CBC health reporter graduates as physician assistant

[PAstudent]

I really really dont get it--if they have "almost the same training as in med school," what is the rationale of NOT going to med school? Higher pay/responsible/influence for what you claim is not much more school--why wouldnt you just do an MD?

 

And I really dont buy the "have better job flexibility." Even if an MD is trained within an extremely specific specialty, they still have enormous flexibility. Is this actually a sort of "saving face" reason, with the real reason being that these programs are easier to gain admission to?

 

The M.D. students do residency, we don't. And, during their M.D., as I mentioned in the earlier posts, they delve deeper into the "zebras" and rarer things.

 

Everyone has there own rational for being a PA. I was actually admitted to MD programs when I graduated with my first degree but choose not to go at the time. I traveled, experienced life in different parts of the world, came back home, and decided I still had an interest in medicine but still did not want to commit to the training involved in becoming a physician. I knew about PAs in the USA and was very happy when I found out this was a possibility for me in Canada. I would rather do 24 months straight and then make work and make money rather than 3-4 years of school plus as much as 5 years of residency, all the while being more in debt (I am still in debt from my first degree). Financially it is a better option for me and pragmatically it is a better option for me. But everyone is different, I can only speak for myself. Several of my classmates are older students coming into this as a second career.

 

As for admissions, the McMaster program is not easy to get into. Check out: http://fhs.mcmaster.ca/physicianassistant/prospective_students.html

 

There is a minimum GPA requirement of 3.00 (which is the same minimum for the MD program, though most successful applicants have a higher GPA). There is also a written sketch (like the M.D. applications, though they are switching to CASPER now which the PA program might do) and then the interview is the MMI (again, like the M.D. program). There are 24 of us in this class selected from I believe just under 300 applicants. I believe about 60 people were interviewed for the 24 spots. These figures might be a bit off as I am estimating from memory.

[astrogirl]

PAstudent, thanks for all the information you've shared. I didn't know very much about what PA's actually do, and it's nice to be able to learn about that.

[hastin11]

The M.D. students do residency, we don't. And, during their M.D., as I mentioned in the earlier posts, they delve deeper into the "zebras" and rarer things.

 

Everyone has there own rational for being a PA. I was actually admitted to MD programs when I graduated with my first degree but choose not to go at the time. I traveled, experienced life in different parts of the world, came back home, and decided I still had an interest in medicine but still did not want to commit to the training involved in becoming a physician. I knew about PAs in the USA and was very happy when I found out this was a possibility for me in Canada. I would rather do 24 months straight and then make work and make money rather than 3-4 years of school plus as much as 5 years of residency, all the while being more in debt (I am still in debt from my first degree). Financially it is a better option for me and pragmatically it is a better option for me. But everyone is different, I can only speak for myself. Several of my classmates are older students coming into this as a second career.

 

As for admissions, the McMaster program is not easy to get into. Check out: http://fhs.mcmaster.ca/physicianassistant/prospective_students.html

 

There is a minimum GPA requirement of 3.00 (which is the same minimum for the MD program, though most successful applicants have a higher GPA). There is also a written sketch (like the M.D. applications, though they are switching to CASPER now which the PA program might do) and then the interview is the MMI (again, like the M.D. program). There are 24 of us in this class selected from I believe just under 300 applicants. I believe about 60 people were interviewed for the 24 spots. These figures might be a bit off as I am estimating from memory.

 

THanks for the info. I suppose for older individuals I can see how it may make sense. Although for younger people (say, those finishing undergrad at 21) it wouldnt really make sense at all. Med school at Mac is 21,000 over 3 years--most of the class gets 10,000-13,000 of that free in grants, and everyone makes an additional 7,000-10,000 free from the government in their final year. In residency, they start at almost 50,000 a year, and by year 5 can make 70,000 (which may be equivalent to a PA, by your figures).

 

That being said, this is a very informative thread; and despite my above argument, you have brought up really good points.

[PAstudent]

PAstudent, thanks for all the information you've shared. I didn't know very much about what PA's actually do, and it's nice to be able to learn about that.

 

Astrogirl, you are more than welcome. And thank-you for taking the time to read my posts, I am glad that you find them informative. I am happy to answer any questions and clarify to the best of my abilities. I, like my classmates, am excited to be one of the pioneers of a relatively new profession in Canada and I know that, in that capacity, I must do my best to represent the profession and educate about it.

