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Is Being a Physician Overrated?

Is being a doctor overrated?

It is according to Careercast.com’s evaluation of the “Most Overrated Jobs of 2011.”

The article summarized Careercast.com’s evaluation of professions that tend to be highly regarded, but when examined more closely have hidden costs that make them less desirable.  [click to continue…]

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Will Being a PA Satisfy You? Worry Not

If you struggle with the career decision of PA vs MD or PA vs NP or even PA vs Starbucks barrista (a job I’ve long fantasized about) you’ve probably wondered once or twice:

“Will Being a Physician Assistant Satisfy Me?”

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PA vs MD: Malpractice, Part I

The PA vs MD section of our site is not intended to cover debates; rather the “vs” in the title is meant to describe the issues that crop up when a student tries to decide between the two professions.  Today, however, debate at least enters into it.  I’m talking about physician assistant malpractice.  Better you should go into this field knowing the reality.

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The Death of Solo Primary Care?

If you’ve been paying attention, you know that America is experiencing a health care crisis.  One of the bigger losses is the solo primary care physician.  My father was one, and it was clear when he died that his kind of work – getting to know patients by treating them for decades by yourself, had seen its golden age.  Today, the New York Times has a great article that explains why this has happened.  It also has an excellent video clip.

How does this affect PAs?  It gives us opportunity – there is great need for clinicians – but it also means that the typical primary care PA will practice in a group.  Not necessarily a bad thing if you expect it going in, but there are sacrifices that come with it.

Read the New York Times Article Here

 

Finals are over – finally - and I can now look at the results of my unofficial survey asking the PA vs MD* question: “Are those in PA school Medical Students? If you missed the post, you can read it by clicking the link, or you can read the article on KevinMD by clicking here. Basically, I wrote an article about my first experience performing a pelvic exam for KevinMD, and a reader didn’t like that I referred to myself as a medical student.  So I started a poll here at IPAT to see what readers thought.

When I asked my classmates about the issue, I was surprised at how differently we all saw it.  It would have been easy to react to this and get defensive, but I decided instead to “put myself out there” by raising it as a topic here for IPAT readers.  Grist for the mill, as they say in my former career as a psychotherapist.

Poll Results

pa vs md poll

What our readers thought

After over a hundred responses, the results indicate that people are essentially divided on the issue.  Here’s a little context for the discussion:

  • My original article was entitled, “My First Real Patient.”  Kevin Pho (owner of KevinMD.com) retitled it to “Pelvic Exam by Medical Student for the First Time.”  This was his choice, and I didn’t know about it in advance.
  • In the article, I referred to myself as a medical student.  I haven’t shared my rationale so far, because I didn’t want to contaminate the survey.  My reason for calling myself a medical student was twofold:
    • In a piece limited to 500 words, extraneous details risk confusing the reader, and I felt that to keep things simple, I would use a term that was got the message across without a ton of explanation.  The experience seemed the important part to me, not my title or degree.
    • I study medicine, and when I need to tell people about my education but don’t have much time to go into details, I use the term medical student.  I have no interest in misleading the public about what I do.  I definitely wouldn’t spent the kind of time that I do writing this blog if I didn’t feel so pumped about my choice to become a PA and not an MD!  And yes, it was a choice.
  • I placed a link to the poll, so that readers of the KevinMD article comments thread could vote too.
  • The various arguments that I’ve read in favor of calling those in PA school medical students include:
    • They study medicine, so what’s all the fuss?  Architects and contractor study building design, but that doesn’t mean they are the same thing.
    • People often don’t know much what a PA does.  Many patients continue to call their PA “doctor,” even after the issue is addressed.  At some point, you just need to let it go.  Are you going to correct them every time you see them?
    • It’s a shorthand; if clarification is necessary, you can provide it (immediately)
    • PAs are becoming better recognized, and the public needs to know that their training is much closer to that of doctors than to that of medical assistants or nurses, or Certified Nursing Assistants (CNAs).
  • Arguments on the other side include:
    • It’s misleading, making people think that you are working toward your MD.  You should be very specific so there is no confusion.
    • Calling  yourself a medical student doesn’t do justice to the longer and different training that traditional medical students do
    • Calling yourself a medical student doesn’t respect the PA profession.
    • Would you say call everyone who studies medicine a medical student?  What about Phlebotomists?  Anatomists?  Dentists?

My take, with hindsight

I can see how some people have a problem with the use of the term.  I think that, as in law, one’s motivation is relevant to the issue;  if you’re using a term it to impress someone, to get laid, or because you wish you were an MD and not a PA, you’re making a mistake.

My classmate and friend, Sundance (who has also been a traditional medical student at UC Davis) made the point that PAs lose credibility with the public when they hold themselves up to be just like doctors, or as something they aren’t.  I might amend this a little: PAs lose credibility when others perceive them to be misrepresenting themselves. It’s a small difference, but an important one to me.  I can’t totally control how others see me, and if anyone was mislead by what I wrote, it was unintentional.

