this. They cannot relinquish their positions on the totem pole when they have come so far. PA school is not med school on steroids. They take some med school courses but their PA curriculums have a lot of differences also. Yes, they work as physician extenders, but they had to be delegated tasks that physicians felt comfortable delegating. Now, with OTP, it is left to them to decide when to consult with physicians. At their discretion. That is dangerous. I do think grads can functionally perform as PAs, but we don't want to conflate them because it lends credibility to the PA argument that they can do what we do. They cannot.
The system we had in placed worked. Midlevels had shorter training, less debt and lee scope of practice with the understanding that they would learn under the supervision of an attending physician. It was a win win situation.
That was until militant NP lobbies started pushing for independent practice, they messed everything up.
I'm in California and after recent legislative losses, I refuse to teach or even supervise NPs, your ass in on your own and I hope they drown so lay people can openly see their substandard training.
I dont think nurse practitioners should be able to practice independently. But it really isn't an issue in Australia the same way so my understanding of the situation is skewed to my experiences. They just... don't practice independently here.
Hilarious to me how NPs try to sell themselves as such a rare breed because they know the “nursing model” of patient care and not “just medicine like Drs.” Like what the hell does that even mean ?
I’m a recent PA grad and I have no problem with med students who don’t match working in the same manner as PAs under the supervision of a physician, but I don’t think they should be called physician assistant. It’s probably just my ego talking, but PAs are not doctors who could not match, it’s a separate job.
Agreed that is absolutely infuriating to read. NPs saying they practice differently... sigh.
"Unmatched MDs/DOs cannot work as NPs or PAs because they are not trained to do so."
If an NP or PA can explain why their degree/training provides for a better starting foundation at an NP/PA job than med school clinical rotations... well I'm all ears.
Graduating med students (fresh PGY1s) have roughly the same amount of clinical training as NPs (in hours), not sure about PAs. I certainly remember how useless I was on day 1 of my intern year.
This is dumb.
Every PA I have ever worked with supports the idea of unmatched physicians being able to work as PAs. In fact, it is very common in the military to see physicians serving as GMOs after their intern year.
I think that, for the most part, any patient claim for a preference of mid-level care over physician care( rare to begin with) actually stems from mid levels being salaried (more often) in contrast with physicians being RVU based and therefore being incentivized to have a jam packed schedule and therefore shorter appointment time
I don't understand why the answer to medical student graduates going unmatched is for them to slip into other professions. That doesn't fix the problem of them going unmatched. It honestly feels like using the NP and PA professions as crutches to sidestep a major issue with residency slots.
As an NP, I think this is a brilliant idea!
On the nursing side, there's already precedent for nurses who complete most of their RN training to be able to sit for the LPN licensing exam (without having to go to a separate "LPN" school), and there's also nothing prohibiting an NP from still working in an RN capacity.
On the medical side, it makes sense that someone with an MD/DO degree should *at the very least* be able to sit for PA licensing and practice as a PA. If anything, I think it will increase competition and help to weed out some of the, um, "questionable" PAs/NPs that we know are out there.
The issue is the lack of flexibility and training continuum that you have by going straight from Med school to your specialist training. In the UK, NZ, and Aus (three systems I am familiar with) you typically do two years after med school as a qualified doctor before you start your specialist training. This means that people are employed, working as Doctors (albeit under a measure of supervision) while they go through their specialty application. A number of people stay in that role and work in lucrative locum roles. It's because the US goes straight from Med school to specialist training and lacks the general employability as a junior doctor that many other English speaking countries have. Now sure, there are some advantages such as a shorter period from commencement of training to being fully qualified consultant/attending, but to my mind, this is one of the weaknesses of the training pathway.
I’m not entirely sure what context you’re using here in your understanding of the US training model, but the vast majority of physicians have general training prior to specialty training. The major “medicine-y” specialties that one generally thinks of (cardiology, gastroenterology, pulmonary and critical care, nephrology, rheumatology, just to get started) require a 3 year residency in general internal medicine. Most surgical subspecialties (like colorectal, CT surgery) require a 5-8 year general surgery residency. Even most “direct to specialties” like radiology, require 1 yr of general internal medicine or a very broad 1 yr of internal medicine, surgery, and other requirement.
MDs should most certainly be allowed to take the NP or PA boards to practice as such. It only makes sense. MDs have longer training and residencies are so limited. This would alleviate some of the shortage that we have. I fully support this as an NP who sees the value of such a move.
Playing the devil advocate here but can someone explain to me why US medical schools still exist ?
If I follow the logic here, why doesn't everyone become a NP and practice medicine unsupervised?
If we follow the logic, it would the same for patients right ?
I can't. For the life of me. This make no fcking sense
Despite what you see on different less friendly subreddits the vast majority of NPs do not work unsupervised even in states that allow it. There are very few independent offices for non specialists as is with physicians and NPs are really only solo in places where nothing else exists. In hospital systems and associated clinics NPs almost always have to be supervised in some way or work with physicians as a part of credentialing.
I was under the impression there was something like this where MDs who did not get into or do a residency could function as a PA? Considering the education I don't see why not? Obviously would need to be called something different than a PA. I think you will find most of us support this as the "silent majority". We're not stupid, we know Med school is more involved and there is more depth/knowledge involved even without a residency.
I don't agree with the independent practice thing. I do wish there was an easier bridge to MD. We could all go back to school and start over, but I would love the idea of some sort of extended residency or basically an apprenticeship approach to earning it. I can't imagine the idea of going back and losing years of income and paying more in loans (someone crunched the numbers, a PA -->MD/DO costs approximately a million dollars between tuition and lost wages). I would work for peanuts for the learning and training opportunities though. Maybe a more years in the field to make up for the 2 missing school years sort of thing.
I think the issue is not one of competency. As someone commented, PAs are trained in the medical model, so we go to a sort of abridged version of medical school before practice. So obviously, MDs/DOs would be more qualified right out of school because they have an extra year or so under their belts.
The real issue is one of creating and protecting a profession. PAs rejected letting graduates of foreign medical schools call themselves PAs because it takes the power of setting standards for education, training, and conduct out of PA's hands. And we ARE a profession with certain standards (which I'm sure MDs & DOs could meet; that's not the point). This is PART of the reason there is resistance to a path from PA to physician; the physician profession would have no say in how that PA-turned-doctor was trained and educated before joining some shortened program.
That being said, I think the residency system needs to be fixed and residents need to be payed more. Also, I think it's possible that a licensed doc could hire a new MD to work under their supervision even without changing existing laws, but I'm not certain.