[future_doc]

I really really dont get it

 

hastin, as you are aware even top students don't get into medicine and there are far more excellent candidates than there are seats available. We all need to plan for doing something other than medicine. Going directly for P.A. is an excellent approach for many. No doubt, all applicants for P.A. have a Plan B as well, as I expect, not all get in. There are considerably less years of study, they are doing well financially and making their contribution to society. And they are pioneers in our healthcare system. So, I think I get it.

[samy]

Is there an equivalent of PAs in Quebec?

[future_doc]

Is there an equivalent of PAs in Quebec?

 

I think they are called physicians.

[hastin11]

hastin, as you are aware even top students don't get into medicine and there are far more excellent candidates than there are seats available. We all need to plan for doing something other than medicine. Going directly for P.A. is an excellent approach for many. No doubt, all applicants for P.A. have a Plan B as well, as I expect, not all get in. There are considerably less years of study, they are doing well financially and making their contribution to society. And they are pioneers in our healthcare system. So, I think I get it.

 

This is essentially what I said if you read my post (or my later acknowledgement of the OP's response)

[PAstudent]

THanks for the info. I suppose for older individuals I can see how it may make sense. Although for younger people (say, those finishing undergrad at 21) it wouldnt really make sense at all. Med school at Mac is 21,000 over 3 years--most of the class gets 10,000-13,000 of that free in grants, and everyone makes an additional 7,000-10,000 free from the government in their final year. In residency, they start at almost 50,000 a year, and by year 5 can make 70,000 (which may be equivalent to a PA, by your figures).

 

That being said, this is a very informative thread; and despite my above argument, you have brought up really good points.

 

 

You are more than welcome, if you have any other questions please don't hesitate to ask; I will try my best to answer. I also want to point out that, as I said, everyone has different reasons for choosing the PA route. There are younger people in my class as well. I have met some young female PAs that told me they knew they wanted to have a family and make that their priority but they were also interested in medicine so for them, doing the PA route let them start a family earlier and in an easier fashion than if they had gone the physician route, that was the rational they explained to me. As a man, I am only relating what I have heard.

 

Not everyone wants to be a physician and I am sure that there are as many different reasons why an individual chooses to become a PA as there are PAs. Some people just want to be PAs.

[future_doc]

This is essentially what I said if you read my post (or my later acknowledgement of the OP's response)

 

You are correct. I only saw/read your later acknowledgement after I posted.

[bustylegs]

To think of it another way: Is MD training too long?

 

Personally, some days I do think so: It's not hard to manage a CHF, since others have already worked out an algorithm to follow.

 

Other days I'm not so sure: A stented triple-vessel disease with a grade III LV admitted for CHF exacerbation, AKI on background of CKD, now is hypotensive secondary to a fib...

[leviathan]

I went to school with a few Americans who used to work as PAs. I think they were overall really knowledgeable and able to handle the basics. However, even in their own opinions, there was a large gap between what they knew before med school, and what they learned after 2 years of basic sciences. I don't know if that would lead to a noticeable difference in abilities, but I will be interested to hear from them after we are done clerkship and residency.

 

I think the common theme is that people say they "didn't know what they didn't know", and the fact that PAs are often working in very independent settings without supervision is what scares me. When it comes to care by a trusted PA for problems that are supervised by an MD, I have absolutely no worries about it.

[PAstudent]

gap between what they knew before med school, and what they learned after 2 years of basic sciences.

 

Yes, I think you make an excellent point that helps differentiate the training of PAs and MDs. From what I understand, the amount, level, and depth of basic medical sciences in the traditional MD curriculum are greater than what is gone into in most PA programs. Things are a bit different at McMaster though because of how the MD and PA programs differ from more traditional programs. I have many friends in the M.D. program at McMaster and many friends who graduated the program and are now in residency. From what we can gather, they do the same tutorials and same cased (made-up patient presentations that we use as springboards for learning) problems as we do but they often intentionally delve deeper into the pathology and pathophysiology than the PA students. There are also large group session lectures that are optional for the M.D. and P.A. students to attend. The PA students tend to focus more in clinical reasoning than on minute details of pathophysiologic mechanism (though we do go into it). But we take the same exams (Personal Progress Index, Clinical Reasoning Exercise, OSCES) and from what I understand, PA student performance and MD student performance have been on-par.

