OT: 10,000 Pt XLIII - The Ultimate Raw Deal (or LS's House of the Dead)

Status
Not open for further replies.

Doctor Soraluce

Registered User
Sep 28, 2017
7,051
4,459
Like I said, that's a whole 'nother conversation, but I just wanted to note patients should be made aware that a PA is nowhere close to a doctor. They absolutely do not have the knowledge, expertise, or training to "handle all responsibilities". The new laws where NPs and PAs are fighting for independent practice is a huge disservice and danger to the public. It's also against the law if any of them introduce themselves as "Doctor" in a clinical setting. You as a patient have the right to see an MD/DO during all of your visits, and you should start demanding to do so if you haven't already.
Sounds like you hate PA's. Is it because some places choose to hire less doctors and use PA's instead to save money? Serious question, not a jab. If you go to Urgent Care for Providence in Oregon there's probably a 50/50 chance you're going to see a PA. I never said they introduce themselves as "Doctors". Everything else I said is a reality whether you approve or not.

Yeah, PAs are nowhere near as qualified as MD/DOs despite them certainly having a role in the healthcare system...and that's fully licensed PAs let alone trainees. A PA trainee basically has the qualifications of a senior medical student...
This is laughable and an insult to physicians who spend 7+ years in training. I don't want to derail the thread but this isn't even remotely true.
Doesn't sound like you two know what a PA actually is and does. So take a moment and enlighten yourself. ;) Maybe you guys are confusing PA's with Nurse practitioners...?

Home - AAPA
"PAs are medical professionals who diagnose illness, develop and manage treatment plans, prescribe medications, and often serve as a patient’s principal healthcare provider. With thousands of hours of medical training, PAs are versatile and collaborative. PAs practice in every state and in every medical setting and specialty, improving healthcare access and quality."

"PAs’ specific duties depend on the setting in which they work, their level of experience, their specialty, and state laws.
Generally, PAs can:
• Take medical histories
• Conduct physical exams
• Diagnose and treat illness
• Order and interpret tests
• Develop treatment plans
• Prescribe medication
• Counsel on preventive care
• Perform procedures
• Assist in surgery
• Make rounds in hospitals and nursing homes
• Do clinical research"

"PAs are committed to team practice with physicians and other healthcare providers. Currently, most state laws require PAs to have an agreement with a specific physician in order to practice. These agreements were included in early PA practice acts 50 years ago when the PA profession was new and untested."
"Today, PAs are still held to these obsolete requirements despite the PA profession being well established, highly trusted, and essential to the U.S. health care workforce."

"PAs are educated at the master’s degree level. There are more than 250 PA programs in the country and admission is highly competitive, requiring a bachelor’s degree and completion of courses in basic and behavioral sciences as prerequisites. Incoming PA students bring with them an average of more than 3,000 hours of direct patient contact experience, having worked as paramedics, athletic trainers, or medical assistants, for example. PA programs are approximately 27 months (three academic years), and include classroom instruction and more than 2,000 hours of clinical rotations."

So yeah, a lot of the same stuff doctors do. ;)
 

DG93

Registered User
Jun 29, 2010
4,343
2,244
San Jose
Sounds like you hate PA's. Is it because some places choose to hire less doctors and use PA's instead to save money? Serious question, not a jab. If you go to Urgent Care for Providence in Oregon there's probably a 50/50 chance you're going to see a PA. I never said they introduce themselves as "Doctors". Everything else I said is a reality whether you approve or not.

Doesn't sound like you two know what a PA actually is and does. So take a moment and enlighten yourself. ;) Maybe you guys are confusing PA's with Nurse practitioners...?

Home - AAPA
"PAs are medical professionals who diagnose illness, develop and manage treatment plans, prescribe medications, and often serve as a patient’s principal healthcare provider. With thousands of hours of medical training, PAs are versatile and collaborative. PAs practice in every state and in every medical setting and specialty, improving healthcare access and quality."

"PAs’ specific duties depend on the setting in which they work, their level of experience, their specialty, and state laws.
Generally, PAs can:
• Take medical histories
• Conduct physical exams
• Diagnose and treat illness
• Order and interpret tests
• Develop treatment plans
• Prescribe medication
• Counsel on preventive care
• Perform procedures
• Assist in surgery
• Make rounds in hospitals and nursing homes
• Do clinical research"

"PAs are committed to team practice with physicians and other healthcare providers. Currently, most state laws require PAs to have an agreement with a specific physician in order to practice. These agreements were included in early PA practice acts 50 years ago when the PA profession was new and untested."
"Today, PAs are still held to these obsolete requirements despite the PA profession being well established, highly trusted, and essential to the U.S. health care workforce."