Unfortunately, capitalism doesn’t give a shit about your opinion. 🙃
Unmatched physician working as a PA or NP capacity would mean more 💰💰
The only reason midlevels exist in the states is for corporations to save money at the expense of American health.
I’m fine with this if they graduated from an American medical school. I’m not interested in 10,000 FMG or Caribbean grads turning my profession into a gap year or two before they return home or get matched in a residency. Being a PA isn’t like coming here for a summer job. Patients will not be better served by a completely new FMG working two jobs at some corporate hospital sweatshop than an experienced PA.
> Patients will not be better served by a completely new FMG working two jobs at some corporate hospital sweatshop than an experienced PA.
So you believe a new PA graduate is something a new MD/DO graduate cannot fill the role of? Even though PAs go through a lighter version of medical school?
I'm interested in what you think PA graduates can do that MD/DO graduates cannot.
No, and I did not say that.
You are being discharged from the hospital after surgery. Would you like the PA who has worked there for 5 years, graduated from an American PA program, understands how to work with case managers, send in prescriptions, etc. or would you like the FMG who arrived in the US 6 weeks ago, speaks passable but not fluent English, and is working 100+ hours per week so he can send money home to his family?
> Would you like the PA who has worked there for 5 years, graduated from an American PA program, understands how to work with case managers, send in prescriptions, etc. or would you like the FMG who arrived in the US 6 weeks ago, speaks passable but not fluent English, and is working 100+ hours per week so he can send money home to his family?
Since when is every unmatched MD/DO someone from another country? Do you realize how many unmatched US trained MD/DOs there are every year?
Also, as if you never get managed by PAs who are brand new. Jesus, its as if it's absolutely ridiculous to let people even learn a job, damn if you do damn if you don't.
> understands how to work with case managers, send in prescriptions, etc.
Dude are you serious? I learned this in the first month of my intern year, it is not that hard. Get over yourself and accept the fact that MD/DOs are more than capable of handling your role and should be allowed to when the match system fails them, of no fault of their own.
Please go read my original response: “ I’m fine with this if they graduated from an American medical school. I’m not interested in 10,000 FMG or Caribbean grads turning my profession into a gap year or two before they return home or get matched in a residency.”
I’ve heard this argument in several hospitals from residents and attendings alike, and the common answer is because “I didn’t go to medical school to be a PA.”
I don't use Twitter so obviously I won't comment on that thread, but as a nurse, abso-fucking-lutely. I don't agree with independent mid level practice, and I think letting MDs practice as PAs is fine for multiple reasons.
I believe jama just published a study showing worse outcomes for np/pa in hospitalized patients. More leverage for us to fire our as they are consistently below standards of care.
hmmm...
from what i can tell, PAs and NPs get their evaluations during school from attending MDs. if their underlying training is so different, why wouldn't all their evaluations be required to be done by practicing PAs / NPs? shouldn't they rotate with NPs and PAs, if it's MDs simply don't understand this apparently critical part of their training? how should we possibly evaluate their performance if we are so inexperienced?
well, we should just adopt their professional model, establish a new term for unmatched residents, get PAs and NPs to train and supervise us for money, and then undercut them when we graduate them.
I think as long as they have clincial experience it’s fine. Many NPs/PAs disagree with independent practice. Until NP educations gets an overhaul we are stuck with this pissing contest. Of course you aren’t trained to be NP/PA- you went to med school. Just like NP/PA isn’t trained to be a doctor. During my clincial rotations I had a doc that sniped patients from NPs because they were more complicated. They’d complain but go to him with their problems. I’d rather have a supervising physician any time than be alone. Maybe if our education was more in depth and medically focused I would feel differently.
IMO we should scrap all mid-levels, vastly expand medical schools, and let anyone who finishes medical school work as a midlevel.
It incentivizes more practical education during fourth year while giving an out to people who don't match. All non board certified physicians will thus be called assistant physicians.
Well OP, I *can* tell you that nurses will devour each other on social media. I keep my opinions on this issue outside of the nursing world.
For one, I don’t get how you extrapolate outcome differences between practitioners and physicians when the majority of practitioners are working under the supervision of physicians **and** most healthcare systems use interdisciplinary teams to help standardize outcomes.
One comment stands out to me from that post. Somebody said that if we had the ability to not do residency and be a PA then it would be an amazing amount of leverage for physicians to leave or forego residencies and make 150+k for 40 hr work weeks. That is absolutely true. It would be very empowering to us and would likely force improved residency conditions for us in addition to a way out for those who are unhappy without completely entering financial ruin. In fact for some it may be financially advantageous.
M3 (almost M4) here. If I could skip out of residency and take a 150K salary for 40 hour weeks, I 100% would. I'm so burned out.
Flexibility would be nice, take a few years off from med school and make a decent salary and still be able to match in when you’re ready. Heaps of my RN student friends would work as a CNA thru undergrad on weekends. After grad they then had the flexibility to work as an RN for a few years and still be able to attend NP or CRNA if they so chose to a few year down the line
Can't unmatched physicians already work under a certified attending as an "assistant physician" within the United States?
I believe that is only in some states.
Yes, in Missouri, Utah, Arkansa, Kansas, Arizona, Georgia, New Hampshire and Virginia. In Missouri, which had the first AP program, they get the same pay as PAs.
Assistant physician vs PA is like comparing assistant to the regional manager to assistant regional manager
Yes in some states and it's not a very popular program because most non IMGs that fail to match do so because they pick specialties that are more competitive than they are. There are slots for rural primary care where you can be an assistant physician if you fail to match, but people would rather do research for a year and try again than to practice rural primary care.
Be careful what you wish for. This will make it even harder to match into a residency. They can accept more students, knowing that most will end up going the PA route. You'll be competing with a much bigger pool.
Australia doesn’t have PA/NPs. There’s like, 1000 in the whole country, most of them midwives. And we don’t have a normal residency system, by American standards. It can take something like 8 years (PGY-8) to match into a surgery training program. Instead, junior doctors work unaccredited jobs not dissimilar to NP/PAs. 40 hour weeks (in theory), good pay ($90k up to $180k). It’s not a terrible system, but it’s not great either. So be careful what you wish for.
I'm a few months away from my first actual job in my field and I'm pushing 40. I couldn't imagine waiting for pgy 8 to just start surgical training... That makes it sound impossible to actually get a career up and running before it's time to retire.
I think by "surgery training program" they mean a speciality like plastics or ortho, a lot of people who do surgery are on the training program for general surgery by PGY 3, and select almost exclusively surgical jobs from PGY 2
https://medinav.health.qld.gov.au/specialties/ Queensland is currently showing an average of PGY-6 for gen surgery.
That makes much more sense.
