What constitues a "Mid-level Provider"

[Veneficus]

In addition, yes, it wasn't just lip service we paid as a early profession to undeserved communities. Even now, just looking at where the DO schools are and where our residencies are shows a significant concentration outside of the big cities... where most MD schools are expected to show up.

While I support MD/DO as being entirely equal, and you are preaching to the choir, I am not so sure I buy the argument that DOs primarily serve underserved populations based on residency location.

Several of the DO residencies I am familiar with are actually suburbs. Wealthy ones at that. While not specifically in the "big city" were it not for the signs telling you that you were in a different city, you would never know.

I will concede I have seen more DO practices in rural America, but not on a very massive scale. Probably only 1.5-2.0 : 1

I would say I have seen the lagest DO concentraions in the suburbs. With the largest MD concentrations in major cities. I would argue that inner city populations are just as underserved as rural communities, and certainly suburbs are not in danger of underservice.

So while at one time DOs may have put their money where there mouth is, I don't find that compelling today.

But it doesn't mean I think any less of them.

But if you were to base your entire value on that and justify lesser qualifications for the same level of practice and billing as a physician on altruisitc reasons when the sole motivation was education cost/time:income ratio, then we would have a quarrel.

 

[BSE]

In my time on this board I have seen all manner of arguments for the mid level provider. Especially physician Assistants. (or arew they calling themselves associates now?)

Some of the more respected members here who have chosen a mid level path have valiently defended it posting studies from every nursing association, PA association, and all manner of biased sources.

We have had this discussion many times.

But here are some of my observations.

PAs in particular like to claim they are just as effective as MDs. They tout their economic benefits ad generally denounce medical education as wasteful excess. Really? Nobody on this tread stated that. It was implied that a PA (not MD) doesn't need the full course....you see, this is why PA's work with physicians. The Doc is the one who has full depth and can help the PA when they encounter something they are stumped on. It's called working together.

But how many people see education as wasteful excess? None, I expect the Docs that I end up working with to have it.

In this very thread, staunch supporters wonder about the history of teeth in modern medicine. Unfortunately they don't see the implications. HUman evolution is intrinsic to the practice of medicine. Unfortunately for them, they were never shown the importance.

In actual US medical practice, I often see PAs talk a tough game. But I have never seen one step up and be equal to an MD. The same talkers are the ones spouting how great the PA profession is, how they are independant, don't need oversight, fill a primary care role, etc. There really isn't a movement for independent practice for PA's....NP's, not PA's. Opinions of the few shouldn't cloud you on this. The AAPA is adamant on this topic...PA's are not solely independent. Where are you getting your info....I have a feeling this is a very jaded speculation.

I have seen the same thing on this discussion.

But I will just point out...

most of the PA propaganda is just that, kool-aid. Anyone who points out the flaws of the propaganda has an ego problem. Whether or not I have an ego problem is debatable, but I will honestly say when it comes to people who claim to be as good, who have not invested the time, money, and other sacrifices I have is a sure fire way to set me off. What propaganda? The only one spewing propaganda is you...???

When the kool-aid approach to convincing MDs of the value of PAs fails or is met with resistance, you never hear them speak of limitations or role on the team. You hear more entrenched delusions of grandeur.

Tell me? How many PAs have walked into their hospital administration, touted the equivalency and economic benefit and suggested hiring only PAs and decreasing the physician staff? I've been in healthcare for 20 years, I have never heard of this happening. Speculation....again.

How many PAs are employed by physician practice groups tell those group members they have useless and wasted education and were not smart enough to go to PA school because they can do the same things? I dare say....none. Agreed!

I will venture to guess none.

I would offer the very same people and organizations spouting how great the PAs are, not coincidentally are the same ones that talked about how PAs would fill the primary care void in the US. But in a quick internet search today, even PA based websites are talking about how this didn't happen and the trend towards PA specialization is expected to continue. Same as the MD's, most folks go where the money is. To humor you, according to the AAPA, approx 35% of PA's work rural/underserved.

Could it be that these same liars about PAs serving underserved community needs are the ones spouting the greatness of PAs? Childish

When you look at the history of medicine, particularly that of the DO, they were first accepted by the military and the underserved populations. It is a true and tested way to break into the medical profession. But unlike PAs most DOs have more education than MDs, not less. They do not pretend they are serving some greater good that MDs are not. They get into the same specialty and high earning practices as everyone else, and are just as capable. (by the way they did meet the internationally recognized minimums)

I am not suggesting DOs and PAs are the same, as DOs and MDs are the same, but their history is applicable to this conversation.

