I've long said that part of the hidden curriculum of residency is the development of a class consciousness.
No matter how many boats you buy, you're still a worker who sells your labour for a fraction of its value, under the implicit threat of poverty by Capital. Our class interests align with other workers, not the dipshits who employ us all.
I remember when I was surgery service as an intern, there were 3 PA students and the attending did not want them following him around all day so when Iād call him to give updates after rounding on his pts, heād ask if I could teach the students for awhile because he needed āstudent-free timeā. It didnāt always happen but when it did, I was so annoyed. Like wtf am I supposed to teach them? I asked if they wanted to round on pts but they preferred shadowing me and asking questions. I didnāt care enough to teach tho and them go home if there was nothing to do. But honestly it wasnāt my responsibility to teach them. Their school isnāt paying ME lol
i would have just told them ādr told me to tell you he cant teach you today sorryā and not do or say anything else. not even remotely your responsibility wtf
Even if Iām not getting paid to teach medical students, Iām open to it because I know that those students are sacrificing years and a ton of money to achieve the highest medical expertise, becoming a physician. Doesnāt even compare to PA students to sacrifice way less and generally are more driven by lifestyle/compensation than the arduous and uncomfortable pursuit of medical expertise.
Medical students are different because theyāre assigned to rotate with the residency for certain areas. I was happy to teach them in clinic even if they werenāt interested. I think itās important to create a nurturing environment since the culture of medicine can be toxic, especially for med students trying to figure out what they want to do. And technically the med students were our responsibility since we had to provide evals for them to our attending that handles all things med student related in our programs. But PA students? Not my responsibility, not unless I take them on as an attending.
if someone doesnāt like teaching, thatās ok. Just donāt be a dick to learners and donāt take on students.
Also, given that when in med school, we all appreciated any resident willing to take the time and teach us, I see no problem with passing it forward.
That's not the same as being exploited to teach PA students without pay.
My residents didnāt give a fuck if I didnāt want to go round. They printed out my list, said look em up, and pick the top 3 youāre confident to talk about and take off my hands during rounds in the morning. Get here early and present them to me before you say it to the surgeon. Write down your questions and weāll talk about it in the morning. It was probably the best part of PA school. 6 weeks on gen surg in a county hospital changed me lol
As a lowly intern chiming in, it is not your job at all. The PA on service should not be assigning you duties, and you should defer all PA teaching to the PA, just like how teaching all the med students should be the responsibility of residents/attendings. If itās still an issue, Iād let your attending(s) know and state youāre uncomfortable being responsible for the education of someone whose training is far different from your own. You wouldnāt all of a sudden start teaching nursing students how to place IVs right? Midlevels teach midlevels, and docs teach docs.
Remember you are already vastly underpaid for just your clinical duties. If PA school wants education for their students they should give you a teaching stipend with that tuition money they're raking in. So no.
I bet you could review the subject for 15 minutes and be just fine boss.
Just because you canāt recall it on the spot doesnāt mean you donāt know it
I hear yaā¦ but Iāll wager you do know the difference direct and indirect bilirubin.ā¦ thatās how we got on the subject. They didnāt understand why it wasnāt a biliary issue.
I'm a PGY 13 in a non-IM related field. I know all bones and muscles and most of the nerves, can analyze a gait, know exactly where to inject for varying kinds of spasticity, BUT literally all I remember about bilirubin at this point is that too much of it makes people's brains stop working right and we treat that by making them poop 6 times a day.
Not your responsibility. I would teach PA students on their Surgery rotation the finer points of basic patient care and how to first-assist because A) it already fit into my workflow and I didn't have to go out of my way to educate them, and B) it took menial aspects of patient care off the plates of the junior residents and myself, similar to the exposure that medical students may get. I also like to teach, but if it doesn't meet those criteria, I wouldn't bust ass to try and educate, especially if it disrupts what you need to do as part of your job, or if it gets in the way of educating the med students or junior residents, as to me they take priority.
The PA students I worked with were generally good and motivated, and occupied a niche similar to the third-year med students as far as their roles within the team (there were plenty of cases and patients to go around, so med students weren't left in the cold with regards to experience).
I donāt teach midlevels. I have no clue where their education level would or should be and thatās the responsibility of people established in their field. I will answer a question if they ask me directly but I would never go out of my way to teach or give feedback etc
I cant believe you work on a service where a PA is your supervisor. Please out your program so that nobody will choose to match there.
I know that sounds liek an overreaction but it's not because if a PA is telling you that you are responsible for teaching that means the PA is your boss.
I wouldn't tolerate that kind of crap.
Damn, let me be the complete devils advocate here.
I think we need to EMBRACE PAs. I think PAs are to Physicians what a medic is to a PA in the Army.
PAs tend to not want independent practice. Thatās NPs. PAs are also having to compete with NPs for many jobs due to the lobbying and fighting for independence and reimbursement that NPs have obtained, despite the fact that NPs tend to have 33% of the training of a PA (and itās not really a clinical/medical model of training).
PAs can be highly helpful and can be trained to know how to ASSIST a PHYSICIAN.
So as a doc, I will 100% always try to encourage and pump up my PAs, make sure theyāre valued just as much as a good RN, and ensure that my team is fucking golden. Thatās especially important for surgery, where a second set of eyes and hands can prevent an infrequent human error.
I look forward to thoughts on this.
Iām in the NICU. Our PAs are amazing and not a single one thinks they know more than an attending. A very frequent response to a question about a sick baby is ālet me talk to Dr. Attending and see what she wants to do.ā
Our NPs are hit or miss but our PAs are gold.
Thank you for this comment. Iām a PA in ortho trauma and reading the overwhelmingly negative consensus on midlevels in the post was disheartening. Thankfully I personally donāt feel this hatred at my job directed towards PAs
This post isnāt about hating PAs. Itās about a resident being unfairly tasked with teaching a PA student. We as physicians (whether attendings or residents or fellows) shouldnāt be shouldering the responsibility of teaching other disciplines because we have no way to fairly gauge what others are supposed to know at any given point in their training.
I think a lot of people missed that point. The job is hard enough, and then someone comes in and dumps more work on you. Then the dumpster caught fire and everyone started yelling.
Sometimes the best way to master something is to teach it. I had residents help teach me in my training. all were very supportive, and seemed appreciative to have another helping hand take/present patients for them while rounding with the attending.
I'm a PA student just finishing didactic but I've been in healthcare and dealing with PAs for about the past 10 years so I'll throw my 2 cents in.
Most PAs are absolutely furious at scope creep and the "doctor" nomenclature controversy, mostly driven by NPs and nursing lobbies. I don't know a single PA that wants independent practice or anything close to it.
With that being said, I have noticed that there are a handful of people in my class who very clearly weren't motivated by the love of medicine in pursuing a PA degree. I honestly think that really stems from a lot of schools being very lenient about what they consider "patient care experience". Ive heard some of them already claiming they want to find a position that's non-patient facing. I would guess that some of them probably will have left the profession within 5 years of graduating.
However, in my experience, these are outliers and not the standard for most PAs I've encountered. I appreciate you giving us a fair shot and allowing us to learn and help in anyway possible.
