Can you apply to Medschool after graduation from the PA program?

[medrad]

Hi to all the PA students and graduates,

 

I am considering this program in the near future. I know that the UofT program is 2 years only, can you apply after you graduate from this program to medical school? I know that this is a BSc program, theoretically, you should be able to. Has any PA graduate considered applying to medical school?

 

Thanks

[future_doc]

I am a med student. I do not see any reason why you could not do so. Those running the PA Program wouldn't be happy as they wasted their resources on you as you would not be fulfilling the intent of the program. But there is nothing they can do about it other than to examine their admission procedures to try to eliminate accepting those likely to then go for med.

 

You should not become a PA if you want to be a physician. You should do this if you want to be a PA.

[medrad]

Very true. However people do change their minds. For a fact I know that PA's are taught about 75% of material from medical school, so if someone wanted to, why not learn the rest of the 25% and become a doctor. The whole reason behind the program is to fulfill the doctor shortage in Ontario, so applying to medical school after the PA program should not be a problem since its fulfilling that role. Students applying to PA program surely most of them don't intend to go to medical school however, since it is a degree granting program, you should have the eligibility to pursue medical school. I am just curious to know if any PA graduate has gone the path of applying to medical school, and how they were able to fulfill the prerequisites etc.

[inspiring-curmudgeon]

If you want to become a PA, become a PA. If you want to become a doctor, become a doctor. Don't become a PA while dreaming of becoming a doctor, as you will be working with them day in and out and it will just aggravate you and make you want it even more. Take pride in what you're doing and stick to it, no matter what it is.

[PAstudent]

There is certainly no rule that one cannot apply to MD programs as a PA. And, indeed, some PAs have gone back to school to become physicians. That said, if you already know you want to be a physician, I'd advise against going to PA school.

 

PA school is essentially fast-track med school where you get over three quarters of what MD students get (at DeGroote anyway). Many of our rotations are the same and are integrated with the MD students. We also take many of the same exams. Why would you want to put yourself through that twice if you know beforehand?

 

Getting into the PA program is not easy and if you want to be an MD my advice is to persue that avenue seriously.

 

Of some interest in this thread may be the popping-up of bridging programs in the USA: http://lecom.edu/pros_pathways.php/accelerated-physician-assistant-pathway-apap/76/0/1955/17899

 

 

Indeed, some American PAs describe a glass-ceiling effect and then wish they had become MDs. See discussions over at http://www.physicianassistantforum.com/forums/showthread.php/34217-What-problems-do-PAs-face-in-the-field?highlight=glass+ceiling

[future_doc]

By preplanning to go into medicine, the insecure PA student will feel that he shall have made med school so much easier. And if he does not get into med school, he will have a job as PA.

[The Journey Man]

Very true. However people do change their minds. For a fact I know that PA's are taught about 75% of material from medical school, so if someone wanted to, why not learn the rest of the 25% and become a doctor. The whole reason behind the program is to fulfill the doctor shortage in Ontario, so applying to medical school after the PA program should not be a problem since its fulfilling that role. Students applying to PA program surely most of them don't intend to go to medical school however, since it is a degree granting program, you should have the eligibility to pursue medical school. I am just curious to know if any PA graduate has gone the path of applying to medical school, and how they were able to fulfill the prerequisites etc.

 

I don't think you know this for a fact - unless you've done both. We have PAs at my school that spit this nonsense as well.

 

Every single PA that has now gone to med school that I have met and talked (there a number that have done this) has said that they did not realize how much they didn't know because they were never exposed. Don't fool yourself over the years. 2 years of PA school is not 1/2 of 4 years of medical school. If what you said is actually whats happening at McMaster, thats more embarrassing for McMaster and I assure you that its not 1/2 or 2/3 of a real medical school. The pace in medical school in reality is unbelievable - you have no idea until you actually do it. Please stop misinforming people on this board regarding this,

 

Head over to SDN, multiple former PA's that have gone through med school who have said what i just said. Its like someone saying law assistant school being 2 years is 2/3 of law school, or going to a 2 year college practical engineering degree is 1/2 of 4 years of University engineering. Nobody in their right mind would believe these things, why would anybody (aside from those within these programs) would believe 2 years of PA is 1/2 of med school.

 

1st year of medical school without exaggerating is roughly 3x the pace of my last year of a difficult undergrad. 2nd year was roughly 2-3x the pace of 1st year medical school and 3rd year the material is roughly 2-3x the pace of 2nd year. You do the math. Its just that you are forced to learn very quickly and efficiently and you force yourself to get better and quicker. This is not something you or others will realize until you actually go through med school and find out for yourself.

[PA Bound]

I don't think you know this for a fact - unless you've done both. We have PAs at my school that spit this nonsense as well.