"PAs are educated at the master’s degree level. There are more than 250 PA programs in the country and admission is highly competitive, requiring a bachelor’s degree and completion of courses in basic and behavioral sciences as prerequisites. Incoming PA students bring with them an average of more than 3,000 hours of direct patient contact experience, having worked as paramedics, athletic trainers, or medical assistants, for example. PA programs are approximately 27 months (three academic years), and include classroom instruction and more than 2,000 hours of clinical rotations."

So yeah, a lot of the same stuff doctors do. ;)

I don't want to give out too much private information, but I do work in the medical field. A lot of what you listed sounds great but after working alongside PAs, you actually get a feel for what they can and cannot do. A lot of those things listed are a very rosy perspective...in reality, they get a very general. short education and clinical training before starting a specific, niche job in a certain setting, which in your scenario was a surgical PA. Fully licensed PAs are usually capable of performing specific tasks that they are assigned, and the physician takes care of the more complicated cases and supervises them for the basic stuff. And yes, some healthcare systems over-hire PAs (Kaiser has been guilty of this in the past) to avoid paying physicians, which can be problematic. Also, NPs are significantly more qualified than PAs...they have more experience and training when they start working.
 
  • Like
Reactions: teravaineSAROS

WTFetus

Marlov
Mar 12, 2009
17,904
3,558
San Francisco
@Kcoyote3 we should've just gone to PA school bruh.

Sounds like you hate PA's. Is it because some places choose to hire less doctors and use PA's instead to save money? Serious question, not a jab. If you go to Urgent Care for Providence in Oregon there's probably a 50/50 chance you're going to see a PA. I never said they introduce themselves as "Doctors". Everything else I said is a reality whether you approve or not.

Ugh, I really didn't want to get into this. No, I don't hate all PAs. I hate all the "providers" who continue to fight for the midlevel creep of independent practice that is hurting the country's healthcare system. No, they aren't taking jobs away from me. My friends and I have 0 issues finding jobs in desirable locations because affluent populations understand the vast difference in knowledge and training between a physician and a midlevel. The population that really hurts is the rural, underserved population, who, like yourself, obviously don't know any better. There are numerous studies emphasizing how patient safety is in danger.

S
Doesn't sound like you two know what a PA actually is and does. So take a moment and enlighten yourself. ;) Maybe you guys are confusing PA's with Nurse practitioners...?
So yeah, a lot of the same stuff doctors do. ;)

1. NPs and PAs both are able to do what you quoted. Both are considered midlevels, so before you decide to tell other posters to "enlighten themselves", you should do the same.
2. You should also "enlighten" yourself on a medical student's training. BigDimitry isn't wrong. A 4th year medical student already has 2000+ clinical hours of training. You know how many hours doctors get before they become fully licensed? A minimum of 15,000 on top of that. Not to mention a resident's training is a lot more intense and thorough than a mid-level, so purely counting the difference in hours doesn't do it justice.
3. Your whole post was a whole lot of nothing. We're all fully aware of what NPs and PAs can do. The point was your BS that they can "handle all the responsibilities". No they can't, they don't have the training or the knowledge. Little do you know that in every UC/ER/clinic, it is required to have an MD/DO in the workroom to look over their shoulder. This can change with them continuing to fight for independent practice, and that is really when mistakes will happen.
 

Doctor Soraluce

Registered User
Sep 28, 2017
7,051
4,459
I don't want to give out too much private information, but I do work in the medical field. A lot of what you listed sounds great but after working alongside PAs, you actually get a feel for what they can and cannot do. A lot of those things listed are a very rosy perspective...in reality, they get a very general. short education and clinical training before starting a specific, niche job in a certain setting, which in your scenario was a surgical PA. Fully licensed PAs are usually capable of performing specific tasks that they are assigned, and the physician takes care of the more complicated cases and supervises them for the basic stuff. And yes, some healthcare systems over-hire PAs (Kaiser has been guilty of this in the past) to avoid paying physicians, which can be problematic. Also, NPs are significantly more qualified than PAs...they have more experience and training when they start working.
Like I said in my reply to fetus... here in Oregon you're just as likely to see a PA as a doctor when you go in for urgent care or an unschedule Primary care visit. Sound like 3 years of schooling on top of the 4 years for a bachelors. It's not nothing. For my personal experience here I never felt like I was getting shorted when I saw a PA. I definitely agree about NPs though. A very close family member was one. Worked a couple decades prior to becoming one. ;)

As far as all this relates to Ting, I do remember the lady said she was almost done with her PA stuff whatever that means. Yeah he should get in trouble if she was doing anything she shouldn't. I didn't feel like she was doing anything that a nurse wouldn't do when we met and like I said, I always saw Ting at some point even when it was a mundane follow up.
 

