CBC health reporter graduates as physician assistant

[0593202]

Just to add to mamie's post. Spoke with a few doctors (note not one doctor, or one hospital, but numerous doctors at numerous hospitals) here in Manitoba as to their experiences with PA's. They said that those that were foreign students that for one reason or another didn't complete their medical degree in their home country, came here and then rather then complete a whole medical degree practically over again, decided to be a PA. They said these people were very helpful and much to what has been said here in the thread about PA's.

However, those that didnt have some form of medical training, in a medical doctor program from another country, and just took the PA course (former nurses, dieticians, Physiotherapists, and EMT's) and they all said it was a disaster. Their knowledge base was not even close to comparable to the residents and they just seemed to be completely missing the "6th sense" that most physicians have and that makes the diagnostic process much more efficient and accurate.

Not trying to **** on PA's as like I said, they are very useful, but the knowledge base and expertise that has been said on here that they have just doesn't exist, post all the stats, and studies as you want, but the bottom line to physicians is that there are a lot of kinks that need to be worked out before they put there necks on the line and pick up a PA.

So Mamie it appears it is the exact same here in Manitoba as it is there in Ontario with respect to the experience doctors have had with PA's that have only taken the PA program, and not had out of country medical training.

[PAstudent]

Just to add to mamie's post. Spoke with a few doctors (note not one doctor, or one hospital, but numerous doctors at numerous hospitals) here in Manitoba as to their experiences with PA's. They said that those that were foreign students that for one reason or another didn't complete their medical degree in their home country, came here and then rather then complete a whole medical degree practically over again, decided to be a PA. They said these people were very helpful and much to what has been said here in the thread about PA's.

However, those that didnt have some form of medical training, in a medical doctor program from another country, and just took the PA course (former nurses, dieticians, Physiotherapists, and EMT's) and they all said it was a disaster. Their knowledge base was not even close to comparable to the residents and they just seemed to be completely missing the "6th sense" that most physicians have and that makes the diagnostic process much more efficient and accurate.

Not trying to **** on PA's as like I said, they are very useful, but the knowledge base and expertise that has been said on here that they have just doesn't exist, post all the stats, and studies as you want, but the bottom line to physicians is that there are a lot of kinks that need to be worked out before they put there necks on the line and pick up a PA.

So Mamie it appears it is the exact same here in Manitoba as it is there in Ontario with respect to the experience doctors have had with PA's that have only taken the PA program, and not had out of country medical training.

 

Funny, most of the research indicates that letting foreign medical grads who are unable to get licensed as physicians work as PAs often doesn't work very well (check this out for instance: http://www.ncbi.nlm.nih.gov/pubmed/9125965 and http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1381804/). In fact, it was tried in Ontario and several physicians told me they didn't like that and much prefer the American-trained PAs and McMaster graduates. A PA is not a physician and a physician is not a PA; an FMG does not have proper training to be a PA. Remember, as well, that the PAs working in Manitoba didn't do the UofM program so far as I know (I don't think they graduated a class yet, but I could be wrong?), they were either FMGs, from the Military, or trained in the USA. People, of course, are entitled to their opinion and opinions will differ, that is why in medicine we try to no-longer do things based solely on opinion, we do them based on evidence and study. Evidence should always be questioned but not necessarily discounted.

 

I have a lot of friends who went abroad for med school and I am a proponent of making it easier for them to come home and for other foreign-trained physicians to get licensed here. But I am not for them becoming PAs because the evidence shows it doesn't work.

[0593202]

I wrote out a long post, but there's no point. You continually miss the point. You use any facts you can to make this program seem amazing and any evidence to the contrary, you misconstrue to show that you have valid points. Case in point I talked about foreign medical students that have gone through the PA program, not foreign graduates that 1. we don't even know if they practiced medicine 2. how long ago their medical education is and 3. how well they grasped the language or 4. where they obtained this medical education (theres a big difference between say a hole in the ground in the middle east compared to members of the European Union) I really don't understand why you have such a hard time saying, well you know this profession is really in its infancy, and has a lot of bugs to work out before a PA is as efficient and effective in practice as it can be in theory. And yes Manitoba has graduated PA's.

I've completely accepted the fact that PA's will be a very useful tool at some point in medicine and agree that it will be a benefit, but right now, at this time, in practice, it has not been working very well. You know admitting this won't dissolve the profession, or lower your salary, or have people respect you less right? I don't know what attachment you have to this, but you are unwilling to hear anything besides, "PA's are great, yay PA's!!"

[PAstudent]

I really don't understand why you have such a hard time saying, well you know this profession is really in its infancy, and has a lot of bugs to work out before a PA is as efficient and effective in practice as it can be in theory.

