Pa = Md

[Pink Tulip]

I've run into many issues with patients going to their pharmacist with a faulty prescription - and it is due to the lack of training a physician receives. They are not meant to be all-knowing in everything, they are generalists, and many of them forget that (hence general practitioner, specialists are of course supposed to know everything of THEIR discipline, and general information of others).

 

In response to MD = PA, this will NEVER happen. PAs will never be in a position where they are autonomous. The whole point of having a PA is to have a primary healthcare provider that can perform many of the same duties as a physician, but not all. They can never truly specialize. PAs are even more generalists than physicians are, and have even less knowledge (when compared to both having equal amount of work experience). You will never see a PA become an obstetrician. You will never see them become a cardiovascular surgeon. There is a reason for this. To say that one day a PA will become equivalent to an MD is a very naive statement. If you want to be autonomous in medicine, become an NP or MD. The years of training these specialist MDs and specialist nurses do enables them to have the ability to provide autonomous healthcare. A PA has two years of training, one in the university and one in placements (Manitoba requires more, but still not a lot). Because of this, they miss out on MANY important details that are essential to being a specialist in healthcare. This is why they will ALWAYS work under an MD and be supervised by one.

 

Think about it this way - if you were critically injured and had the choice to be treated by a PA "specialist" or an MD "specialist", which one would you prefer? No offense, but I would take the guy that did 8-10 years of training before they were put into the workforce over someone with only 2 years plus whatever they have for clinical experience. Keep in mind the clinical experience gained through work can be beneficial or not - just because you work on a unit for x amount of years does not mean you learn everything.

 

Also, PAs can bill for up to 80% of what physicians bill for prescriptions and tests in private offices. That's going to depend on the insurance companies and the physician themselves, it has nothing to do with the PA becoming independent. Likely to be seen, insurance will be the hardest to bump along the way for PAs to become prominent in our healthcare system. And on a side note: if PAs ever got fed up and wanted to be billed 100%, insurance companies would stop them flat out. No way would they allow someone with less training and possibly experience to take away the same amount of money from their bank as someone with a substantial amount of training and possibly experience. That's practically common sense.

[PAstudent]

By definition, a PA has autonomy but not independence. The whole point of a PA is that they have autonomy (negotiated and different for each PA) with some emerg PAs, for example, doing solo emerg work where the supervising physician is off-site and some, like myself (a new grad) discussing every case with a supervising physician in real time and working similar to how a PGY1 works. Independence, no. By definition a PA is not independent. Autonomy? Yes. Also,there are many experienced specialist PAs (btw, there are residencies for PAs in the USA).

 

It is disingenuous to frame PA training as 2 years vs MD or NP training. With regard to the latter, the majority of the additional training is in nursing, not in medicine. With regard to the former, the significant difference between a PA and a MD is residency. Indeed, an important and weighty difference. But, at the new grad level, the PA new-grads at McMaster and the MD new grads at McMaster are at a similar level, on average. The main differences between the MD and PA programs at McMaster, as I have pointed-out in other threads, are that MDs get double the elective time and core in obs/gyn and anesthesia (whereas I had to schedule that into my elective time). There are also a few more checks and balances in the current MD program compared with the PA (but historically the MD program had few checks and balances, which seemingly contributed to the higher LMCC failure rate from McMaster grads).

 

I know these details because I am, of course, a graduate of the PA program at McMaster and, as a McMaster Health Sciences grad, many of my classmates, friends, and acquaintances are McMaster MD grads/students. Indeed, my partner is graduating the MD program in a few months.

 

PA training, at McMaster anyway, is very close to MD training and, with proper study, reading, guidance, and on-the-job learning there is no good reason why a PA with many years of experience in a specialty should not be as competent a clinician as MDs in that specialty providing the PA has not been held back or limited in any way and that the PA has made a point of learning, growing, and improving. That is why experienced emerg PAs or PAs who have done emerg residencies can run an emerg solo successfully. Remember, supervision is a legal arrangement and autonomy is a negotiated one.

 

 

 

In response to MD = PA, this will NEVER happen. PAs will never be in a position where they are autonomous.

[jerkoutnow2]

By definition, a PA has autonomy but not independence. The whole point of a PA is that they have autonomy (negotiated and different for each PA) with some emerg PAs, for example, doing solo emerg work where the supervising physician is off-site and some, like myself (a new grad) discussing every case with a supervising physician in real time and working similar to how a PGY1 works. Independence, no. By definition a PA is not independent. Autonomy? Yes. Also,there are many experienced specialist PAs (btw, there are residencies for PAs in the USA).

