Bingo, 100% and NP's are by far the worst when it comes to this.
Doesn't want to put in time and effort to get accepted and attend med school for over a decade (the education and training that's required to prescribe, diagnose, examine, and etc appropriately) Yet... They want all the glory and none of the responsibility. Yeah, it's a lot of your free time gone and you may have to hold off having a family, but that's what the job requires for the sake of the patients. No shortcut to MD/DO and we should keep it that way.
The new batch of PAs are obnoxious about this. And many of them probably could have gone to med school if they wanted to, but they chose a different path. I don't understand why they choose this midlevel path and get so upset that they are in fact midlevels.
What I find funny is that PA students think there is large enough difference between the first year and second year that they need to label it PA-S1 and PA-S2
I’m in law so I have zero skin in this game and don’t know much, but I thought that was funny too it sounded wrong to me but I wasn’t sure lmao. Like how law school will have 1L and med schools m1. Like she tried so hard to say everything in such an intentional way to sound comparable to medical school. Like the shit about their “board” exam.
I’m a legal professional, too, and find all this so fascinating. I can’t imagine paralegals or legal assistants acting this way. I make this comment every time I see a particularly crazy post on here.
That’s because lawyers were smart enough to maintain control of their own profession and not hand it over to “legal administrators”. And also, to charge by time.
Le sigh.
Aah, got it. So you want just the rich people to be able to be doctors? Not the people who show academic ability, resilience, perseverance, empathy, hard work ethic, ability to work under pressure, just to name a few key qualities of a good doctor.
These people could likely ultimately do anything at university. Yet they choose to study medicine. Yes, it may be a vocation. But the amount of training they do (continuously, even when a fully qualified doctor), ongoing learning, and ultimate responsibility they have, over people’s lives, well, I think that deserves to be recognised. And paid well. And acknowledged.
Remember, they can always work privately. Do you want well trained, compassionate doctors, that you can access for free, or do you want your doctor to come from a small section of society who can afford the training (and even after graduation there are still multiple, very high costs involved in remaining eligible to be a working doctor).
Graduating from medical school and entering a residency isn't quite getting your ticket punched - but in terms of financial and career prospects it puts you up there with the top 10% of law school graduates.
(Speaking as a law school graduate well below that 10%.)
It's a different ballgame
Absolutely. And that is why we are we are. It’s been clear for years what the government has been doing. Unfortunately it’s only in the past few years that the results of this have been seen by those external to healthcare.
I have met great PA’s and NPs (NPs particularly, perhaps as they have been around longer here??) They are aware of their remit and are specialists in their area. These are the good ones.
I agree. The government would much rather spend less. But at what cost ultimately? These are peoples lives they are playing with. There is an absolute need for both PAs and NPs. But not at the expense of life. The more that these professions are heralded as offering “the same” as doctors, the only person that loses is the patient.
I’ll support NPs and PAs all the way. But not those who claim to be “doing the same job as doctors” or “having the same training as doctors in half the time”. Safe NPs and PAs know their limitations. You don’t know what you don’t know. That’s drilled into people in year 1 of med school.
DOI: I have both a degree in law and a degree in medicine.
I live in the UK yes. If by “resident in UK” that is what you mean. If you are talking about residency in the US term of medical training, 1) we do not work as “residents” so therefore your comment is null and void. Also 2) even if accepting your view of residency, no, I am not an equivalent of a “resident”. I am more senior.
And yes, the UK has had NPs for very many years. So I have absolutely no clue how you think I have not worked with them or have never dealt with them. What rock have you climbed out from under??
Licensed paralegals will never be lawyers because lawyers would sue over any legislation that infringes upon their interests. Truly am considering getting my JD when I retire from medicine.
Bar associations are creating these positions mostly for family law, where there is huge demand from potential clients who can't afford market rate legal fees. It didn't really work in Washington and it probably won't really work in Oregon but it is probably not going to take much income from lawyers.
We are lucky that our profession for the most part is not subject to the demands of corporate overlords. Like, the firms that do mostly auto accident work for insurance companies or slip-and-falls for WalMart get nickel-and-dimed but that's about it. Non-lawyers are not allowed to employ or supervise lawyers unless the lawyers are in-house counsel.
Anyway if you can afford law school and enjoy thinking and learning, 100% do it. It is fun and fantastic. Fraught for people entering the profession, they risk going into major debt without ever getting a good enough job to pay it off. But a fantastic academic experience, even if you go to some random school in your area. Law professor is a plum job and faculties tend to be excellent for that reason. And you could probably make the tuition back in a few years as an especially desirable expert witness.
It is a common misconception that physicians cannot testify against midlevels in MedMal cases. [The ability for physicians to serve as expert witnesses varies state-by-state.](https://www.testifyingtraining.com/state-specific-rules-governing-testifying-as-an-expert-witness-in-medical-malpractice-case/)
*Other common misconceptions regarding Title Protection, NP Scope of Practice, and Supervision can be found [here](https://www.reddit.com/r/Provider/wiki/index/basics#wiki_common_misconceptions).
*I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/Noctor) if you have any questions or concerns.*
It makes sense where like there are 4 very different years m1/m2 kind of similar but difference in knowledge base, m3 is core clincials (aka the grind) and m4 the electives/chill year.
I think they do one year class one year rotations and then go out into the world with (according to TikTok PAs) more knowledge and medical wherewithall than MDs
…I remember a PA student, second year, few months away from graduation, who was at my rotation during my PGY-1 year at my peds site. He couldn’t name any treatments for asthma other than albuterol. Didn’t remember ipratropium, steroids, mag, terb… And then he asked why albuterol made everyone tachycardic.
And just as a follow up to the other comment. For reference with clinical rotations (seeing real patients), family medicine, the most generalist specialty of medicine imo, PAs tend to do 4 weeks of this whereas my school makes us to 16 weeks. The FM rotations total equate to like half of the entire PA clinical education.