So let's just call a spade a spade. PAs tout themselves as a cost effective, mission specific solution to healthcare. Basically moving into direct competition for money that MDs are competing for. General system healthcare dollars. By their own admission they are not flocking to serve thier underserved targets. For profit healthcare embraces lesser paid "alternatives" that can bill for the same or similar rates. With even the largest academic centers filling their halls with them. Competing for money? You do realize most PA's are hired by MD's? Right? From the BLS, 70% of PA's directly for an MD.

But here is a question:

If a PAs equal to an MD, why do they accept less money? Because they are not equal to the education of an MD. Seems obvious. What's your point?

Conversly, if a PA is not equal an MD, what gives them the right to bill equally? Here is where it gets sticky. If a patient sees me for a sore throat and I dx strep and give the appropriate abx...didn't I do the exact same thing as an MD? It's work paid for the work done. Doesn't matter though, PA's generally are billed at an 80% rate. This can be argued both ways.

What's reall vexing to me is if a healthcare organization, hospital or private practice group bills the same, why do PAs accept less salary? Ummm, you're getting repetitive...PA's are not MD's...PA's seem to know this....why don't you?

It seems an aweful lot like scabs in a union shop to me. Childish

But here is something else to think about.

When I defend my value and commitment, I am egotistical, arrogant, and ignorant. Sorry, but it is how your coming off.

But many people who we have never seen here before get wind of my arguments against the PA kool-aid, they are compelled to come here and offer counter-point.

I have never posted on a PA forum. I don't even look at them. They might have PA vs MD vs garbage man vs street walker arguments all year. I would never know and certainly don't feel compelled to defend my profession there.
Ummm, the high ground. I am a Paramedic transitioning to PA. Oh, you really won't find too many of those threads on a PA forum. PA's tend to know they are tied to MD's...and are ok with it.

It seems like that response is similar to religious zealots who have their faith questioned.

Could it be I question your faith? Could it be that you feel threatened somebody might actually be persuaded by my arguments as to why PAs are not equal to doctors and might then decide they will not accept PAs? What if those people are politicians? Patients? Your game would be up. Nope

I suggest you offer such passioned and spirited defense, because the PA profession might have to answer for some of its propaganda and it can't.

Perhaps more policy makers should have this discussion?

Now I don't think I will convince my new detractors, but not everyone here is immune from rational or counter argument.

The defense of my profession is no more egotistical, arrogant, and ignorant than yours. That is simply the pot calling the kettle black.

Rather than argue with me, why not simply surround yourself with people who make you feel better by drinking the koool-aid with you and call me an fool?

"And then He said, get this, that having more education makes you a better provider and people should not pay the same for less... arrogant fool."

"I am better than thou art now; I am a fool, thou art nothing"

Wise words from one of those useless literature classes.

Brevity isn't your thing eh? You have yet to state one fact. Good luck to you in whatever you do. Sorry you have such a bad opinion of PA's...guess I'll have to live with that. Don't worry...I'm not crushed.

 

[Veneficus]

to those still following

Really? Nobody on this tread stated that. It was implied that a PA (not MD) doesn't need the full course....you see, this is why PA's work with physicians. The Doc is the one who has full depth and can help the PA when they encounter something they are stumped on. It's called working together.

Tell your colleagues, not me, do a youtube search and see some of the crap actually videoed by PA students and PAs on it.

I would have a much better opinion of them if this is what I was hearing from them instead of the constant BS. So far in my >20 years, the only one I have heard this from is you.

There really isn't a movement for independent practice for PA's....NP's, not PA's. Opinions of the few shouldn't cloud you on this. The AAPA is adamant on this topic...PA's are not solely independent. Where are you getting your info....I have a feeling this is a very jaded speculation.

Mostly from PA and CRNA students here. But there is usually an article or two in my medical news sources I run across every week.

What propaganda? The only one spewing propaganda is you...???

Use the search function, turn on the TV, read the news. Again, I don't sit here wondering how I can pick on PAs. I hear the lies from somewhere. I can also call a spade a spade, so childish as you may see it, and certainly not flattering, it still is accurate.

I've been in healthcare for 20 years, I have never heard of this happening. Speculation....again.

That is my point. What is adverted to patients and policy makers is different from reality. At best it is 2 faced. That is not childish, it is a terrible thing known as the truth.

Same as the MD's, most folks go where the money is. To humor you, according to the AAPA, approx 35% of PA's work rural/underserved.