 

It is disingenuous to frame PA training as 2 years vs MD or NP training. With regard to the latter, the majority of the additional training is in nursing, not in medicine. With regard to the former, the significant difference between a PA and a MD is residency. Indeed, an important and weighty difference. But, at the new grad level, the PA new-grads at McMaster and the MD new grads at McMaster are at a similar level, on average. The main differences between the MD and PA programs at McMaster, as I have pointed-out in other threads, are that MDs get double the elective time and core in obs/gyn and anesthesia (whereas I had to schedule that into my elective time). There are also a few more checks and balances in the current MD program compared with the PA (but historically the MD program had few checks and balances, which seemingly contributed to the higher LMCC failure rate from McMaster grads).

 

I know these details because I am, of course, a graduate of the PA program at McMaster and, as a McMaster Health Sciences grad, many of my classmates, friends, and acquaintances are McMaster MD grads/students. Indeed, my partner is graduating the MD program in a few months.

 

PA training, at McMaster anyway, is very close to MD training and, with proper study, reading, guidance, and on-the-job learning there is no good reason why a PA with many years of experience in a specialty should not be as competent a clinician as MDs in that specialty providing the PA has not been held back or limited in any way and that the PA has made a point of learning, growing, and improving. That is why experienced emerg PAs or PAs who have done emerg residencies can run an emerg solo successfully. Remember, supervision is a legal arrangement and autonomy is a negotiated one.

 

This is exactly my point.

 

Autonomy is negotiated but supervision is a legal arrangement.

 

Look 20-30 years down the road, there might be a PA advocacy group looking to challenge that legal arrangement because they don't want to bother with going to med school to do it all over again when they truly feel competent enough and feel good enough like other MDs.

 

Just because it's legal doesn't mean it's absolute. Laws are changing all the time

[Pink Tulip]

Then can you explain why it hasn't happened in the States already? They've had PAs for over 40 years now and they've remained a dependent practice. There's nothing to show there that Canada will introduce a whole new type of healthcare profession just to have it completely change its values and definitions after 20-30 years. That'd defeat the majority of the point of introducing PAs in the first place. And by that I mean they are being introduced to be a cheaper way to provide similar healthcare as an MD for the government. If they have to suddenly start dishing out 100% of wages to PAs as they do MDs, why would they create the profession here? What's the use? It will not save the government money in the long run if PAs fight for independence and I still doubt that the government will ever let it happen, just because of this reason. It's defeating the whole point of being a PA in the first place. If you want to be an independent practitioner, don't be a PA. That's not what they're here for. Even in the PA program for McMaster in the Supplementary Application they have a question relating to how you feel about the PA being a dependent practitioner... so you're really just digging yourself into a pit by saying that one day PAs will gain independence from MDs, because they won't. That's like saying all of the other assistant professions will suddenly become equivalent to their supervisors (for example, LPNs becoming equivalent to RN status or physiotherapy assistants to physiotherapists).

 

Now bridging programs are a completely different topic and the only way that you would ever see a PA go to MD. But those have yet to exist. That's the only way I could possibly see this ever happening. Meaning, PAs will eventually do schooling equivalent to MDs to become an MD. But PAs will not be independent in Canada until the States makes that move, and you will most likely see it in bridging from PA to MD.

[PAstudent]

That's like saying all of the other assistant professions will suddenly become equivalent to their supervisors (for example, LPNs becoming equivalent to RN status or physiotherapy assistants to physiotherapists).

 

Now bridging programs are a completely different topic and the only way that you would ever see a PA go to MD. But those have yet to exist.

 

While I agree with you that PAs in general will not seek independence as the whole point of our profession is to be dependent I must disagree with a few of your points.

 

There is one bridging program in the USA but it is less than ideal in many ways.

 

Also, comparing PAs to "other assistant professions" doesn't make much sense. As you likely know, the name of our profession is a misnomer in so many ways and in many places, noteably, Yale University School of Medicine, the name is Physician Associate.