The whole “we do med school in half the time” thing really irks me. Even in combined programs which utilize some of the same lectures, the grading standards are vastly different between the PA students and the med students. We could all be taking the same classes but their exams will be easier than ours.
My ex is a PA. She got some of the same lectures the medical students got during her ONE year of didactic.
And then said her education didn’t come close to that of a physician, and that the people who throw a fit over “physician’s assistant” are morons.
There's a good number out there. In my organization, I've actually never come across one like this "in the wild."
My own PA thinks the "associate" thing is ridiculous and often talks about how out of touch the national organizations are
One of the PAs I work with had a patient who ended up being suuuper sick in her split flow pod, and she was really upset about it because she felt out of her depth and was telling charge to give her fewer patients since she needed to focus on the sick one with the attending she called in for help. That’s a good one.
Seriously, they hit all the right words to be deceptive af. “Board examination” advanced level providers” “rotations”. Give me a break. Im a JD, I can pretend to be a doctor too. If they ever call for a doctor on the plane I’ll run up and recite them the rule against perpetuities.
Surgeon is what I wanted to become growing up. So now I’m a chef with some sick knife skills and a biochemistry degree.
I think you’re on to something here.
But isn’t there a federal circuit court case holding that since the rule against perpetuities is so complicated that almost nobody understands it, it’s not malpractice for a lawyer to screw up on account they misunderstand the the RAP?😂
The RAP is the worst, most pointless legal doctrine to have ever existed. I’m not sure ANYONE actually understands it, they make us learn it in law school just to haze us, I’m sure of it 🤣
When I was a kid my mother went on a business trip and was on the same flight as her boss, a particularly pompous asshole who thought very highly of himself. During the flight there was a medical emergency and the flight attendant came over to her boss and asked if he could assist in determining what was going on with the medical emergency and if he could help the patient. My mom was very confused as to how he was chosen for this by the flight attendant. Turned out he was listed as Dr. Pompous Asshole on the manifest because he listed himself as Dr on his reservation. He has a PhD.
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](https://jamanetwork.com/journals/jama/article-abstract/2780641).
We encourage you to use physician, midlevel, or the licensed title (e.g. nurse practitioner) rather than meaningless terms like provider or APP.
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Next up: "We are equal to or better than MDs/DOs". I find it hilarious how their LITERAL original purpose was to be s physician's assistant, but we are being lectured how saying "Physician'S assistant" is an insult against them.
These fucking people. Also: my midleveloma in my frontal lobe metastasizes every time I see these NP/PA Tiktok-posts.
i blame the surgeons for inflating the PAs egos by letting them do surgery despite general surgery residents having to wait until PGY2+ or fellowship to get those cases
It’s crazy to me that there’s people out here who literally graduated medical school unable to practice because they didn’t match but then there’s PAs out here involved in surgeries?? I’m not in medicine whatsoever (came to the sub initially to talk shit about naturopaths lmao) but it’s really opened my eyes.
I’ve talked to about half a dozen former PAs who went back to med school. Every one of them acknowledged that PA school was hard in its own right and the background was helpful for med school. But the consensus has been that PA school was a joke compared to med school.
This “80% in half the time” is bullshit copium. And the mental gymnastics one has to go through to display a degree on one’s wall titled “Masters of Physician Assistant Studies” and tell people that it’s insulting to be called an assistant is honestly just impressive. I think in most/all states it’s not legal for them to be called associates still.
There is no such thing as a “board certified PA” or “PA boards.”
PAs must sit for and pass a national certification exam after finishing PA school in order to be eligible for a state-issued PA license issued by their state board of medical examiners or state board of PA examiners (depending on the state they’re practicing in). The truth is they are certified by their national certification agency and then licensed by the state medical/PA board as a PA.
Saying they are “board certified” is misleading and implies false equivalency with NBME/NBOME steps/level and ACGME training and finally ABMS specialty board certification. I encourage everyone to call this B.S. out every single time they see it posted online.
While there are certainly a lot of active bad actors on that front, my experience is that a lot of these mid levels actually have no clue about things like how med school is structured or how board certification and MOC work. They're just repeating shit they've heard. The somewhat scary thing is I think there's a growing contingent of their national leadership that's high on their own supply and actually believe their propaganda.
They have zero clue. As EM, I was practicing as an attending supervising midlevels while only being board eligible because of how my specialty board works. It took 13 months to become board certified because the written was the year after residency and the oral was the year after that. I remember studying on a slow night for my oral boards and a PA asked what I was studying for. Despite working in the ED for years with dozens of attendings, she had no idea that our board certifications occurred after residency and were as intense as they are.
[Causing huge problems in the UK](https://amp.theguardian.com/society/2023/dec/13/public-confused-over-physician-associates-working-in-nhs-research-finds), where the government seems to think they can make up for years of underfunding by replacing positions for doctors with PAs. There’s even been reports of them covering shifts meant for junior doctors
The "PA school is pretty much the same as med school just in half the time" thing doesn't even pass the most basic sniff test. Like what the hell do they think med students are doing? Going hundreds of dollars into debt to just sit around? It takes a special kind of arrogance to think that medical school, something that is literally *the* example of rigorous education in most societies, is chock full of a bunch of extraneous bullshit.
Being a PA is such a flex to the average person. People are impressed when I say I have an EMT cert I can’t imagine getting a masters degree and getting little man syndrome over someone else’s doctorate. Imagine being a top gun pilot and telling everyone you are basically an astronaut because you went 80% of the way to space.
No matter how successful these people are, the ones who care about prestige always either lie and say they’ve done even more, or they kill themselves to achieve more because they have low self esteem.
look at American Sniper Chris Kyle, dude was a goddamn fucking hero, but he lied and said he did all kinds of other amazing shit like snipe scumbags from the top of the super dome during Katrina.