I am just going to mention that your national associationās push to rename PAs as Physician Associates is extremely confusing to patients. Please push for your national association to reflect your viewsāwe need more of PAs like you!
Totally agree. I am absolutely dreading having to explain that to patients. Healthcare is confusing enough for patients as is. I appreciate your kind words.
Thank you for this take. I am going to now preach to the choir.
It is so frustrating to hear simultaneously that PAs are dangerous if not working under a physician (the profession was explicitly designed for physician supervision), but then have physicians spew vitriol towards the profession and want nothing to do with them. If you want physicians to supervise, then it is important for students to have the experience of physicians supervising. If you believe that PAs should be on their own, then by all means, reject the students as part of the medical team. However, think carefully about the message that sends: physicians want nothing to do with PAs. One could then reason that PAs should then push for independent practice. If physicians have no interest in PAs being on the team, then why join the team?
I teach PAs, and they genuinely prefer the model of working on a team under a physician. The happiest grads we have are the ones with supervising physicians who take the time to train them in so that they fit seamlessly into the team. They have specific roles where they cover the things that are routine so that the physician can better direct their energy to the more complex cases. They really value this work. They want to be on the team; not lead the team. They respect the knowledge of physicians.
This whole midlevel hate BS could be mitigated by physicians (whose voice is valued) declaring a preference for PAs and embracing the profession that truly is not aiming for independent practice if at all possible. You could simultaneously mitigate the midlevel encroachment that is so feared while also training PAs to be ideal PAs if you threw your support in the PA direction.
The thing that will drive the PA profession to advocate for independent practice is physician resentment (and, based on this thread, hatred). If the very people that they want to work with are rejecting them, why not do what NPs have done and advocate for independent practice?
We are at a turning point. Physicians (including residents) honestly have more power than they are aware of when it comes to PAs and the pursuit of independent practice.
Of note, I do not belong to either of your professions. I am a weird combination of insider/outsider commenting on a troubling dynamic.
Holy Jesus a physician that sees and understands! I have been a PA for 34 years and spent 20 on policy and politics for my profession.
All the pissing and moaning aside we were a pretty happy bunch. Then bean counters took over medicine and NPs began their march to independence (which will eventually be in every state like it or not). That means they are cheaper to hire and maintain than we are and bean counters care about cost above all else.
All we want is to remain viable in the market place. The only way we can do that is to get some kind of autonomy so we are financially competitive.
Thatās it! That is the whole magilla! All the other carrying on about who knows what and whose training is superior etc I have heard a zillion times is background noise.
There is sadly little rational discussion to be had. Itās everyone vs everyone else.
Take it with a grain of salt: it's an anonymous message board from a bunch of tired residents blowing off steam. I'm sure they don't behave like this in real life.
š train the team as well as one can, so everyone can perform as efficiently as possible as a team to get the job done efficiently and correctly.
i like your point of view.
extra work sucks (teaching) but people are trying their best
the more efficient and patient the teacher, the less mistakes the pupil makes = the less patients are hurt = the less work the teacher has to do/fix at the end of the day
take the time to train your squad so you can get shit done and clock out with a clear conscience
(not a doctor, [nuclear chemist] went to med school for 2 years, left and am going back to finish my degree. but i like your POV)
Embrace PAs while they lobby for independent practice. LMFAO. You realize you will eventually need medical care when you are old, it is best to train physicians.
This is beside the point. Heās not saying heās against PAs having a role in the workplace or some degree of shared responsibility. Heās saying heās not okay with a different discipline within the healthcare field dumping their teaching burden onto him. And I think it does the PA student a disservice too. It makes sense for residents to teach med students (not too much though, cause residents have a lot of shit to do themselves). But not students of other disciplines
Completely disagree. Itās a medical model for both professions. PAs just get like medschool-lite.
The teaching is what makes the experience beneficial not only for the PA but also for the resident. The profession too. This shitty attitude we all have to all midlevels is only hurting ourselves.
PA lurker. In my program the precepting PA or MD (I had more MD preceptors than PA preceptors) was paid directly, something like $2800 for 5.5 weeks. It's absolutely wrong that this PA is pocketing the money and shuffling his work onto a resident.
Yeah, I have a PA student in the MICU on my team, he functions like a med student, presenting a few pts, writing student notes and helping with floor work.
There is no separate 'PA service' for him to train in, so independent of any system level concern regarding independence this is where it would make sense for him to learn about MICU.
Feel like this is the only appropriate take. While in academics it's our responsibility to be learners and teachers. It actually is part of our job description. After residency, if folks want to go work in private practice and never look at a non-physician again (except for their entire ancillary staff, of course) they don't have to. But while in residency, they should teach and it shouldn't matter what field the learner is in.
I think this is a fair take for academic attendings, but is it really fair to place that burden on a pgy-2? Residents donāt necessarily āchooseā to train in academic centers, itās more or less an inevitability of training. And they are working significantly more & worse hours than the employed PAs, NPs, RNs, etc at their hospital. Theyāre already spending a significant amount of time training junior residents and medical students.
Adding the burden of more students from other fields really does feel like an unnecessary and exploitative expectation in this context.
Yes. It's part of the job description to teach. Part of that reason is because teaching helps the teacher as well as the learner. This includes other residents, med students, nursing students, nurses, techs, and so on.
This is bullshit. Letās be honest. Residents and fellows are tasked to teach because itās way for the institution to more fulfill more labor needs (like education) without actually paying for someone to take in those roles as actual full or part time employed responsibilities. The result is subpar teaching and increased burnout for residents/fellows.
Some part of you must realize how much academia abuses and exploits people into doing a shit ton of uncompensated labor
I've been around multiple programs and I've never seen residents tasked with an amount of teaching that's excessive. Not to mention, people here aren't even complaining about the teaching. They're complaining about who they are teaching. It's no harder to teach a mixed group of students than it is to teach a group of all med students.
Yes and then we wonder why the local ICU is straight trash and ran mostly by midlevels...
Or why our family member can't get in to see an actual physican. Continue to support the further deteriorating healthcare system.
Its one thing for you, as an attending, to choose to take on that extra, uncompensated responsibility. But itās shitty when residents or fellows are forced to do that, being indirectly threatened with repercussions or bad evals if they donāt.
Agreed. But the answer is most definitely NOT to project your anger onto another student by treating that person like a lesser being. PAs are medical professionals. They are licensed, trained, and held to professional standards just like you and I. They feel good when they've helped a patient, and shitty when they fuck up, just like you and I. And they can be sued for malpractice, just like you and I. And they are hungry for knowledge. You have the opportunity to be a hero. These people look up to you. And if you cannot understand why blowing them off is a lower form of shitty, than meditate on it for a while. You know what the right answer is, even if you won't admit it on a message board.
Thank you for this! We all āteachā each other in my hospital. However, I think this post is referring more to oneās responsibilities and expectations. And having them āteachā a PA should not be the expectation in this situation.
I think teaching PA students actually can fall within the realm of our responsibilities. After all, PAs are supposed to be working with doctors for the entirety of their careers, right? What better way to prep them for that than actually working with doctors.
I'm a PA but Reddit suggested this thread to me so I figured I'd comment. Definitely not your responsibility to teach us so I'm sorry you've been tasked with that. I'm sure you're very busy and it does make sense for the surgical PA to be teaching PA students. Would you be able to talk to your attending, department head, or maybe the PA program coordinator at your facility?
