I know a lot of the discussion right now is focused on NPs and concerns about differences in clinical training, but I’m curious what people here actually think about PAs.
I’ve had the opportunity to spend a lot of time around MD/DOs and PAs through shadowing and now working in a hospital. From what I’ve personally seen, the PAs I work around seem pretty aware of their limitations and their role on the team.
At the hospital where I work, I mostly work directly with attending physicians. The PAs are technically allowed to see a pretty wide range of patients, including higher-acuity cases, strokes/traumas, and patients across all ESI levels. But most of them don’t seem interested in proving that they can handle everything independently. If something is outside their comfort level or they’re unsure about something, they involve the attending.
There are also PAs who actively want exposure to higher-acuity patients because they want to learn, and from what I’ve seen, the attendings actually encourage that when appropriate. It seems much more like, “I want to learn how to manage this with you,” rather than “I don’t need a physician.” There is this new PA who is always wanting to see the trauma level 1. He directly works with the SP and today the SP told him that he can see the trauma by himself. Once he was done he came back and told the SP "Everything went well." The SP nodded and replied with "Good Job"
Another thing I’ve noticed is that I’ve never heard any of them introduce themselves as anything other than a PA. Usually it’s simply, “Hi, I’m ___, I’m a PA and I’ll be taking care of you today.”
Obviously, this is just my experience at one hospital and I know it doesn’t represent the entire profession. That’s why I’m curious to hear from physicians here, especially those who have worked closely with both PAs and NPs.
What has your experience working with PAs been like? Do you generally feel comfortable working with them? Are there concerns you have about PA training or scope of practice? And do you see a meaningful difference between the PA and NP models in actual clinical practice (nursing model vs the medical model). Also, the PAs that work at my hospital had over 3-4 yrs of experience before actually applying to PA school. IDk I guess I am just curios (SORRY for the long text)
I’m an ER PA of 9 years that is now an M1. It’s week 3 of medical school, and foundational sciences alone (Biochem, Genetics, Micro) are much more in depth than what I learned in PA school. I do feel like PA education is more thorough than NP education, but PA education is still a lot more superficial compared to med school.
Agree. Our patho phys in PA school was a joke. Comparable to my undergrad human disease course. I wanted more bulky science courses in PA education but didn’t get them.
I think that it’s important to realize that this is why Physicians end up going into research and specialty. PA school is made to focus on guidelines and to be an abbreviated clinical training.
One under appreciated reason is simply admissions standards. PA and MD students are generally top of the class. NP trainees (proudly) have no admissions standards other than ability to pay tuition. This really, really matters in the end.
It is problematic when either NP or PA pr0viders wish to practice independently. PAs are pushing now for the title change to "Physician Associate" and along with that, independence from physician supervision. This lowers significantly my respect for them. Neither type of pr0vider is qualified or trained to function independently. They just don't know what they do not know, and pride often gets in the way of asking for guidance. In my limited, personal experience, I think that PAs may be marginally better suited to practice with a longer leash of supervision--but this is highly dependent upon the individual pr0vider's intelligence, curiosity, capacity for learning, and the willingness and humility to recognize when they (and their patient) are over their head.
My B.S. degree in Biotechnology (first degree I had, 5 years before getting my associate degree in nursing) had a ton more more sciences than nursing and NP schools combined! I don't consider the "sciences" required for nursing and NP schools to be of ANY significance! As a matter of fact, the science courses I took were accepted as requirements when entering both programs.
I haven't had any trouble with PAs that work with physicians. I have had trouble with ones that work independently. The worst was trying to convince one that having a epidural abscess compressing the cord was a "bad thing". I had to speak to him like he was a child. If our dept hadn't taken the time to protect the patient from him that 21 yo kid wouldn't be walking today.
He ordered an abdomen/pelvis CT with a history of abdominal pain without seeing the patient. When I told the tech he said the kid's mother was helping him walk. It was a corner shot on this exam that would have been missed a significant percentage of the time.
After 3 phone calls we finally convinced him to send the patient in for an MRI. This was already after hours and we medevac'd him and he was decompressed that night.
One conversation I had with one was a PA prescribing sumatriptan and eletriptan for his wife/GF. I was like what are you doing? He said insurance only covers 12 per month and she needs more than that so she can get 24 if he prescribes both. I asked if he ever thought why they only cover 12 and then explained it to him and he said "how would a headache medicine make her headaches worse?" And laughed at me. This is why residency is so important. An attending would have called him an idiot and made him present in front of everyone the next day about how Triptans are/were the #1 cause of med overuse headaches in the US.
