Paramedic Practitioners

[systemet]

At typical State U lecture halls are jammed with hundreds of students to one professor and TA's are used as cheap labor to fill in the gaps. We should utilize more Ph.D.'s. instead of a student to teacher ratio of a bazillion to one.

I would argue that the universities should focus more on the educational part of their role. Because, let's face it, right now teaching isn't very important to the career of an average postdoctoral fellow or tenured researcher. It's largely seen as an inconvenience, and something that distracts them from their "real" work. This is a terrible attitude, but very pervasive.

If you went through all the horrors of academics to get that Ph.D. and to get tenure tracked wouldn't you be frustrated if TA's tried to edge you out or were used to maximize profit over of education?

Honestly, I think most PhD's would be very happy if their teaching and administrative loads were reduced so that they could do more lab work, spend more time designing experiments, and less time interacting with undergraduate students and filling in grant applications. I think they'd be more than happy to have more graduate students teaching.

I'd also argue that there's almost no development of teaching skill within the university system, and that lecturers are often left to sink or swim as graduate TAs, then postdocs, and any skill they develop by the time they are tenured is simply a result of having spent more hours in the classroom than of any structured commitment to building better teachers.

I'd also suggest that the graduate TAs may be the people most driven and interested in the education of the undergraduate students, because they haven't yet been contaminated with the attitude that teaching =/= real work, and is a distraction from more important matters.

Or, in the case of the DNP, created a phoney baloney degree just so they could call themselves Dr.?

I doubt most PhDs are that informed about DNPs, unless they're dual trained, and also working or conducting research in a clinical environment and having to work with them. I assume here we're talking about the relatively narrow field of PhDs doing biomedical research who might be interacting with undergraduate biology students or teaching in professional medical or dental programs.

If there's anything I've seen from people with PhDs it's been a sense of confusion with the way clinicians insist on being called "Dr. Blank" all the time. This seems to be much less important in an academic environment.

As a student I was extremely frustrated that I was having to pay obscene sums for a professor that was just some dude who stood down front and you had to squint really hard to try and see him.

As was I, and I think it's a fair complaint. Undergraduate students money is used to subsidise administration and research programs. The same programs that are already being funded (however inadequately) through other sources. To a certain point, getting an undergraduate degree is as much about branding yourself by association with a (hopefully) famous / prestigious institution, than it is about obtaining knowledge. And for many students "knowledge" is roughly defined as "any combination of required courses and ridiculously easy electives that will be acceptable for preparation for the MCAT, and used in calculating a cGPA". It's far from a perfect system.

 

[jjesusfreak01]

If there's anything I've seen from people with PhDs it's been a sense of confusion with the way clinicians insist on being called "Dr. Blank" all the time. This seems to be much less important in an academic environment.

I have to disagree here. While they may not insist on constantly being called "Doctor", the letters of their official title are the only things that matter in an academic environment. If you don't have a PhD, you are considered useless in many academic circles.

 

[Veneficus]

PAs are a much better fit within specialities ie EM/trauma,IR,Cards,CritCare, nonsurgical ortho, pulm, GI ect, however PA's also do very well in primary care. I don't think midlevels should be in the OR at all, it further perpetuates the "assistant" image and is usually a vast underuse of education and skills.

Thanks for that, I really needed a laugh today.

A PA cannot even come close to the ability of a physician in these categories.

PAs are just assistants who think because they have a rudementary medical education they are worth more than they really are.

The only thing they are good for is routine care of noncritical conditions. There are way too many exceptions, deviations, and balances required in critical care than any PA I have ever met or heard of is capable of performing at an acceptable level.

I wouldn't let a PA treat a dog I didn't like. I certainly wouldn't pay for one.

 

[systemet]

I have to disagree here. While they may not insist on constantly being called "Doctor", the letters of their official title are the only things that matter in an academic environment. If you don't have a PhD, you are considered useless in many academic circles.

I don't think we're actually disagreeing here. A PhD is the entry-level qualification to be considered a researcher, or an academic. A lot of people within the academic community wouldn't consider someone fully trained until after completing a postdoctoral fellowship or two, and even then, that person might be considered a very junior member of the community.

I'm not trying to suggest that academia isn't also very hierarchical, or that there's no prestige associated with getting a PhD, just that the title of "Dr." seems a lot less important to the people I've met in that particular environment. This may also be a cultural thing. It may also be a form of passive aggression that's formed after hearing "Oh, PhD.. so you're not a real doctor?" too many times

[* I'm not a PhD. I just have a few friends who are.]

 

[jjesusfreak01]

I don't think we're actually disagreeing here. A PhD is the entry-level qualification to be considered a researcher, or an academic. A lot of people within the academic community wouldn't consider someone fully trained until after completing a postdoctoral fellowship or two, and even then, that person might be considered a very junior member of the community.

I'm not trying to suggest that academia isn't also very hierarchical, or that there's no prestige associated with getting a PhD, just that the title of "Dr." seems a lot less important to the people I've met in that particular environment. This may also be a cultural thing. It may also be a form of passive aggression that's formed after hearing "Oh, PhD.. so you're not a real doctor?" too many times

[* I'm not a PhD. I just have a few friends who are.]