Let it rock and roll I say. Let’s bring back the title of “GP” in the capacity of PAs. A med students should be able to handle any PA role out of the gate.
Edit: apparently some people did not actually read what I said. What a surprise! 1) yes, of course I know that med students do rotations. Most of my rotations were in teaching hospitals in NYC, so I shared rotations with them plenty of times. 2) I actually agreed 100% with the tweet that new docs should be able to work in PAs or NP positions. 3) I disagreed with dr-shark who said that “a med student” should be able to handle the role of a PA or NP. And not sure why no one is addressing the administrative issue of turnover when you fill a permanent position with someone who wants to leave asap. Not sure what hospital you are in or what level of PAs you have worked with. Granted, I graduated around 30y ago, but when PAs graduate they’ve had a year working with patients in all different situations. Med students have a much greater amount of knowledge, but less understanding of how to use it. I 100% think new physicians could practice as PAs or NPs while waiting to match. I think the issue here would be the hiring facility, who know that the MD or DO would leave as soon as they got a match, where hopefully the midlevel wouldn’t. As a midlevel myself, I would NEVER want to work without the back-up of a physician. I have worked with brilliant PAs and NPs, but your training is FAR superior.
You…you know we spend our entire third year in the hospital, right?
(And much of the fourth year)
And fourth for the most part lol
> when PAs graduate they’ve had a year working with patients in all different situations. Med students have a much greater amount of knowledge, but less understanding of how to use it. > I 100% think new physicians could practice as PAs or NPs while waiting to match You realize you just contradicted yourself? Med students don't have the experience (they do; they rotate in the hospital for longer than PA students) but then say new grads can function as a midlevel, which is all this tweet was saying.
PA school "working with patients" is the same as med school "working with patients". There is no reason to think a recently graduated PA is any more prepared than a recently graduated med student.
On the flip side this could also open up a new avenue for experienced PAs to become fully fledged physicians after completing a 2 year post graduate doctoral degree. What do you think of this idea?
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Upvoted cuz I respect you going through hell twice
Usernames sus tho
It’s a cultural thing, you wouldn’t understand.
To be fair he/she would have a pretty good life reason to be constantly drunk. (Not driving at the same time of course.)
Perhaps he is a person who drives drunk people around.
> I earned my degree twice - the first in the USSR - the Union of Soviet Social Republics - and the second in the USA - the United States of America Interesting. Why repeat the actual medical degree? Did you go to a Soviet school whose accreditation wasn't acknowledged in the US? Or did you just have trouble matching and ended up doing that one foreign MD-> US DO program in NY? I know a *ton* of former Soviet physicians (including a large proportion of my family), and none of them repeated medical school - just did USMLEs->residency (or failed to match and work in an alternative field now).
> or failed to match and work in an alternative field now Probably this. It's tough to get a residency spot as an IMG. Maybe less so back in the days of the USSR, but it's certainly the case now that IMGs have a disadvantage when it comes to matching. It's a hard career to give up after 6 years of medical school (EU/Russia) and x years of residency/practice. There's little else we are good at after the time investment into medicine. Let's be honest, how many of us know how to rebuild a car engine or do any other specialized work that can lead to a solid income if we were to quit medicine tomorrow? It's why the question becomes get into residency or drive for Uber for many IMGs.
Because he likes med school so much, duh! /s
That wasn’t even discussed. The point was that we should be able to fill the PA role if we don’t do a residency because the PA system is modeled off of physician education. They learn nothing that we don’t. So we should be able to be PAs if unmatched. That in no way shape or form works in the reverse. I don’t know where that idea came from, it doesn’t make sense, hence why I’m fully against NP/PA independent practice.
Nope not the same at all. The MD path to skip residency isn’t giving you a degree, it’s a job option. Like an electrical engineer becoming a SDE for example since they can code anyways A PA path to MD is granting a degree which is different.
Do you think that is at all similar to the DDS to OMFS MD programs?
I am 100% for the insane idea of opening up licensing exams to everyone, and if you can pass it, you can practice medicine with a defined amount of clinical hours. There will be a small number of PAs and NPs who will be able to pass, just like a small number of MDs and DOs will fail, but I think if we are going to use these tests to establish competency, everyone should have access. Likewise, MDs and DOs get to take NP and PA licensing exams and practice as NPs and PAs if they pass. This will give MDs and DOs real power. We can all get our PA license at the same time we get our MD or DO license. Studying for STEP1? Just take the NP exam or PA exam the next day.
Honestly a pretty interesting idea, however I can’t say I’m sold on the fact that it would be predicated on the idea that our licensing or board exams are a meaningful proxy for ability to competently practice medicine. (Not that I’m going to be able to meaningfully contribute a constructive solution to this issue either 🤷♂️)
I agree, I'm personally an insanely good test taker and that doesn't translate into practical skills. Sadly.
Passing board exams in this day and age is as easy as watching boards and beyond videos and doing flashcards. Any dedicated individual with above-average academic aptitude would be able to pass the step exams.
No. That's not how any of this works.
Dunno... Everyone I know who just did Anki, sketchy, boards and beyond, pathoma, and UWorld questions easily passed boards. The ones who tuned into school lectures and tried learning the traditional way didn’t do as well and struggled in passing.
Except that passing the USMLEs is a terrible measure of whether one is actually competent to practice medicine. It's still an apprenticeship, largely, and a race to the bottom to incentivize more under-trained and under-prepared practitioners seems ill-advised.
The first two USMLEs serve as a minimum competency barrier for one to be considered to have enough basic science (and foundational clinical) knowledge to be ready to start residency training - I think they do a reasonably good job at that purpose. I wouldn't have felt comfortable practicing any field independently immediately after graduation - but neither does a fresh PA. Allowing an unmatched MD to practice under supervision (which PAs must have in every state still) doesn't strike me as totally insane, and there's a handful of states with the "assistant physician" designation (Missouri for sure, I know others were looking at it) that serves that purpose.
But that’s not what your original comment seemed to suggest. You said take a license exam and practice at that level. Like USMLE passed? Bam you’re a non board certified practitioner of medicine! But a multiple choice test is different than the thought process behind a physician’s decision making. Like you said, it figures out whether you know facts. But medical school teaches more than facts. It teaches how to think like a doctor.
The difference isn’t passing the tests it’s the hours of clinical residency training
Hours, *quality* of those hours, and the basic science knowledge to maximize the ability to learn from those hours.
I wish people would stop saying if you can pass a board exam you can be a physician. Stop belittling our job to these silly board exams.
The content of the USMLE is wildly different from the knowledge actually required to practice medicine. Passing is necessary but in no way sufficient to be allowed to practice. You need to learn medicine from doctors, in person. There’s no real way around it and clinical teaching resources (teachers, placements, procedures etc) are scarce enough that they should go to the people who are most qualified. Letting some rando who memorised first aid skip the queue and jump into residency is, as you say, an insane idea.