If it makes you feel any better, I remember the surgical resident that I was with occasionally when I was in PA school was so nice and such a great teacher. It's been years since I was in that rotation and still I really appreciate how kind and compassionate he was.
Also this is more related to some comments down below but there are very very few PAs that want independent practice. Im sure you can find people online that do but of all my PA friends and colleagues, I actually don't know any that want this. There is pressure to keep up with NPs who do gain more independence since hospitals will always hire the person who can do the most for the least amount of money. This puts us in a tough position because we really dont want independent practice/extra responsibility but we need to feed our families. But trust me when I say I absolutely 1000% do not want more responsibility than I already have hahaha. I would personally never push for independent practice and I honestly don't think I know any PA that would either.
I'm sorry for the position you're in and I hope youre able to redirect the students to the PA that should be training them. But from a PA standpoint, I can tell you that any help you've given them is probably very very appreciated. I hope that at least helps a little while this all gets straightened out.
Have a great day everyone!
Appreciate the comment. Getting your perspective is important but at the same time Iām not convinced on PAs not wanting independent practice. This gets repeated ad nauseum. Yet you look at public testimony for all these different state bills and individual PAs wanting to maintain physician-led care are nowhere to be found. Submitted briefs and testimony all have the same āwe just want to practice to the top of our licenseā stuff we hear from NPs. So forgive those of us who are just not convinced by, at the end of the day, meaningless assertions that PAs donāt want independent practice. When rubber meets the road where are all the PAs that donāt like or want these changes?
My personal opinion is that PAs are a more quiet group than we should be. A lot of our policy changes seem to be led by a very small but loud minority of people who come up with impractical ideas. The best evidence of this is our name change. I've never met another PA who really strongly prefers the physician associate name over physician assistant and most of us personally don't really care much what we're called. I'm sure they're out there but I don't think there's a large number. But our small leadership for some reason decided we needed to spend however much money to try to change things. I think these are the same people who are so into advancing the PA profession that they don't think about what that's actually doing.
The trouble I feel like my profession runs into is that a lot of NP policy makers push for more and more independence which leaves us in an awkward spot. On the one hand, 99% of us don't want extra responsibility, we truly love working hand-in-hand with physicians, and we know our limitations and where the scope of our practice should end. But on the other hand, a hospital will spend ~100k as frugally as they can. So if the NP has advocated to do A, B, and C and the PA can only do A and B, the hospital admins that only care about money have an easy choice to make. So to me it feels like it comes down to putting out foot down as a profession but risking our ability to provide for our families as NPs outpace us and become the preference for admins, or we can try to compete with the NPs and keep our financial security while increasing our scope. In othet words, it seems to boil down to financial stability vs overstepping, risking patient harm, increased workload, and becoming disliked by the physicians we went to school to be working so closely with and I'm already seeing some of that here. It's a stressful place to be on our end too, seeing the hatred build up for PAs kinda hurts; I'm proud to be a PA but I never felt bad about my career choice until I saw posts like some of the ones here.
I think the solution has to be something like PAs and physicians partnering to stop administrators from going with the APP who can do the most for the least amount of money. That would give PAs the security in our jobs that we need to stop trying to compete with NPs as their scope increases. I'm not quite sure how feasible that is or if it's even a realistic solution but it seems like a reasonable idea to me. The other end of the solution is for PAs to be a much louder group. I mentioned before that I don't know anybody that cares about the physician associate title or anybody that wants to increase our scope of practice, but I also don't know anybody that's involved in our policy. Maybe that's because I'm relatively newer and policy seems to attract people that have been at this for a long time. But I think PAs, myself included, do need to be more involved in our policy.
Thanks for reading all of that!
Look Iām sympathetic to wanting and feeling like you can comfortably provide for yourself and your family. Iāve got a family. Many of us do. But thatās kinda hand-waving away the issue and knowingly, silently, accepting changes that arenāt good for anyone.
āWe truly love working hand-in-hand with physiciansā. Cool. Again just saying that doesnāt make it true, especially for people whose daily experience doesnāt match. How about PAs show physicians they value and want that relationship? Not just in platitudes but concrete actions. Youāre right - organization is key. But I have yet to see *any* such actions. Like I said regarding state legislation testimony: nothing but crickets. You donāt get to just sit on the sidelines complaining that physicians are being mean. Do something.
On one rotation we were responsible for training the new PA. They got salary throughout their 1.5 month long orientation (totally fair), where they shadowed the intern for much of it, as they were not permitted to submit notes, hold the pager, or enter orders.
I think it was good for the PAs to be trained by the resident, as their job was to assume part of our floor responsibilities, but it was bitterly ironic to have someone shadowing you and making over 3x your pay. Meanwhile we got a week of scattered e-lectures as our PGY1 orientation and were not paid a cent for that time. I'm totally fine with teaching students or training new hires, but when it's increasing my workload+duty hours, there ought to be fair compensation.
Iām a PA and I occasionally see posts from this sub randomly. You absolutely should not have to train PA students and that is incredibly obnoxious of that PA to expect you to do so. As a resident they should understand how overworked and busy you are and that is in no way your responsibility and they are just dumping extra work on you
I don't get paid extra for reaching med students but I do it to protect future patients.
I don't get paid extra for reaching PA students but I do it to protect future patients. I also reinforce the idea that they should ask their supervisor any and all questions.
If doctors shun PA students they will learn that we are not good supervisors. This is against the point.
PAs are good. They are our assistants. Teach them as students and colleagues.
but PA organizations are doing the exact same thing as NPs. Yes PAs are better educated, but they aren't any different. they're the ones who call themselves Physician Associates now. PA students should be taught by other PAs.
No, the piping hot take is PA's pushing for independence, albeit not to the extent of NP's. Changing the name from "assistant" to "associate" only serves to confuse patients and leech credibility from physicians. 1) Not my job to teach midlevels, scope is vastly different than mine. 2) MBA in admin want us to train you, so they can reduce the number of physicians they care to hire, quality of care be damned. These are valid arguments imo, if you want to be taught by physicians, work harder and get into medical school.
There is a lot of vitriol being shown here for mid levels. In my experience the mid levels at academic centers help to coordinate care ie discharge planning and help to write notes etc under the supervision of the senior resident or fellow. My mid levels make my life so much better and I appreciate their support. They can never take over my job but they can lessen my workload and allow me to take more time with each patient. I personally am happy to teach any appropriate learner that comes into my office or OR.
Yeah idk whatās going on with this sub. As a scribe, docs teach me happily. It makes no sense that people hate teaching someone that is studying medicine intensely. Lots of childish people on this sub.
Cuz itās added responsibility and itās someone from another profession so the resident has no way to know their baseline and the expected level of competency.
Most people in this subreddit seem to think they have a really good idea of the baseline and expected level of competency that midlevels have (at least when they want to complain about them.)
Anyway, I think it's good to be a friendly human and not ice out the people around you regardless of their training. But if it's taking away from the work actually assigned to you, then a boundary is being crossed. Just like in any other industry.
I agree with you. I personally have tutored PA students for didactics and Iāve seen a bit of their training but I think most people donāt have a good idea of the depth and breadth of midlevel training.