 

The Physician Assistant Profession is over 40 years old and is well-established in the USA where it has a great track-record http://www.pahx.org/ It is relatively new to the civilian sector in Canada, but it isn't even knew to Canada; we have had military PAs for over 20 years.

[MarathonRunner]

Military PAs work incredibly well - they are incredibly valuable members of the Canadian Forces health care system. But there are some important differences between military PAs and civilian PAs.

 

Military PAs are senior medics. They hold at least the rank of Sergeant, which means they have several years experience as medics and they have undergone a lot of training, both as a medic, and then as a PA. To quote from a past director of the CF's PA training program: "The CF's PA training is open to personnel who have at least 10 years' military experience and a medical assistant/paramedic background; the training takes two years." So it is obvious that most military PAs have a lot more experience in the health care field than many of the civilian PAs.

 

The Canadian Forces population is also rather different from the general population. Members tend to be young, healthy and physically fit - the manadatory age of retirement from the CF is 55, unless you are a senior officer, where it can be extended to 60. Most of the injuries/illnesses a medic or PA will see, while in Canada, are musculoskeletal injuries of one type or another, combined with your "regular" illnesses, such as influenza and other viral illnesses.

 

While deployed, obviously, things are different, and medics and PAs tend so see a lot of musculoskeletal injuries again - everything from sprains to broken bones - but then you have to add in combat injuries - bullet wounds, concussions, limb losses/amputations, other severe trauma from IED explosions, etc.

 

I DO think that there is an important role that PAs can play in the Canadian Health Care system. They work in the US and they work in the Canadian military. Every PA I've come across in the Canadian Forces has been an incredibly competant health care provider, who I would trust as much as I trust a physician. But I know they are well trained and have years of military and medical experience.

 

The civilian PA programs in Canada, if they want to produce competent PAs, I think need to be a little more "picky" in who they accept, and have a minimum amount of health care experience required. I see that U of T has this requirement, but Mac does not.

 

Do I think PAs are a good idea? Yes. Do I think they can be valuable members of the health care team? Yes. I do think the current programs graduating PAs from civilian universities need to be carefully evaluated, to ensure that they are graduating professionals who have the skills and abilities required of the profession.

[thisguy]

What exactly is the difference between a PA and an MD?

 

Do PAs think they are as qualified as an MD?

 

Do PAs think they should be able to provide care without an MD evaluating?

 

Those are serious questions. Essentially, and I haven't read everything in here on the subject, but it seems as though PAs are explained as able to function as residents? The whole point of residency is that after a certain amount of time, you can practice independently. Therefore, what is the PA niche? They are either: a. able to perform any diagnostic or therapeutic task a resident can, with less training and less debt and less salary, or b. not.

 

If a., then I fear that physicians are irrelevant. If b, then I fear that PAs are.

 

Story revealing my bias:

 

I only once met a PA. He had been working a couple years I believe. He did not know the treatment for anaphylaxis. He then did not know what I meant by epinephrine. I know that is n=1, but I'm just saying.

[PAstudent]

What exactly is the difference between a PA and an MD?

 

Do PAs think they are as qualified as an MD?

 

Do PAs think they should be able to provide care without an MD evaluating?

 

Answer 1: Assuming you mean physician by MD, they are licensed to practice medicine without supervision within the field they have trained-in. They achieve this position after completing a degree in medicine and post-graduate training (residency and sometimes additional fellowship training) as well as writing the appropriate licensing and certification exams. They are the top of the medical food chain if you will. PAs, on the other hand, are licensed to practice medicine only with supervision, directly under the supervision of a physician. PAs acheive this position by completing a degree that is slightly less detailed than the degree physicians take and then going to work directly after (that said, there are PA residencies in the USA but that is an entirely different issue). A PA's learning is supposed to take-place on the job as well and within the supervisory relationship of an MD-PA team the MD should be teaching and helping to develop the PA and mold them to his/her practice. A PA is trained initially as a generalist, a polyvalent clinician who can adapt to different specialties.

 

Answer 2: No. But a PA with many years of experience in a particular specialty is likely to be damn-close if they are any good.

 

Answer 3. No.

 

 

A PA is a DEPENDENT practitioner. That is the entire point of the role. A PA's job is to EXTEND the practice of a physician.

[pathman]

I've only worked with a couple of PA's in my day. Both were on an ortho rotation when I was a 3rd year clerk in med school. One of these PA's was previously an orthopod in China. He functioned at the level of a senior resident and was excellent.