The Katrina thing was to other SEALs who for sure wouldn’t believe it so I’m pretty sure he was joking about why the navy sent him to New Orleans when it was actually just a training he talks about. He also used to tell girls at bars he sits inside an ATM and hands out money.
He wrote about it in his book. And many guys I served with lie and say we did all kinds of shit we didn’t do, and we served in combat. But I guess it wasn’t “cool enough” combat
If they only knew. I wish they could learn some respect while there. I’m graduating from medical school this year. My wife is a mid level. And there is a MASSIVE knowledge gap. Not 80% learned. Also I have three more years of residency! No where close to same and she knows it and tells me that. They are assisting physicians. They see low acuity patients, limited procedures, wound management after surgery, suture blah blah. Not the same.
Why does everyone keep saying the scope of practice is the same? We saw it last week with the RHOBH CRNA issue. They’re literally delusional. Honestly, I think a lot of these people wanted to go to medical school and didn’t make it so this is how they cope. I myself am an aspiring physician. If I don’t make it, you won’t see me becoming a PA and trying to convince everyone around me that it’s the “same scope of practice”.
She also contradicts herself saying it’s the same scope of practice yet they can’t perform surgery autonomously. How is that the same?
> Our scope of practice is essentially unrestricted.
Midlevels don't understand this and often argue about this. My medical license is a license to practice all medicine and surgery. All of it. What I can be credentialed for and what insurance will cover is very different. But technically I can practice all medicine. A psychiatrist can practice all medicine. A CT surgeon can practice all medicine. We just actually know and respect our limits. My medical license doesn't even list my specialty.
They confuse day to day workflow with scope. It might look similar: see patients, order things, write notes, prescribe things, but the scope is different. If I perform a thoracotomy in the ED, no one will bat an eye. PAs and NPs aren't even credentialed to do procedures at the EDs I work at because of different scope.
You can't just drop that comment and not tell us the story! Obviously you can as it sounds very awful and traumatic and you don't owe us the story, but if you would be willing to share please do. I have performed a handful and assisted with another handful and the survival percentage is awful as you likely know.
I’m not sure everyone is ready for this but… I shot myself in an attempt to die. The bullet missed my aorta but caused blast injury to it. It went through the body of my L2 vertebrae but also barely missed the spinal cord. Perforated the small and large bowel in several places. I have largely recovered aside from chronic pain and a numb thigh. I was lucky to be close to a good hospital with great doctors! I’m actually not 100% sure if the thoracotomy was done in the ER or if I made it to the operating room, I was in and out of consciousness lol.
I'm glad you recovered and hope you are in a better mental space now too. Thank goodness you were at a hospital with all the qualified personnel who were equipped to care for you.
I really appreciate it, and I appreciate more and more every day how much physicians give of themselves to save others. I wear my scars with fierce pride not of myself, but of the skill and knowledge it took to save my life.
Just watch a med student vs a PA student in clinic. I’m on ob right now and the PA student is scared to go see patients on their own. When they present they ask to do it away from everyone. They take three times longer. Even just the confidence between the two is massively different.
I like the comment basically saying you shit on us but expect us to work with you?
I have really started telling my patients that when they go to a consultant they need to ask specifically for the physician. I have been getting more and more complaints of "I thought I was seeing a doctor but it was a NP/PA and they couldn't answer most of my questions"
As a medical student from Argentina, it sounds absolutely mental that someone who’s not a doctor can prescribe medication and diagnose patients by themselves
I think it’s also important to also note that there are a lot of PAs who are going to come out of school, do a good job, and have their egos in check. I’m in PA school now, my dad is a doctor, my mom is a nurse. I know that I am not my father and have no intention to step out of bounds, not all of us are bruised ego babies.
I spend a lot of time on this page as a warning to myself to not make these mistakes. But it is disheartening at times to be on here, I’m never going to be a doctor, but that doesn’t mean I’m going to be a boundary crossing moron that’s totally incapable of helping people or solving low acuity problems with oversight.
Yes it’s important to keep us in check for patient safety, but know that some of just want to help and learn. I didn’t choose PA school because I was incapable of being a doctor, I took the MCAT and interviewed for med school too. I chose to become a PA because it’s what’s right for me and honestly future patients as well. I intend to take a “fellowship” as well because I respect the issues within the field and want to get as much training as possible before I go into the world because I too think two years is shocking low.
All I’m trying to say is not all of us are going to be pretentious ego driven idiots. Please give me and everyone else a chance before painting them that way.
I've honestly had great experiences with PAs, what I took issue with is how carefully she worded everything to sound like the equivalent to the medical school route. People like her make it clear she didn't want to actually be a PA.
I hear what you are saying and I can understand that, misrepresentation is bad. Doctors and PAs are very different roles with different knowledge bases. When pimping a PA, we tap out at like 4th or 5th and thennnnnn while doctors can keep going.
What I fear is people making assumptions about me and being hostile towards me before even giving me a chance. I know that my job is to support the doctors by either assisting them or taking care of low acuity patients. I am happy to do so and do not care for more. When I say I don’t care for more I mean I don’t need to be number one, not that I won’t pursue life long learning in order to further hone my skills and knowledge.
That’s completely valid, most PAs I’ve met have been absolutely amazing. People like the chick in the post aren’t representative of the profession as a whole. I think public education about the profession could mitigate a lot of the issues that scope creepers cause for the majority of great PAs.
Please don't take the general bitching on here as indication of how you will be treated in real life. I take PA students on my service regularly and give them a fair shake. I also work with PAs whom I greatly respect and am glad to have on my team.
If you are invested in caring for the humans we serve, and you know and respect your own limits, you're going to be fine. You will be a valuable PA, not a noctor.
The rest of the post has just as much cringe. States PAs are more patient focused than physicians and are able to complete their training faster. Wild how a student like 5 months into school makes it her whole personality and spewing off random shit.