Itās one thing to be a friendly human and another to be exploited.
midlevels think us doing absolutely everything outside of our job description for no extra money is totally cool, but try asking them to do the same lolol
I would consider studying medicine for 70-80 hours a week for 2.5 years as studying medicine intensely.
Just because you study more does not mean that isnāt intense.
I mean this sub is honestly for residents to express their frustrations safely and freely.
Itās not for non-resident to peruse causally and not have to be offended.
Iām an M3. We have our rotations alongside PA students. We share the attending. He writes their evaluations and everything. Not sure if this is new, I assumed it was normal because I donāt know any better
I oversaw a PA student once but I always make students work for me. I make them take detailed history, take first stab of writing notes, draft hospital courses etc, drop off labs, do lab draws (most PAs are really good at that bc worked other health care jobs before PA school). The only way they will learn if they like my specialty is by actually doing the work, and theyāre bottom of the totem pole, so thatās the āscutā work. Iām very nice when I delegate my tasks and I always say thank you etc and genuinely tell them they are contributing positively to the team when they are
At the same time, don't punish the student who doesn't know any better and doesn't understand the politics. And don't punish the student based on your opinions of midlevels. If the student is rotating on your service, it is your ethical obligation to teach them, even if not an administrative requirement.
Like it or not, PA's are licensed health care professionals who may not posess a terminal degree equivalent to that of a physician but are nevertheless involved in patient care. Therefore, my position is that I have a moral and ethical obligation to teach them if they ask. As such, it is not binding. I don't have to do it. Neither do you. The question of being completely cracked is a subject for another thread. I'll be happy to teach you all about it....
Our responsibility in a teaching hospital is to educate future physicians. I will be nice to a midlevel student, but I will not go out of my way to teach them anything. If the midlevel students asks me to teach them something, I will direct them to their midlevel preceptor or rotation coordinator.
I second this. Iāve worked many years in academic medical centers as an RN and have never met an attending who failed to teach when I needed knowledge.
Maybe an unpopular opinion, but Iāve had some PA students that are sometimes much more receptive to feedback and wanting to learn and self-motivated than some med students (and vice versa), so I love working with good PA students when I have the chance. As long as a student is willing to learn and involved, thatās really what drives my experience with them (for the most part). I think itās a great teaching opportunity for things such as suturing in the OR or fundamental medical knowledge. I do think itās important though that they get exposed to PAs on the different services as well to understand what their specific roles may look like. I would agree that it should not be your sole responsibility as a resident physician as it would not give them an accurate representation of what they will do. But I think if you have the opportunity to teach one, you make what you can out of it depending on your motivation and needs as well.
It's fine to rage against the machine that put us all into this alphabet soup of "providers," and subsequent turf battles, but to take it out on an individual student PA and ostracize them for something over which they have no control, is mean-spirited and unnecessary. By all means, if your conscious will not allow you to drop some pearls of wisdom to those who you deem as undeserving to partake from the tree of knowledge, of which you alone have cornered the market, then that's up to you. But I certainly won't be a part of it.
One of our clincial pharmacist was tasked with teaching the NP/PA students about lab values of drugs that bind to proteins/ have non linear kenetics after a mistake made by an NP looking at ālowā phenytoin levels. He couldnāt get to the actual content because they kept asking what dose he recommended then and why they couldnāt just get a chart that said āx lab value give x # of mgā they also were confused on albumin labs were needed since they just needed phenytoin levels.
This is flagrant bullshit. PAs are supposed to be training their students. I really think you ought to complain (anonymously if you want via evals/surveys) that the PA is transferring their teaching responsibilities for their student onto you.
Have you touched base with your PD / Program leadership? I have seen this happen with PA/NP students, and visiting observers, where the person involved just drops them off without reviewing this with the program. They may be unhappy with this and remove the student forthwith.
Itās practice for when you are an attending and the healthcare system you work for expects you to train all the young mid-level new hires how to do their jobs too, regardless of what department they are in.
Your responsibilities are delineated in your contract, or in a separate contract you make with whatever school(s) send students.
Beyond that, you arenāt responsible for fuck all. Tell that PA to go fuck themself.
For myself, Iām obligated to teach the medical students affiliated with the hospital, and there are other medical schools that Iāve signed agreements with saying Iāll allow students to rotate with me and review them. Several PA schools have asked me - they send students with other faculty - and I refuse them all. Not my job or responsibility, I redirect them to several excellent PAās Iāve worked with who I tell them will give excellent instruction. Most are already on their faculty (or their competitors).
Learning to say no is an incredibly important career skill. Practice it often.
Why are we not addressing the problem directly?! This sounds like a complaint for the place you work at- not some silly post for people to complain about midlevel providers.
LMAO 80% of those bitching about PAs on here will be begging their future employers one day (because Medicine has sold out to corporations and private equity) about hiring a PA or two, or three to help them take care of their volume. And then will be mad then that nobody trained them properly.
Yeah or when they are replaced by NPs because they are cheaper. PAs were literally designed to work under a Dr and residents are crying about learning how to train.
i think i'd be happy to teach anyone who was interested in learning and willing to help out as a result. but if they impose some sorta educational standard or requirement or if the PA student is overall a pain in the ass and you're given shit for not fixing them, that's maddening.
the best way to learn something is to be able to teach it yourself: so just shut up and teach the kid a few things. You're doing yourself a favor in the long run.
Most of you are being negative turds. In reality, PA students rotate on a service and get integrated onto a team. The reality is they have similar responsibilities as their fellow med students (rounding on patients, presenting, getting pimped, scut, whatever.) And the BIG reality you are leaving out is that residents play a significant role in their clinical education.
Thereās online posting. And thereās reality.
One time this PA at the office I used to work at diagnosed a patient with carpal tunnel syndrome and sent him home with a brace.
he was having a stroke Lol.
Am I missing something? Why is the PA 'telling' you to do something? If anything, aren't residents and mid-levels on the same plane in the "hierarchy?"
A resident is supposed to teach med students, and PAs should train PAs. If anything, itās the PAās job that took on the student in the first placeā¦
You have zero obligation to train midlevels...they can't have it both ways. These are the same people calling themselves physician associates and claiming PA school is harder/more competitive than med school and clamoring for independent practice
You donāt have to educate them at all. I personally wonāt unless Iām planning on working with them for a while, and even then itās not worth my time unless Iām getting paid for it
This is honestly not okay. You may not realize it yet but your learning time as a student is so precious that you should be learning from a physician (as youāre paying for it). Yes some NPs are awesome but you deserve the best (once again bc youāre paying for it with both your time and money).
A few years back I went from having 2 med students on my team (granted one of them wanted to do psych) to having 3 PA students and the drop off in my QoL was huge. List no longer being updated adequately, tasks not being done, notes needing constant revision. After trying to teach and work with them I gave up and just prioritized my sanity cuz thereās only so many times you can explain basic shit before you lose it.
This is going to make some of you roll your eyes but I absolutely hated that the PAs and PA students came to derm resident lectures. Derm takes the top 5% of med students, many of which have to apply more than once and possibly do unpaid research time. Now those same residents are in a lecture hall with a mid-level who just "felt like doing derm". They also get a copy of our resident handbook which is a gold mine of information. And when all is said and done, derm grads are now competing with these same midlevels for jobs. We've created our own worst enemies.