The other had no medical training. He graduated from a Canadian PA program. He typically followed no more than 2-3 patients and was known to frequently disappear...he could often be found on the computers in the library. He wasn't even functioning as a poor clerk. He was just a burden to the team.

I know this is just one situation...but...just sayin'

 

And I think some PA student claimed in an earlier post that they write the same exams as med students? WTH?

[PAstudent]

 

And I think some PA student claimed in an earlier post that they write the same exams as med students? WTH?

 

 

At McMaster we take the PPI, the CAEs/CREs (they keep changing the name) and the OSCEs.

[pathman]

At McMaster we take the PPI, the CAEs/CREs (they keep changing the name) and the OSCEs.

 

I've never heard of the PPI or the CAE/CREs. And I've never spoken to med students or residents who went to different Canadian schools than myself who took whatever these exams are.

In pre-clerkship we wrote exams and completed lab exams that were made up by our school. In clerkship we wrote the NBMEs (National Board of Medical Examiners - these are the exams taken by all American med students in clerkship. I know not all Canadian med schools use them though). And then obviously we did the MCCQEs.

And we of course also had OSCEs. I'd be more than willing to wager that medical school OSCEs are far more comprehensive and challenging than those of PA programs.

To compare standards of evaluation between medical and physician assistant programs seems a bit ludicrous in my opinion.

[PAstudent]

I've never heard of the PPI or the CAE/CREs. And I've never spoken to med students or residents who went to different Canadian schools than myself who took whatever these exams are.

In pre-clerkship we wrote exams and completed lab exams that were made up by our school. In clerkship we wrote the NBMEs (National Board of Medical Examiners - these are the exams taken by all American med students in clerkship. I know not all Canadian med schools use them though). And then obviously we did the MCCQEs.

And we of course also had OSCEs. I'd be more than willing to wager that medical school OSCEs are far more comprehensive and challenging than those of PA programs.

To compare standards of evaluation between medical and physician assistant programs seems a bit ludicrous in my opinion.

 

Hi Pathman,

 

Thank you for the opportunity to discuss more about the unique forms of evaluation at McMaster and now being adopted by other schools worldwide. The Clinical Reasoning Exericse/Concept Application Exercise exams and the Personal Progress Index are the exams given to both M.D. and P.A. students at the Michael G. DeGroote School of Medicine.

 

Here are some links to the PPI web-site and publications about the evaluations themselves: http://ipptx.org/ , http://www.eric.ed.gov/ERICWebPortal/search/detailmini.jsp?_nfpb=true&_&ERICExtSearch_SearchValue_0=EJ532653&ERICExtSearch_SearchType_0=no&accno=EJ532653 and http://www.ncbi.nlm.nih.gov/pubmed/12109455 as well as http://www.ncbi.nlm.nih.gov/pubmed/11273369

 

The OSCE for the PA students has the same evaluation standards as the OSCE for the MD students. You might find it helpful to read through my post comparing and contrasting the MD and PA programs at McMaster.

[pathman]

Hi Pathman,

 

Thank you for the opportunity to discuss more about the unique forms of evaluation at McMaster and now being adopted by other schools worldwide. The Clinical Reasoning Exericse/Concept Application Exercise exams and the Personal Progress Index are the exams given to both M.D. and P.A. students at the Michael G. DeGroote School of Medicine.

 

Here are some links to the PPI web-site and publications about the evaluations themselves: http://ipptx.org/ , http://www.eric.ed.gov/ERICWebPortal/search/detailmini.jsp?_nfpb=true&_&ERICExtSearch_SearchValue_0=EJ532653&ERICExtSearch_SearchType_0=no&accno=EJ532653 and http://www.ncbi.nlm.nih.gov/pubmed/12109455 as well as http://www.ncbi.nlm.nih.gov/pubmed/11273369

 

The OSCE for the PA students has the same evaluation standards as the OSCE for the MD students. You might find it helpful to read through my post comparing and contrasting the MD and PA programs at McMaster.

 

I see.

From reading some of this thread you seem to be very concerned with comparing McMaster's PA and MD programs, and pointing out how similar you feel they are.

Do you mind if I ask what your motivation for pursuing the PA program was?

[PAstudent]

I see.

From reading some of this thread you seem to be very concerned with comparing McMaster's PA and MD programs, and pointing out how similar you feel they are.

Do you mind if I ask what your motivation for pursuing the PA program was?

 

Hi Pathman,

 

Indeed, I have made a point of demonstrating that the rigour of the PA program, while not the same as the MD program, is similar. I have also pointed-out how the PA program is based on the MD program. I have done this mostly to point-out that the training McMaster PAs get is indeed appropriate for the role of a PA (i.e. practicing medicine under physician supervision).