 

Every single PA that has now gone to med school that I have met and talked (there a number that have done this) has said that they did not realize how much they didn't know because they were never exposed. Don't fool yourself over the years. 2 years of PA school is not 1/2 of 4 years of medical school. If what you said is actually whats happening at McMaster, thats more embarrassing for McMaster and I assure you that its not 1/2 or 2/3 of a real medical school. The pace in medical school in reality is unbelievable - you have no idea until you actually do it. Please stop misinforming people on this board regarding this,

 

Head over to SDN, multiple former PA's that have gone through med school who have said what i just said. Its like someone saying law assistant school being 2 years is 2/3 of law school, or going to a 2 year college practical engineering degree is 1/2 of 4 years of University engineering. Nobody in their right mind would believe these things, why would anybody (aside from those within these programs) would believe 2 years of PA is 1/2 of med school.

 

1st year of medical school without exaggerating is roughly 3x the pace of my last year of a difficult undergrad. 2nd year was roughly 2-3x the pace of 1st year medical school and 3rd year the material is roughly 2-3x the pace of 2nd year. You do the math. Its just that you are forced to learn very quickly and efficiently and you force yourself to get better and quicker. This is not something you or others will realize until you actually go through med school and find out for yourself.

 

This is exactly what I heard at U of T's PA info session as well...75% of an MD's program in 50% of the time.

[PAstudent]

At first I wasn't going to reply to this. However, after reflection and discussion with my significant other (who is in the DeGroote MD Programme) I will respond pointing you toward this thread: http://premed101.com/forums/showthread.php?t=47305 in which I have already, at some length, albeit informally, explained how the PA Programme at the DeGroote School of Medicine was structured on the MD Programme and how they currently differ. Indeed, it is not erroneous to say that the Mac PA Programme is about 75 per cent (really, more) the content of the Mac MD Programme.

 

I cannot, however, comment on the substance, content, or quality of PA programmes anywhere else.

 

 

I don't think you know this for a fact - unless you've done both. We have PAs at my school that spit this nonsense as well.

 

Every single PA that has now gone to med school that I have met and talked (there a number that have done this) has said that they did not realize how much they didn't know because they were never exposed. Don't fool yourself over the years. 2 years of PA school is not 1/2 of 4 years of medical school. If what you said is actually whats happening at McMaster, thats more embarrassing for McMaster and I assure you that its not 1/2 or 2/3 of a real medical school. The pace in medical school in reality is unbelievable - you have no idea until you actually do it. Please stop misinforming people on this board regarding this,

 

Head over to SDN, multiple former PA's that have gone through med school who have said what i just said. Its like someone saying law assistant school being 2 years is 2/3 of law school, or going to a 2 year college practical engineering degree is 1/2 of 4 years of University engineering. Nobody in their right mind would believe these things, why would anybody (aside from those within these programs) would believe 2 years of PA is 1/2 of med school.

 

1st year of medical school without exaggerating is roughly 3x the pace of my last year of a difficult undergrad. 2nd year was roughly 2-3x the pace of 1st year medical school and 3rd year the material is roughly 2-3x the pace of 2nd year. You do the math. Its just that you are forced to learn very quickly and efficiently and you force yourself to get better and quicker. This is not something you or others will realize until you actually go through med school and find out for yourself.

[PA Bound]

At first I wasn't going to reply to this. However, after reflection and discussion with my significant other (who is in the DeGroote MD Programme) I will respond pointing you toward this thread: http://premed101.com/forums/showthread.php?t=47305 in which I have already, at some length, albeit informally, explained how the PA Programme at the DeGroote School of Medicine was structured on the MD Programme and how they currently differ. Indeed, it is not erroneous to say that the Mac PA Programme is about 75 per cent (really, more) the content of the Mac MD Programme.

 

I cannot, however, comment on the substance, content, or quality of PA programmes anywhere else.

 

Hi and thanks for your reply, PAstudent.

 

Any chance you know what # the post was? There's a lot of pages (16 pages) of replies to go through to find your specific post.

 

Would be really appreciated. =)

 

EDIT...OK, I've gone through your posts from your profile...I think this is it:

 

"

This is my understanding of the differences and similarities. I get most of my knowledge of the MD program from friends in the program so I might be incorrect so anyone with more knowledge, please feel free to correct me!

 

For the MD program: There are the Medical Foundations that last, in total, about 13 months followed by clerkship which lasts about 17 months. (the figure can vary a bit, I suppose, taking into account vacations, extra placements, electives, etc.).

 

For the PA program: There are the Medical Foundations that last, in total, about 11 months followed by clerkship which lasts about 12 months. (again, figures can vary a bit).

 

Why are the PA MFs shorter by a few months? Partially because some of the more complex cases have been changed for us (for instance, the MDs study a case with polycystic ovary disease and Diabetes Melittus type II whereas we have the same case without the polycistic ovary disease, though it may be put back next year). The second reason is that some of the MD cases have simply not been included because of time constraints. That does not mean that a PA would not be able to understand and deal with a patient with polycistic ovary disease. Nobody can study every disease in med school, PA or MD. The important thing is to know how to understand the underlying mechanisms and to have enough knowledge and skills to continue learning and to become more proficient at medicine. The MDs certainly get a more thorough education, but not a better one.