Doctor Soraluce

Registered User
Sep 28, 2017
7,051
4,459
@Kcoyote3 we should've just gone to PA school bruh.



Ugh, I really didn't want to get into this. No, I don't hate all PAs. I hate all the "providers" who continue to fight for the midlevel creep of independent practice that is hurting the country's healthcare system. No, they aren't taking jobs away from me. My friends and I have 0 issues finding jobs in desirable locations because affluent populations understand the vast difference in knowledge and training between a physician and a midlevel. The population that really hurts is the rural, underserved population, who, like yourself, obviously don't know any better. There are numerous studies emphasizing how patient safety is in danger.



1. NPs and PAs both are able to do what you quoted. Both are considered midlevels, so before you decide to tell other posters to "enlighten themselves", you should do the same.
2. You should also "enlighten" yourself on a medical student's training. BigDimitry isn't wrong. A 4th year medical student already has 2000+ clinical hours of training. You know how many hours doctors get before they become fully licensed? A minimum of 15,000 on top of that. Not to mention a resident's training is a lot more intense and thorough than a mid-level, so purely counting the difference in hours doesn't do it justice.
3. Your whole post was a whole lot of nothing. We're all fully aware of what NPs and PAs can do. The point was your BS that they can "handle all the responsibilities". No they can't, they don't have the training or the knowledge. Little do you know that in every UC/ER/clinic, it is required to have an MD/DO in the workroom to look over their shoulder. This can change with them continuing to fight for independent practice, and that is really when mistakes will happen.
None of that changes what I quoted or stated. You're talking "mid-levels" or whatever and I'm quoting what they actually do and what their training is. I never misrepresented it as anything more. No shit MDs go to more intensive training. I never said they didn't. Also are you sure about having an MD in the room? Anytime I've seen a PA in urgent care or in my primary care office there was never another person other than a nurse there. If you mean they work under an MD, yeah I already said that. Sounds like your post might be just as if not more guilty of being "a whole lot of nothing"... "Bruh" ;)
 
Last edited:

DG93

Registered User
Jun 29, 2010
4,343
2,244
San Jose
None of that changes what I quoted or stated. You're talking "mid-levels" or whatever and I'm quoting what they actually do and what their training is. I never misrepresented it as anything more. No shit MDs go to more intensive training. I never said they didn't. Also are you sure about having an MD in the room? Anytime I've seen a PA in urgent care or in my primary care office there was never another person other than a nurse there. If you mean they work under an MD, yeah I already said that. Sounds like your post might be just as if not more guilty of being "a whole lot of nothing". ;)

So mid-levels refers to PAs and NPs because they're below the MD/DOs in the hierarchy, and yes, WTFetus is correct that they continue to fight for more real estate in the medical field, which is leading to increased workload...that is not always for the best. In academic medical centers, for example, NPs and PAs see patients independently just like the residents (doctors receiving their training after medical school) do, but the patients are still at the end of the day cared for by attending (the main supervising) physicians. I'm not entirely sure how it works in community practice, but from my limited experience (this was primarily in the ED setting), they did see patients first, which was then followed by the MD/DO seeing the patients. If you see only the PA during your visits to the urgent care or primary care office, that is honestly not really what should be happening and isn't a good thing. Even if it's a very straightforward situation, the doctor is supposed to come see you briefly and double-check things and confirm to you that what the PA said in terms of next steps in your care is what will be happening.
 
  • Like
Reactions: Doctor Soraluce

Doctor Soraluce

Registered User
Sep 28, 2017
7,051
4,459
So mid-levels refers to PAs and NPs because they're below the MD/DOs in the hierarchy, and yes, WTFetus is correct that they continue to fight for more real estate in the medical field, which is leading to increased workload...that is not always for the best. In academic medical centers, for example, NPs and PAs see patients independently just like the residents (doctors receiving their training after medical school) do, but the patients are still at the end of the day cared for by attending (the main supervising) physicians. I'm not entirely sure how it works in community practice, but from my limited experience (this was primarily in the ED setting), they did see patients first, which was then followed by the MD/DO seeing the patients. If you see only the PA during your visits to the urgent care or primary care office, that is honestly not really what should be happening and isn't a good thing. Even if it's a very straightforward situation, the doctor is supposed to come see you briefly and double-check things and confirm to you that what the PA said in terms of next steps in your care is what will be happening.
It's entirely possible the MD did come in at the end and it wasn't memorable so I don't want to discount that possibility. There was a kind of weird time in my doctors visits up here when my PC moved to a different facility and they kind of handed me off to whoever was available which ended up being the PA. Also my kids saw the same PA a few times because the facility where my PC was is also our closest Urgent Care Office. I never felt like we weren't getting the right care here and frankly it was light years better than my decades of experience dealing with Kaiser. Thank you for the thoughtful explanation. :)
 