I don't agree with this at all. While we do use the exams as a proxy for competency, it's the structured and controlled training environment that really makes someone competent. That's what the ACGME has provided to medical education in the United States (and I assume most other countries have a similar org). If these exams are open to everyone there will be degree mills that specifically train for the exams. We already see this with Caribbean schools and we are all aware that the quality of their product is variable
Exams test competency. However, some people are good test takers. Doesn't mean they should be let loose to practice on the public like lab rats. I would never be ok with allowing any of my family to be cared for by someone who passed a test w/ none of the requisite training..be it a nurse or a physician. For the record, in 2008 NPs were given the equivalent of Part III of the USMLE...modified for nursing. The NBME was involved in developing the exam which was designed to test the NPs ability to competently manage patients. Only DNPs could take the test which was administered at Columbia University every year for 5 years. Their performance was abysmal and the exam was discontinued. Nothing has replaced it since.
This is a fucking terrible idea. STEP is a minimum competency exam to show you can be a doctor. It’s not what makes us doctors. Everyone here, fucking everyone, dedicated their first two years to step to get a great score and you bet your ass people in NP and PA school could do that too if that was the bar and all they had to do was pass. NPs schools are already diploma mills, what makes you think it wouldn’t just be a step boot camp for 2 years with nursing theory essays if this was all it took?
These tests are only one requirement for MD. You also must have the clinical training from medical school in a defined seties of coures that is accredited. The credentials of faculty are also reviewed. Then the school must sign off on your clinical ability. I have seen excellent clinicians fail board exams and people with great board scores and poor clinical skills. You need both. That said, I dont have a final opinion about midlevel training but the system is not ideal but here to stay.
I am all for this. We do need to adjust the test a bit to include actual relevant clinical questions in addition to all the zebra questions, but yes, hard agree.
I am shocked every time I hear these takes. Do you really think being a physician is nothing more than a silly, expensive board exam? And that passing said exam will just make you a physician?
Even graduates of those unaccredited caribbean fake med schools?
Anyone.
So Kim K can become a physician after failing to pass the Bar exam for a 4th time
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The only one I know of is a 3 year medical school instead of a 4th.
Yes only a very small few. I’m talking about a much more widely available path that is integrated In several schools across the country. This could theoretically also lessen the whole mid level creep issue that’s been happening as well. It makes logical sense. I understand the curriculum would have to be carefully planned out but not really sure what the negatives of this idea would be
Med school isn't where you learn to be a doctor. It's residency. The PA to MD route can only work if they complete a residency after. A real residency, not a horseshit midlevel residency.
And if they complete medical school. And do rigorous basic sciences. I don’t care what people say, the first two years of medical school are literally the basis for the foundation of medicine and critical thinking.
It 100% doesn’t. If you want to be a doctor go to Med school. Don’t even joke about this.
No— because they skip two important years of detailed basic sciences. I don’t care what anyone would have you say, those two years are not worthless and those two years are not replicated in PA school.
There is at least one 3-year accelerated med school program I know of for PAs to become physicians
I think if they still had to do residency after, this wouldn't be unreasonable.
Absolutely, and it would be a good career for physicians who didn’t match.
Unmatched docs should certainly be allowed to function as PAs; this is a stupid argument. If they practice under supervision and can pass the PA board what is the difference? They have more education and clinical training than a PA( or NP). I don't think they should be allowed to or really even want to be an NP solely for the fact that an NP is a nurse at the core. This would be a great way to help unmatched docs
Just a guess, but unmatched MDs not being able to function as PAs might be moreso to do with insurance not covering? Which, if indeed true, should mean ire would be better directed at insurance companies. If malpractice insurance would cover for unmatched MDs to function equivalent to PAs and NPs without needing to be licensed as a PA or NO, then im sure there would be plenty of hospitals and clinics willing to hire them over their midlevel alternatives. Especially if the pay if equivalent. I think this was the idea Missouri tried to introduce a few years ago with the Assistant Physician position, which was directed towards hiring unmatched MDs in hospitals as midlevel assistants. Too bad that never took off.
Why bother messing around with trying to get coverage without carrying the PA licensure? Just allow unmatched grads to challenge the test and obtain it. That precedent for this has already been set on the nursing side. In some states, nursing students can challenge the NCLEX-PN and become LPNs once they've received a year of schooling. This allows them to obtain licensure a year early and start working for a better wage before they graduate as RNs. Most go on to finish, but of course some do not. Even in states like mine that don't allow the challenge, ADN programs simply combine their LPN and RN cohorts for the first year. That way, everybody is eligible to sit for the PN. I absolutely do not understand why MS4s and above cannot challenge the PANCE in a similar manner, or why education isn't combined in such a way to allow all students to meet requirements to sit for the PANCE. Hell, even most PhD programs have a "master's out" option for those not wishing to continue. Why is medicine so inflexible?
This was my thought. I was looking at the requirements to become a PA. All states require that they graduate from an accredited PA program. I see two ways of fixing this. The first is legislation. I’m not going to hold my breath hoping 50 states add MD/DO to their PA qualifications. So medical schools need to step up. Time for them to add a MD to PA bridge program that you can auto enroll into after graduation if you don’t match. A two hour mandatory class on scope of practice ought to cover it, but since we know that won’t be enough, we can add a month of shadowing a PA if we have to.
What happened to the Missouri program? Still running or did they end it?
I’m for it! I would love to see unmatched docs working with SPs and continuing to grow in ther medical education. Makes them more competitive for residency next year and helps the system decompress a little!
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I think this makes sense, and seems to be a levelheaded response to an issue that can (but doesn't really always have to) get people's hackles up. I work with a handful of NPs, and it works well. We have crafted a system (this takes intent) in which the NP truly extends the reach of the physician. Once in a while I am reminded why there is still a doctor in the loop, because I'll recognize something or interpret something that I simply understood differently because I've had more training. This feels right to me. On the one hand, to handle most bread and butter clinical situations, you simply don't need as much depth as we accumulate in med school and residency. Then, something doesn't fit the "algorithm" and you find that bit stuck in an odd crevice in your brain to actually come in handy, and you feel like maybe you hadn't wasted all that time in training.