 

Why is the PA clerkship shorter by about 5 months than the MD clerkship? Simply because we don't rotate through all the same specialties as the MDs do. The core PA rotations are: family medicine, internal medicine, emergency medicine, surgery, psychiatry, and pediatrics (though there is talk of adding ob/gyn as a core rotation for the next class). Integrated into the core rotations are selectives (e.g. one could finish general surgery with 2 weeks of neurosurg, ortho surg, etc., etc.) We are given only 10 weeks for electives. The MD core rotations have everything the PA rotations have PLUS ob/gyn, anesthesia, ortho, and others. I also understand that the MDs have more elective opportunities than we do.

 

 

That gives you a cursory overview of the differences in curriculum. As I have stated before, both the MDs and PAs take the PPI exams, the OSCEs, and the CREs/CAEs (the name has changed a few times)."

[The Journey Man]

I think you guys are missing the point - and I don't blame you guys for believing what you are told - the midlevels here are told the exact same things and they believe it until they actually come to med school and face the reality

 

Like I said, it's not the number of years, it's what's in those years so it's pretty useless to say how many months of this and thats. As for someone's saying that U of T PA is 75% of Md in 50% of the time is very laughable. Think about it instead of just believing what the administrators tell you and if that it's even possible given thats one of the most intense curriculums in all of Canada.

 

The depth and breadth can only be imagined if you go through it. I use to be an EMS prior to being in medical school and A lot of them fed me the same bull in that we knew a lot compared to the docs. I was embarrassed when I got to medical school.

 

What you are also ignoring is the numberous people who have said they have gone to both and there is absolutely no comparison between the two and that it would be ridiculous to say so. go to the SDN midlevels message board and see for yourself.

 

I only make these points because I was fooled too, and that others should no have false information regarding their future profession whatever they choose. They should not have a false sense of role and training which is what comments above produce. I apologize if it's harsh but its the reality and something you will only truly understand if you go through it.

 

I have no idea of Macs curriculum but you do not take NBME exams, USMLEs, LMCC - furthermore not trained by physicians on a daily basis. Point is that most MD programs are extraordinarily intense and increase in intensit in years 1-3. From what Ive heard anectodatlly is that the MD program at Mac is embarassing anyway and the grads oftne find it difficult come residency unless they work there butt off to overcome the ridiculousness in the curriculum. This may also give you that false impression .

[PAstudent]

 

I have no idea of Macs curriculum but you do not take NBME exams, USMLEs, LMCC - furthermore not trained by physicians on a daily basis. Point is that most MD programs are extraordinarily intense and increase in intensit in years 1-3. From what Ive heard anectodatlly is that the MD program at Mac is embarassing anyway and the grads oftne find it difficult come residency unless they work there butt off to overcome the ridiculousness in the curriculum. This may also give you that false impression .

 

 

Actually, at Mac, PAs are trained by physicians on a daily basis, both in pre-clerkship and clerkship, and we do have the board exams for some rotations. And of course we don't write physician licensing exams!, if we did, we would be licensed physicians. We write PA licensing exams such as the PACCC which is based, in large part, on the LMCC.

 

You are now going on to disparage the Mac MD Programme as well. You make comments questioning the qualities of the PA Programme yet you admit you have "...no idea of Macs curriculum." I don't think this requires further debate.

[PA Bound]

Thanks for your reply, Journey man.

 

Me simply regurgitating what a UofT Admin said and reposting PAstudent's post, however, in no way states my opinion on the matter, ie, not sure how that says I'm "missing the point."

 

If you could, please...what is this SDN you keep referring to? A link would be appreciated.

 

re: anecdotally McMaster MD program embarrassing.

 

McMaster is ranked #6 by McLean's magazine ahead of 9 other CDN medical schools. http://www.university-list.net/canada/rank/univ-090001.html. If McMaster, at #6, is embarrassing... How would you describe the other 9? And what does that say of our medical schools as a whole?

 

Re: PA not trained by doctors.

 

What are you basing this on... Opinion or fact?

 

Journeyman, I appreciate your comment that the two programs may not be at the stated ratios, according to those you've spoken with and in your own opinion, but in the wisdom of your own words:

 

"I don't think you know this for a fact - unless you've done both."

 

Based on the fact that you haven't done both ("I have no idea of Macs curriculum") and that MDs and MDs-to-be, as people practicing the art of science, should refrain from speaking critically and adamantly of something that they only have a cursory knowledge of, i.e., unsubstantiated anecdotes and opinion, please chill out and speak respectfully. Your tone is exactly that which many patients complain about regarding doctors...poor bedside manner, to put it politely. "We have PAs at my school that spit this nonsense as well."

 

We're all on the same team...wanting to help people who are sick.

 

 

Sorry to the OP for hijacking the thread.

[The Journey Man]

Thanks for your reply, Journey man.

 

Me simply regurgitating what a UofT Admin said and reposting PAstudent's post, however, in no way states my opinion on the matter, ie, not sure how that says I'm "missing the point."

 

If you could, please...what is this SDN you keep referring to? A link would be appreciated.

 

re: anecdotally McMaster MD program embarrassing.