I don't think the problem is in needing a PhD to be a researcher or academic, but that in academia there is little respect for those who are excellent teachers but who lack a PhD, or who have acquired practical knowledge in a field far above the PhDs (say a CEO vs a PhD in business). What annoys me is that we have tenured PhDs teaching in universities who have no business in a classroom while staff instructors are being cut from budgets because they don't bring in research dollars. The hierarchy of academia is slowly eating away at the quality of our educational system.

 

[Arovetli]

@wildmed, bro I don't mean to pick on you but Veneficus is right..and your post is pretty funny. You named some of the most intensive and nuanced subspecialites in medicine...PA's running diagnostic/interventional rads??? Nice.

Honestly dude, I'm not trying to be rude to ya. I respect you in that you have your opinion and doubt I can change it.

Where are you coming up with this midlevels doing 80% of what a physician can? It is an oft repeated party line with no basis in fact. A political slogan.

Heck I drive an ambulance fast...does that mean I do 80% of what a Nascar driver can? I mean its just a couple pedals and a steering wheel. The only thing missing is the shifter and clutch...


@epiEMS: I agree we have created a system that encourages abuse. "Emergency" providers can complain all day long about routine use of the ER but when Hospital admins are erecting billboards all over town and broadcasting the wait times and use programs like inquicker.com and primary physicians are extremely inaccessible why not go to the ER? The doc is there, the lab is there, the imaging is there...we have created an inefficient unsustainable system, but one that is highly profitable to the right people. It is out of touch with reality and will change or collapse or be propped up by the government more than it is now to survive....like Wall St.


@everyone else: I guess I opened a can of worms with the academia analogy and now spawned a whole other side discussion. I was trying for a simple comparison but I guess I was a little off. Yes, the current higher education system deemphasizes teaching over research prestige and funding dollars...and sports I might add. Research is important and a academician must generate it, but the academician has his duty to educate as well. Anyways, sorry to open that tangent up, I guess it wasn't the best analogy.

However just as alot of PhD's would rather deal less with undergrad students alot of physicians rather deal less with uncomplicated patients. Personal preferences are fine and vary from person to person but anyone who prioritizes one and neglects the other or delegates it to a lesser qualified person wholesale is a farce, has little professional pride, and should be booted swiftly out the door.

I understand that for Dr. Internist switching John Public from Avapro to Micardis because it gives him a headache is probably boring but get over it. You chose primary care and following people for most of their lives through their cool diseases and their boring diseases is what you signed up for and what they are paying you for. Spend time with John because he is paying for your expertise and advice and most importantly he is your patient. He is yours. Take ownership. In another life I was a beat cop. The streets in my zone were my MF'ing streets and nobody messed with them or the people who lived on them without answering to me. Ownership and professional pride. That HTN patient is your patient, no matter if you think his HTN is boring or not. Nothing should make him sick without answering to you. It infuriates me to see the physicians walk around high and mighty because they make large sums of money and understand what a carboxylation reaction is. The ability to be a physician is a gift, an honor, and privilege and is to be used for the benefit of you patient. Be accessible to that patient. Not that there is anything wrong with being compensated, but do precisely what you are being compensated to do.

Back in the day there were alot of pioneering and innovative physicians who saw all these guys coming back from war with alot of advanced training and came up with a way to put all that knowledge to use to fill a gap in rural/austere/low physician saturation environments. PA's are great for what they were designed for on the drawing board but in reality they have proved to be just like doctors, not wanting to go to the far to reach environments, following the money and the gravy train, and physician and hospitals hire them for the sole fact that they increase the money and pour more gravy on the train. Now we have this weird Master's level half educated no residency provider and we are letting this person be a primary provider to patients when the physician is a few feet away. It makes as much sense as assigning an ambulance to roam the halls of the hospital. We don't need field providers in an environment where there is no field.

 

[systemet]

I don't think the problem is in needing a PhD to be a researcher or academic, but that in academia there is little respect for those who are excellent teachers but who lack a PhD, or who have acquired practical knowledge in a field far above the PhDs (say a CEO vs a PhD in business).

I agree, to a point. I think when you start getting into higher level courses you need someone who can evaluate the current literature critically, and teach someone how to be a researcher. For biosci or physics, or most science disciplines, it's going to be hard to find people without a PhD who are going to be able to do that.

On the other hand, when you consider introductory courses, where you're presenting material that's mostly already in the textbooks, and you're not really evaluating that information critically, then it's easy to think that someone without a PhD could be excellent -- and may be a far superior student.

When you start looking at applied fields like business or nursing, then I think the line gets blurrier. If you're teaching someone how to do research into business methodology, etc., then you probably need an instructor with a PhD -- if you're teaching someone to be an entreprenour, or act as a CEO to a large company, then I'm sure that no one would turn down the opportunity to get lectures from someone like Bill Gates.

Business schools are interesting to me. I have a friend who took an MBA, and was considering going for a DBA. He took a bit of step back, and started asking himself what the point was --- could he really be an expert on how to run a business, without having ever done it himself? At what point was his lack of personal business experience going to hurt his ability to teach business related courses to other people. The old, "a bunch of virgins teaching someone about sex" analogy.