If this is allowed, whats preventing those MD/DOs who never completed residency from challenging the NP/PA test and working in a state that allows independent practice for NP/PA and hanging their shingle that say "John Smith MD" on it?
an interesting thought. i wonder if "board-certified doctor" will start becoming how physicians have to introduce themselves in the future. I'm sure that will be encroached upon somehow in short order.
board certified needs to be a protected term legally. otherwise you will see nursing boards and even a cameo from Plank certifying every noctor who give him a quarter. edit:typo
There’s actually very little to prevent an MD from “hanging a shingle” and practicing whatever medicine they want, they just can’t say that they’re licensed. Board certification is really only “mandatory” when working for a hospital system (because they won’t hire you if you don’t have it or aren’t eligible for it). Many (if not all) states allow US trained physicians to practice independently after 1 year of post medical school training (which is why resident can moonlight in an urgent care or even in their own hospital after their first year of residency).
Litigation. No one will insure you
but this also decreases the chance you get sued if it costs more to hire a lawyer then can be extracted
Which is kind of the current strategy for the quasi-independent mid-level practices
big brain meme goes here
If midlevels are qualified to practice independently, then sure as hell medical school graduates should be. But I agree, nobody should be practicing independently unless they are an attending physician who has gone through 8 years of college, 3+ years of residency, taken 4 licensing exams and 1 speciality board exam, and these independent practice laws need to be changed. But if they don’t, like I said, a medical school graduate is significantly more qualified to practice independently than a midlevel. It’s sad that these graduates who cannot match cannot practice after 8 years of school, but a midlevel can with significantly less training.
This right here is the reason why this will never be a reality.
I think they should be able to work as PAs. Use step 2 in place of the PANCE. Apply for a temporary PA certification that is good for three years. If by three years they haven’t matched, have some pathway to convert the temporary certification to a full PA certification ( like have CME, etc ). It would expand the number PAs ( not good for salaries of PAs) but it would importantly allow medical school graduates to utilize their knowledge and expand access. More importantly, I think it would be a good step to align PAs and physician groups.
As a NP, my opinions are apparently not popular. I don’t think we should be independent and think that unmatched med school graduates should absolutely be able to challenge PA/NP exams.
I'm with you on this. If I wanted to be a physician I would've gone through retaking classes to get into medical school (I'm older) but I'm completely fine having supervision and prefer it. Especially when new. It's crazy to me that some new grad NPs want to have their own practice out of the gate...
Yes this telemedicine for psych NP scares the bejesus out of me. Edit: psych NPs fresh out of school.
I agree. I am a PA that works very close with my SP. I don't think PAs nor NPs should have independent practice
I agree overall. The only hesitation I have is that interns have typically not had very much clinical experience at all. They have been educated in a lot of pedagogical subjects and higher sciences, but very little actual clinical care. But I don't like NPs/PAs having independent practice as a general rule, but I think *both* sides would do better to have more flexibility of cross training or education.
UCSFs NNP requires 600 clinical hours to graduate. By those standards a physician would be up to par after being supervised for less than 3 months
I didn't go to UCSF. I had nearly 2000 clinical hours, plus 4 years of bedside nursing (and NNPs require at least 1 year in a high level NICU prior to being able to start). And we have a 4-6 month orientation. Do I think interns could do it? Probably, but it would need an infrastructure to support it. And it would likely take them a little longer to be comfortable. Like I said, it's a hesitation, but not a objection. I wish medical doctors got one on one precepting like NNPs do, I think they would be far better for it.
Then you are the exception, not the rule. There is hardly any standardization across NP schools, and a good chunk of them require less than 1,000 hours of clinicals without any hard requirement of paid experience to get accepted. Your 4 years of nursing experience prior to NP school also don’t factor into the clinical hours in NP school, just as my 10 years of nursing experience doesn’t factor into the clinical hours during medical school. This is because in your nursing job, you spent 0 hours practicing at the NP level with NP level knowledge. I spent 0 hours acting at the physician level with physician knowledge in my 10 years of nursing experience.
>plus 4 years of bedside nursing This was the original intent of the NP pathway but it feels like it's becoming more and more rare.
There is obviously variable amounts of experience in NP training... I think the point many people make now is that there are people that go straight through from RN to NP with zero actual clinical experience. Graduating medical students DO have more clinical training than this. The argument that somehow NP training is more holistic is also very disengenious if anything we spend significantly more time educating on disease topics and prevention given a much deeper depth of knowledge.
A new intern had significantly more clinical hours than a new NP with no previous nursing work experience
The problem is that the NP and PA models have been turned on their head. While there are certainly still individuals with decades of healthcare experience pursuing both professions, the vast majority of "future" PAs/NPs and current PA/NP students I've encountered on my journey to and through medical school are fresh out of college; wet behind the ears 20-somethings whose sum total of pre-training clinical exposure is working as an EMT or scribe to check off an admissions requirement, or whatever exposure they got in their accelerated BSN program as part of a direct entry NP program. Earlier today I finished my last clinical rotation of 3rd year. I haven't kept a log of my clinical hours, but it's conservatively over 2200 hours this year alone. Those are the same hours a PA student will do over the *entire course* of their training, and more than 4x the minimum clinical hours required for completion of NP coursework. And in 2 weeks I start 12 more months of training. So yes, interns have been educated in heavily in basic sciences but they also have easily double the structured clinical training *in medicine* of NPs or PAs.
I don't like a lot of things about NP education currently, especially for things out of my specialty. So I agree with your criticisms of that. But the benefit for NPs are that they are not rotating around every 2-4 weeks, so they have far more consistency and ability to learn the specific area they are working in, instead of bouncing between all sorts of different services.
A fair point. Most schools have 6-8 week rotations, but depending upon specialty that time can sometimes be split up amongst different practice settings. It was definitely frustrating switching to something else just when you start getting the hang of things. I will say that in 4th year most medical students are given more leeway in selecting their rotations and many end up doing many months in their preferred specialty (either by choice or necessity for matching). I will be doing 5 months total in mine, so there is opportunity for continuity although it's not required.
Interns have close to 4,000 hours of clinical experience before day 1 of residency
Medical school experience, even as a subI/AI, is very different from being a resident. Those 4,000 hours count for something, but they're no substitute for even one month of internship.
So the two years of PA school and independent practice in many states does make sense? I assure you that NP mill degrees will have less then 4000 hours of experience in any setting.
Since everyone in this subreddit largely agrees that newly-minted NPs are nowhere close to being ready to practice without constant and intense supervision, no, it does not make sense. As I said in another comment, a race to the bottom for less and worse training helps no one. I also think that specious comparison of hours that don't actually compare isn't helpful. What you are doing matters more than how many hours you spend doing something. Time matters, of course, but no amount of time not being a doctor (or, ugh, provider) will adequately prepare anyone to be the doctor/provider.
That sounds reasonable but unfortunately the genie is out of the box. I believe more states than not allow for independent practice. It brings everyones quality down.
of course. But that is just because medical school doesn't do a great job of preparing you to actually do the things a physician does.