 

McMaster is ranked #6 by McLean's magazine ahead of 9 other CDN medical schools. http://www.university-list.net/canada/rank/univ-090001.html. If McMaster, at #6, is embarrassing... How would you describe the other 9? And what does that say of our medical schools as a whole?

 

Re: PA not trained by doctors.

 

What are you basing this on... Opinion or fact?

 

Journeyman, I appreciate your comment that the two programs may not be at the stated ratios, according to those you've spoken with and in your own opinion, but in the wisdom of your own words:

 

"I don't think you know this for a fact - unless you've done both."

 

Based on the fact that you haven't done both ("I have no idea of Macs curriculum") and that MDs and MDs-to-be, as people practicing the art of science, should refrain from speaking critically and adamantly of something that they only have a cursory knowledge of, i.e., unsubstantiated anecdotes and opinion, please chill out and speak respectfully. Your tone is exactly that which many patients complain about regarding doctors...poor bedside manner, to put it politely. "We have PAs at my school that spit this nonsense as well."

 

We're all on the same team...wanting to help people who are sick.

 

 

Sorry to the OP for hijacking the thread.

 

SDN is studentdoctor.net/forums

 

What I mean by you don't know unless you've done both is based on people who are in my class who were PAs prior and those who've posted their experiences on SDN. I have yet to meet or see a post by someone not repeating that they did not realize how much they did not know and were embarassed that they thought that they were close to a MDs level. I also meant by that because I used to be a paramedic and used to think that I could handle things and compared myself to ER MD residents when in reality I didn't know squat. I knew protocols, I didn't understand a thing in retrospect and I would've been dangerous if I continued thinking like that - I didn't realize all the background thinking that went into a physicians mind until I actually became one.

 

Regarding McMaster being ranked #6 - I said that IF what you said is correct - that your PA curriculum is 2/3 of MD program than that is embarrassing for the MD program - however I attribute that belief you have more to what you've been told (of no fault of your own) rather than reality because the pace in medical school is ridiculous and the demands and expectations are quite high as an MD, however I dont go there so I cannot comment. I have looked at the course material and exams of PAs at my school and I can tell you that the depth and breadth is unbelievably far greater in the MD program. You are expected to understand everything. In addition, The expectations are night and day. furthermore, ranking don't take into account the quality of physicians trained - how is MacLeans qualified to do that? Anecdotally yes I have heard that Mac grads CAN be equivalent to 4 year MDs however their curriculum allows for many people who don't know much to get through as many people can cram for exams. The critique of their curriculum and quality of students comes from posts on this board in their sub forum.

 

The reason I spoke like this is more from the anger that teachers of midlevels are trying to indoctrinate their trainees into believing this stuff - it's not specifically directed at the students who internalize those same beliefs. Im speaking like this because I have seen first hand how dangerous it is for patients.

 

I get equally mad when I see lazy med students or incompetent residents because they are also dangerous to patients. There is an incredible amount of knowledge to be mastered and everyday you have to work on reading and trying to master it. Anyone who doesn't have a knowledge of their own limitation of their understanding of medicine is dangerous. Its just that I see this mentality of being "almost equivalent" more so in PAs and NPs I've been around to no fault of their own because that simply what they've been told by their superiors and they believe it. It's the same things with bad residents - they believe they are almost equivalent to attendings - if they knew how little they actually know theyd tried to improve. The things is you don't know what you don't know. In a good residency and a good medical school, you are constantly exposed of how little you actually know which forces the individual to go study more.

 

I am constantly exposed how little I know compared to my attenidngs which makes me work harder. There is a reason why most specialist residencies are 4-5 intense years, and that's also why I think Family should increase to 3 years given that it's just so difficult to really know what you are doing in such a short time.

 

The problem is that midlevels are overtrained to do the work that helps out docs the most (notes, discharge summaries, etc..) but insufficiently trained to actually take care of patients because they often work on protocol - you have to understand disease, understand the biology of the body and then understand and critique the body of evidence to actually treat patients which is impossible in the frame of time of PA school. They exist in the US mainly because docs know that procedures make more money and patient care doesn't so they leave it to hired midlevels. Which of course leads to poor patient care but these greedy docs and hospitals don't care so which led to the insurgence of midlevels.

 

In Canada, I understand the purpose is to fill the physician gap temporarily - however it makes no sense because no midlevels will want to work in rural regions for the same reasons MDs don't and thats mainly because they aren't from the region so they are less likely to move there long term. Furthermore that's supposed to be a stop gap solution, not long term.

 

I hope no one takes this as I am critiquing the individuals ability - anyone can be an MD but its just that the person needs to be committed and work hard everyday. the training needs to be intense and long and huge amount of hard work goes into this to even becoming and MD and then when you get to residency you still don't know anything relative to a fully independent attending and as a MD student you know this because it's pounded in your head the message that "you don't know anything yet", so not just me but it gets everyone quite irritated when those who have trained for less intensity and less years claim some sort of "almost equal" jargon. this is not something you can fully appreciate once you've given your blood and sweat to something for four years as an MD and still be an infant compared to fully qualified doctor. But I know that this is necessary to provide quality care for patients - all patients deserve a doctor who worked his/her butt off everyday to know and learn as much as possible.