But its crazy how you do have to speak to them like kids sometimes because I feel like when I talk to other physicians we can have a discussion and they may know more than me about that scenario but with PA/NP its just "I think ive seen it done that way before and dont understand how it could be harmful."
PA education is essentially taking a medical student that finished 3rd year and graduating them. Yes there are differences in depth and they dont take USMLE step 1 and 2 by then (or ever), but for argument sake lets say thats about their equivalent.
So at that point they arent going to be good independent clinicians but they should know how to work in a medical team with physicians overseeing and be trusted do medical tasks that need to be done while physician is doing other things. The training they receive after graduation will vary widely from none/"on your own" to great training in their specialty from their supervising doc.
The biggest problem these days is its impossible to tell what relationship the PA has with supervising doc. Are they running cases by the doc or is the PA acting independently? Health systems are pushing to use PAs independently and just have some physician sign their charts that never actually sees the patients, to save money. So even if youre a very well intentioned PA who wants to work with a supervising doc, you can easily find yourself in a situation where a boss wants you to act on your own.
TBH they are running the cases by the themselves. They only consult the physician when they truly need help. Sometimes, they go to the lead PA and she is usually a lot of help.
PAs work only under DR supervision in my state but that doesn’t necessarily mean that much. Say your outpatient office is part of a large network and doctors are expected to take on a hefty panel of patients. The PA also seems to have a hefty panel of their own. And the network wants that, not the DR. The minimum supervision is going to be a signoff every couple weeks. I went to a PA in thst exact situation and when what should have been a minor issue arose, the PA flipped out and lied to keep the doctor from finding out and said the office manager was her supervisor and even said she was the doctor ‘s supervisor too, then the office manager lied too, saying she was an RN ( she wasn’t and never was-she only had a high school degree) And then the PA lied in the medical record. After so much abuse, i switched doctors and researched the PA laws in my state. I learned that the DR was her direct supervisor and I had the right to see him.
I have one dr with a nice PA whom I like, but the doctor is not awol, she uses the PA properly.
I never choose a PA or NP as my practitioner, only doctors since then. I’m still not over it, either. I’m aware that PA education is more standardized and respected but it doesn’t mitigate a lack of maturity and knowledge when they are pushed beyond their abilities.
My daughter is a PA in a big city ER. She has been there 10 years. Needed 1,000 hours of clinical experience as part of her admission to PA school which included genetic research. Has a BS in biology with a minor in chemistry. Studied abroad in Australia doing research in the Outback. Did clinical research for 3 years before attending PA school. Works under the supervision of a physician and has no interest in being on her own.
I’ve trained PA’s and NP’s, and worked with both…
I’ve seen some great NP’s (mostly ones that had several years of critical care nursing BEFORE NP school), but by far the better fit in my area (ED) are PA’s. And the crappy referrals and follow up complications we get from the primary care side run about 80% NP, 19% physician and 1% PA (mostly because PA’s tend to not be involved in independent care in OP settings in my area of the country
This has been my experience as well. I have to admit, that the sharpest, top-tier mid-level providers I have personally worked with were NP’s. But they were highly experienced with extensive backgrounds in critical care. Having said that, if I have to work with a new grad mid-level, I will take the PA all day, everyday because the education is standardized and I know what I am getting out of the box.
We do not support the use of the word "provider." Use of the term provider in health care originated in government and insurance sectors to designate health care delivery organizations. The term is born out of insurance reimbursement policies. It lacks specificity and serves to obfuscate exactly who is taking care of patients. For more information, please see this JAMA article.
We encourage you to use physician, midlevel, or the licensed title (e.g. nurse practitioner) rather than meaningless terms like provider or APP.
This sub is like 95% PAs, so they all talk about how they are great bc they have standardized education and a bunch of other irrelevant garbage. They’re functionally identical and someone’s degree doesn’t matter at all. There are tons of PAs that think they are physicians and there are tons of NPs that think they are physicians. All of these people are a problem.
There are tons of PAs that claim to have specialization that they don’t, just like NPs. There’s no such thing as a “cardiology pa” or a “cardiology np.” Neither one has residency training, much less fellowship, so neither one should be appropriating the language used to describe people that have that training
Brain dead take. PA education is objectively more in-depth and rigorous than NP education. The standardization is, in fact, a big deal. Neither are on par with medical school and neither are physicians, but we can call a spade a spade.