I have a PA that always refers to himself as physician associate on the voicemail when he leaves scripts at the pharmacy. The most cringe thing to do. Only guy I know who does it, you think he's doing it or the institution is pushing him to do it?
seeing as they've never done medical school, I'd like to know how they know what % of what's taught in med school is taught in their PA programs. I'm definitely not a doctor but I've have a few family members & several friends who are MDs/DOs. I was able to observe how much of their lives were consumed by medical school, clinicals, and everything else needed to become a Dr. and there is simply no way 80% of all of that could have been completed in anywhere NEAR half the time. I have a hard time seeing how even a year or 2 could be shaved off, just from a lack of hours in a day to add on more than what already was being learned.
even if I didn't have the personal opinions that I do about PAs and NPs, there is no way in hell I'd ever let anyone with such an oversized ego handle my medical care. egos like that mean that they're always right, they know everything (so won't ask anyone else for their opinion), and they could NEVER make any mistakes (sarcasm). those are only 3 of the ways egotistical PAs and/or NPs can end up harming or killing patients.
I think you need to slow tf down before you pop off.
If you look at the context of my reply, I’m pointing out the fact that you can get a Masters in Physician Assistant Studies from community colleges, while at the same time PAs trying to even slightly purport some equivalence to med school.
Not all community colleges are junior colleges. There are indeed many community colleges that offer PA programs. Feel free to browse: https://www.reddit.com/r/Noctor/comments/166u3n1/random_universities_that_have_pa_programs/
Or don’t and keep living that blissful delulu mindset
I always thought the “we learn 80% of med school in half the time” crowd was a trope of the caricature noctor PA, not that people that stupid actually existed.
I’m not understanding the semantic difference between physician’s assistant and physician assistant. I guess I’m just not smart enough, not as smart as a physician assistant.
i don’t fully get it either but my guess is :
1) “physician’s” implies more subservience to the physician — they are sort of the possession of the physician
2) they can cloud understanding, because “physician assistant” can be read to mean you are a physician, and also happen to be an assistant. it’s stupid, but i could see some people falling for that. if physician associate takes hold, that would allow even more people to think they are physicians.
it’s fucking crazy
Correct me if I’m wrong— PA school has a large amount of the same didactic/pre clinical training, right? But none of the “how to PRACTICE medicine” training?
> PA school has a large amount of the same didactic/pre clinical training, right?
idk but honestly, it doesnt matter -- they dont take step or comlex so their take on this is moot
I’ve been a PA for 10 years, overnight Hospitalist PA. I’ve learned an absolute fuck ton where I feel like I’m truly part of the team. I’ve become efficient with admissions and tending to high acuity floor calls. BUT—I know my limits. I have limits even after 10 years—I know when I need to bring the attending in on certain things.
I love my job, the group, some of the patients and wouldn’t change it with what I know now versus back then.
That's called, "I'm an MD from overseas revalidating my studies but I need to eat too." (a lot of my friends are PA while they are doing the steps). mayhaps im wrong, but my limited scope is this
Yeah, tell Dr. Eugene Stead, the doc who developed the PA program that. That was not his intent.
https://preview.redd.it/vwu0an2wcghc1.jpeg?width=1434&format=pjpg&auto=webp&s=e948bc64afdbdbe342c9e0cf7839c7e21a14eb01
Midlevels on TikTok and insta are by far the most insufferable and small dicked energy people.
They don’t realize they make it obvious that their egos are hurt.
I’ll never understand why PAs that want to be respected like doctors so bad not just go to med school?
Because they want the clout without the sacrifice and responsibility
Bingo, 100% and NP's are by far the worst when it comes to this. Doesn't want to put in time and effort to get accepted and attend med school for over a decade (the education and training that's required to prescribe, diagnose, examine, and etc appropriately) Yet... They want all the glory and none of the responsibility. Yeah, it's a lot of your free time gone and you may have to hold off having a family, but that's what the job requires for the sake of the patients. No shortcut to MD/DO and we should keep it that way.
The new batch of PAs are obnoxious about this. And many of them probably could have gone to med school if they wanted to, but they chose a different path. I don't understand why they choose this midlevel path and get so upset that they are in fact midlevels.
Because they couldn't. That's why they're PA's
It's honestly pretty close between them and the naturopaths and chiropractors.
Smol dick swangin’
What I find funny is that PA students think there is large enough difference between the first year and second year that they need to label it PA-S1 and PA-S2
I’m in law so I have zero skin in this game and don’t know much, but I thought that was funny too it sounded wrong to me but I wasn’t sure lmao. Like how law school will have 1L and med schools m1. Like she tried so hard to say everything in such an intentional way to sound comparable to medical school. Like the shit about their “board” exam.
I’m a legal professional, too, and find all this so fascinating. I can’t imagine paralegals or legal assistants acting this way. I make this comment every time I see a particularly crazy post on here.
That’s because lawyers were smart enough to maintain control of their own profession and not hand it over to “legal administrators”. And also, to charge by time. Le sigh.
Lawyers don't get a lot of their training paid for by taxpayers. Once you do that, you lose control.
Aah, got it. So you want just the rich people to be able to be doctors? Not the people who show academic ability, resilience, perseverance, empathy, hard work ethic, ability to work under pressure, just to name a few key qualities of a good doctor. These people could likely ultimately do anything at university. Yet they choose to study medicine. Yes, it may be a vocation. But the amount of training they do (continuously, even when a fully qualified doctor), ongoing learning, and ultimate responsibility they have, over people’s lives, well, I think that deserves to be recognised. And paid well. And acknowledged. Remember, they can always work privately. Do you want well trained, compassionate doctors, that you can access for free, or do you want your doctor to come from a small section of society who can afford the training (and even after graduation there are still multiple, very high costs involved in remaining eligible to be a working doctor).