Kcoyote3

Half-wall Hockey - link below!
Sponsor
Apr 3, 2012
12,585
11,058
www.half-wallhockey.com
The scope of practice for mid levels varies by state and hospital systems. But they are not doctors, and the vast vast majority of them will admit that and will act as a conduit of the physician they are working with. When your surgeon or your attending physician is busy with xyz, they can be teeing up stuff until they can be seen by the doctor and in many cases take care of simple things themselves. That’s for the inpatient side.

From my perspective in the ED,PAs and NPs see the lower acuity patients, and if they deem that a patient needs “main ED” care, they are upgraded to one of the resident or attending doctors in the back. However they frequently consult one of us if they’re unsure of management, how to do a procedure, etc. but they do operate with a lot of autonomy in their low acuity area. Their notes are signed by the physicians in the back who state they were available for consult at any time, etc.
 

Kcoyote3

Half-wall Hockey - link below!
Sponsor
Apr 3, 2012
12,585
11,058
www.half-wallhockey.com
But to reiterate, “practically doctors” is just not accurate. I’ve worked in my specific ED for three years, I have never seen a PA or NP that works in our ED work on an acutely ill patient that can die at any minute. Ever. They are either immediately handed to the doctor or were never seen by a mid level in the first place.
 

WTFetus

Marlov
Mar 12, 2009
17,904
3,558
San Francisco
None of that changes what I quoted or stated. You're talking "mid-levels" or whatever and I'm quoting what they actually do and what their training is. I never misrepresented it as anything more. No shit MDs go to more intensive training. I never said they didn't. Also are you sure about having an MD in the room? Anytime I've seen a PA in urgent care or in my primary care office there was never another person other than a nurse there. If you mean they work under an MD, yeah I already said that. Sounds like your post might be just as if not more guilty of being "a whole lot of nothing"... "Bruh" ;)

In California right now, whenever a mid-level sees a patient, there needs to be a licensed physician in the workroom, not patient room, to co-sign the encounter. Which brings up the entire point of this conversation that you seem to be ignoring. The whole point of this discussion was against your post of "They can handle all responsibilities or a primary care physician" and they are "basically a doctor". How are they "handling all the responsibilities" if a physician has to co-sign all of their notes and essentially look over their shoulder? How are they "basically a doctor" if even you are acknowledging their training isn't as intensive or in-depth, unless you're suggesting a doctor's training is redundant (spoilers, it isn't). They do not have the training, knowledge, or experience to function as a licensed physician, and if they get that ability (which many are trying to fight for), patient safety will seriously be in trouble. I would never send my family members to see one. Like I said, patients have the right to see an MD/DO and they should utilize that right. How would you feel if you went to the ED and the only person who saw you was a 3rd year medical student? That's how much clinical training a fully licensed midlevel has.
 

Doctor Soraluce

Registered User
Sep 28, 2017
7,051
4,459
In California right now, whenever a mid-level sees a patient, there needs to be a licensed physician in the workroom, not patient room, to co-sign the encounter. Which brings up the entire point of this conversation that you seem to be ignoring. The whole point of this discussion was against your post of "They can handle all responsibilities or a primary care physician" and they are "basically a doctor". How are they "handling all the responsibilities" if a physician has to co-sign all of their notes and essentially look over their shoulder? How are they "basically a doctor" if even you are acknowledging their training isn't as intensive or in-depth, unless you're suggesting a doctor's training is redundant (spoilers, it isn't). They do not have the training, knowledge, or experience to function as a licensed physician, and if they get that ability (which many are trying to fight for), patient safety will seriously be in trouble. I would never send my family members to see one. Like I said, patients have the right to see an MD/DO and they should utilize that right. How would you feel if you went to the ED and the only person who saw you was a 3rd year medical student? That's how much clinical training a fully licensed midlevel has.


Yeah... I don't think I really give a f*** about wrangling over this with you anymore dude... This started as me defending a person I actually know and no one else here seems to and you seized on one mischaracterization (When I wrote "not a doctor yet". Meant to type PA, but whatever...), and spent pages being your typical self. Yes, they are "basically a doctor for all the reasons I listed already. To the layman they "basically" are. I'm sorry that ruffled your feathers so much but it's true no matter what the f*** you think. I'm out.
 