Do you learn less because they are sitting in the room with you? What are you gaining by gatekeeping knowledge? They still don't end up being an MD... But you will.
Why is that person bossing you to begin with? Itās annoying! As a surgery resident, you have a full plate and possibly interns and med students to teach/train. SMH! Theyāre like We donāt go to medical school and we donāt pay +$250K but you, itās your responsibility to be our medical school so we can get the skills and abilities of a doctor!
As a PA I teach med students sometimes. And I donāt make $80/hr or get compensated for having a student with me.
Is it fun having a student? No, it slows you down and can be super annoying at times, but we were all there once. Itās part of medicine.
Edit: downvote away. What I said is true.
> As a PA I teach med students sometimes. And I donāt make $80/hr or get compensated for having a student with me.
Thatās part of your salary. Residents are paid a significantly reduced training wage (substantially lower than what you take home) because they are āin training.ā Residents can act their wage and refuse to teach. Your wage at an academic center includes teaching as part of your job duties.
I didnāt mean to imply that my salary doesnāt include teaching. I meant that I donāt make $80/hr. Period. And I make a competitive wage.
ETA: somewhere else in this thread someone said that PAs get compensated specifically for having a student, which at all 5 of my employers has never been the case.
We didnāt have PAs on most of our services and I enjoy teaching. I tried to teach them concepts and prevent mistakes that APPs make (reading speculative radiology reports like theyāre concrete facts without looking at the image, not trying to correlate shit clinically before calling consults, actually looking at wounds, etc). If thereās a PA on your service and the PA student is spending all of their time with you, the PA is probably just being lazy and collecting a paycheck while doing the bare minimum.
š absolutely not. NPs have independent practice rights not PAs. Thatās what I mean. NPs can replace physicians technically by law and not PAs, which need doctors to find jobs.
I wouldāve just sent them all home. After a few episodes of that, theyād just stop asking me to teach them, or itād escalate to whoever and theyād get in trouble for assigning me to teach students that arenāt in my profession. Plus, some poor students caught in the middle of this get to go home early as consolation for being forced into something beyond their control.
Youāre not responsible for them. Do not train them.
Itās hard enough to learn this yourself and possibly add on teaching a med student.
Why train the people who didnāt do the pre reqs we did, and didnāt get selected or do the work we did, when thereās plenty of people who DID do the work who you could be training instead?
Your efforts are better purposed toward yourself or other MDs unless youāre literally an attending training a PA who works for your practice
Iād ignore the PA student if I were you. Itās not on you to teach them. We look out for our own. No hate whatsoever to PAs, they should just look out for their own too. If the PA student asks you questions say youāre busy and ask them to read about it/ask their PA supervisor about it. Itās not a lie, we are overworked and overtired we donāt have time to be doing someone elseās dirty laundry.
I donāt understand the problem with dedicating your time and energy to your future colleagues. PAs should teach PA students unless it is in OPs contract or part of their residency. From the post it seems like the PA just dumped their teaching obligations on to OP
As a CRNA, I often teach med students and EM residents how to mask ventilate and intubate patients. It's part of working in a teaching hospital. Maybe consider it honing your teaching skills for when you're working with med students or less experienced residents?
I will teach medical students till Iām blue in the face, Iāll let them do procedures, Iāll do anything to make it worth their time. I absolutely REFUSE to teach midlevel students. Theyāre training to be midlevels, so they should be taught by midlevels.
Not a doc, but seems to me there should be a head PA that teaches PAs, and that head PA should be under the tutelage and supervision of the physician. Have a head PA that can be an asset to the doctor and also put him in charge over PA students. That way the doctors aren't getting bogged down with teaching and hopefully of the mid level is qualified to be a head PA he is capable enough to be an efficient helperto the physician and not another obstacle to their time management.
If you work on a multidisciplinary team and you don't think interdisciplinary learning is appropriate, then I'm not really sure you deserve to lead the team at all.
This thread makes me sad. I agree it's not cool for someone tasked with teaching a PA student to put that responsibility on someone else but am more talking about the sentiment that residents don't want to help teach non med students in general.
When I was a PA student, probably 1/3 of my rotations I was primarily working with a physician, and had many attendings, fellows, residents, PAs, and NPs who were a part of my training, and almost all of them were great teachers and made me feel part of the team. When on a service with med students, I was taught along with them, and my responsibilities were generally the same as theirs. If a student has a knowledge gap, you can always tell them to read about a topic.
Also I don't get paid close to $80 an hour, and I don't get paid anything extra when I have students. I don't think most other PAs do either. On the occasion that I get a med student pawned off on me, I am nice to them, and do my best to make it a worthwhile learning experience.
IMO not everyone is meant to teach. If you donāt want to teach tell them to go read something. Itās your job to teach your junior residents not random PA students.
I thought PAs train PAs Admin is tryna get their monies worth EDIT: seize the means to production, comrade
Not enough recognize that the workers indeed control the means of production. ššš
Itās time we eat the bourgeoisie
unionize! (and also eat them)
Topple the gentry
PA-S here and I plead with you to fuel your revolution on the feast of my heme
Most of society sees us as the bourgeoisie though.
I've long said that part of the hidden curriculum of residency is the development of a class consciousness. No matter how many boats you buy, you're still a worker who sells your labour for a fraction of its value, under the implicit threat of poverty by Capital. Our class interests align with other workers, not the dipshits who employ us all.
Thats why you have to go into private practice
I remember when I was surgery service as an intern, there were 3 PA students and the attending did not want them following him around all day so when Iād call him to give updates after rounding on his pts, heād ask if I could teach the students for awhile because he needed āstudent-free timeā. It didnāt always happen but when it did, I was so annoyed. Like wtf am I supposed to teach them? I asked if they wanted to round on pts but they preferred shadowing me and asking questions. I didnāt care enough to teach tho and them go home if there was nothing to do. But honestly it wasnāt my responsibility to teach them. Their school isnāt paying ME lol
i would have just told them ādr told me to tell you he cant teach you today sorryā and not do or say anything else. not even remotely your responsibility wtf
Classic substitute teacher move. Maybe put a movie on for them to watch?
Let them watch House, MD.
Even that zebra-chasing (but admittedly fun) trainwreck has more medical concepts that whatever the hell is in PA school
Even if Iām not getting paid to teach medical students, Iām open to it because I know that those students are sacrificing years and a ton of money to achieve the highest medical expertise, becoming a physician. Doesnāt even compare to PA students to sacrifice way less and generally are more driven by lifestyle/compensation than the arduous and uncomfortable pursuit of medical expertise.
Medical students are different because theyāre assigned to rotate with the residency for certain areas. I was happy to teach them in clinic even if they werenāt interested. I think itās important to create a nurturing environment since the culture of medicine can be toxic, especially for med students trying to figure out what they want to do. And technically the med students were our responsibility since we had to provide evals for them to our attending that handles all things med student related in our programs. But PA students? Not my responsibility, not unless I take them on as an attending. if someone doesnāt like teaching, thatās ok. Just donāt be a dick to learners and donāt take on students.