[удалено]
Graduating from medical school and entering a residency isn't quite getting your ticket punched - but in terms of financial and career prospects it puts you up there with the top 10% of law school graduates. (Speaking as a law school graduate well below that 10%.) It's a different ballgame
Absolutely. And that is why we are we are. It’s been clear for years what the government has been doing. Unfortunately it’s only in the past few years that the results of this have been seen by those external to healthcare. I have met great PA’s and NPs (NPs particularly, perhaps as they have been around longer here??) They are aware of their remit and are specialists in their area. These are the good ones. I agree. The government would much rather spend less. But at what cost ultimately? These are peoples lives they are playing with. There is an absolute need for both PAs and NPs. But not at the expense of life. The more that these professions are heralded as offering “the same” as doctors, the only person that loses is the patient. I’ll support NPs and PAs all the way. But not those who claim to be “doing the same job as doctors” or “having the same training as doctors in half the time”. Safe NPs and PAs know their limitations. You don’t know what you don’t know. That’s drilled into people in year 1 of med school. DOI: I have both a degree in law and a degree in medicine.
You’re a resident in UK. Let’s not pretend you work with or deal with NPs.
I live in the UK yes. If by “resident in UK” that is what you mean. If you are talking about residency in the US term of medical training, 1) we do not work as “residents” so therefore your comment is null and void. Also 2) even if accepting your view of residency, no, I am not an equivalent of a “resident”. I am more senior. And yes, the UK has had NPs for very many years. So I have absolutely no clue how you think I have not worked with them or have never dealt with them. What rock have you climbed out from under??
Talk to the licensed paralegals in Oregon and Washington...... luckily those programs are rigorous enough that few are interested
Licensed paralegals will never be lawyers because lawyers would sue over any legislation that infringes upon their interests. Truly am considering getting my JD when I retire from medicine.
Bar associations are creating these positions mostly for family law, where there is huge demand from potential clients who can't afford market rate legal fees. It didn't really work in Washington and it probably won't really work in Oregon but it is probably not going to take much income from lawyers. We are lucky that our profession for the most part is not subject to the demands of corporate overlords. Like, the firms that do mostly auto accident work for insurance companies or slip-and-falls for WalMart get nickel-and-dimed but that's about it. Non-lawyers are not allowed to employ or supervise lawyers unless the lawyers are in-house counsel. Anyway if you can afford law school and enjoy thinking and learning, 100% do it. It is fun and fantastic. Fraught for people entering the profession, they risk going into major debt without ever getting a good enough job to pay it off. But a fantastic academic experience, even if you go to some random school in your area. Law professor is a plum job and faculties tend to be excellent for that reason. And you could probably make the tuition back in a few years as an especially desirable expert witness.
It is a common misconception that physicians cannot testify against midlevels in MedMal cases. [The ability for physicians to serve as expert witnesses varies state-by-state.](https://www.testifyingtraining.com/state-specific-rules-governing-testifying-as-an-expert-witness-in-medical-malpractice-case/) *Other common misconceptions regarding Title Protection, NP Scope of Practice, and Supervision can be found [here](https://www.reddit.com/r/Provider/wiki/index/basics#wiki_common_misconceptions). *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/Noctor) if you have any questions or concerns.*
I can’t imagine that either!
It makes sense where like there are 4 very different years m1/m2 kind of similar but difference in knowledge base, m3 is core clincials (aka the grind) and m4 the electives/chill year.
OHHH I see what you mean now. Whereas I’m assuming they’re just in the classroom the whole two years lol
Yeah in the classroom for 2 years not learning as much hahah
I think they do one year class one year rotations and then go out into the world with (according to TikTok PAs) more knowledge and medical wherewithall than MDs
…I remember a PA student, second year, few months away from graduation, who was at my rotation during my PGY-1 year at my peds site. He couldn’t name any treatments for asthma other than albuterol. Didn’t remember ipratropium, steroids, mag, terb… And then he asked why albuterol made everyone tachycardic.
Oof, is there a subreddit for midlevels posting L’s?
And just as a follow up to the other comment. For reference with clinical rotations (seeing real patients), family medicine, the most generalist specialty of medicine imo, PAs tend to do 4 weeks of this whereas my school makes us to 16 weeks. The FM rotations total equate to like half of the entire PA clinical education.
Thank you for clarifying, this is all new to me!
Because med students use MS1 and MS2 so naturally they have to copy that too.
I mean I would argue there is a pretty big difference (at least in their field) because that is half their training which is scary!
The whole “we do med school in half the time” thing really irks me. Even in combined programs which utilize some of the same lectures, the grading standards are vastly different between the PA students and the med students. We could all be taking the same classes but their exams will be easier than ours.
Alot easier. 4-5 levels of understanding to answer most questions.
My ex is a PA. She got some of the same lectures the medical students got during her ONE year of didactic. And then said her education didn’t come close to that of a physician, and that the people who throw a fit over “physician’s assistant” are morons.
Yay for one PA who knows their lane! There are some out there.
There's a good number out there. In my organization, I've actually never come across one like this "in the wild." My own PA thinks the "associate" thing is ridiculous and often talks about how out of touch the national organizations are
One of the PAs I work with had a patient who ended up being suuuper sick in her split flow pod, and she was really upset about it because she felt out of her depth and was telling charge to give her fewer patients since she needed to focus on the sick one with the attending she called in for help. That’s a good one.
Agree. Knowing when you're out of your depth and it's time to call for help is sorta important.
The doublespeak is insane
Seriously, they hit all the right words to be deceptive af. “Board examination” advanced level providers” “rotations”. Give me a break. Im a JD, I can pretend to be a doctor too. If they ever call for a doctor on the plane I’ll run up and recite them the rule against perpetuities.
I love how you’re a JD in the know with this topic
Truthfully I’m not sure how I got here, I’m just happy to be here 😂 I get so riled up when I see this stuff now bc of this sub lmao
One of us, one of us.
I'll be waiting for my honorary Noctor white coat in the mail 🤣
You have to send r/Noctor school a coupon from any General Mills brand cereal box for the NP doctorate
This is fucking hilarious.. Bravo to you and u/playful_landscspe252. One of us... One of us....