 

In no other "assistant profession" do the assistants do the same job as the profession they are assisting. PAs practice medicine. Dental assistants do not practice dentistry, for instance. As PA David Mittman says:

 

"As a PA I am not a technician or an assistant level profession. One cannot be trained to do much of what a physician can do, and then do it well for 10, 20 or 30 years, and still be an “assistant,” still need “supervision,” which is a word that was picked for us by organized medicine. Supervision to the public means “they need to be watched.” It means they’ll NEVER really get “good enough” to do it alone. That is not the basis of a profession. These words hurt and are confusing to patients."

see: http://www.kevinmd.com/blog/2011/04/physician-assistant-writes-doctors-america.html

 

The job of a PA is to practice medicine under and arrangement of supervision and many experienced PAs, particularly in family and emergency medicine do the exact same job as their supervising physicians and have the same scope of practice, skills, and knowledge. Many experienced PAs mentor new physicians.

[thebouque]

How is the job market for PAs in Quebec?

[Pink Tulip]

Then why argue about whether they will seek independence through their own College or not?

 

Also, I have heard of the term physician associate being pulled around and many in the profession wanting to change to it. I do understand how the PAs do sit in a bit of a different stance between SOME of the "assistant" professions, but nevertheless that is their scope of training. And going back to my previous comment, both LPNs and RNs practice nursing, which is the reason probably why bridging programs between these two professions have been developed. Since the LPN could be seen as an assistant to the RN, they could with various years of practice and experience gain enough insight and skill to be licensed as an RN. The same would go for PAs and MDs. My point is that you will not see it happen without additional formal education of some sort - there has to be something to make up for the years that PAs did not spend in medical school to make them equivalent to the status of an MD. Otherwise you run the issue of having many people choosing to become a PA instead of an MD to avoid medical school fees. If you could become an MD from being a PA for a certain amount of years, gaining experience, avoiding high medical costs, performing many of the same techniques, working in the same environment, why WOULDN'T anyone just become a PA first and then transfer to an MD? I couldn't see many new MDs coming out of a situation like just because of where the economy sits right now. It's much cheaper to become a PA than an MD, especially if you could eventually be granted MD status of being independent without going to medical school (and I would imagine bridging programs would cost considerably less). Maybe it's a good thing to have less young doctors out there and save all of the supervisory/management roles for those MDs/PAs with more experience.

 

All assistants need to be watched, that's why they are assistants. I do agree with your point that PAs should change their professions official name to that of associate, because really they do perform many of the same procedures that MDs do. And both professions practice medicine. Just like LPNs and RNs both practice nursing. You don't see LPNs being called assistants, and there is probably a reason why. So the PA profession might want to take a note from the nursing profession and agree to change their name or they will be just "assistants who practice medicine". Because I could say now that when a patient sees a LPN or RN, all they see is a nurse. Same should go for PAs and MDs if they really want to expand their scope of practice to be less of "assistant and supervisor".

[Lunasly]

This entire thread is useless. How the hell can any one of us predict what the medical field will be like in the next 20 - 30 years?

[Pink Tulip]

Why not? If you ever hope to expand your career as a professional in any domain you always need to be looking ahead into the future of what could be. Why destroy the ideas of creative minds that could one day create a different tomorrow? It's an interesting topic of discussion and if you don't feel the need to take part in it, don't.

[Lunasly]

Why not? If you ever hope to expand your career as a professional in any domain you always need to be looking ahead into the future of what could be. Why destroy the ideas of creative minds that could one day create a different tomorrow? It's an interesting topic of discussion and if you don't feel the need to take part in it, don't.

 

You know what, you're right. Putting your creative mind to the test trying to expand the field of medicine... yeah, that's the ticket...

[concernedmedstudent]

Some very strange arguments being made.

 

Why can't people just be satisfied being in the career that they are in?

 

1.) Just because you change the title of your degree to a Doctorate in Nursing or to Physician Associate in no way means you are equal. I have heard a lot of janitors refer to themselves as Custodial Engineers - this doesn't make them engineers - perhaps they should change their two week orientation course so that it awards a Doctorate in Custodial Engineering - would this make them Doctors and engineers? RIDICULOUS!

 

2.) Why is it that nurses and other professionals feel the need to encroach on physicians - they are extremely different roles - BOTH I might add are important - and any safe and effective nurse or physician recognizes this

 

3.) Can you imagine flight attendants taking an extra course or two on navigation and then considering themselves to be the same as pilots? Perhaps if paralegals take a course on public speaking we should consider them to be the same as lawyers?