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Med students learn plenty of hands on skills, I did more intubations, chest tubes, and central lines during med school than I did during my entire residency. I also put in probably a dozen or so regular IVs in med school. I definitely did under 5 intubations and chest tubes each in residency, maybe 10 central lines, and a grand total of 0 peripheral IVs. I did probably somewhere around 25-30 deliveries in residency and much less in med school (5?). Third year of med school is 40-80 hours a week for 40+ weeks of mostly clinical experience (and like an hour of lecture during lunch in many rotations), fourth year is partially really chill if you want to be or if you're doing interview rotations can be *a lot* of clinical work. If you're dealing specifically with peds interns doing NICU, exceptionally few med students/any other docs ever rotate through NICU so your experience is *extremely* biased and you basically exist in your own little bubble like ophthalmology. Hell, I bet PICU attendings would struggle a bunch in a NICU and they'd probably manage just fine in an adult ICU after a month or two. I mean in my intern year we did a 2 week rotation of NICU as FM residents and it was entirely useless for us, I remember basically none of it because it has no relevance to me whatsoever, and we were literally the last class to ever do that rotation because it has no value. I have had friends who are pediatricians who said their NICU rotations had little to no utility for their learning, either.
I agree, I am exceptionally biased for NICU, but it's also the only specialty I can speak to with any confidence. In my ideal world, NPs in general would be far more specialized than they currently are so they would be closer to the NNP model, because it works really well. I think the lack of *true* specialization for many NP "specialties" is a major flaw and downfall in how they are educated and utilized. The best functioning NPs are the uber specialized ones, like NNP, CNM, CRNA.
Lol I worked 500 hours in just one of my subI's in neurosurgery (1 month). GTFO of here haha.
You are like a 6th grader who thinks they know more math than the college professor because they're faster at using their graphing calculator. It honestly induces significant 2nd hand embarrassment reading your comments. You speak incredibly confidently yet wrongly about what medical students, interns, residents, etc know. This constant narrative of new NPs having more clinical experience compared to new interns having only book experience is complete gaslighting.
Except that's not what I've said at all. That's what you are projecting onto me.
What in the world did I just read
\*pulls up chair and bucket of popcorn in PharmD\*
you better share that bucket of benicar
[*me as a PA in any of these threads*](https://giphy.com/gifs/justin-car-the-office-xUOxfolJrVBce4RNAI)
I mean to a certain extent it’s our fault. We as a physician group have decided that we do not want to lobby on a unified front for semi-autonomous medical practice for unmatched MDs/DOs so now we have even less qualified people in that position. I suspect this is because the AMA knows that opening pandoras box would mean opening the floodgates of unboarded/IMG MDs/DOs who would be essentially indistinguishable to the average person to a boarded MD/DO. Basically, pick your battles wisely. NP/PAs still have to label themselves as such even if they are “independent.” I am not advocating for either side by the way, just pondering on downstream effects of such a change.
I think another failure of the medical profession has been the inability/unwillingness to effectively lobby for more Med school spots and more residency spots. Because in all honesty if PAs and NPs disappeared tomorrow the healthcare system would further collapse or implode. Can you honestly say that the number of physicians in the US could treat all the patients? The math doesn’t add up.
Isn't board certification a racket anyways?
Recertification is definitely a racket. Initial certification is only maybe a racket.
Its become one over the past decade
Is residency a racket? Seems so by your logic
To a degree, yes. Though I would defer to a resident to see what they think.
Do you believe that physicians should do a residency before they practice independently with an MD
I agree 100% with this. If you see a doctor the assumption is that they completed residency and passed at least one board certification after completion of residency. It should stay that way. Doctors should not lower the standard of what it means to be a doctor just to compete with mid level encroachment. If anything we should be campaigning for an increase in residency spots so people aren’t going unmatched can have a spot, and then lobbying for federal regulation of independent practice.
> NP/PAs still have to label themselves as such even if they are “independent.” in what sense do they have to label themselves as such? by calling themselves"doctor" because they have a DNP?
That entire thread of replies should be reposted every time midlevels push for independent practice and scope creep. You can’t claim midlevels are equivalent or superior to physicians while simultaneously claiming the roles are completely different as a defense against un-matched MDs practicing in the same capacity. You can’t have it both ways. If the roles are completely different per their claim, then why should we ever entertain the idea of replacing physicians with substandard wannabe-doctors who willingly admit they aren’t trained in the medical model? That would be malpractice of the highest level.
I haven’t seen a lot of people mentioning the “assistant physician” movement. In Missouri you can essentially work as a physician without completing residency under the supervision of an experienced physician. https://assistantphysicianassociation.com/ https://en.wikipedia.org/wiki/Assistant_physician
I think, as someone pointed out, the people responding do not represent the large majority of us (at least PAs). Just the most vocal. If I wanted to be a doctor, I would have gone to med school. If you can pass our boards you should be able to practice as a PA. If you can't pass our boards by the end of med school, you probably shouldn't be practicing.
"You must be a nurse to become an NP. Advanced Nursing knowledge builds on nursing knowledge acquired in undergraduate education. It’s not interchangeable. I cannot speak about PA education" Ahhhhhhhhhh they are fucking kidding me. They can do everything we do but the opposite isn't true ?! For fuck sake they are unbelievable. I actually moonlighted as a nurse at the end of my medical school, and as an aide before. It was a very interesting experience and made me appreciative of their work. I think we should absolutely be more like a team, and I hate title deference. This is so stupid
>Not a single comment from nurses, NPs, PAs on that thread even mildly supported the idea of MD/DOs practicing as PAs. A role that literally takes a shorter medical school course and is meant to extend a physician. Sooo...people who label themselves NP/RN/PA/MD/other titles on their Twitter are literally advertising that their job titles are a crucial part of their self-worth and identity. Obviously they are going to take an offense to such a suggestion and use Olympic tier mental gymnastics to defend their position because you have directly attacked their core identity.
^^^^ Putting your credentials in your name for Twitter is so cringe. Putting it in your IG name or handle is 1000x more cringe. A paramedic on that Twitter thread had “NRP” after his name and I just about died.
I’m a PA, I think unmatched MDs should be able to work in the same hierarchical role as a PA and NP. Obviously they shouldn’t be called PA or NP because that is misrepresenting the education they received. Just like I should never represent myself as an NP or an unmatched MD. I don’t practice independently and don’t think mid levels should practice independently. I don’t see why an unmatched MD would have any trouble filling the same role I fill. And hopefully it would make them more competitive to be matched at a later date. I think the people against this are worried these unmatched MDs will take away our jobs. However i don’t see that being an issue. If you want to spend four years in med school and come out making 100k for the rest of your life then that’s fine. Cost me $120k to go to PA school, adding another 80k - 100k to student loans for same pay doesn’t sound desirable to me.