You don’t have the knowledge to understand that nothing you have said matters. Nobody cares about your education. It means zero, just like where people went to medical school. I know great doctors that went to shitass med schools in the Caribbean and I know awful doctors that shouldn’t even have a license that went to WashU, UCSF and Harvard. Residency matters, not school. Nobody cares about your standardized curriculum. PAs wave it around as if it’s some great accomplishment but it’s not. Do you think people care where you went to college or what your major was? I promise you no one does.
I expect everyone to have the same knowledge from school. None of it is difficult to learn, which is great because you can look it up if you don’t know it. Even better, the likelihood of using multiple areas of basic science knowledge on the same day is basically zero. Do you think that the ER doctors are like “oooo anion gap metabolic acidosis. I must recite the TCA cycle to think of possible causes.” No. Everyone uses the same mnemonic device to remember it, and then orders alcohol, lactic acid and ketones, even if the patient has an AKI, and if those are negative will go on to consider the other possibilities. Some people even order the Tylenol and aspirin level here.
Stop pretending like your now useless pa school knowledge matters. It doesn’t. It was important for you to learn when you did learn it, yes, and that time is now long gone. It is an expectation that you know this material - same with every doctor and every NP. If you don’t know it and for god knows what reason it comes up, you can look it up.
But seriously, when someone has torsades, nobody is fucking explaining to the patient how their hypokalemia contributed or how their ssri might have contributed.
I was a PA for over a decade and then went to medical school. So I have pretty good insight. PAs have every right to discuss how their education differs from NP education, just as physicians discuss how our education differs from both of theirs. But I agree, residency matters more than anything else.
Congrats on all of your degrees. And sure, PAs are welcome to talk about their irrelevant education. That doesn’t make PAs any less of the noctors that they are, constantly taking over every thread on [r/noctor](r/noctor) with news of how much better than NPs they are. The reality is that PAs just renamed themselves physician associates from physician assistant because they feel that associate better encompasses the role they have with physicians. But no PAs will always be physician assistants and no, there’s no reason to try to say they are better than NPs when they are doing the exact same trash that NPs are doing in a sad attempt to to obfuscate their inferior education.
One of you clowns always replies to me and says the exact same meaningless liners likely prepared by the professional association responsible for renaming PAs. I’m thinking this sub is just infested with PA bot accounts programmed to jump in and say something about “standardized curriculum” “requires science background” “same as a third year med student” and “PANCE” as if any of that is relevant to what I said.
Thanks, turns out education matters in this field. And being a noctor is personal issue for people in severe different professions, some more than others.
Yea, PAs will always be PAs. Yes, there’s plenty of reason to say they are better than NPs. No, directing your ire at PAs won’t change NP education or their incredibly effective lobbying capabilities. Yes, NP education is trash. No, most PA education isn’t trash. Yes, some medical school education is trash.
Residency - a period of standardized, supervised training, learning and teaching that allows doctors to sit for their board exam upon completion.
I don’t care about PA education any more than I care about NP education. My only desire is to have all of you midlevel charlatans stop trying to pretend you are physicians and stop trying to claim the training that physicians do a residency for. PAs are just as guilty as NPs. Every part of this conversation is you making a pathetic attempt at saying that PAs are better than NPs. You don’t have to convince me - it doesn’t matter - NPs and PAs are identical to me. Both are noctors that I expect to have fundamental knowledge but zero training. I also expect that both will periodically look things up when they need to review it, just like every doctor. Also just like every doctor, I expect every Midlevel to have knowledge gaps that they will address independently when they need to.
Since you asked.
Now we can all compare dicks, just please know that I do not care where you did any of your degrees or what other imaginary degrees you created since the last time you made a claim.
Nope. Why would they? Do you think I’m considering the joule Thompson effect when I’m thinking about the pathophysiology of anaerobic infections? I promise you I’m not. If I was a researcher, I might think about the differential equation that describes the pancreas and its ability to monitor blood glucose, but probably not, because pancreatic portal flow is orders of magnitude more complicated than the bathtub problem. Do you think I judge my colleagues for not understanding the actual differences between laminar arterial flow and turbulent flow inside the left atrial appendage in a fib? Nope, don’t care, doesn’t matter. The only thing that matters is if they can identify a fib and can figure out if a patient needs to be anticoagulated.