 

Statements about these two being equivalent is proof in itself about the discrepancy in education.

 

A great nurse is much bette at nursing than a physician and I don't see a lot of doctors claiming to be proficient in nursing - that would be arrogant and would fall outside the scope of their practice and training.

[concernedmedstudent]

As an ex-pharmacist, now doing doing my residency in anesthesia, I have to say many of you have wrong ideas about pharmacy and a false sense in your own superiority.

 

Med students get a bare minimum of pharmacology teaching in school and learning on the job as a resident is not enough. I just hope most of you won't become the pompous asses that I encountered a lot when trying to correct physicians on their prescribing choices.

 

Pharmacists provide a valuable service to patients and often are the front-line for initial health care for minor ailments. Secondly, they emphasize things to patients that most docs would rarely think to tell their patients (ie. where to store drugs, which to take with food or not etc)

 

Well said - people on this blog should listen to you.

 

Everyone has their own important role.

 

As a doctor (goal of anesthesia also) I will never be so pompous as to suggest that I know more about pharmacy than pharmacists, the same way I will never claim to know more about nursing than nurses. I think that any reasonably educated person would realize the scope of their own practice.

 

Why is it then that nurses (Ill say once again - who are great at nursing and whom I have a ton of respect for) think that they have even close to the knowledge, education and skills of a physician - who not only received a different education but also received a lot more of it at significantly more competitive institutions and programs.

 

If you want to become a doctor go to medical school. If you would to become a nurse go to nursing school.

[maritimer]

Some very strange arguments being made.

 

Why can't people just be satisfied being in the career that they are in?

 

1.) Just because you change the title of your degree to a Doctorate in Nursing or to Physician Associate in no way means you are equal. I have heard a lot of janitors refer to themselves as Custodial Engineers - this doesn't make them engineers - perhaps they should change their two week orientation course so that it awards a Doctorate in Custodial Engineering - would this make them Doctors and engineers? RIDICULOUS!

 

I'll only comment on PAs (as I am a PA Student), but I don't think you'll find any who are not satisfied with their profession, or AT ALL calling ourselves "equal" or "better" than Physicians. If you go back in this thread, the one who started this thread I don't believe is a PA or PA student-and clearly doesn't know about PAs or the profession. Actually talk to any PA or PA student...they do not want to become MDs, nor call themselves MDs...or wish to become independent. It was more of a trolling statement than anything else to get people riled up and cause the exact misconceptions and preconceived notions that are being stated now because of it.

[concernedmedstudent]

I'll only comment on PAs (as I am a PA Student), but I don't think you'll find any who are not satisfied with their profession, or AT ALL calling ourselves "equal" or "better" than Physicians. If you go back in this thread, the one who started this thread I don't believe is a PA or PA student-and clearly doesn't know about PAs or the profession. Actually talk to any PA or PA student...they do not want to become MDs, nor call themselves MDs...or wish to become independent. It was more of a trolling statement than anything else to get people riled up and cause the exact misconceptions and preconceived notions that are being stated now because of it.

 

Thank you. This is a very important post. I apologize if my statements were construed as referring to all PAs or other midlevel providers. I think that the majority of people that go into this profession do it for the right reason. The same argument is probably true for nurse anesthetists in the states - its a few bad apples with inflammatory statements that gets everyone (including myself) all riled up!

 

PA's that recognize their limitations and work within their scope are an instrumental part of our healthcare system and are extremely beneficial. The same goes for docs - a doctor working beyond their limitations and scope is just as or even more dangerous than a mid level doing the same thing.

[BoneNJoint]

While PAs do play an important role in assisting physicians in practice, the idea that PA = MD is short-sighted and misguided. No one knows how difficult medical school is and the volume of information one has to study without going through the process themselves. The training time of a 2 year program does not compare to the 4 years of undergraduate medical education and 2-7 years of residency training.

 

This article should help put things in perspective:

 

http://www.kevinmd.com/blog/2014/10/pa-md-appreciation-physician-education.html

[cookiemonster99]

China, India, etc etc. the lifespan of Chinese population is the same as the US and their hospitals hire high school grads to dispense meds, works just fine. Hospital/clinical pharmacists can be quite useful but I don't know what those guys in department stores are doing (probably where 90% of pharmacists work). The cream is already pre-packaged, they squeeze it out and repackage it in another tube and charge you $12 dispensing fee. Like thanks Eisenstein.