 

Now, the thing is, my classmates and I all come from different backgrounds so while some people need to focus on the basics, others are able to spend their time studying things at a greater level of depth, akin to what you might learn in a traditional M.D. curriculum.

 

To me, that is one of the advantages of a PBL curriculum: the ability to direct and taper one's own learning based on his/her level of knowledge/skill.

 

But this is now looking like a McMaster/PBL VS more traditional route debate and I don't want to hijack the thread for that purpose.

 

I just wanted to use what you said, leviathan, to help explain further how MD and PA learning is alike and how it differs, thank-you for the contribution. I am tired and about to go to bed so I hope this posting was coherent, if not, please feel free to ask for clarification.

[LeX-]

To think of it another way: Is MD training too long?

 

Personally, some days I do think so: It's not hard to manage a CHF, since others have already worked out an algorithm to follow.

 

Other days I'm not so sure: A stented triple-vessel disease with a grade III LV admitted for CHF exacerbation, AKI on background of CKD, now is hypotensive secondary to a fib...

 

Sounds like a fun case

 

Is the patient on rate/rhythm control (could be on BB already due to CHF stage III) for their afib and have they been previously cardioverted?

 

CKD due to ACEI? Not just prerenal failure?

 

Or is it a new diagnosis? Are you sure they are hypotensive due to afib and not due to the edema/diuretics?

[cardiomegaly]

O gosh, medical training is definitely not too long when you think about your actual responsibility. Residency is long for a reason. I have no idea how McMaster and Calgary do it in 3 years without being super burned out.

 

Not to mean any offense to the PA program, but does anyone else wonder how McMaster meds and PA students can have the same scores on exams and OSCEs? I mean, if you asked a first year student to write the comp exam meant for second year they might do OK (because comp is usually not too detailed) but if you threw them into clerkship they'd struggle more in comparison.

[hEALTH]

PAstudent, the article seemed to point out that some student used the PA route for medical school. Like you said, each individual has is own reasons, but don't you think it's somewhat counter-intuitive to enroll in a program that emulates parts of the M.D. degree if your planing to apply to med school anyway? Do you get some sort of advance standing? Dental student get AS for the M.D./M.Sc. program, but for the basic 2 years of medical sciences. Wouldn't it be odd to have a gap between residency and basic medical science if you actually get AS for a PA degree?

[PAstudent]

CHCH did a short story on our first graduating class including some sound bytes with Professor John Cunnington, M.D., Assistant Dean, Director of the PAEP at McMaster. I thought some of you might like to see it: http://www.chch.com/index.php/home/item/1295-new-kind-of-grad-ceremony-is-a-first-at-mcmaster

[Tara21]

Thanks for all the info, PAstudent.

I have been following the PA development here in Ontario. Thank you for sharing your thoughts and experiences with us.

[GatewayMD]

Have been thinking and discussing this for a while, and I think my opinions are started to become better formed. I think the reasons for setting up this program are purely political, and for the most part aren't taking the patient's best needs into account.

 

Having a pseudo MD program may in the long run create more problems then it fixes. Basically you have a profession with slightly more pay and responsibility than a nurse and slighly less responsibility and pay than an MD. If there are deficinecies in this area I agree with pervious posters that the most sustainable solution would be to increase nurses and doctors rather than creating more midlevels.

 

The arguement that Nurses and PA's have a different scope of practice may be true. But in the end PA's are at the mercy of what their doctor supervisors tell them to do, so they could easily have PA's doing traditional nurse work +/- simple physicals and histories (btw nurses do that too).

 

I've had some discussions with docs from the OMA who seem to be less afraid of PA's than NP's increasing scope, mainly because the PA programs were set up by doctors for doctors so at least for the time being they do what we say. Where as NP's lobby directly to the government to increase their scope's of practice. It still doesn't change the fact that increasing nursing spots and having better ROS contracts and renumeration for primary care physicians in underserviced areas would probably do more to help the system overall.

 

I suppose what I'm worried about is the sustinability of this program, I have 0 clue how much it costs to train a PA (true costs), but say it's half the cost vs. a family doc, how is it even remotely worth the price? A fully trained family doc can not only work independantly, but I think most importantly is capable of TEACHING other docs, which PA's are from the sounds of it unable to do, making them fairly unsustainable.