 

I suppose this is quite the long rant - I'm not sure what the real role of midlevels should be however i don't agree with wasting peoples time. I have seen NPs do great jobs in niche areas where they take of specific populatios of patients - for example having a NP run anticoagulation education, checking up on patients getting chemotherapy etc..

 

I do know that I agree with a bridge program like in the US for the currently trained Canadian PAs who have no jobs. Get them into a 3 year MD program and so we have more fully qualified MDs to get into residencies.

[NLengr]

Just to point out, the maclean's rankings are NOT of the med schools, they are a ranking of the overall universities. The category is called doctoral-medical or some other foolishness. They are schools that have a signifigant number of phd programs PLUS a med school.

 

Once again, they are not rankings of med schools. Memorial isn't even on the list (it's comprehensive because it has less phd granting programs I think).

 

You can read the methodology in the magazine (they lay it out in the issue). the methodology is pretty weak by the way.

 

This is a very common mistake people make when reading That issue.

[A-Stark]

Why are the PA MFs shorter by a few months? Partially because some of the more complex cases have been changed for us (for instance, the MDs study a case with polycystic ovary disease and Diabetes Melittus type II whereas we have the same case without the polycistic ovary disease, though it may be put back next year). The second reason is that some of the MD cases have simply not been included because of time constraints. That does not mean that a PA would not be able to understand and deal with a patient with polycistic ovary disease. Nobody can study every disease in med school, PA or MD. The important thing is to know how to understand the underlying mechanisms and to have enough knowledge and skills to continue learning and to become more proficient at medicine. The MDs certainly get a more thorough education, but not a better one.

 

Thorough = better. I find it appalling that you don't think so.

 

And as near as I can tell, the PA program at Mac includes only three "Medical Foundations" blocks compared to five in the MD program. How do you account for that 2/3 increase? And PCOS + DM is a "complex case"?

 

From what I can tell, the PA basic science curriculum at Mac is considerably condensed - and it's not as if Mac is well known for being especially comprehensive in that respect.

 

Why is the PA clerkship shorter by about 5 months than the MD clerkship? Simply because we don't rotate through all the same specialties as the MDs do. The core PA rotations are: family medicine, internal medicine, emergency medicine, surgery, psychiatry, and pediatrics (though there is talk of adding ob/gyn as a core rotation for the next class). Integrated into the core rotations are selectives (e.g. one could finish general surgery with 2 weeks of neurosurg, ortho surg, etc., etc.) We are given only 10 weeks for electives. The MD core rotations have everything the PA rotations have PLUS ob/gyn, anesthesia, ortho, and others. I also understand that the MDs have more elective opportunities than we do.

 

My understanding is that the PA clerkship is 48 weeks in length in total. By comparison, at Dal we have 51 weeks of mandatory rotations (pediatrics, obs/gyn, surgery, emergency medicine, family medicine, psychiatry, internal medicine, and geriatrics) and 20 weeks of electives (though I've done 22).

 

Of course, the primary difference is that these rotations serve as a basis for moving forward with residency training, which will cover more basic science and clinical topics in academic half-days, and provide the essential experience and knowledge to work as a staff physician and independent, licensed practitioner. This is actually a considerable difference - and as argued by Journey, it affords MD students with the most important knowledge of all, namely how much there is yet to learn.

 

That gives you a cursory overview of the differences in curriculum. As I have stated before, both the MDs and PAs take the PPI exams, the OSCEs, and the CREs/CAEs (the name has changed a few times)."

 

This is beside the point. There is an important role for midlevel practitioners or "physician-extenders" in some contexts. However, the PA education program is not designed to lead to further training nor to independent practice. Limitations in scope of practice pertain to limited knowledge and responsibility. To take an example, an RT with 20 years experience will really know a lot more than an R1 on-call for ICU, but this won't really compare to the staff anesthetist/intensivist.

[The Journey Man]

Thorough = better. I find it appalling that you don't think so.

 

And as near as I can tell, the PA program at Mac includes only three "Medical Foundations" blocks compared to five in the MD program. How do you account for that 2/3 increase? And PCOS + DM is a "complex case"?

 

From what I can tell, the PA basic science curriculum at Mac is considerably condensed - and it's not as if Mac is well known for being especially comprehensive in that respect.

 

 

 

My understanding is that the PA clerkship is 48 weeks in length in total. By comparison, at Dal we have 51 weeks of mandatory rotations (pediatrics, obs/gyn, surgery, emergency medicine, family medicine, psychiatry, internal medicine, and geriatrics) and 20 weeks of electives (though I've done 22).

 

Of course, the primary difference is that these rotations serve as a basis for moving forward with residency training, which will cover more basic science and clinical topics in academic half-days, and provide the essential experience and knowledge to work as a staff physician and independent, licensed practitioner. This is actually a considerable difference - and as argued by Journey, it affords MD students with the most important knowledge of all, namely how much there is yet to learn.