One reader summed up my feelings nicely: hopefully someday the public will have more familiarity with the PA profession, and when they hear that you are a medical student, they will add, “Really?  MD, or PA?”  Until that time, we should be thoughtful about how we describe ourselves, and be prepared to clarify when there is a misunderstanding.

Would I do it differently if it happened again, the same way?  I don’t think so.  Will I consider carefully which words I use each and every time that an issue like this comes up?  Definitely.  -P

* PA Vs. MD is not meant to indicate any animosity or even competition between PAs and MDs.  It’s a category of discussion that pops up from time to time at Inside PA Training – how the two fields are alike, different, and how people make decisions about which one is right for them.
PA vs. MD: are PA students call themselves medical students?

PA vs. MD: are those in PA school medical students?

PA vs. MD topics always seem to stir peoples’ emotions —

or should I say frappé?

About two weeks ago, I got into an interesting debate with a reader of an article I wrote for the medical blog, KevinMD.com (click for the article and comments).  In the article, I referred to myself as a medical student.  I had several reasons for doing this which I won’t share at this point.  Anyway, one of the readers took me to task, saying that I shouldn’t use that title since I was working toward my PA and not my MD.  Some of my classmates and I discussed the issue, and I was surprised at how differently some of us felt.  I thought I would put it out there and see what you think.  Recall my last post, where I argued that PA school may not be right for you if your title is more important to you than what you do at work.

The poll isn’t scientific, and it won’t make policy, but I have to admit I’m curious.  When I have enough data, I’ll report back with the results, and add them to the PA vs MD category.  If you’d like to share your opinion, please do; we’d love to hear what you think!        -Paul

pa vs md poll

What our readers thought

Why a PA career may be wrong for you

Look first, or you may regret it

It’s easy to get excited about a physician assistant career.   I wrote recently about how to tell if you have the PA personality.  But what about the values you hold?  Excitement has a way of discouraging us from seeing the little negatives we sometimes need to see.  So today’s topic is a little different – 180 degrees, in fact: how to tell if it’s the wrong field for you.  Here are five big ones as I see it.  If you have one to add, float in a comment below.

5 Reasons a Physician Assistant Career is Wrong for You:

  1. Your job title is more important to you than what you actually do. I’m not being snide here – for some people (and they usually know who they are), the prestige attached to job titles is crucial.  If you’re one of these folks, think twice about a PA career.  Why?  Even though PAs are gaining acceptance in the eye of the public every day, they have a way to go; many people still don’t really know what a PA is.  To be one is to accept that you will be explaining your role to your patients as a normal part of your work.  You will occasionally be mistaken for a medical assistant or a doctor.  You will be neither, and it’s your job to patiently explain what you are and do.
  2. Your interest in medicine is more about the science than about caring for patients. Don’t get me wrong – as a PA, you’ll need to know and work with plenty of science.  And PAs aren’t the only medical providers who care about their patients.  But as a PA, your patients are a larger focus.  Your communication with them and your ability to educate and counsel them about their health and treatment are your “magic bullets,” not your specialized knowledge of biochemical pathways or fluid dynamics.
  3. You need to be at the top of the decision making chain on every decision you make, as opposed to working as a member of a team. PAs are supervised by physicians.  They make many decisions independently every day.  But sometimes the supervising MD makes the call.  If you can’t stomach the idea of not having the final say about everything that  happens with every patient, you shouldn’t be a PA.
  4. You prefer to be the expert on one or two subjects than to be competent in many. One of the recognized strengths of the PA profession is its flexibility.  It’s great to be able to work in, say, primary care for a few years, and then switch to a job in emergency.  It leaves you open to more employment opportunities, and it’s one reason PAs are so sought after; they are “physician extenders.”  But it’s not ideal if you want to be the regional or national expert on a particular illness or procedure.
  5. You think it’s an easy way to get into medicine. Medicine is hard, in part because it’s complicated, and in part because there’s simply more of it than you could learn in three lifetimes.  It takes fewer years to become a PA than a physician, but there isn’t much about it that’s easy, and believe me, you’ll still be learning when you get out of school.  It’s loads of work and time to become solid, and a PA’s mistake can kill or harm a patient just easily as a physician’s.

If you have thoughts about these, or have one to add, just leave a comment – we’d love to hear what you think.     -P

Female physician assistant

Good news for female physician assistant candidates

I’ve been asked a few times by readers about how welcoming the physician assistant profession is to women.  My answer: very.