So about 1/3 I find that staggeringly low, especially based on their propaganda and how many I have encountered in academic medical institutions.

But this is exaclty my point, the PA is a lesser trained, lesser skilled substitute chasing money over dedication to medicine. That mercenary attitude is exactly what leads to poor patient care and a bloated unsustainable medical system. Whether it is from a doctor or a PA.

I would find it a lot more palatable to just advert: "I am here for the money, patient care is secondary concern." I wouldn't like to hear it, but prefer the truth.

Competing for money? You do realize most PA's are hired by MD's? Right? From the BLS, 70% of PA's directly for an MD.

Do you realize that every PA hired takes away the demand to train more doctors? To pay more doctors? Do you realize it directly takes away moonlighting spots for junior doctors? Who could follow guidlines just as well as you, consulting as necessary and getting paid more? Every PA spot is a residency spot. Every residency spot is a medical school spot. And all of those are fully trained doctors caring for patients.

Perhaps you realize it supports the postion of the very doctors who created a physician shortage in order to justify their outrageous and unsustainable salaries? Perhaps you realize those are the same professors paid by medical school which cause student debt so high there is actually a tracked suicide rate for it specifically for those in medicine from student to attending?

Perhaps you realize that if given the choice, a patent might actually want to see the doctor? After all, didn't somebody in this thread state he would rather see the doctor but didn't want to wait? Do you think that is a lone sentiment?

Here is where it gets sticky. If a patient sees me for a sore throat and I dx strep and give the appropriate abx...didn't I do the exact same thing as an MD? It's work paid for the work done. Doesn't matter though, PA's generally are billed at an 80% rate. This can be argued both ways.

Work paid for work done. Outstanding. So should a paramedic be paid as an anesthesiologist everytime they intubate? RSI? How about as a cardiologist for interpreting 12 leads? Is is the argument of a labor mentality. I didn't lay any bricks today, I must have done no work.

Ummm, you're getting repetitive...PA's are not MD's...PA's seem to know this....why don't you?

Hang around here, not too many of them seem to.

Ummm, the high ground. I am a Paramedic transitioning to PA. Oh, you really won't find too many of those threads on a PA forum. PA's tend to know they are tied to MD's...and are ok with it.

I am not claiming the highground, just introspection. I also must apologize because I am not wasting time searching out propaganda, I don't sit around making this stuff up, I hear it, and I acknowledge it as such.

I believe somebody here already posted a link about PA in CA claiming the right to more independance.


Brevity isn't your thing eh? You have yet to state one fact.

I often repeat my thoughts because the format here coupled with my often having to leave and come back to what I am typing. Sorry, People don't seem to mind. I also find that I have to use a lot fo words to explain complex issues.

I also don't see things as disconnected. So when there are PA students who show up in one thread, they may not understand that my opinions are collective of my total experience, and not just here.

If you do a search I know Mr. Otto has posted studies on the outcomes associated with PAs, perhaps he might help you find them? I actually get a lot of my information from him (Though I am probably not interpreting it in a way he would like)

 

[BSE]

Again, not a single fact, that is verifiable. Even your mention of the proposal in California is wrong. I take it you didn't read it? *Hint, you should be nodding your head in agreement. It was about independent practice for NP's....not PA's. The only mention of PA's had to do with supervision rules....that are not going away.

Although you did make me laugh.....all those poor out of work MD's because of those "scab" PA's.:rofl: I could say, you mean those poor MD's that didn't place in anything other than FM and are PO'ed that they aren't making $300K like their specialty friends...but that would be awfully cynical.

You are using youtube videos as your sources of information. Really? You are a man of science....you should know better. :unsure:

No hard feeling...really. You are entitled to your opinions. Don't hire a PA if you are a Doc. I won't lack for employers.

 

[Brandon O]

If you do a search I know Mr. Otto has posted studies on the outcomes associated with PAs, perhaps he might help you find them? I actually get a lot of my information from him (Though I am probably not interpreting it in a way he would like)

You must mean me, but I didn't. I try to stay out of this, since it's clearly about us and not about taking care of people. The only pertinent studies would be comparing the predictive value of post-nominal initials for genital size.

 

[JPINFV]

While I support MD/DO as being entirely equal, and you are preaching to the choir, I am not so sure I buy the argument that DOs primarily serve underserved populations based on residency location.

I was mentioning that from a historical stance, not from a current stance. As it is now, I'd argue that DOs, especially since a significant number of people go to DO because they weren't accepted at an MD school, are just as likely to go wherever they want than to specifically serve an underserved area.

 

[ffemt8978]