JPINFV
Gadfly
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...and since we're generalizing, any difficult decisions gets punted to medical control anyways... so go to medical school where you really get to treat patients... instead of following cookbook protocols.
PA vs. Med School
- Thread starter JPINFV
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...and since we're generalizing, any difficult decisions gets punted to medical control anyways... so go to medical school where you really get to treat patients... instead of following cookbook protocols.
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...and since we're generalizing, any difficult decisions gets punted to medical control anyways... so go to medical school where you get to spend the best years of your life doing scut work, cramming for exams, competing fiercely with everyone around you at every turn, and accruing massive levels of debt only to enter a field that 90% of current workers would not recommend as a career... instead of following cookbook protocols.
Fixt it for you.
Since we're generalizing.
OP
OP
JPINFV
Gadfly
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Fixt it for you.
Since we're generalizing.
To be fair, the competition drops off in medical school. Not everyone wants to go into Derm or Ortho. Also, at least for Ortho, their look at candidates are a bit different. Step 1 + bench press > 500.
Fixt it for you.
Since we're generalizing.
Sad but true. Ifsomeone tells me that they would like to be a doctor, I suggest that they become a PA instead. I explain that they're dedicating their entire adult life to intense study, then they have to do years of residency, then perhaps a fellowship, and they're not really going to makie any money until they're about 35 years old, since they'll have to pay off medical school. Meanwhile, their youth is basically gone. Being a doctor nowadays isn't as lucrative as it used to be, due to TORT and inadequate reimbursement rates.
I'd choose to ba a PA making a low to mid six figure salary, and be able to fully enjoy my twenties. Really, if you're a PA, and marry with another medical professional, your household income will probably be in the ballpark of an Attending Physician.
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Ortho is one of the most competitive residencies these days, no?
I've heard more good ortho jokes that I can count, but none are coming to me at the moment.
If I had gone the MD route I probably would have done EM. Is that what you are doing?
IR would be sweet, too. And anesthesia's not too shabby.
OP
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JPINFV
Gadfly
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Ortho is one of the most competitive residencies these days, no?
I've heard more good ortho jokes that I can count, but none are coming to me at the moment.
How do you hide a $100 bill from an orthopod? Put it in a textbook.
What's the difference between a carpenter and an orthopod? The carpenter knows more than 1 antibiotic.
When ortho is rounding, how can you tell which one is the attending? It's the one whose knuckles aren't dragging on the ground.
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JPINFV
Gadfly
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I've heard that being a PA is like being stuck in the 3rd year of residency for the rest of your life. Also, when I was on OB/Gyn, we had PA students rotating with us. There was an obvious difference in the knowledge base between the PA students and the medical students.
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WBExpatMedic
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...and since we're generalizing, any difficult decisions gets punted to medical control anyways... so go to medical school where you really get to treat patients... instead of following cookbook protocols.
Everyone has protocols to work under, but that doesn't mean we're not treating our patients. We are the one's deciding the treatment plan to following and which parts of the protocol we use and which ones not to and I'm differently not above asking for advised from anyone while in a difficult situation.
Yes I'm making a statement that "there's nothing to them" in reference to IFT’s. I explained my extremely limited experience with IFT's so that people will understand that I am only talking about my limited experience. I'm sure that somewhere out there someone is actually using his or her skills on a transport ambulance.
This is true, but I'm not sure that it's worth it anymore to sacrifice your social life as a young adult just for that extra knowledge base. The financial reward isn't there anymore, from what I'm reading and seeing.
The PA = 3rd year Resident is a good comparison. Personally, I'd be fine with that if I got to enjoy most of my 20's while pullling in a low to mid $100k salary.
Don't PA students and Med students at your school share some of the same classes?
And do you think the knowledge base between the two could be compensated by the fact that PAs begin working in their specialties sooner thus have more experience per say by the time med students finish school?