[PAstudent]

Have been thinking and discussing this for a while, and I think my opinions are started to become better formed. I think the reasons for setting up this program are purely political, and for the most part aren't taking the patient's best needs into account.

 

Having a pseudo MD program may in the long run create more problems then it fixes. Basically you have a profession with slightly more pay and responsibility than a nurse and slighly less responsibility and pay than an MD. If there are deficinecies in this area I agree with pervious posters that the most sustainable solution would be to increase nurses and doctors rather than creating more midlevels.

 

The arguement that Nurses and PA's have a different scope of practice may be true. But in the end PA's are at the mercy of what their doctor supervisors tell them to do, so they could easily have PA's doing traditional nurse work +/- simple physicals and histories (btw nurses do that too).

 

I've had some discussions with docs from the OMA who seem to be less afraid of PA's than NP's increasing scope, mainly because the PA programs were set up by doctors for doctors so at least for the time being they do what we say. Where as NP's lobby directly to the government to increase their scope's of practice. It still doesn't change the fact that increasing nursing spots and having better ROS contracts and renumeration for primary care physicians in underserviced areas would probably do more to help the system overall.

 

I suppose what I'm worried about is the sustinability of this program, I have 0 clue how much it costs to train a PA (true costs), but say it's half the cost vs. a family doc, how is it even remotely worth the price? A fully trained family doc can not only work independantly, but I think most importantly is capable of TEACHING other docs, which PA's are from the sounds of it unable to do, making them fairly unsustainable.

 

 

 

PAs are not meant to be in just family medicine, PAs can and do work in every specialty so, in that sense, they offer a different value than a family physician. Also, PAs can and do teach MD students/residents etc., etc.

 

I agree that we need more nurses and more NPs, but those are different roles than PAs or physicians. We all fill different niches.

 

Also, PAs are diagnosticians whose job it is to diagnose and treat medical problems. It would be both irresponsible and a waste of resources for a physician to attempt to have a PA performing mostly "traditional nurse work." Nurses won't stand for that, PAs won't stand for that, and no physician in his right mind would want to do that. PAs are enormously helpful to physicians, that is the whole point. A physician can easily double her/his workload with a PA.

 

Really, the best way to think about it is that PAs are like residents, we practice medicine and do the same things as a physician, but we do it under supervision, just as a resident does it under supervision.

 

In Manitoba, where PAs (also, Clinical Assistants) have been working since 1999, great improvements in health care provision and physician productivity have been seen as a result of the work of PAs. Check out this study, for instance, http://www.winnipeghealthregion.ca/careers/careersinhealth/files/PA_NSCPAReport.pdf

 

 

 

Or this study:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2845948/

Where the conclusion was:

"Results

In this study, PAs “saved” their supervising physician about 204 hours per year; this time can be used for other clinical, administrative or research duties. Physician assistants are regarded as important members of the health care team by surgeons, nurses, orthopedic residents and patients. When we compared the billing costs with those that would have been generated by the use of GP surgical assists, PAs were essentially cost neutral. Furthermore, they potentially freed GPs from the operating room to spend more time delivering primary care. We found that use of the double operating room model facilitated by PAs increased the surgical throughput of primary hip and knee replacements by 42%, and median wait times decreased from 44 weeks to 30 weeks compared with the preceding year.

Conclusion

Physician assistants integrate well into the care team and can increase surgical volumes to reduce wait times in a cost-effective manner."

 

 

Most physicians and surgeons I have spoken to, especially the ones who have had previous experiences with PAs, are enthusiastic and excited about the profession and recognize very-well how helpful the introduction of PAs is for patients, physicians, nurses, and the bottom dollar.

[LeX-]

Methods

We calculated time savings by the use of a daily diary kept by the PAs. Surgeons’, residents’, nurses’ and patients’ opinions about PAs were recorded by use of a selfadministered questionnaire. We calculated costs using forgone general practitioner (GP) surgical assist fees and salary costs for PAs. We obtained information about surgical throughput and wait times from the WRHA waitlist database.

 

 

What are your thoughts about doing a study to test the usefulness of PAs when the data comes from the PAs themselves?