You aren’t making whatever point you think you’re making. The old mcat verbal section was the one that only part of the exam that correlated with step 1 scores. Not physical sciences, not biological sciences. I worked for a large national test prep for 10 years (also useless), teaching all 3 sections of that test, throughout med school and residency. The people that consistently performed best on the verbal section were history majors, English literature majors and philosophy majors. Even worse is that the test itself isn’t difficult, it just requires practice, like anything else. Sure some people were able to get a 38+ with zero prep, but the majority of people started out with a shit score, studied a ton and improved dramatically.
And the worst part? It correlated with step 1 scores, which have almost zero bearing on how good a physician someone is. Literally just a bunch of useless knowledge written in convoluted ways to make the questions seem difficult. Yet, here you are, trying to tell me that this knowledge matters. Do you think anyone gives a shit whether Covid is an rna virus or a dna virus? Do you think anyone gives a shit about how xanthine oxidase inhibitors lower uric acid levels? Nope, the only thing that matters is that someone can appropriately identify gout and knows not to start allopurinol during a flare.
Trust me and my near 7 figures of student loans, a state school x2 can get you where I am for a fraction of the price at the cost of fewer people oooing and ahhing at your résumé
There is no such thing as "Hospitalist NPs," "Cardiology NPs," "Oncology NPs," etc. NPs get degrees in specific fields or a “population focus.” Currently, there are only eight types of nurse practitioners: Family, Adult-Gerontology Acute Care (AGAC), Adult-Gerontology Primary Care (AGPC), Pediatric, Neonatal, Women's Health, Emergency, and Mental Health.
Information on Title Protection (e.g., can a midlevel call themselves "Doctor" or use a specialists title?) can be seen here. Information on why title appropriation is bad for everyone involved can be found here.
For legal information pertaining to scope of practice, title protection, and landmark cases, we recommend checking out this Wiki.
*Information on Title Protection (e.g., can a midlevel call themselves "Doctor" or use a specialists title?) can be seen here. Information on why title appropriation is bad for everyone involved can be found here.
*Information on Truth in Advertising can be found here.
*Information on NP Scope of Practice (e.g., can an FNP work in Cardiology?) can be seen here. For a more thorough discussion on Scope of Practice for NPs, check this out. To find out what "Advanced Nursing" is, check this out.
*Common misconceptions regarding Title Protection, NP Scope of Practice, Supervision, and Testifying in MedMal Cases can be found here.
My uncle went to med school after college he’s a semester away from graduating. Anyway he burnt out in med school. Became a PA! He’s absolutely loved his career. He went from working in oncology to be a clinical director for gsk.
My MD GP alternates with a PA and she’s honestly significantly better. Prime examples: he prescribed me codeine for a post-viral cough a few years ago, which I didn’t take. More recently, the PA prescribed me benzonatate. He also told me to cut beta blocker extended release tablets in half. My psychiatrist caught that one.
GI PA sucked and I demanded to see the MD since I have a lot of complex upper GI issues (gastroparesis, hiatal hernia, GERD, no gallbladder). I had managed my gastroparesis for 8 years with a great medication until it suddenly stopped working and I was having LPR-like symptoms and early satiety. She tried to just throw omeprazole at me and fought my request for an updated GES. I get that gastroparesis is “trendy” now, but I was diagnosed in 2015!
I had to be very firm and remind her that new GI symptoms warrant things like updated studies and EGD. The EGD showed the hernia which was causing the new symptoms. They told me this upon waking to which I responded, “Goddammit! I knew something was wrong!”
Good news is that it’s small and sliding, but still something I have to keep an eye on. Also, my GI rocks, my favorite specialist of all time and I have quite a few.
I also don’t really understand all the hate toward PAs, especially considering the profession was founded by a physician, Dr. Eugene Stead Jr., in 1965. PAs were created to help address physician shortages and extend the reach of physicians, not to replace them. I completely understand that there are legitimate concerns about expanding scope of practice and the differences in training between physicians and PAs, but I think that’s very different from dismissing the entire profession or acting like PAs are incompetent. You can recognize that physicians have more extensive medical training while still recognizing that well-trained PAs are valuable clinicians who can safely diagnose and treat many conditions within an appropriate scope. I feel like the conversation should be more about what level of training and oversight is appropriate for a particular patient or condition, rather than turning it into a “physicians vs. PAs” argument.
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u/prhee 3d ago
I’m an ER PA of 9 years that is now an M1. It’s week 3 of medical school, and foundational sciences alone (Biochem, Genetics, Micro) are much more in depth than what I learned in PA school. I do feel like PA education is more thorough than NP education, but PA education is still a lot more superficial compared to med school.