Medicine From The Trenches

Experiences from medical school, residency and beyond.

Common Myths about Physician Assistants

Introduction

As we move further into the 21st century, the presence of  mid-level practitioners will become more and more prevalent in medical centers and in general health-care. Long gone are the days of one’s total health care being managed by a physician only in the ranks of primary care. For some patients (and practitioners), the presence of a mid-level practitioner is both confusing and unwelcome. Physician assistants make up a portion of the mid-level practitioners that will be found in many modern health care centers (along with nurse practitioners) but patients will often be unaware of their training and purpose in adding(extending) what a physician can do for them.  Many of my physician colleagues will feel that physician assistants will somehow encroach on their areas of practice which is far from the truth. In essence, my physician assistants extend and reinforce what I am able to do in medicine. They function as my eyes, ears and hands in places that I physically cannot be present and  my PA colleagues provide a very high level of care for my patients. In my practice it isn’t you see the physician or the physician assistant but in most cases, you will be seen by both.

Myth No. 1 -Most people who become physician assistants couldn’t get into medical school so they are physician “wannabes”.

In 2012, the entry-level for most physician assistant programs is at the level of master’s degree.  Not only is a minimum 3.0 GPA required to apply to these programs, the competition to enter these programs is much stricter and more stringent than ever. Most of the folks who applied the Physician Assistant (PA) program at my university had over a 3.5 GPA and most who were accepted into the program had over a 3.7 GPA. This would indicate that the folks who were able to enter our PA program were definitely capable and would have been competitive for many medical schools in this country. Many of the people who entered our program sought to become a PA rather than an MD because they didn’t feel that they wanted to spend a minimum of 7 years before they could practice. Our program is 27 months from start to finish with our graduates being able to enter any area of medicine one would find physicians. In addition, they can seek additional training in anesthesia and critical care if they choose to work in these areas. The vast majority of our PA grads go into surgery, pediatrics , emergency medicine and internal medicine much the same as our MD graduates.

Myth # 2- PA school is easier than medical school so these folks give inferior care

In truth, PA school is a bit more difficult than medical school. In essence, I had two years of pre-clinical didactics before I entered the clinical phase of my medical school. PA students have about one year of pre-clinical didactics before entering their clinical phase and they are taught on clinical rotations alongside 3rd and 4th year medical students. PA students attend the same clinical lectures and are expected to carry the same clinical loads as the 3rd and 4th year medical students. We often don’t know whether a student is a PA student or a medical student unless we are able to read the name badges. I ask rotating students the same questions and expect the same level of functioning regardless of which degree they will complete. In the end, the PA student will leave at the level of a  PGY-1-2 resident and function at that level  for most of their career while the medical student will leave at the level of a PGY-1 resident and move through residency to become an attending physician. Most of the patients that are treated in clinics at medical centers are seen by a combination of PAs and residents on teams that are run by a chief resident or attending physician with no compromise of care.

Myth 3- PA don’t know things at the level of a physician so they might miss something in my care

Most PAs are very adept at self-directed learning in the same manner as a physician. Whether one attends medical school or PA school, one cannot expect that what is learned in school is all that is needed to be a competent practitioner. My state requires that I complete many hours of continuing education in order for me to maintain a license to practice with PA having the same licensure requirements. In addition to seeing patients, PAs are constantly upgrading and honing their knowledge often at the same conferences and meeting as physicians.  Physicians often consult each other in terms of taking care of complicated patients and good PAs will consult with more experienced PAs or physicians in the care of their patients. The PA that work on my service know the scope of their practice and do not exceed this. While the PA may be able to do 90% of what I do as a physician, they are very aware of when a patient is beyond their scope of care the same as any physician is aware of when a patient is beyond their scope of care.

Myth #4- If I see the PA, I have to see the doctor too so why the extra step?

Many of my patients may not be seen by me on some office visits where they see the PA only. If the PA feels that the patient does not need to be seen by me, they will take care of the problem and the patient gets out sooner. On the other hand, most of the PA who work in my practice will state that, I know the doctor wants to see you so wait a couple of minutes until she is available” while in the meantime, I will consult with the PA on how the care of that patient is going along. PAs in our practice will perform treatments, manage wound care and work patients up for surgery. In most cases, just as with the residents who are on our team, the PA will assist in the surgery of the patient that they worked up unless the case is of vital learning for a resident.

Myth #5- PA education is inferior to physician education

PAs are educated under the same model as physicians. They take the same coursework in some cases but they don’t spend the same amount of time in school as a medical student and they don’t spend the same amount of time in post-graduate training as a medial student would. The ability to practice medicine with less training is something that is very appealing for most of the people who enter PA school. At the end of training and upon passage of their certification examination, most PAs start out at around $78,000 and max out around $110,000 after a few years in practice. For many people, spending a minimum of 3 years in residency above 4 years of medical school (expensive) only to earn about $47,000 as a resident is not something that they can afford financially. Most PA programs will cost far less than medical school and will enable their graduates to get into the health care work force much sooner at higher salary. Additionally, physician assistants can apply for and qualify for public health care scholarships that will pay back their student loans which are far less than the average $158,000 that a medical student will owe after medical school.

Finally…

I wrote this post because many students have negative ideas of what the training and work of a physician assistant will involve. For many students who have a strong desire to work in the medical field but family and financial obligations that will not allow them to spend a minimum of 7 years in training above  the baccalaureate level, becoming a physician assistant is something that they might find appealing. In today’s world of medical practice, PAs diagnose, treat and prescribe right alongside physicians. Often it’s the PA who gets to spend more time with the patient and who will develop a more personal relationship with their patient because the PA is not subject to the time constraints that a physician is often subject to. Good PAs build upon their clinical skills learned in school and spend as much time upgrading those skills through continuing education and journal reading as any physician would. It’s no accident that physician assistants enjoy the highest job satisfaction of any profession in health care with other professions not even coming close to their level of satisfaction.

I would encourage any premedical student to take a long and objective look at the physician assistant profession in addition to medicine. You may find that it’s a good fit for your professional ideals especially if you enjoy one-on-one interaction with your patients. One of our frequent questions for entry into PA or medical school is ,”What other health care professions have you looked at and what did you find out about them?”.  I am always surprised at the number of students who have applied to PA or medical school that didn’t do a thorough investigation of health care careers besides physician or physician assistant. Certainly if one anticipates preparing for a career as a physician, one should definitely make sure that they have done a thorough investigation of everything that is available, including alternatives and make the most informed decision before they embark on a career that takes a minimum of 7 years beyond university. Additionally,every PA that works in my practice is far from envious of my practice and love the scope of their profession. As you look at becoming a PA, make no mistake in believing that compared to medicine, it’s inferior or easier because this simply isn’t accurate and you may find that this very modern career is a great one for you.

14 January, 2012 Posted by | can't get into medical school, medical school, physican assistant, pre-med courses | | 35 Comments