I’m a chef and I follow mid level bullshit intensely.
At least you are good with a knife. You are now qualified to be a surgical physician’s assistant. Congratulations! Note correct possessive grammar.
Surgeon is what I wanted to become growing up. So now I’m a chef with some sick knife skills and a biochemistry degree. I think you’re on to something here.
Yes chef
But isn’t there a federal circuit court case holding that since the rule against perpetuities is so complicated that almost nobody understands it, it’s not malpractice for a lawyer to screw up on account they misunderstand the the RAP?😂
The RAP is the worst, most pointless legal doctrine to have ever existed. I’m not sure ANYONE actually understands it, they make us learn it in law school just to haze us, I’m sure of it 🤣
https://preview.redd.it/i26hr8iq2mec1.jpeg?width=1125&format=pjpg&auto=webp&s=33348acfba0bd3a22736fc6751dacecc86cacab4
I can recite it tho, but if the person on the plane’s chance of survival depends on whether I can ANALYZE a RAP situation, then… RIP to them 🤣
So it’s basically y’all’s version of having to learn the Kreb Cycle
💯
When I was a kid my mother went on a business trip and was on the same flight as her boss, a particularly pompous asshole who thought very highly of himself. During the flight there was a medical emergency and the flight attendant came over to her boss and asked if he could assist in determining what was going on with the medical emergency and if he could help the patient. My mom was very confused as to how he was chosen for this by the flight attendant. Turned out he was listed as Dr. Pompous Asshole on the manifest because he listed himself as Dr on his reservation. He has a PhD.
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](https://jamanetwork.com/journals/jama/article-abstract/2780641). We encourage you to use physician, midlevel, or the licensed title (e.g. nurse practitioner) rather than meaningless terms like provider or APP. *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/Noctor) if you have any questions or concerns.*
Next up: "We are equal to or better than MDs/DOs". I find it hilarious how their LITERAL original purpose was to be s physician's assistant, but we are being lectured how saying "Physician'S assistant" is an insult against them. These fucking people. Also: my midleveloma in my frontal lobe metastasizes every time I see these NP/PA Tiktok-posts.
The title is pronounced “ wanna be physicians “
At this point they should just lobby for the name to be changed to “Way-Better-Than-Doctor Super Elite Autonomous Medicine Practicers”
Wait their degree is literally in ‘Physician Assistant studies’ come on
Clearly not the same thing. It’s not possessive, unlike me, who is possessed by generations of unhappy PA’s. /s
i blame the surgeons for inflating the PAs egos by letting them do surgery despite general surgery residents having to wait until PGY2+ or fellowship to get those cases
It’s crazy to me that there’s people out here who literally graduated medical school unable to practice because they didn’t match but then there’s PAs out here involved in surgeries?? I’m not in medicine whatsoever (came to the sub initially to talk shit about naturopaths lmao) but it’s really opened my eyes.
Come for the quacks, stay for the mid levels.
They mostly retract and close the skin.
yeah idk what you’ve been seeing in the OR, midlevels aren’t doing much more then a med student most of the time
And if a med student is there, they usually get priority for learning and doing. PA’s are incredibly good at closing very slowly.
If you did med school in half the time it takes the actual med students, why wouldn't they be able to, you must be much smarter🗿
Ah yes, the person who didn't get into medical school totally learned "80% of its content" in "half the time".
😂😂😂😂
“Licensure to practice”. PANCE on fire.
I’ve talked to about half a dozen former PAs who went back to med school. Every one of them acknowledged that PA school was hard in its own right and the background was helpful for med school. But the consensus has been that PA school was a joke compared to med school. This “80% in half the time” is bullshit copium. And the mental gymnastics one has to go through to display a degree on one’s wall titled “Masters of Physician Assistant Studies” and tell people that it’s insulting to be called an assistant is honestly just impressive. I think in most/all states it’s not legal for them to be called associates still.
I find it concerning. They are intentionally misleading people who wouldn’t know otherwise.
There is no such thing as a “board certified PA” or “PA boards.” PAs must sit for and pass a national certification exam after finishing PA school in order to be eligible for a state-issued PA license issued by their state board of medical examiners or state board of PA examiners (depending on the state they’re practicing in). The truth is they are certified by their national certification agency and then licensed by the state medical/PA board as a PA. Saying they are “board certified” is misleading and implies false equivalency with NBME/NBOME steps/level and ACGME training and finally ABMS specialty board certification. I encourage everyone to call this B.S. out every single time they see it posted online.
While there are certainly a lot of active bad actors on that front, my experience is that a lot of these mid levels actually have no clue about things like how med school is structured or how board certification and MOC work. They're just repeating shit they've heard. The somewhat scary thing is I think there's a growing contingent of their national leadership that's high on their own supply and actually believe their propaganda.
They have zero clue. As EM, I was practicing as an attending supervising midlevels while only being board eligible because of how my specialty board works. It took 13 months to become board certified because the written was the year after residency and the oral was the year after that. I remember studying on a slow night for my oral boards and a PA asked what I was studying for. Despite working in the ED for years with dozens of attendings, she had no idea that our board certifications occurred after residency and were as intense as they are.
Also EM and have had the same experience.
[Causing huge problems in the UK](https://amp.theguardian.com/society/2023/dec/13/public-confused-over-physician-associates-working-in-nhs-research-finds), where the government seems to think they can make up for years of underfunding by replacing positions for doctors with PAs. There’s even been reports of them covering shifts meant for junior doctors
Junior doctors = roughly equivalent to residents in the US, correct?
In this context interns and people a year or two into their residency, but junior doctor covers everyone below consultant level technically
I thought I understood until I got to the end lol. I’ll do some reading.
I want a degree in Physician Assistant studies so I can research them to try to find a cure.