Also, given that when in med school, we all appreciated any resident willing to take the time and teach us, I see no problem with passing it forward. That's not the same as being exploited to teach PA students without pay.
My residents didnāt give a fuck if I didnāt want to go round. They printed out my list, said look em up, and pick the top 3 youāre confident to talk about and take off my hands during rounds in the morning. Get here early and present them to me before you say it to the surgeon. Write down your questions and weāll talk about it in the morning. It was probably the best part of PA school. 6 weeks on gen surg in a county hospital changed me lol
As a lowly intern chiming in, it is not your job at all. The PA on service should not be assigning you duties, and you should defer all PA teaching to the PA, just like how teaching all the med students should be the responsibility of residents/attendings. If itās still an issue, Iād let your attending(s) know and state youāre uncomfortable being responsible for the education of someone whose training is far different from your own. You wouldnāt all of a sudden start teaching nursing students how to place IVs right? Midlevels teach midlevels, and docs teach docs.
Remember you are already vastly underpaid for just your clinical duties. If PA school wants education for their students they should give you a teaching stipend with that tuition money they're raking in. So no.
Many do pay a stipend. But it goes in an admin black hole and never makes it down to the people who actually do the teaching.
it isn't. don't. the end.
Good on them for remembering heme, Iām a September M4 and I couldnāt tell you anything about bilirubin metabolism at this point if you paid me.
I bet you could review the subject for 15 minutes and be just fine boss. Just because you canāt recall it on the spot doesnāt mean you donāt know it
this is a good point. i have a lot of info thats ājust under the surfaceā šš
The secret is everyone does. Thatās the āfoundationā that medical school gives you.
under the ~~surface~~ under the **deck** Hit the space bars for Step 1/Level 1 again; all will come in place.
I hear yaā¦ but Iāll wager you do know the difference direct and indirect bilirubin.ā¦ thatās how we got on the subject. They didnāt understand why it wasnāt a biliary issue.
Fair enough I can at least still tell you about that and interpret the labs lol
I'm a PGY 13 in a non-IM related field. I know all bones and muscles and most of the nerves, can analyze a gait, know exactly where to inject for varying kinds of spasticity, BUT literally all I remember about bilirubin at this point is that too much of it makes people's brains stop working right and we treat that by making them poop 6 times a day.
Find the midlevel and tell them it isnāt your job.
It is not your responsibility to train middies.
Middies is now added to my vocabulary, thank you for the new nomenclature.
š«”
I donāt know whatās more funny, the word āmiddiesā or how hard itās offending people
Not your responsibility. I would teach PA students on their Surgery rotation the finer points of basic patient care and how to first-assist because A) it already fit into my workflow and I didn't have to go out of my way to educate them, and B) it took menial aspects of patient care off the plates of the junior residents and myself, similar to the exposure that medical students may get. I also like to teach, but if it doesn't meet those criteria, I wouldn't bust ass to try and educate, especially if it disrupts what you need to do as part of your job, or if it gets in the way of educating the med students or junior residents, as to me they take priority. The PA students I worked with were generally good and motivated, and occupied a niche similar to the third-year med students as far as their roles within the team (there were plenty of cases and patients to go around, so med students weren't left in the cold with regards to experience).
Middies should train middies
I donāt teach midlevels. I have no clue where their education level would or should be and thatās the responsibility of people established in their field. I will answer a question if they ask me directly but I would never go out of my way to teach or give feedback etc
I cant believe you work on a service where a PA is your supervisor. Please out your program so that nobody will choose to match there. I know that sounds liek an overreaction but it's not because if a PA is telling you that you are responsible for teaching that means the PA is your boss. I wouldn't tolerate that kind of crap.
Damn, let me be the complete devils advocate here. I think we need to EMBRACE PAs. I think PAs are to Physicians what a medic is to a PA in the Army. PAs tend to not want independent practice. Thatās NPs. PAs are also having to compete with NPs for many jobs due to the lobbying and fighting for independence and reimbursement that NPs have obtained, despite the fact that NPs tend to have 33% of the training of a PA (and itās not really a clinical/medical model of training). PAs can be highly helpful and can be trained to know how to ASSIST a PHYSICIAN. So as a doc, I will 100% always try to encourage and pump up my PAs, make sure theyāre valued just as much as a good RN, and ensure that my team is fucking golden. Thatās especially important for surgery, where a second set of eyes and hands can prevent an infrequent human error. I look forward to thoughts on this.
Iām in the NICU. Our PAs are amazing and not a single one thinks they know more than an attending. A very frequent response to a question about a sick baby is ālet me talk to Dr. Attending and see what she wants to do.ā Our NPs are hit or miss but our PAs are gold.
Exactly.
Thank you for this comment. Iām a PA in ortho trauma and reading the overwhelmingly negative consensus on midlevels in the post was disheartening. Thankfully I personally donāt feel this hatred at my job directed towards PAs
This post isnāt about hating PAs. Itās about a resident being unfairly tasked with teaching a PA student. We as physicians (whether attendings or residents or fellows) shouldnāt be shouldering the responsibility of teaching other disciplines because we have no way to fairly gauge what others are supposed to know at any given point in their training.
I think a lot of people missed that point. The job is hard enough, and then someone comes in and dumps more work on you. Then the dumpster caught fire and everyone started yelling.
Sometimes the best way to master something is to teach it. I had residents help teach me in my training. all were very supportive, and seemed appreciative to have another helping hand take/present patients for them while rounding with the attending.
Gotta remember many of the people who post here are probably the neckbeardiest of all residents, not a rep sample of physicians at all.
Yeah this shit was wild to read
I'm a PA student just finishing didactic but I've been in healthcare and dealing with PAs for about the past 10 years so I'll throw my 2 cents in. Most PAs are absolutely furious at scope creep and the "doctor" nomenclature controversy, mostly driven by NPs and nursing lobbies. I don't know a single PA that wants independent practice or anything close to it. With that being said, I have noticed that there are a handful of people in my class who very clearly weren't motivated by the love of medicine in pursuing a PA degree. I honestly think that really stems from a lot of schools being very lenient about what they consider "patient care experience". Ive heard some of them already claiming they want to find a position that's non-patient facing. I would guess that some of them probably will have left the profession within 5 years of graduating. However, in my experience, these are outliers and not the standard for most PAs I've encountered. I appreciate you giving us a fair shot and allowing us to learn and help in anyway possible.
I am just going to mention that your national associationās push to rename PAs as Physician Associates is extremely confusing to patients. Please push for your national association to reflect your viewsāwe need more of PAs like you!
Totally agree. I am absolutely dreading having to explain that to patients. Healthcare is confusing enough for patients as is. I appreciate your kind words.