 

 

 

This is beside the point. There is an important role for midlevel practitioners or "physician-extenders" in some contexts. However, the PA education program is not designed to lead to further training nor to independent practice. Limitations in scope of practice pertain to limited knowledge and responsibility. To take an example, an RT with 20 years experience will really know a lot more than an R1 on-call for ICU, but this won't really compare to the staff anesthetist/intensivist.

 

Do PAs now take biochemistry too to understand the biochemistry of insulin resistance, androgen biosynthesis in the theca interna and granulosa cells and the adrenal glands? Do they take time to understand the physiology of menstrual cycle and then learn the differential and how they can present? But how does one go from learning type II diabetes in school and then feel confident on their own not only to understand but TREAT PCOS. Its ridiculous. This is the type of talk that makes it scary when they don't understand how the biochemistry/histology/physiology works but just shoot in the dark. And this quite the simple case.

 

That's a great example A-stark. RTs a great in the ICU and can teach a lot of practical stuff to MDs in training but for some reason they are able to know their role and their limits much better than other midlevels I have come in contact with.

[wizalla]

I graduated from the U.S. Army PA school. Most instructors were MD's or PA's with clinical doctorates. Many came from the military's med. school and told us there were only three courses we did not take that they did and we had 16 months. We did not take histology, embryology and can't remember the last course. They said the courses were the exact same. The military's PA school just lifted the classes from the medical school. They did this by taking instructors from the medical school and bringing them to there PA school. Now that I am in my MS-3 I can tell you the didactic portion there was little difference noted. I am 7 years removed from PA school, but I doubt it changed that much. The difference comes in the hands on experience in clinical rotations and residency. PA's only get between 12-18 months depending on the program. This handicaps them starting out. After my experience as a PA. I can tell you that the senior residents I run into know less than I. Kind of funny.

[NLengr]

I graduated from the U.S. Army PA school. Most instructors were MD's or PA's with clinical doctorates. Many came from the military's med. school and told us there were only three courses we did not take that they did and we had 16 months. We did not take histology, embryology and can't remember the last course. They said the courses were the exact same. The military's PA school just lifted the classes from the medical school. They did this by taking instructors from the medical school and bringing them to there PA school. Now that I am in my MS-3 I can tell you the didactic portion there was little difference noted. I am 7 years removed from PA school, but I doubt it changed that much. The difference comes in the hands on experience in clinical rotations and residency. PA's only get between 12-18 months depending on the program. This handicaps them starting out. After my experience as a PA. I can tell you that the senior residents I run into know less than I. Kind of funny.

 

I agree, residency is what makes a staff physician. Medical school is but stepping stone. I have no trouble believing a PA/NP could easily function at a med student/junior resident level in their particular field.

 

On the other hand, senior residents are generally quite well versed in their specialty. At the chief level, especially late in the year due to studying for the royal college exams, they generally have a better BROAD knowledge of their specialty than the staff (the staff usually know more in their particular sub area). They are essentially functioning at a junior staff level. I would be EXTREMELY hesitant as an MS-3 (even one with 7 years under his/her belt as a PA) to claim that you know more than a senior resident. That's the kinda misplaced overconfidence that gets med students/junior residents in over their heads on the floor/in the OR.

[PA Bound]

SDN is studentdoctor.net/forums

 

What I mean by you don't know unless you've done both is based on people who are in my class who were PAs prior and those who've posted their experiences on SDN. I have yet to meet or see a post by someone not repeating that they did not realize how much they did not know and were embarassed that they thought that they were close to a MDs level. I also meant by that because I used to be a paramedic and used to think that I could handle things and compared myself to ER MD residents when in reality I didn't know squat. I knew protocols, I didn't understand a thing in retrospect and I would've been dangerous if I continued thinking like that - I didn't realize all the background thinking that went into a physicians mind until I actually became one.

 

Regarding McMaster being ranked #6 - I said that IF what you said is correct - that your PA curriculum is 2/3 of MD program than that is embarrassing for the MD program - however I attribute that belief you have more to what you've been told (of no fault of your own) rather than reality because the pace in medical school is ridiculous and the demands and expectations are quite high as an MD, however I dont go there so I cannot comment. I have looked at the course material and exams of PAs at my school and I can tell you that the depth and breadth is unbelievably far greater in the MD program. You are expected to understand everything. In addition, The expectations are night and day. furthermore, ranking don't take into account the quality of physicians trained - how is MacLeans qualified to do that? Anecdotally yes I have heard that Mac grads CAN be equivalent to 4 year MDs however their curriculum allows for many people who don't know much to get through as many people can cram for exams. The critique of their curriculum and quality of students comes from posts on this board in their sub forum.

 

The reason I spoke like this is more from the anger that teachers of midlevels are trying to indoctrinate their trainees into believing this stuff - it's not specifically directed at the students who internalize those same beliefs. Im speaking like this because I have seen first hand how dangerous it is for patients.