[PAstudent]

Methods

 

What are your thoughts about doing a study to test the usefulness of PAs when the data comes from the PAs themselves?

 

I think that that is one part of one source of data of a study that has multiple data sources and that, even in and of itself, that data should not necessarily be discounted. The entire paper is available at that link and reading through it gives a much better picture of the entire study.

 

I joined the thread to offer information about PAs and am doing my best. I am not involved in that study in any way but I am sure the study authors themselves would be happy to discuss their methods. Their names and contact information as published are:

Experience with physician assistants in a Canadian arthroplasty program

Eric R. Bohm, BEng, MD, MSc,* Michael Dunbar, MD, PhD,† David Pitman, MBA, MPH,‡ Chris Rhule, MHS, PA-C/CA (Cert.),§ and Jose Araneta, MD§

* Divisions of Orthopedic Surgery University of Manitoba, Winnipeg, Man

† Dalhousie University, Halifax, NS, the

‡ Canadian Orthopedic Association, and the

§ Winnipeg Regional Health Authority, Winnipeg, Man

Correspondence to: Dr. E.R. Bohm, Concordia Joint Replacement Group, 310-1155 Concordia Ave., Winnipeg MB R2K 2M9, fax 204 940 2263, Email: ebohm@cjrg.ca

[bustylegs]

Objective evidence aside, thus far I haven't read any posters explicitly expressing their subjective feelings, positive or negative, about PAs. I guess I will be the first one.

 

I'm a fourth year student and I am offended to hear newly graduated PAs refer to themselves as working at the level of the residents (NOT directly targeted at anyone). There is absolutely no scientific or rational basis behind how I feel; after all, it is emotions.

 

I am offended because it makes my two years of pre-clerkship seem worthless. I will also be offended when as a junior resident, I will be the one managing the ward when PAs stay in the ORs and operate all day.

 

Many of us would agree that, barring complications or complicated patients, medicine is relatively simple. Despite being a clerk, I am already very comfortable managing uncomplicated medical issues and have no problems doing vasectomies or performing bowel re-anastomosis (ensure ample blood supply, anti-mesentry to anti-mesentry, and fire the staples. Dealing with complications is a completely different matter which I have no clue how to manage). Most people can safely practice uncomplicated medicine, including PAs.

 

It just doesn't feel good that PAs will be able to do my job, but spending much less time getting there.

 

At the end of the day, we are all here to help. I would simply like to state the fact that personal emotions may have much to do with how mid level care providers are perceived.

 

I apologize in advance if I have offended anyone.

[A-Stark]

I don't have much to add, but I'm not sure I understand the need for more midlevels or why PAs are at all necessary. They're certainly expensive, though, and despite comparisons to residents they are interestingly enough paid more while being less qualified; $75,000/year is more than a fifth-year resident's base salary. They also don't seem to have any particular skills sets different specialist RNs or NPs. Additionally, there are more than enough problems with the supervision of learners as it stands. Why institute another class of practice?

[PAstudent]

I don't have much to add, but I'm not sure I understand the need for more midlevels or why PAs are at all necessary. They're certainly expensive, though, and despite comparisons to residents they are interestingly enough paid more while being less qualified; $75,000/year is more than a fifth-year resident's base salary. They also don't seem to have any particular skills sets different specialist RNs or NPs. Additionally, there are more than enough problems with the supervision of learners as it stands. Why institute another class of practice?

 

Hi A-Stark, I think you bring-up some good concerns that I have heard expressed before but I believe I can answer some of them. As for cost, in addition to the salary of a resident, the government has to put a lot more money into that persons training from day one of med school through till the end of residency (tuition does not truly cover the cost of educating a physician) and, at the end of that residency, that physician is going to be billing a lot more than a PA (as they should!). The analysis of cost and experience with PAs in Manitoba and the USA thus far shows that PAs do save money (and time).

 

As for skill sets and differences between PAs and NPs and RNs, I think I have already gone over that elsewhere in the thread, so I won't go over it again here. Remember, as a a physician, the PA is going to make your life easier. Most physicians and surgeons with whom I have spoken who have worked with PAs tell me they think PAs are great. There is good reason why the Colleges of Physicians and Surgeons of Manitoba and Ontario, the OMA, the CMA, and other physician organizations are enthusiastic supporters of physician assistants.