 

I have attempted to avoid personal discussions within the thread, preferring, instead to bring such conversation to the realm of private messaging. That said, I have made some personal revelations here already that do address why I choose the PA program. I suggest reading through the entire thread, though I realize that can be rather time-consuming. So, in short, my motivation for pursuing the PA program was wanting to be a PA.

[pathman]

I read a bit more of the thread and gathered that you apparently turned down a spot in an MD program? Instead, you decided to travel for a time, and following this, thought that a PA program provided more flexibility with less schooling....therefore this is the route you chose...?

Are you serious? Are you deranged? Why did you apply for medicine in the first place? You speak of debt from undergraduate studies, but becoming a family physician would only have required two more years of school, followed by two years of residency. So, an extra four years. Following that, you would have the ability to make far more money and also be a completely autonomous, and better trained health care professional. Your debt would be inconsequential.

And I don't care if I'm offending you.

[PAstudent]

lol. Dear Pathman, you certainly don't offend, but you sure do make me laugh. I simply feel that PA is the better route for me. And, while I might disagree with what you have said, I certainly didn't come on to this board to discuss or defend my own life-choices. I am here simply to help people learn about PAs and the development of the profession in Ontario. :-)

 

 

I read a bit more of the thread and gathered that you apparently turned down a spot in an MD program? Instead, you decided to travel for a time, and following this, thought that a PA program provided more flexibility with less schooling....therefore this is the route you chose...?

Are you serious? Are you deranged? Why did you apply for medicine in the first place? You speak of debt from undergraduate studies, but becoming a family physician would only have required two more years of school, followed by two years of residency. So, an extra four years. Following that, you would have the ability to make far more money and also be a completely autonomous, and better trained health care professional. Your debt would be inconsequential.

And I don't care if I'm offending you.

[dstevens]

It seems to me, after reading this entire thread, that the NP route is still the better route.

The major flaw with PAs is lack of prior health care experience , which is vital in any medical setting. NPs must have 3 years Crit. Care let alone Med/Surg before enrolling in their Program. NPs are Autonomous, they are licensed and subject to loss of their license if they screw up, unlike a PA. Example- hitting a nerve whilst giving an injection- a simple basic task that even first year nursing students do, can wreak havoc upon the supervising physician's license or insurance.

My argument is at the end of the day regardless of capabilities, if I were a physician I would not want someone jeopardizing my license that I spent years arduously attaining. Not to mention not getting paid for a PAs work that I have to supervise. I think, like NPs, PAs belong only in mid level care, dealing with triage levels 3 and up. But, if I were a patient, I'd want an NP for the bedside manner and prior expertise.

 

-please note I am not a Physician-

[PAstudent]

The major flaw with PAs is lack of prior health care experience , which is vital in any medical setting.

 

It is erroneous to assert that PAs in general lack prior health care experience or that a lack of prior health care experience is somehow a flaw.

 

First, the same could be said about physicians, many of whom also do not have prior health care careers before staring med school. PAs learn what they need to know by forming a base to work with in school and then continue learning on the job just as MDs learn what they need to know to form a base in school and then continue learning in residency. Most of my physician friends would say that it is really residency that makes the physician. Heck, most of my physician friends who are finished residency are still learning every day. That is the nature of practicing medicine-the need for constant learning.

 

Second, many PA programs, including the one at UofT/NOSM require previous health care experience. And even at the PA program of the Michael G. DeGroote School of Medicine, which has no formal requirement for such experience, most of my classmates do indeed have former health care experience, much of it rather substantial. Also, most practicing PAs I know in the US and Canada did indeed have prior health care careers. Perhaps you should read-up on the history of the profession: http://www.nlm.nih.gov/medlineplus/ency/article/001935.htm

 

http://www.pahx.org/timeline.html

 

Finally, I caution against this direct compare/contrast of NPs and PAs. They are different roles with different training. Once again, I refer to: http://caopa.net/images/stories/COMPARISON_PA_NP_final_aug2010.pdf

[MarathonRunner]

PAs in the Canadian Forces definitely have previous health care experience. They are senior medics, so they've served many years as medics before being "picked up" to do the PA training.

[goleafsgochris]

I read a bit more of the thread and gathered that you apparently turned down a spot in an MD program? Instead, you decided to travel for a time, and following this, thought that a PA program provided more flexibility with less schooling....therefore this is the route you chose...?

Are you serious? Are you deranged? Why did you apply for medicine in the first place? You speak of debt from undergraduate studies, but becoming a family physician would only have required two more years of school, followed by two years of residency. So, an extra four years. Following that, you would have the ability to make far more money and also be a completely autonomous, and better trained health care professional. Your debt would be inconsequential.