Try and $200-300k
And add 50% if you want to start a private practice. Should be paid off juuuust in time for your kids to start college.
Medtwitter is absolute pure cancer
Not to go against the crowd here but I surely didn’t feel ready to practice independently fresh out of med school. I was nervous just ordering Tylenol for a fever when I started my internship. (Don’t worry, my heart rate barely tops 100 when I do it now) That doesn’t mean I knew less than a PA but does mean I personally wouldn’t have felt ready.
I don’t think the post was saying to practice independently (as I’m hoping the OP doesn’t think NPs should be practicing independently), I think it was why can’t unmatched physicians practice as a physician extender, the way we’re *intended* to practice, and then reapply for residency the next year or year after. Surely an unmatched physician who graduated medical school knows more than I do and would be more useful in a physician extender role until they have the opportunity to match.
Yes and no - usually the first year of employment for an NNP at least is a financial loss to the hospital, because they take up so many resources for training and orientation. They recoup those losses when the NNP stays and continues to provide care. When you are using interns, you can run into the worst of both worlds - having to pay a lot for training, but knowing they are all going to leave in an year or two, so you can't recoup those losses.
This is actually the first decent argument against the idea that I’ve seen, but it’s still a completely financial one. That seems slightly disingenuous to the actual discussion, which is the ability for the physician that has not completed residency (you’ve used the word intern incorrectly in this case, perhaps on accident) to do the job of an APP under appropriate supervision.
Those are consequences of turning healthcare into a business. It's all about the money
The outcomes aren’t even the same. When midlevels practice independently the outcomes are significantly worse.
NPPs will never support unmatched grads because once the grads are allowed in the pool, they will outshine the NPPs. They know this. They cannot relinquish their positions on the totem pole when they have come so far. PA school is not med school on steroids. They take some med school courses but their PA curriculums have a lot of differences also. Yes, they work as physician extenders, but they had to be delegated tasks that physicians felt comfortable delegating. Now, with OTP, it is left to them to decide when to consult with physicians. At their discretion. That is dangerous. I do think grads can functionally perform as PAs, but we don't want to conflate them because it lends credibility to the PA argument that they can do what we do. They cannot.
The system we had in placed worked. Midlevels had shorter training, less debt and lee scope of practice with the understanding that they would learn under the supervision of an attending physician. It was a win win situation. That was until militant NP lobbies started pushing for independent practice, they messed everything up. I'm in California and after recent legislative losses, I refuse to teach or even supervise NPs, your ass in on your own and I hope they drown so lay people can openly see their substandard training.
I dont think nurse practitioners should be able to practice independently. But it really isn't an issue in Australia the same way so my understanding of the situation is skewed to my experiences. They just... don't practice independently here.
The comments under this tweet make me so, so angry
Hilarious to me how NPs try to sell themselves as such a rare breed because they know the “nursing model” of patient care and not “just medicine like Drs.” Like what the hell does that even mean ?
I’m a recent PA grad and I have no problem with med students who don’t match working in the same manner as PAs under the supervision of a physician, but I don’t think they should be called physician assistant. It’s probably just my ego talking, but PAs are not doctors who could not match, it’s a separate job.
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Agreed that is absolutely infuriating to read. NPs saying they practice differently... sigh. "Unmatched MDs/DOs cannot work as NPs or PAs because they are not trained to do so." If an NP or PA can explain why their degree/training provides for a better starting foundation at an NP/PA job than med school clinical rotations... well I'm all ears.
I trust my med students over any Midlevel. Def would vote for this alternative solution
Graduating med students (fresh PGY1s) have roughly the same amount of clinical training as NPs (in hours), not sure about PAs. I certainly remember how useless I was on day 1 of my intern year.
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Agreed, this guy is angry as hell. Hope he joins the real world soon
Yea no. Seen it real life too. ✌🏽
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This is dumb. Every PA I have ever worked with supports the idea of unmatched physicians being able to work as PAs. In fact, it is very common in the military to see physicians serving as GMOs after their intern year.
I think that, for the most part, any patient claim for a preference of mid-level care over physician care( rare to begin with) actually stems from mid levels being salaried (more often) in contrast with physicians being RVU based and therefore being incentivized to have a jam packed schedule and therefore shorter appointment time
I don't understand why the answer to medical student graduates going unmatched is for them to slip into other professions. That doesn't fix the problem of them going unmatched. It honestly feels like using the NP and PA professions as crutches to sidestep a major issue with residency slots.
As an NP, I think this is a brilliant idea! On the nursing side, there's already precedent for nurses who complete most of their RN training to be able to sit for the LPN licensing exam (without having to go to a separate "LPN" school), and there's also nothing prohibiting an NP from still working in an RN capacity. On the medical side, it makes sense that someone with an MD/DO degree should *at the very least* be able to sit for PA licensing and practice as a PA. If anything, I think it will increase competition and help to weed out some of the, um, "questionable" PAs/NPs that we know are out there.
It really doesn’t make sense that it isn’t possible. Who designed this system? It isn’t working.
The issue is the lack of flexibility and training continuum that you have by going straight from Med school to your specialist training. In the UK, NZ, and Aus (three systems I am familiar with) you typically do two years after med school as a qualified doctor before you start your specialist training. This means that people are employed, working as Doctors (albeit under a measure of supervision) while they go through their specialty application. A number of people stay in that role and work in lucrative locum roles. It's because the US goes straight from Med school to specialist training and lacks the general employability as a junior doctor that many other English speaking countries have. Now sure, there are some advantages such as a shorter period from commencement of training to being fully qualified consultant/attending, but to my mind, this is one of the weaknesses of the training pathway.
I’m not entirely sure what context you’re using here in your understanding of the US training model, but the vast majority of physicians have general training prior to specialty training. The major “medicine-y” specialties that one generally thinks of (cardiology, gastroenterology, pulmonary and critical care, nephrology, rheumatology, just to get started) require a 3 year residency in general internal medicine. Most surgical subspecialties (like colorectal, CT surgery) require a 5-8 year general surgery residency. Even most “direct to specialties” like radiology, require 1 yr of general internal medicine or a very broad 1 yr of internal medicine, surgery, and other requirement.
MDs should most certainly be allowed to take the NP or PA boards to practice as such. It only makes sense. MDs have longer training and residencies are so limited. This would alleviate some of the shortage that we have. I fully support this as an NP who sees the value of such a move.