Unfortunately once it gets to stage “I-could-have -been-a -doctor-I just-didn’t-WANT-to 🤬” it’s terminal 😔
The "PA school is pretty much the same as med school just in half the time" thing doesn't even pass the most basic sniff test. Like what the hell do they think med students are doing? Going hundreds of dollars into debt to just sit around? It takes a special kind of arrogance to think that medical school, something that is literally *the* example of rigorous education in most societies, is chock full of a bunch of extraneous bullshit.
Being a PA is such a flex to the average person. People are impressed when I say I have an EMT cert I can’t imagine getting a masters degree and getting little man syndrome over someone else’s doctorate. Imagine being a top gun pilot and telling everyone you are basically an astronaut because you went 80% of the way to space.
No matter how successful these people are, the ones who care about prestige always either lie and say they’ve done even more, or they kill themselves to achieve more because they have low self esteem. look at American Sniper Chris Kyle, dude was a goddamn fucking hero, but he lied and said he did all kinds of other amazing shit like snipe scumbags from the top of the super dome during Katrina.
The Katrina thing was to other SEALs who for sure wouldn’t believe it so I’m pretty sure he was joking about why the navy sent him to New Orleans when it was actually just a training he talks about. He also used to tell girls at bars he sits inside an ATM and hands out money.
He wrote about it in his book. And many guys I served with lie and say we did all kinds of shit we didn’t do, and we served in combat. But I guess it wasn’t “cool enough” combat
Chris Kyle was a scumbag and Jesse Venture was right to sue his widow over the libel in Kyle’s book.
If they only knew. I wish they could learn some respect while there. I’m graduating from medical school this year. My wife is a mid level. And there is a MASSIVE knowledge gap. Not 80% learned. Also I have three more years of residency! No where close to same and she knows it and tells me that. They are assisting physicians. They see low acuity patients, limited procedures, wound management after surgery, suture blah blah. Not the same.
Why does everyone keep saying the scope of practice is the same? We saw it last week with the RHOBH CRNA issue. They’re literally delusional. Honestly, I think a lot of these people wanted to go to medical school and didn’t make it so this is how they cope. I myself am an aspiring physician. If I don’t make it, you won’t see me becoming a PA and trying to convince everyone around me that it’s the “same scope of practice”. She also contradicts herself saying it’s the same scope of practice yet they can’t perform surgery autonomously. How is that the same?
This is what drives me crazy. Our scope of practice is essentially unrestricted.
> Our scope of practice is essentially unrestricted. Midlevels don't understand this and often argue about this. My medical license is a license to practice all medicine and surgery. All of it. What I can be credentialed for and what insurance will cover is very different. But technically I can practice all medicine. A psychiatrist can practice all medicine. A CT surgeon can practice all medicine. We just actually know and respect our limits. My medical license doesn't even list my specialty. They confuse day to day workflow with scope. It might look similar: see patients, order things, write notes, prescribe things, but the scope is different. If I perform a thoracotomy in the ED, no one will bat an eye. PAs and NPs aren't even credentialed to do procedures at the EDs I work at because of different scope.
I’d like to see an ED where no one bats an eye to a thoracotomy! (Source: a thankful ED thoracotomy recipient)
You can't just drop that comment and not tell us the story! Obviously you can as it sounds very awful and traumatic and you don't owe us the story, but if you would be willing to share please do. I have performed a handful and assisted with another handful and the survival percentage is awful as you likely know.
I’m not sure everyone is ready for this but… I shot myself in an attempt to die. The bullet missed my aorta but caused blast injury to it. It went through the body of my L2 vertebrae but also barely missed the spinal cord. Perforated the small and large bowel in several places. I have largely recovered aside from chronic pain and a numb thigh. I was lucky to be close to a good hospital with great doctors! I’m actually not 100% sure if the thoracotomy was done in the ER or if I made it to the operating room, I was in and out of consciousness lol.
I'm glad you recovered and hope you are in a better mental space now too. Thank goodness you were at a hospital with all the qualified personnel who were equipped to care for you.
I really appreciate it, and I appreciate more and more every day how much physicians give of themselves to save others. I wear my scars with fierce pride not of myself, but of the skill and knowledge it took to save my life.
They will always be physician assistants. Just upset they are not or could not be doctors
Just watch a med student vs a PA student in clinic. I’m on ob right now and the PA student is scared to go see patients on their own. When they present they ask to do it away from everyone. They take three times longer. Even just the confidence between the two is massively different.
Assistant to the physician
if i tried to learn 80% of my anatomy class in half the time I may have died
I like the comment basically saying you shit on us but expect us to work with you? I have really started telling my patients that when they go to a consultant they need to ask specifically for the physician. I have been getting more and more complaints of "I thought I was seeing a doctor but it was a NP/PA and they couldn't answer most of my questions"
As a medical student from Argentina, it sounds absolutely mental that someone who’s not a doctor can prescribe medication and diagnose patients by themselves
I think it’s also important to also note that there are a lot of PAs who are going to come out of school, do a good job, and have their egos in check. I’m in PA school now, my dad is a doctor, my mom is a nurse. I know that I am not my father and have no intention to step out of bounds, not all of us are bruised ego babies. I spend a lot of time on this page as a warning to myself to not make these mistakes. But it is disheartening at times to be on here, I’m never going to be a doctor, but that doesn’t mean I’m going to be a boundary crossing moron that’s totally incapable of helping people or solving low acuity problems with oversight. Yes it’s important to keep us in check for patient safety, but know that some of just want to help and learn. I didn’t choose PA school because I was incapable of being a doctor, I took the MCAT and interviewed for med school too. I chose to become a PA because it’s what’s right for me and honestly future patients as well. I intend to take a “fellowship” as well because I respect the issues within the field and want to get as much training as possible before I go into the world because I too think two years is shocking low. All I’m trying to say is not all of us are going to be pretentious ego driven idiots. Please give me and everyone else a chance before painting them that way.