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JPINFV
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Not the PA students. The DO, OD, DPT, and DMD share a variety of 1st and 2nd year courses. The only course that the PA and DO students shared was the bogus "interprofessional education" (aka, "how not to be an A-hole like previous generation of physicians were") courses.
To be honest, I don't think so. There's a utility in having a little bit of knowledge about everything in addition to what's specifically in your specialty. You might not be able to treat everything, but to at least be able to go, "Oh, this patient has disease _____, characterized by _____, I might need to look something up just to be sure that it's not going to interfere with what I want to do."
For example, when I was on pain management we scheduled a lot of epidural steroid injections for patients with back pain. The injections are done by an anesthesiologist under fluoroscopy (x-ray guided), but an NP runs the clinic and does the referrals. We had a patient who had osteogenesis imperfecta ("brittle bone disease." It's a collagen defect that drastically reduces bone strength to the point where it can be confused with child abuse). Now in my mind, "steroids + OI = Um... maybe a problem because glucocorticoids can futz with bone formation... this might be a problem."
The NP thought, "Steroids + OI = "What's OI? Oh, well, this is a local injection so it shouldn't be a problem."
I have no problem with the "local injection = not a problem." I have a problem with "What's OI?" especially when any 3rd year medical student knows what OI is.
However, as far as pain management went, the NP was great, and I learned a lot from her. However if she's never heard of OI, she can't consider it as a potential issue, or really definitively state it's not an issue.
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rmabrey
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EMT's from busy systems should know what OI is.
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JPINFV
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How many patients with OI have you seen? How much education on OI have you received in EMT or paramedic school? I know it didn't come up at all in my EMT course.
rmabrey
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Zero education in EMT and a small snippet in medic class. I have encountered 3 in the 2 years ive been doing this.
Unlike some of my coworkers, I research things I encounter that ive never heard of. That could be the difference.
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Subject came up in my Sports Med coursework... Briefly was touched on in Paramedic. However, if the NP really hadn't heard of OI, I pretty much can guarantee that I know more about it than she did. I'm not claiming to be an expert in OI, but...:blink:
Needless to say that there's no way I'm going to clear a patient with OI to play contact sports, much less collision sports. Even some non-contact sports could present problems.
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OP
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JPINFV
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Oh, I'll fully admit that my current knowledge is "blue sclera, bad collagen, looks like child abuse." For what I want to do, that's really honestly enough. It's enough that I can consider it and engage in a consult if I need to (formal consult, bedside consult [Hey, Mr. Specialist, quick question about ___], or consult UpToDate/PubMed/Google).
There's a point where medicine stops being task orientated and more connecting the dots. That's the point where it doesn't matter how much ____ you've done or how much time you've spent working, but how much time you've spent with your nose in a book or watching a lecture, or etc.
I think that's the one beauty about how medical licensure exams are set up, and to an extent abused. It's a three step system where a pass/fail exam has been co-opted to essentially a residency admissions test. This forces the students to constantly review everything and shoot for more than passing.
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JPINFV
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You could make the argument that dealing with Med/Surg nurses is more challenging
No.... nurse managers. My favorite recent story is that my hospital is trying to standardize communications between nurses, between physicians, and between nurses and physicians in hopes of reducing errors.
Issues:
1. At the start, Mrs. Nurse Manager stands up and says "studies show that nurses think about other people and physicians think about themselves." I'm thinking, "Ok, first, can we actually cite the study? Next, you want to have this whole powwow and then you start by insulting physicians. Umm... yea."
2. During Q&A at the end one physician asks for an example of a physician to physician communication error that has happened. "Umm, there was this one time when... ummm... [turns to partner] Do you remember that one case a while back... ummm, yea... it's happened."
3. Also during Q&A, "The residents don't always respond when we call them with an emergency and claim their "busy"." Attending "Well, they are often really busy, and if they can't respond than you need to call the attending, and if it's an "Either you come now or we'll call a rapid response team," than you need to call the rapid response team anyways."
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I'm not sure that anecdote really does much to support your point.