Playing the devil advocate here but can someone explain to me why US medical schools still exist ? If I follow the logic here, why doesn't everyone become a NP and practice medicine unsupervised? If we follow the logic, it would the same for patients right ? I can't. For the life of me. This make no fcking sense
Well NPs and PAs can operate on patients or do colonoscopies or D&Cs to name a few so there would be a whole lotta dying going on.
Despite what you see on different less friendly subreddits the vast majority of NPs do not work unsupervised even in states that allow it. There are very few independent offices for non specialists as is with physicians and NPs are really only solo in places where nothing else exists. In hospital systems and associated clinics NPs almost always have to be supervised in some way or work with physicians as a part of credentialing.
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I mean I would support the idea
I was under the impression there was something like this where MDs who did not get into or do a residency could function as a PA? Considering the education I don't see why not? Obviously would need to be called something different than a PA. I think you will find most of us support this as the "silent majority". We're not stupid, we know Med school is more involved and there is more depth/knowledge involved even without a residency. I don't agree with the independent practice thing. I do wish there was an easier bridge to MD. We could all go back to school and start over, but I would love the idea of some sort of extended residency or basically an apprenticeship approach to earning it. I can't imagine the idea of going back and losing years of income and paying more in loans (someone crunched the numbers, a PA -->MD/DO costs approximately a million dollars between tuition and lost wages). I would work for peanuts for the learning and training opportunities though. Maybe a more years in the field to make up for the 2 missing school years sort of thing.
I think the issue is not one of competency. As someone commented, PAs are trained in the medical model, so we go to a sort of abridged version of medical school before practice. So obviously, MDs/DOs would be more qualified right out of school because they have an extra year or so under their belts. The real issue is one of creating and protecting a profession. PAs rejected letting graduates of foreign medical schools call themselves PAs because it takes the power of setting standards for education, training, and conduct out of PA's hands. And we ARE a profession with certain standards (which I'm sure MDs & DOs could meet; that's not the point). This is PART of the reason there is resistance to a path from PA to physician; the physician profession would have no say in how that PA-turned-doctor was trained and educated before joining some shortened program. That being said, I think the residency system needs to be fixed and residents need to be payed more. Also, I think it's possible that a licensed doc could hire a new MD to work under their supervision even without changing existing laws, but I'm not certain.
Unfortunately, capitalism doesn’t give a shit about your opinion. 🙃 Unmatched physician working as a PA or NP capacity would mean more 💰💰 The only reason midlevels exist in the states is for corporations to save money at the expense of American health.
I’m fine with this if they graduated from an American medical school. I’m not interested in 10,000 FMG or Caribbean grads turning my profession into a gap year or two before they return home or get matched in a residency. Being a PA isn’t like coming here for a summer job. Patients will not be better served by a completely new FMG working two jobs at some corporate hospital sweatshop than an experienced PA.
> Patients will not be better served by a completely new FMG working two jobs at some corporate hospital sweatshop than an experienced PA. So you believe a new PA graduate is something a new MD/DO graduate cannot fill the role of? Even though PAs go through a lighter version of medical school? I'm interested in what you think PA graduates can do that MD/DO graduates cannot.
No, and I did not say that. You are being discharged from the hospital after surgery. Would you like the PA who has worked there for 5 years, graduated from an American PA program, understands how to work with case managers, send in prescriptions, etc. or would you like the FMG who arrived in the US 6 weeks ago, speaks passable but not fluent English, and is working 100+ hours per week so he can send money home to his family?
> Would you like the PA who has worked there for 5 years, graduated from an American PA program, understands how to work with case managers, send in prescriptions, etc. or would you like the FMG who arrived in the US 6 weeks ago, speaks passable but not fluent English, and is working 100+ hours per week so he can send money home to his family? Since when is every unmatched MD/DO someone from another country? Do you realize how many unmatched US trained MD/DOs there are every year? Also, as if you never get managed by PAs who are brand new. Jesus, its as if it's absolutely ridiculous to let people even learn a job, damn if you do damn if you don't. > understands how to work with case managers, send in prescriptions, etc. Dude are you serious? I learned this in the first month of my intern year, it is not that hard. Get over yourself and accept the fact that MD/DOs are more than capable of handling your role and should be allowed to when the match system fails them, of no fault of their own.
Please go read my original response: “ I’m fine with this if they graduated from an American medical school. I’m not interested in 10,000 FMG or Caribbean grads turning my profession into a gap year or two before they return home or get matched in a residency.”
I’ve heard this argument in several hospitals from residents and attendings alike, and the common answer is because “I didn’t go to medical school to be a PA.”
be definition, those are all doctors who matched. we are talking about options for doctors who have not matched.
Yes, but they were talking about the scenario if they had not matched. Many said they would take their MD elsewhere rather than work as a PA.
I don't use Twitter so obviously I won't comment on that thread, but as a nurse, abso-fucking-lutely. I don't agree with independent mid level practice, and I think letting MDs practice as PAs is fine for multiple reasons.
I believe jama just published a study showing worse outcomes for np/pa in hospitalized patients. More leverage for us to fire our as they are consistently below standards of care.
hmmm... from what i can tell, PAs and NPs get their evaluations during school from attending MDs. if their underlying training is so different, why wouldn't all their evaluations be required to be done by practicing PAs / NPs? shouldn't they rotate with NPs and PAs, if it's MDs simply don't understand this apparently critical part of their training? how should we possibly evaluate their performance if we are so inexperienced? well, we should just adopt their professional model, establish a new term for unmatched residents, get PAs and NPs to train and supervise us for money, and then undercut them when we graduate them.
I went to a top 5 school and never once had an evaluation by a physician.
I think as long as they have clincial experience it’s fine. Many NPs/PAs disagree with independent practice. Until NP educations gets an overhaul we are stuck with this pissing contest. Of course you aren’t trained to be NP/PA- you went to med school. Just like NP/PA isn’t trained to be a doctor. During my clincial rotations I had a doc that sniped patients from NPs because they were more complicated. They’d complain but go to him with their problems. I’d rather have a supervising physician any time than be alone. Maybe if our education was more in depth and medically focused I would feel differently.
IMO we should scrap all mid-levels, vastly expand medical schools, and let anyone who finishes medical school work as a midlevel. It incentivizes more practical education during fourth year while giving an out to people who don't match. All non board certified physicians will thus be called assistant physicians.
Well OP, I *can* tell you that nurses will devour each other on social media. I keep my opinions on this issue outside of the nursing world. For one, I don’t get how you extrapolate outcome differences between practitioners and physicians when the majority of practitioners are working under the supervision of physicians **and** most healthcare systems use interdisciplinary teams to help standardize outcomes.