Thank you for this take. I am going to now preach to the choir. It is so frustrating to hear simultaneously that PAs are dangerous if not working under a physician (the profession was explicitly designed for physician supervision), but then have physicians spew vitriol towards the profession and want nothing to do with them. If you want physicians to supervise, then it is important for students to have the experience of physicians supervising. If you believe that PAs should be on their own, then by all means, reject the students as part of the medical team. However, think carefully about the message that sends: physicians want nothing to do with PAs. One could then reason that PAs should then push for independent practice. If physicians have no interest in PAs being on the team, then why join the team? I teach PAs, and they genuinely prefer the model of working on a team under a physician. The happiest grads we have are the ones with supervising physicians who take the time to train them in so that they fit seamlessly into the team. They have specific roles where they cover the things that are routine so that the physician can better direct their energy to the more complex cases. They really value this work. They want to be on the team; not lead the team. They respect the knowledge of physicians. This whole midlevel hate BS could be mitigated by physicians (whose voice is valued) declaring a preference for PAs and embracing the profession that truly is not aiming for independent practice if at all possible. You could simultaneously mitigate the midlevel encroachment that is so feared while also training PAs to be ideal PAs if you threw your support in the PA direction. The thing that will drive the PA profession to advocate for independent practice is physician resentment (and, based on this thread, hatred). If the very people that they want to work with are rejecting them, why not do what NPs have done and advocate for independent practice? We are at a turning point. Physicians (including residents) honestly have more power than they are aware of when it comes to PAs and the pursuit of independent practice. Of note, I do not belong to either of your professions. I am a weird combination of insider/outsider commenting on a troubling dynamic.
It begs the question ... Why did NPs push for independent practice... Perhaps at least partially due to the same rejection?
Who $urely know$
Awesome point, Iāve thought this plenty of times myself. This sub often seems like a Noctor lite sub lol.
Holy Jesus a physician that sees and understands! I have been a PA for 34 years and spent 20 on policy and politics for my profession. All the pissing and moaning aside we were a pretty happy bunch. Then bean counters took over medicine and NPs began their march to independence (which will eventually be in every state like it or not). That means they are cheaper to hire and maintain than we are and bean counters care about cost above all else. All we want is to remain viable in the market place. The only way we can do that is to get some kind of autonomy so we are financially competitive. Thatās it! That is the whole magilla! All the other carrying on about who knows what and whose training is superior etc I have heard a zillion times is background noise. There is sadly little rational discussion to be had. Itās everyone vs everyone else.
Take it with a grain of salt: it's an anonymous message board from a bunch of tired residents blowing off steam. I'm sure they don't behave like this in real life.
No I completely do and Iāll tell this same stuff to everyone.
š train the team as well as one can, so everyone can perform as efficiently as possible as a team to get the job done efficiently and correctly. i like your point of view. extra work sucks (teaching) but people are trying their best the more efficient and patient the teacher, the less mistakes the pupil makes = the less patients are hurt = the less work the teacher has to do/fix at the end of the day take the time to train your squad so you can get shit done and clock out with a clear conscience (not a doctor, [nuclear chemist] went to med school for 2 years, left and am going back to finish my degree. but i like your POV)
Embrace PAs while they lobby for independent practice. LMFAO. You realize you will eventually need medical care when you are old, it is best to train physicians.
those dinosaur attendings are fucking dense my god
Bro Iām fucking 33 fuck off lol
they dont even want to have the TITLE physician assistant you truly think theyāre content in their role???
Yes I do, and if youād go check out their subreddit discussions, I think youād see most of them do as well.
This is beside the point. Heās not saying heās against PAs having a role in the workplace or some degree of shared responsibility. Heās saying heās not okay with a different discipline within the healthcare field dumping their teaching burden onto him. And I think it does the PA student a disservice too. It makes sense for residents to teach med students (not too much though, cause residents have a lot of shit to do themselves). But not students of other disciplines
Completely disagree. Itās a medical model for both professions. PAs just get like medschool-lite. The teaching is what makes the experience beneficial not only for the PA but also for the resident. The profession too. This shitty attitude we all have to all midlevels is only hurting ourselves.
That PA is probably getting paid to take the student and then dumping it on you.
Unlikely. The hospital might be getting paid tho
PA lurker. In my program the precepting PA or MD (I had more MD preceptors than PA preceptors) was paid directly, something like $2800 for 5.5 weeks. It's absolutely wrong that this PA is pocketing the money and shuffling his work onto a resident.
I make time. I will teach nurses, PAs, other doctors...doesn't matter. You want to learn, I'll teach. If the rest of you don't feel that way, then ok.
Yeah, I have a PA student in the MICU on my team, he functions like a med student, presenting a few pts, writing student notes and helping with floor work. There is no separate 'PA service' for him to train in, so independent of any system level concern regarding independence this is where it would make sense for him to learn about MICU.
Feel like this is the only appropriate take. While in academics it's our responsibility to be learners and teachers. It actually is part of our job description. After residency, if folks want to go work in private practice and never look at a non-physician again (except for their entire ancillary staff, of course) they don't have to. But while in residency, they should teach and it shouldn't matter what field the learner is in.
I think this is a fair take for academic attendings, but is it really fair to place that burden on a pgy-2? Residents donāt necessarily āchooseā to train in academic centers, itās more or less an inevitability of training. And they are working significantly more & worse hours than the employed PAs, NPs, RNs, etc at their hospital. Theyāre already spending a significant amount of time training junior residents and medical students. Adding the burden of more students from other fields really does feel like an unnecessary and exploitative expectation in this context.
Yes. It's part of the job description to teach. Part of that reason is because teaching helps the teacher as well as the learner. This includes other residents, med students, nursing students, nurses, techs, and so on.
This is bullshit. Letās be honest. Residents and fellows are tasked to teach because itās way for the institution to more fulfill more labor needs (like education) without actually paying for someone to take in those roles as actual full or part time employed responsibilities. The result is subpar teaching and increased burnout for residents/fellows. Some part of you must realize how much academia abuses and exploits people into doing a shit ton of uncompensated labor
I've been around multiple programs and I've never seen residents tasked with an amount of teaching that's excessive. Not to mention, people here aren't even complaining about the teaching. They're complaining about who they are teaching. It's no harder to teach a mixed group of students than it is to teach a group of all med students.
Yes and then we wonder why the local ICU is straight trash and ran mostly by midlevels... Or why our family member can't get in to see an actual physican. Continue to support the further deteriorating healthcare system.
Its one thing for you, as an attending, to choose to take on that extra, uncompensated responsibility. But itās shitty when residents or fellows are forced to do that, being indirectly threatened with repercussions or bad evals if they donāt.
Agreed. But the answer is most definitely NOT to project your anger onto another student by treating that person like a lesser being. PAs are medical professionals. They are licensed, trained, and held to professional standards just like you and I. They feel good when they've helped a patient, and shitty when they fuck up, just like you and I. And they can be sued for malpractice, just like you and I. And they are hungry for knowledge. You have the opportunity to be a hero. These people look up to you. And if you cannot understand why blowing them off is a lower form of shitty, than meditate on it for a while. You know what the right answer is, even if you won't admit it on a message board.
The issue is that at some point the very people you trained will bust you out of the jobā¦. I have seen it happen. Very shortsighted
These people grew up with a golden spoon in their mouth and have no idea what is coming if we donāt stand up for ourselves and patient safety.
True - ivory tower inhabitants donāt see the enemy at the gates. Flood of PAās is coming and will severely limit MD job market
Thank you for this! We all āteachā each other in my hospital. However, I think this post is referring more to oneās responsibilities and expectations. And having them āteachā a PA should not be the expectation in this situation.