And I don't care if I'm offending you.

 

There is no way anyone would turn down an MD spot for a PA spot lol, the OP is just trying to defend how he thinks his program is important--and so in his mind, he thinks that if he says "I got into both!", what we are all assiming wont be true. (What we are all assuming, of course, is that the PA program is more or less for people who did ok academically, but not well enough to get into meds/dent etc).

 

I just graduated from Mac MD (well, I will be graduating in May). I still really dont understand the point of the PA program. I even more dont understand why anyone would WANT to be in the program. You write the same tests as us, and that apparently prepares you to essentially become a lifelong assistant? And that is OK with you?

 

I bring this up not to insult the OP, but to clarify to people who are possibly considering applying to the PA program. I realize that before you get into med school, you are worried that you will go through life with no career. You are willing to take lesser options just to be in *something* and not be a lifelong research assistant. All Im saying is that doing MD-type training to do what (to me and others I have talked to) appears to be lifelong scut work does not seem to be a great option.

 

To the OP: I dont mean to be a ****. I am glad you are passionate. I realize I may just be crabby because of LMCC prep. Im just presenting an ulterior view to people whi might be considering this path.

[PAstudent]

There is no way anyone would turn down an MD spot for a PA spot lol, the OP is just trying to defend how he thinks his program is important--.

 

I don't think calling me a liar is called-for; I have been honest. Also, I am not the OP in this thread. I jumped in to offer insight and information about PAs.

 

I just graduated from Mac MD (well, I will be graduating in May). I still really dont understand the point of the PA program. I even more dont understand why anyone would WANT to be in the program. You write the same tests as us, and that apparently prepares you to essentially become a lifelong assistant? And that is OK with you?

 

The name "physician assistant" is misleading as the job is not really one of being an assistant. In fact, the Yale University PA program is called "Physician Associate" and there is a movement for official name change in the USA. Many are now using the term "associate" instead of "assistant" because it is indeed a more accurate descriptive of what the role entails.

 

All Im saying is that doing MD-type training to do what (to me and others I have talked to) appears to be lifelong scut work does not seem to be a great option.

 

You are right; and some PAs wouldn't take a job where all they are is a scutmonkey, so to speak. There are people who would and there are places where that is how PAs are thought of and used. But that depends largely on where you work and who you work with.

 

To the OP: I dont mean to be a ****. I am glad you are passionate. I realize I may just be crabby because of LMCC prep. Im just presenting an ulterior view to people whi might be considering this path.

 

Aside from accusing me of lying about my admission to M.D., I didn't find the rest of your post offensive in any way and I appreciate your point of view. And, as I am friends with many of your classmates, I know what LMCC prepping entails. Congratulations on finishing your M.D. and good luck with the LMCC.

[m00gle]

Hi PAstudent,

 

First of all, thank you for your insight! I thought you fared extremely well against all those attacks...And after reading this entire thread, I'm about 60% sure that I want to pursue a PA career. I do have some questions, so any help you or anybody else could give me would be very appreciated

 

About myself: I was always 100% interested in a medical career, but never fully envisioned myself as an MD. The PA position appeals to me because: I wasn't always that kind of "leader," I was scared of burning out before 30, and being a PA seems like being a health care professional without the ego.

 

I'm entering my 2nd year at McMaster's Health Sci program. I'm interested in applying next year merely for prep, since only 2 undergrad years are needed. How many PA students did you see at Mac actually got accepted before 3rd year, or without a Bachelor's degree? Or without extensive, paid experience in direct patient care?

 

Also, I'm slightly...uncomfortable at the fact that I would be receiving a Bachelor's degree (even if I had 2 total by the end of it). And because I firmly believe in higher education, I don't think 2 more years are enough to complete my education for the rest of my life . Can I intentionally extend my training in the PA program, and possibly achieve another degree/diploma/certificate?

 

And for the above reason, I can apply to American PA programs because they offer Masters of Medical Science instead. I've researched and found that Canadian-trained PAs are not certified for the States, but can US-trained PAs work in Canada?

 

And because it seems that the majority of PAs were previous health care professionals, I'm concerned that I may head into this lifetime career too fast. What are the possibilities of being "promoted" as a PA (like a Head or Senior PA, lol) or upgrading to a higher paying specialization?

 

That's it...for now lol. Appreciate any advice.

[medhelp4]

a PA is of great help to the doctor in tight situations where the doctor is overloaded

[BridgetJones]

I am glad that I found this thread because I am interested in doing the Physician's Assitant program myself.

[maritimer]

This thread is enlightening and educational, and makes me want to be a PA even more!