 

If they removed pharmacy as a profession in North America, the savings produced can probably increase med school admissions and doctor positions by 25%, so the smart pharmacy kids can just become doctors instead so they don't have to waste their intelligence in a community pharmacy counting pills for rest of their lives.

 

I honestly think this post is so ignorant. You are kind of comparing apples and oranges. I can't comment on India but in China the healthcare system is so different.

 

1st-medicine is very very very very very money orientated there. 

2nd-prescribing is how most doctors make money there

3rd-there is no insurance in terms of if a doctor screws up and kills their patient

4th-there's two types of medicine there, there's the traditional eastern medicine that they have been using for thousands of years and the western style that we all are aware of. Can you imagine you going to a doctor in China complaining of a headache and they tell you to drink Chinese traditional medicine consisting of dried roots and tree bark brewed into a black soup...?

 

there's much more differences that I probably don't know but those are kinda of the drastic ones. 

 

Let's entertain the idea of putting high school grads in pharmacist positions, how would they interpret the dosage issue? How would they know how to mix some variation of drugs and what amount to mix to give to the patient. Some drugs need to be mixed before giving it to the patient because keeping them apart increases shelf life. Would you know that from high school? You wouldn't even know what pharmacology is! let along mixing drugs and counting tablets for patients. How many tablets does this patient need? How long do they take this medication for? How many times a day? With food or without food? What other medication are they taking? 

 

While i'm on this topic I might as well add my personal story: I went to the dentist for pericoronitis(http://en.wikipedia.org/wiki/Pericoronitis) and he prescribed me antibiotics for it. The dentist was careless and didn't read my medical history not knowing I was allergic to penicillin. It was the pharmacist that asked if i was allergic to any medication and LUCKILY he did because I would have gotten amoxicillin which I would have had a terrible allergic reaction to! So we definitely need pharmacists!!

 

In terms of this discussion I figure that I'll add in my 2 cents. 

Although i'm not a medical student or a PA student but there is something in my field that many people do not know. 

 

There are traditional dental hygienist roles where they can give patients cleanings and oral health advice. 

HOWEVER, there are programs in Ontario where a dental hygienist can undergo specialized training to do restorative work

which INCLUDES fillings. 

 

HOWEVER, just because they trained as a restorative hygienist to do filling does not mean they are dentists! We do much more work that just fillings as dentists. 

Endo, Crown, Bridges, Veneers etc that as a hygienist they CAN NOT DO period. 

 

I'm not sure if there are some things that PAs can do that MD can do too but I'm sure there are scopes of practices that do parallel and some things that PAs are not allowed to do. 

[JohnGrisham]

Then can you explain why it hasn't happened in the States already? They've had PAs for over 40 years now and they've remained a dependent practice. There's nothing to show there that Canada will introduce a whole new type of healthcare profession just to have it completely change its values and definitions after 20-30 years. That'd defeat the majority of the point of introducing PAs in the first place. And by that I mean they are being introduced to be a cheaper way to provide similar healthcare as an MD for the government. If they have to suddenly start dishing out 100% of wages to PAs as they do MDs, why would they create the profession here? What's the use? It will not save the government money in the long run if PAs fight for independence and I still doubt that the government will ever let it happen, just because of this reason. It's defeating the whole point of being a PA in the first place. If you want to be an independent practitioner, don't be a PA. That's not what they're here for. Even in the PA program for McMaster in the Supplementary Application they have a question relating to how you feel about the PA being a dependent practitioner... so you're really just digging yourself into a pit by saying that one day PAs will gain independence from MDs, because they won't. That's like saying all of the other assistant professions will suddenly become equivalent to their supervisors (for example, LPNs becoming equivalent to RN status or physiotherapy assistants to physiotherapists).

 

Now bridging programs are a completely different topic and the only way that you would ever see a PA go to MD. But those have yet to exist. That's the only way I could possibly see this ever happening. Meaning, PAs will eventually do schooling equivalent to MDs to become an MD. But PAs will not be independent in Canada until the States makes that move, and you will most likely see it in bridging from PA to MD.

Just fyi, bridging programs do exist in the US.

[hexonu]

The powerful physician lobby in this country would never let this happen. It also seems a bit redundant to me. If you want more autonomy, go to medical school.