WTFetus

Marlov
Mar 12, 2009
17,904
3,558
San Francisco


Yeah... I don't think I really give a f*** about wrangling over this with you anymore dude... This started as me defending a person I actually know and no one else here seems to and you seized on one mischaracterization (When I wrote "not a doctor yet". Meant to type PA, but whatever...), and spent pages being your typical self. Yes, they are "basically a doctor for all the reasons I listed already. To the layman they "basically" are. I'm sorry that ruffled your feathers so much but it's true no matter what the f*** you think. I'm out.


Literally every single poster that commented disagreed with you but "it's true no matter what". You be you then.
giphy.gif
 

Quid Pro Clowe

Registered User
Dec 28, 2008
52,293
9,161
530
Good man. Got hit with subjective fevers and chills after #2, but I was back to normal by like hour 30. My parents unfortunately don't qualify yet, but can't wait until they do.
I was pretty fortunate to get an appointment. Had to drive a couple counties over but it was well worth it. Sorry to hear about your parents, I wish there was more of a supply so that there wasn’t picking and choosing.

I’ve heard that about the 2nd shot from just about every person I know. I’ve already put in for that night off, which also leads into my weekend.
 

sharkbyte

Registered User
May 10, 2020
295
349
Orange, CA
Sounds like you hate PA's. Is it because some places choose to hire less doctors and use PA's instead to save money? Serious question, not a jab. If you go to Urgent Care for Providence in Oregon there's probably a 50/50 chance you're going to see a PA. I never said they introduce themselves as "Doctors". Everything else I said is a reality whether you approve or not.



Doesn't sound like you two know what a PA actually is and does. So take a moment and enlighten yourself. ;) Maybe you guys are confusing PA's with Nurse practitioners...?

Home - AAPA
"PAs are medical professionals who diagnose illness, develop and manage treatment plans, prescribe medications, and often serve as a patient’s principal healthcare provider. With thousands of hours of medical training, PAs are versatile and collaborative. PAs practice in every state and in every medical setting and specialty, improving healthcare access and quality."

"PAs’ specific duties depend on the setting in which they work, their level of experience, their specialty, and state laws.
Generally, PAs can:
• Take medical histories
• Conduct physical exams
• Diagnose and treat illness
• Order and interpret tests
• Develop treatment plans
• Prescribe medication
• Counsel on preventive care
• Perform procedures
• Assist in surgery
• Make rounds in hospitals and nursing homes
• Do clinical research"

"PAs are committed to team practice with physicians and other healthcare providers. Currently, most state laws require PAs to have an agreement with a specific physician in order to practice. These agreements were included in early PA practice acts 50 years ago when the PA profession was new and untested."
"Today, PAs are still held to these obsolete requirements despite the PA profession being well established, highly trusted, and essential to the U.S. health care workforce."

"PAs are educated at the master’s degree level. There are more than 250 PA programs in the country and admission is highly competitive, requiring a bachelor’s degree and completion of courses in basic and behavioral sciences as prerequisites. Incoming PA students bring with them an average of more than 3,000 hours of direct patient contact experience, having worked as paramedics, athletic trainers, or medical assistants, for example. PA programs are approximately 27 months (three academic years), and include classroom instruction and more than 2,000 hours of clinical rotations."

So yeah, a lot of the same stuff doctors do. ;)

I don't need to be lectured about what a PA is. I'm a resident. I'm fully aware of what they do. And you basically just copy pasted their descriptions from the actual PA website which is gonna promote the **** out of them.

I respect PAs and NPs. They have a role. But they have a role as midlevel providers. The problem is when they start lobbying to be seen as equal to physicians when the disparity in rigor of training and education is immense. My sister's in PA school so I appreciate how hard they work, but PAs/NPs (especially NPs) do not receive anywhere near the rigor that physicians do in their training. They don't do 4 years of medical school and 3-7 years of residency (with possible fellowship on top of that that can be 1-3 years) before they start practicing. They're capable of treating the simple stuff but when things get difficult a lot of stuff gets missed which I've seen directly in the clinics and rotations I've been on (not to say that doctors don't make mistakes either of course, but we see some alarming things).

And the public thinking that they are basically the same is exactly the problem. It's already a mess in the hospital these days with social workers, case managers, pharmacists, nutritionists, dietitians all wearing white coats so the patients don't even have a clue who their actual physician is.

But whatever. It's entirely reasonable to defend a physician you've had good experiences with.
 
Last edited by a moderator:
Status
Not open for further replies.

Ad

Upcoming events

Ad

Ad

-->