Over the years I've had occasion to see MD's make plenty of mistakes, or do or say just dumb things. The most memorable ones are ED docs who got stressed out trying to manage a sick airway when they apparently have very little background (at least recently) doing so. Doing things like ordering 1mg of lorazepam and 5mg of succinylcholine, or giving vec on induction and not understanding why the patient isn't instantly flaccid, or telling me that the patient doesn't need "more" sedation because they've "already had" vecuronium, or tubing the goose and thinking they are good to go.
Never once did I walk away from those thinking "man, these ED docs are really inadequately educated", or even thinking that about the particular ED doc in question. I assumed they were rusty or weak in that particular area but otherwise probably quite competent, or that they probably normally perform better than that and are just having a lousy day. People have bad days, people have brain farts, and they say or do dumb things that they wouldn't normally.
I find it unlikely that an NP who runs a pain clinic doesn't have any idea what OI is, considering it's implications in the area of interventional pain management. It is covered in nursing school and probably again in NP school, whether FNP or ACNP (I know from experience it is covered in some depth in CRNA school). Even if this particular NP really didn't know, it doesn't mean that NP's in general lack that knowledge, any more than my coming across a handful of MD's who appear to have forgotten how to hold a laryngoscope means that ED doctors in general are poorly educated at airway management.
I'm willing to bet that once you are a few years out of training, there will be quite few things that you learned in school but you have a difficult time recalling because you never see them in your practice and haven't studied it in years.
Fixt it for you.
Since we're generalizing.
So much wrong with what you said.
Summit
Critical Crazy
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I think about what if I had a time machine, and I'd gone back in time and told my highschool self, "nuts to engineering. Go to med school." I could have aimed for and acheived entry into an accelerated med school program. I would be an attending now.
But I don't know that is what I would want, even if I could snap my fingers and make it so. Why? Because of all the experiences I'd have lost.
I have the greatest respect for physicians. I have many physicians in my family, including my father. None of them would advise going into the profession for a variety of reasons: work/life balance, work environment, decreasing compensation, etc. The one nurse in the family did advise nursing.
The US medical education system is brutal. It produces the finest physicians in the world. My cousin asked me if I thought she should be a doctor. I told her this: if you want to be fully immersed, at the top, to have medicine to be your life, if you want it to be the number one priority in your world above all other things, family, hobbies, travel, etc, then being a physician is for you. You might not be wealthy, but will be better than comfortable.
Now, if I could snap my fingers and have the knowledge experience and credentials imparted upon me AND not surrender the entirety of 12 years of my life, and not be looking at debt and 60+ hour weeks or call, I couldn't imagine something I'd want to be more than an MD. In the real world, it isn't worth the sacrifice TO ME. I have great respect for those that do choose that sacrifice.
Otherwise: What Halothane said in his last post. Echoing in summary:
Don't let anecdotes feed your ego via confirmation bias.
But I don't know that is what I would want, even if I could snap my fingers and make it so. Why? Because of all the experiences I'd have lost.
I have the greatest respect for physicians. I have many physicians in my family, including my father. None of them would advise going into the profession for a variety of reasons: work/life balance, work environment, decreasing compensation, etc. The one nurse in the family did advise nursing.
The US medical education system is brutal. It produces the finest physicians in the world. My cousin asked me if I thought she should be a doctor. I told her this: if you want to be fully immersed, at the top, to have medicine to be your life, if you want it to be the number one priority in your world above all other things, family, hobbies, travel, etc, then being a physician is for you. You might not be wealthy, but will be better than comfortable.
Now, if I could snap my fingers and have the knowledge experience and credentials imparted upon me AND not surrender the entirety of 12 years of my life, and not be looking at debt and 60+ hour weeks or call, I couldn't imagine something I'd want to be more than an MD. In the real world, it isn't worth the sacrifice TO ME. I have great respect for those that do choose that sacrifice.
Otherwise: What Halothane said in his last post. Echoing in summary:
Don't let anecdotes feed your ego via confirmation bias.