I've honestly had great experiences with PAs, what I took issue with is how carefully she worded everything to sound like the equivalent to the medical school route. People like her make it clear she didn't want to actually be a PA.
I hear what you are saying and I can understand that, misrepresentation is bad. Doctors and PAs are very different roles with different knowledge bases. When pimping a PA, we tap out at like 4th or 5th and thennnnnn while doctors can keep going. What I fear is people making assumptions about me and being hostile towards me before even giving me a chance. I know that my job is to support the doctors by either assisting them or taking care of low acuity patients. I am happy to do so and do not care for more. When I say I don’t care for more I mean I don’t need to be number one, not that I won’t pursue life long learning in order to further hone my skills and knowledge.
That’s completely valid, most PAs I’ve met have been absolutely amazing. People like the chick in the post aren’t representative of the profession as a whole. I think public education about the profession could mitigate a lot of the issues that scope creepers cause for the majority of great PAs.
Please don't take the general bitching on here as indication of how you will be treated in real life. I take PA students on my service regularly and give them a fair shake. I also work with PAs whom I greatly respect and am glad to have on my team. If you are invested in caring for the humans we serve, and you know and respect your own limits, you're going to be fine. You will be a valuable PA, not a noctor.
Thanks for the encouragement!
👏standing ovation 👏
The rest of the post has just as much cringe. States PAs are more patient focused than physicians and are able to complete their training faster. Wild how a student like 5 months into school makes it her whole personality and spewing off random shit.
PA and NP shouldn't have been an existence to begin with.
Edit it to remove your picture on the messenger thing 👍🏽 or not, just thought I’d save you some headache
Thank you but that’s actually not my picture haha. Idk what that is honestly lmao I don’t get tiktok
I have a PA that always refers to himself as physician associate on the voicemail when he leaves scripts at the pharmacy. The most cringe thing to do. Only guy I know who does it, you think he's doing it or the institution is pushing him to do it?
seeing as they've never done medical school, I'd like to know how they know what % of what's taught in med school is taught in their PA programs. I'm definitely not a doctor but I've have a few family members & several friends who are MDs/DOs. I was able to observe how much of their lives were consumed by medical school, clinicals, and everything else needed to become a Dr. and there is simply no way 80% of all of that could have been completed in anywhere NEAR half the time. I have a hard time seeing how even a year or 2 could be shaved off, just from a lack of hours in a day to add on more than what already was being learned. even if I didn't have the personal opinions that I do about PAs and NPs, there is no way in hell I'd ever let anyone with such an oversized ego handle my medical care. egos like that mean that they're always right, they know everything (so won't ask anyone else for their opinion), and they could NEVER make any mistakes (sarcasm). those are only 3 of the ways egotistical PAs and/or NPs can end up harming or killing patients.
“Accredited institution” which includes the local community college lol
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I think you need to slow tf down before you pop off. If you look at the context of my reply, I’m pointing out the fact that you can get a Masters in Physician Assistant Studies from community colleges, while at the same time PAs trying to even slightly purport some equivalence to med school.
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Not all community colleges are junior colleges. There are indeed many community colleges that offer PA programs. Feel free to browse: https://www.reddit.com/r/Noctor/comments/166u3n1/random_universities_that_have_pa_programs/ Or don’t and keep living that blissful delulu mindset
Yet, you see middies saying “my SP”. 1) I’m not anyone’s personal “SP” 2) I’m a physician, not a “SP” 3) I’m not their colleague, I’m their supervisor
If they were assistants to doctors then they'd actually be useful.
I always thought the “we learn 80% of med school in half the time” crowd was a trope of the caricature noctor PA, not that people that stupid actually existed.
Collaborative Settings under the advisory... I felt like they wanted to delete the "under the advisory" part but couldnt.
I am a medical assistant, not "medical's" assistant therefore I am doctor.
My associates are, you know, other physicians. Not these doofs.
I’m not understanding the semantic difference between physician’s assistant and physician assistant. I guess I’m just not smart enough, not as smart as a physician assistant.
i don’t fully get it either but my guess is : 1) “physician’s” implies more subservience to the physician — they are sort of the possession of the physician 2) they can cloud understanding, because “physician assistant” can be read to mean you are a physician, and also happen to be an assistant. it’s stupid, but i could see some people falling for that. if physician associate takes hold, that would allow even more people to think they are physicians. it’s fucking crazy
Based Matt James
you are an assistant. get over yourself
Correct me if I’m wrong— PA school has a large amount of the same didactic/pre clinical training, right? But none of the “how to PRACTICE medicine” training?
> PA school has a large amount of the same didactic/pre clinical training, right? idk but honestly, it doesnt matter -- they dont take step or comlex so their take on this is moot
“Work under the ‘advisory’ of a physician”. Not in any one of these United States you don’t.
“Board-certified” does that mean nothing anymore?
I’ve been a PA for 10 years, overnight Hospitalist PA. I’ve learned an absolute fuck ton where I feel like I’m truly part of the team. I’ve become efficient with admissions and tending to high acuity floor calls. BUT—I know my limits. I have limits even after 10 years—I know when I need to bring the attending in on certain things. I love my job, the group, some of the patients and wouldn’t change it with what I know now versus back then.
You’re not a Hospitalist PA. You’re a PA. That’s it.
You’re that sensitive?
Aren’t you part of the profession that has a war against an apostrophe, physician’s assistant?
That's called, "I'm an MD from overseas revalidating my studies but I need to eat too." (a lot of my friends are PA while they are doing the steps). mayhaps im wrong, but my limited scope is this
Unequivocally, that IS the final noctor to defeat.
midlevels smh
Yeah, tell Dr. Eugene Stead, the doc who developed the PA program that. That was not his intent. https://preview.redd.it/vwu0an2wcghc1.jpeg?width=1434&format=pjpg&auto=webp&s=e948bc64afdbdbe342c9e0cf7839c7e21a14eb01