 

I get equally mad when I see lazy med students or incompetent residents because they are also dangerous to patients. There is an incredible amount of knowledge to be mastered and everyday you have to work on reading and trying to master it. Anyone who doesn't have a knowledge of their own limitation of their understanding of medicine is dangerous. Its just that I see this mentality of being "almost equivalent" more so in PAs and NPs I've been around to no fault of their own because that simply what they've been told by their superiors and they believe it. It's the same things with bad residents - they believe they are almost equivalent to attendings - if they knew how little they actually know theyd tried to improve. The things is you don't know what you don't know. In a good residency and a good medical school, you are constantly exposed of how little you actually know which forces the individual to go study more.

 

I am constantly exposed how little I know compared to my attenidngs which makes me work harder. There is a reason why most specialist residencies are 4-5 intense years, and that's also why I think Family should increase to 3 years given that it's just so difficult to really know what you are doing in such a short time.

 

The problem is that midlevels are overtrained to do the work that helps out docs the most (notes, discharge summaries, etc..) but insufficiently trained to actually take care of patients because they often work on protocol - you have to understand disease, understand the biology of the body and then understand and critique the body of evidence to actually treat patients which is impossible in the frame of time of PA school. They exist in the US mainly because docs know that procedures make more money and patient care doesn't so they leave it to hired midlevels. Which of course leads to poor patient care but these greedy docs and hospitals don't care so which led to the insurgence of midlevels.

 

In Canada, I understand the purpose is to fill the physician gap temporarily - however it makes no sense because no midlevels will want to work in rural regions for the same reasons MDs don't and thats mainly because they aren't from the region so they are less likely to move there long term. Furthermore that's supposed to be a stop gap solution, not long term.

 

I hope no one takes this as I am critiquing the individuals ability - anyone can be an MD but its just that the person needs to be committed and work hard everyday. the training needs to be intense and long and huge amount of hard work goes into this to even becoming and MD and then when you get to residency you still don't know anything relative to a fully independent attending and as a MD student you know this because it's pounded in your head the message that "you don't know anything yet", so not just me but it gets everyone quite irritated when those who have trained for less intensity and less years claim some sort of "almost equal" jargon. this is not something you can fully appreciate once you've given your blood and sweat to something for four years as an MD and still be an infant compared to fully qualified doctor. But I know that this is necessary to provide quality care for patients - all patients deserve a doctor who worked his/her butt off everyday to know and learn as much as possible.

 

I suppose this is quite the long rant - I'm not sure what the real role of midlevels should be however i don't agree with wasting peoples time. I have seen NPs do great jobs in niche areas where they take of specific populatios of patients - for example having a NP run anticoagulation education, checking up on patients getting chemotherapy etc..

 

I do know that I agree with a bridge program like in the US for the currently trained Canadian PAs who have no jobs. Get them into a 3 year MD program and so we have more fully qualified MDs to get into residencies.

 

My overall point is this...have an opinion...speak it critically and vociferously...just be nice about it.

[fskatergirl]

And as near as I can tell, the PA program at Mac includes only three "Medical Foundations" blocks compared to five in the MD program. How do you account for that 2/3 increase? And PCOS + DM is a "complex case"?

 

You're correct in that the PA program only has three Medical Foundations whereas the MD program has five; however, this is not because two units have been removed, rather, the curriculum is grouped differently. Basically, MF2 for PAs includes the material covered in MF2&3 for MDs, and MF3 for PAs includes the material covered in MF4&5 for MDs (see below).

 

MD Medical Foundation 1: Oxygen supply and exchange - respiratory, hematologic and cardiovascular systems.

MD Medical Foundation 2: Homeostasis and energy balance, issues related to the GI tract, endocrine system and nutrition.

MD Medical Foundation 3: Homeostasis and balance of acid and base, blood pressure and renal function; reproduction and pregnancy, genetics related to reproduction.

MD Medical Foundation 4: Host defence, immunology and infectious disease, neoplasia and the genetics of neoplasia.

MD Medical Foundation 5: The locomotor system, the nervous system and behaviour.

 

PA Medical Foundation 1: Oxygen transport - cardiovascular, respiratory and hematologic physiology and disease.

PA Medical Foundation 2: Homeostasis - energy balance, GI, endocrine, nutrition, fluid and electrolyte balance (including renal, acid base, BP) and reproduction, and pregnancy.

PA Medical Foundation 3: Infection, neoplasia, neurologic, psychiatric and musculoskeletal physiology and disease.

 

I don't think that anybody here is suggesting that PAs are getting the exact same education as the MD students - they are merely pointing out the similarities that exist in their education. Obviously, the MD program in its entirety is much more comprehensive. We complete many of the same cases as the MD students, and yes, sometimes certain aspects of the problem are deleted (i.e., PCOS from the DM case). I wouldn't say that this is because this material is "too complex" for PA students - I had the director of the program as my tutorial leader for this exact case and he told us that PCOS was taken out of the case due to time constraints. Often, we are given a few cases to solve for our next tutorial - when additional problems like PCOS appear within a case, it takes away from the time that we have to learn about DM. I think it's important to note that PCOS did come up in our discussion about epidemiology and that we did actually discuss it within our tutorial anyways.