What annoys me is that we have tenured PhDs teaching in universities who have no business in a classroom while staff instructors are being cut from budgets because they don't bring in research dollars. The hierarchy of academia is slowly eating away at the quality of our educational system.

I agree wholeheartedly. And even in the technical colleges and lesser university colleges, there seems to be a push to have more and more PhDs teaching, award more advanced degrees, and even run small research programs.

Part of this problem is also a market saturation of qualified PhDs, not unlike what we see in EMS. You can go to school for 10 years, get a PhD in genetics, and yet most entry-level postdoctoral positions are paying less than $40,000, and you're working 70-80 hour weeks. You have a large pool of people chasing an increasingly smaller number of jobs, and at some point a lot of them either can't progress in their chosen career path, or no longer want to. A lot of these people look for instructional jobs that were traditional held by people without PhD degrees. The smaller institutions salivate at the idea of having more PhDs on staff, and expanding their degree-granting status.

There's also a lack of consumer awareness when it comes to university education. People in the 18-22 demographic that makes up the bulk of undergraduate students aren't good at getting their voices heard by anyone other than market retailers, and often don't recognise that they're paying a ridiculous amount of money to get an increasingly poorer product.

 

[systemet]

Research is important and a academician must generate it, but the academician has his duty to educate as well. Anyways, sorry to open that tangent up, I guess it wasn't the best analogy.

Sorry if I've derailed the thread a little.

 

[Angel]

Thanks for that, I really needed a laugh today.

A PA cannot even come close to the ability of a physician in these categories.

PAs are just assistants who think because they have a rudementary medical education they are worth more than they really are.

The only thing they are good for is routine care of noncritical conditions. There are way too many exceptions, deviations, and balances required in critical care than any PA I have ever met or heard of is capable of performing at an acceptable level.

I wouldn't let a PA treat a dog I didn't like. I certainly wouldn't pay for one.

HAHA this makes you sound jealous or bitter...maybe both. :rofl:
the ignorance is astonishing

 

[Veneficus]

HAHA this makes you sound jealous or bitter...maybe both. :rofl:
the ignorance is astonishing

Jealous no...

Bitter? Perhaps. I have never had a positive or even neutral encounter with a PA in my life.

They talk a mean game between themselves and "lower" level providers. They are astonishingly quiet and humble in the presence of a physician.

They also don't seem to be so kind to providers they find "beneath" them.

I am also not impressed by why people become PAs.

"Medical school is too long, I am too old, the cost is too much, I don't want to work that hard"

They are just excuses for not putting for the dedication and effort required for medicine.

The most credit for them I can muster is they are better than nothing. But not by much.

I stand by my position, I would not let one treat or even see a member of my family or close friends.

I would never consent to pay one.

"They have been measured and are found wanting."

 

[Arovetli]

HAHA this makes you sound jealous or bitter...maybe both. :rofl:
the ignorance is astonishing

Nothing he said is inaccurate.

The truth is harsh at times.

Midlevels have limitations.

And who is ignorant and how?

 

[Angel]

Jealous no...

Bitter? Perhaps. I have never had a positive or even neutral encounter with a PA in my life.

They talk a mean game between themselves and "lower" level providers. They are astonishingly quiet and humble in the presence of a physician.

They also don't seem to be so kind to providers they find "beneath" them.

I am also not impressed by why people become PAs.

"Medical school is too long, I am too old, the cost is too much, I don't want to work that hard"

They are just excuses for not putting for the dedication and effort required for medicine.

The most credit for them I can muster is they are better than nothing. But not by much.

I stand by my position, I would not let one treat or even see a member of my family or close friends.

I would never consent to pay one.

"They have been measured and are found wanting."

This coming from an EMT? Medic even? OK.

 

[Arovetli]

This coming from an EMT? Medic even? OK.

Just because this board is geared towards EMT's and medics doesn't mean all who post here are.

On a side note, Ad hominem much?

 

[EpiEMS]

"They have been measured and are found wanting."

The issue is: they haven't been measured sufficiently. However, where they have been measured, far as I can tell, they've been found to perform equivalently or even better.

 

[terrible one]

This coming from an EMT? Medic even? OK.

Pretty sure Veneficus has either completed or near completion of med school.

 

[STXmedic]

This coming from an EMT? Medic even? OK.

I think he's got a little more experience than you give him credit for.

 

[EpiEMS]

I think he's got a little more experience than you give him credit for.

Anecdotes do not evidence make.

 

[Arovetli]

Anecdotes do not evidence make.

As we covered some point earlier in the thread, there is a paucity in scientific evidence.

In light of that we just have to resort to hurling opinions at one another.

 

[STXmedic]

Anecdotes do not evidence make.

Clarifying thanks for it.

 

[EpiEMS]

As we covered some point earlier in the thread, there is a paucity in scientific evidence.

In light of that we just have to resort to hurling opinions at one another.

I suppose so. I was just about to edit my post to say that I meant no offense in my statement. I'm just saying that we ought to withhold final judgement in the absence of evidence.