But First, the Good New for Both Genders

A quick look at the Occupational Outlook Handbook, 2010-11 Edition, published by the US Bureau of Labor Statistics makes the good news for all of us clear:

  1. There is a shortage of PAs, and there’s no sign of it ending.  The report describes the job outlook for PAs in its most positive terms: it’s expected to grow by at least 20% in the next ten years.
  2. Overall, physician assistants enjoy their jobs.  See the graph at right.
  3. The median PA income is good at $84,420 as of 2009.
  4. For these and other reasons, US News and World Report Money called physician assistant one of the best careers this year.  Not bad, eh?  How about CNN Money?  They had a similar take on PAs.

Now, the Good News for Women PA Career Satisfaction Graph

Historically, medicine has been dominated by men – particularly those with the most authority – physicians.  This being true, as a woman, you might wonder if you will:

  • Be challenged or bored as a PA
  • Be respected or disrespected in your workplace
  • Have the freedom to do other things, or be chained to your job

According to a recent study published in the Journal of the American Academy of Physician Assistants (JAAPA), these are these are areas that most female PAs rate highest when asked about their work.  In addition, women are slightly more likely to recommend the profession to a friend than their male counterparts.

Isn’t medicine dominated by men?  Not this part of it.  True, the first PAs were men, and it wasn’t until 1970 that Joyce Nichols became the first female PA.  Incidentally, she was also the first African American PA!  Her story is inspirational and probably set the stage for the profession being similarly welcoming to men and women.  Check it out!

Today, about 55% of PAs and 72% of new PA students are female.  This means that the percentage of PAs will continue to grow.  In most medical schools, students these days are more often female by a slim margin, so the physicians who supervise tomorrow’s PAs are more likely to be female too (though with doctors it’s changing much more slowly).

The researchers in the JAAPA study theorized that the PA profession is attractive to women because it offers satisfying work that is well compensated, and more flexibility than that of physician, particularly for those who wish to be both PAs and mothers.  My friend Sundance spoke to this her video interview

(if you haven’t seen it, you should), and how the need for balance in her life was the primary reason she chose to switch from MD to PA career paths.

Clearly, PA medicine has a lot to offer women, and they seem to be leaving their mark on the field.  Are you sold yet?  I thought so.

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PA vs MD: Meet Sundance – She’s Done Both

Debating about PA vs MD?

Many pre-meds ask themselves, “Should I become a PA, or a physician?”  We have complete respect for both fields, and believe that the PA vs MD question is definitely a personal decision.  Knowing this, I interviewed my classmate Sundance; she had the chance to do both.  She explains her decision-making process, as well as how both paths felt.  The results are enlightening…

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The PA Students Tour the MD Students’ Anatomy Lab

pa school cadaver lab

The cadaver lab was a great experience

Today we were invited by the MD med students to tour the cadaver lab and see their completed dissections.

It’s a strange topic for me.

I had anatomy before beginning PA school, and my PA training class studies it constantly.  But as my pal,  Sundance, puts it, it’s the “applied” kind.   Our program has no anatomy lab class;  the program assumes you’ve had enough anatomy on entry to the program, and plenty of clinical experience to fill it out as well.  It’s something I sometimes wish for, but so far more because it looks like fun, than because I think dissecting the iliohypogastric nerve myself will serve me greatly in primary care (no, it definitely couldn’t hurt).  But instead of cadaver time, we learn anatomy in the context of our medicine courses, and there is plenty of it.

The med students were wonderful.  Their lab is a large and modern, with the latest equipment (the photos in this post are not the UCD lab, which is much bigger and better equipped).  There, we toured 16 cadaver stations, each featuring one or two students sharing the area of focus for that dissection. They were reviewing for their exams, so they were only too glad to give us  run-downs of what we were seeing.  If there was something we wanted to see and they could locate it, they were only too happy to show us.

I saw a few things I hadn’t seen when I took anatomy.  For example, my course didn’t dissect the pharynx.   I’m proud to report that I felt very competent throughout and could definitely hold my own. Sure, I didn’t know as many details as the med students, but I knew plenty, and at times my fellow PA  students and I were able to offer up some “clinical correlates” about what we were seeing.  Several times the med students admitted that we were teaching them things (they won’t do physical exam of real patients for another year).  But it wasn’t about competition.  It was a collegial sharing of medicine, and m y appreciation for their knowledge and detail was complete.   Just as well, too, since someday soon we’ll be working closely with these folks.

Proper dissection takes many hours of teamwork

Proper dissection takes many hours of teamwork

To my surprise, the experience took them off of the pedestal I once saw them on.  They weren’t any different from me: loving the chance to learn everything they can, proud to be in the

field, human–fallible even–and friendly.

There’s a humility you have to develop to work effectively in medicine.  Sure, there are people who don’t, or who slather over it with bravado.  But the culture of it — for MDs and PAs alike — is that if you do it right, there’s so much that there that you’ll never learn it all.

But damn, it’s fun to try.

 

Postscript

We were notified that we may be returning to the lab next year for  supplemental lessons, possibly including suturing practice on cadavers – something medical students don’t get to do (they practice on pig feet).

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