 

While it is frequently pointed out that many MD cases are taken out of the PA program, I think it's important to note that within the last two years, the program has started to fill out the PA curriculum a bit more - whereas previous years may have had one or two cases to solve for their next tutorial, additional cases have been added to ensure that we are exposed to as much as possible in the short period of time that we are in school. There are a few instances where we cover topics/cases that are not included in the MD curriculum.

 

While we are exposed to many of the same cases and have some of the same tutorial leaders, I would not say that I know more than any MD student in their first year. However, do I think that I have developed the background knowledge needed to begin to clinically reason though a problem? Yes, I do. Perhaps my knowledge of the precise pathophysiology of each disease is a bit lacking...although we do cover this in detail, I don't think it is hammered into our heads and emphasized as much as it probably is in the MD program. We are encouraged to look at detail, but to really focus on solidifying our knowledge of the big picture. Knowing all of the interleukins involved in the asthmatic response is not going to change my approach to a patient with asthma. PAs are not doctors nor cellular physiologists. If we don't have an answer to a problem, we will go an ask our supervising physician - after all, they have more formal education.

[PAstudent]

Great post! May I presume you are in the class below me? I have not yet had the chance to meet any of the first years but chat with a few of them on Facebook.

You're correct in that the PA program only has three Medical Foundations whereas the MD program has five; however, this is not because two units have been removed, rather, the curriculum is grouped differently. Basically, MF2 for PAs includes the material covered in MF2&3 for MDs, and MF3 for PAs includes the material covered in MF4&5 for MDs (see below).

 

MD Medical Foundation 1: Oxygen supply and exchange - respiratory, hematologic and cardiovascular systems.

MD Medical Foundation 2: Homeostasis and energy balance, issues related to the GI tract, endocrine system and nutrition.

MD Medical Foundation 3: Homeostasis and balance of acid and base, blood pressure and renal function; reproduction and pregnancy, genetics related to reproduction.

MD Medical Foundation 4: Host defence, immunology and infectious disease, neoplasia and the genetics of neoplasia.

MD Medical Foundation 5: The locomotor system, the nervous system and behaviour.

 

PA Medical Foundation 1: Oxygen transport - cardiovascular, respiratory and hematologic physiology and disease.

PA Medical Foundation 2: Homeostasis - energy balance, GI, endocrine, nutrition, fluid and electrolyte balance (including renal, acid base, BP) and reproduction, and pregnancy.

PA Medical Foundation 3: Infection, neoplasia, neurologic, psychiatric and musculoskeletal physiology and disease.

 

I don't think that anybody here is suggesting that PAs are getting the exact same education as the MD students - they are merely pointing out the similarities that exist in their education. Obviously, the MD program in its entirety is much more comprehensive. We complete many of the same cases as the MD students, and yes, sometimes certain aspects of the problem are deleted (i.e., PCOS from the DM case). I wouldn't say that this is because this material is "too complex" for PA students - I had the director of the program as my tutorial leader for this exact case and he told us that PCOS was taken out of the case due to time constraints. Often, we are given a few cases to solve for our next tutorial - when additional problems like PCOS appear within a case, it takes away from the time that we have to learn about DM. I think it's important to note that PCOS did come up in our discussion about epidemiology and that we did actually discuss it within our tutorial anyways.

 

While it is frequently pointed out that many MD cases are taken out of the PA program, I think it's important to note that within the last two years, the program has started to fill out the PA curriculum a bit more - whereas previous years may have had one or two cases to solve for their next tutorial, additional cases have been added to ensure that we are exposed to as much as possible in the short period of time that we are in school. There are a few instances where we cover topics/cases that are not included in the MD curriculum.

 

While we are exposed to many of the same cases and have some of the same tutorial leaders, I would not say that I know more than any MD student in their first year. However, do I think that I have developed the background knowledge needed to begin to clinically reason though a problem? Yes, I do. Perhaps my knowledge of the precise pathophysiology of each disease is a bit lacking...although we do cover this in detail, I don't think it is hammered into our heads and emphasized as much as it probably is in the MD program. We are encouraged to look at detail, but to really focus on solidifying our knowledge of the big picture. Knowing all of the interleukins involved in the asthmatic response is not going to change my approach to a patient with asthma. PAs are not doctors nor cellular physiologists. If we don't have an answer to a problem, we will go an ask our supervising physician - after all, they have more formal education.

[fskatergirl]

Great post! May I presume you are in the class below me? I have not yet had the chance to meet any of the first years but chat with a few of them on Facebook.

 

Yes, I'm in my first year I'd love to hear about your experience in clerkship so far! I'd PM you my facebook details but it seems as if that function is not working at the moment.

[PAstudent]

Yes, I'm in my first year I'd love to hear about your experience in clerkship so far! I'd PM you my facebook details but it seems as if that function is not working at the moment.

 

I just posted on your male classmate's wall. His initials are S.E. Go ahead and message me/add me there. My initials on FB are K.K.