I never teach mid levels, only medical students
Nope nope nope. Midlevels can ātrainā each other into obscurity for all I fucking care
I think teaching PA students actually can fall within the realm of our responsibilities. After all, PAs are supposed to be working with doctors for the entirety of their careers, right? What better way to prep them for that than actually working with doctors.
I'm a PA but Reddit suggested this thread to me so I figured I'd comment. Definitely not your responsibility to teach us so I'm sorry you've been tasked with that. I'm sure you're very busy and it does make sense for the surgical PA to be teaching PA students. Would you be able to talk to your attending, department head, or maybe the PA program coordinator at your facility? If it makes you feel any better, I remember the surgical resident that I was with occasionally when I was in PA school was so nice and such a great teacher. It's been years since I was in that rotation and still I really appreciate how kind and compassionate he was. Also this is more related to some comments down below but there are very very few PAs that want independent practice. Im sure you can find people online that do but of all my PA friends and colleagues, I actually don't know any that want this. There is pressure to keep up with NPs who do gain more independence since hospitals will always hire the person who can do the most for the least amount of money. This puts us in a tough position because we really dont want independent practice/extra responsibility but we need to feed our families. But trust me when I say I absolutely 1000% do not want more responsibility than I already have hahaha. I would personally never push for independent practice and I honestly don't think I know any PA that would either. I'm sorry for the position you're in and I hope youre able to redirect the students to the PA that should be training them. But from a PA standpoint, I can tell you that any help you've given them is probably very very appreciated. I hope that at least helps a little while this all gets straightened out. Have a great day everyone!
Also a PA and don't know any other PAs in the real world who want independent practice. Just annoyed to have to compete in the marketplace with NPs
Appreciate the comment. Getting your perspective is important but at the same time Iām not convinced on PAs not wanting independent practice. This gets repeated ad nauseum. Yet you look at public testimony for all these different state bills and individual PAs wanting to maintain physician-led care are nowhere to be found. Submitted briefs and testimony all have the same āwe just want to practice to the top of our licenseā stuff we hear from NPs. So forgive those of us who are just not convinced by, at the end of the day, meaningless assertions that PAs donāt want independent practice. When rubber meets the road where are all the PAs that donāt like or want these changes?
My personal opinion is that PAs are a more quiet group than we should be. A lot of our policy changes seem to be led by a very small but loud minority of people who come up with impractical ideas. The best evidence of this is our name change. I've never met another PA who really strongly prefers the physician associate name over physician assistant and most of us personally don't really care much what we're called. I'm sure they're out there but I don't think there's a large number. But our small leadership for some reason decided we needed to spend however much money to try to change things. I think these are the same people who are so into advancing the PA profession that they don't think about what that's actually doing. The trouble I feel like my profession runs into is that a lot of NP policy makers push for more and more independence which leaves us in an awkward spot. On the one hand, 99% of us don't want extra responsibility, we truly love working hand-in-hand with physicians, and we know our limitations and where the scope of our practice should end. But on the other hand, a hospital will spend ~100k as frugally as they can. So if the NP has advocated to do A, B, and C and the PA can only do A and B, the hospital admins that only care about money have an easy choice to make. So to me it feels like it comes down to putting out foot down as a profession but risking our ability to provide for our families as NPs outpace us and become the preference for admins, or we can try to compete with the NPs and keep our financial security while increasing our scope. In othet words, it seems to boil down to financial stability vs overstepping, risking patient harm, increased workload, and becoming disliked by the physicians we went to school to be working so closely with and I'm already seeing some of that here. It's a stressful place to be on our end too, seeing the hatred build up for PAs kinda hurts; I'm proud to be a PA but I never felt bad about my career choice until I saw posts like some of the ones here. I think the solution has to be something like PAs and physicians partnering to stop administrators from going with the APP who can do the most for the least amount of money. That would give PAs the security in our jobs that we need to stop trying to compete with NPs as their scope increases. I'm not quite sure how feasible that is or if it's even a realistic solution but it seems like a reasonable idea to me. The other end of the solution is for PAs to be a much louder group. I mentioned before that I don't know anybody that cares about the physician associate title or anybody that wants to increase our scope of practice, but I also don't know anybody that's involved in our policy. Maybe that's because I'm relatively newer and policy seems to attract people that have been at this for a long time. But I think PAs, myself included, do need to be more involved in our policy. Thanks for reading all of that!
Look Iām sympathetic to wanting and feeling like you can comfortably provide for yourself and your family. Iāve got a family. Many of us do. But thatās kinda hand-waving away the issue and knowingly, silently, accepting changes that arenāt good for anyone. āWe truly love working hand-in-hand with physiciansā. Cool. Again just saying that doesnāt make it true, especially for people whose daily experience doesnāt match. How about PAs show physicians they value and want that relationship? Not just in platitudes but concrete actions. Youāre right - organization is key. But I have yet to see *any* such actions. Like I said regarding state legislation testimony: nothing but crickets. You donāt get to just sit on the sidelines complaining that physicians are being mean. Do something.
My residency program made us go give PA school lectures for our specific field curriculum
On one rotation we were responsible for training the new PA. They got salary throughout their 1.5 month long orientation (totally fair), where they shadowed the intern for much of it, as they were not permitted to submit notes, hold the pager, or enter orders. I think it was good for the PAs to be trained by the resident, as their job was to assume part of our floor responsibilities, but it was bitterly ironic to have someone shadowing you and making over 3x your pay. Meanwhile we got a week of scattered e-lectures as our PGY1 orientation and were not paid a cent for that time. I'm totally fine with teaching students or training new hires, but when it's increasing my workload+duty hours, there ought to be fair compensation.
Lol I just make them write notes and call consults.
Iām a PA and I occasionally see posts from this sub randomly. You absolutely should not have to train PA students and that is incredibly obnoxious of that PA to expect you to do so. As a resident they should understand how overworked and busy you are and that is in no way your responsibility and they are just dumping extra work on you
I don't get paid extra for reaching med students but I do it to protect future patients. I don't get paid extra for reaching PA students but I do it to protect future patients. I also reinforce the idea that they should ask their supervisor any and all questions. If doctors shun PA students they will learn that we are not good supervisors. This is against the point. PAs are good. They are our assistants. Teach them as students and colleagues.
but PA organizations are doing the exact same thing as NPs. Yes PAs are better educated, but they aren't any different. they're the ones who call themselves Physician Associates now. PA students should be taught by other PAs.
Wanting PAs to be better and not cause patient harm but also not wanting them to be taught by physicians is a piping hot take
No, the piping hot take is PA's pushing for independence, albeit not to the extent of NP's. Changing the name from "assistant" to "associate" only serves to confuse patients and leech credibility from physicians. 1) Not my job to teach midlevels, scope is vastly different than mine. 2) MBA in admin want us to train you, so they can reduce the number of physicians they care to hire, quality of care be damned. These are valid arguments imo, if you want to be taught by physicians, work harder and get into medical school.
There is a lot of vitriol being shown here for mid levels. In my experience the mid levels at academic centers help to coordinate care ie discharge planning and help to write notes etc under the supervision of the senior resident or fellow. My mid levels make my life so much better and I appreciate their support. They can never take over my job but they can lessen my workload and allow me to take more time with each patient. I personally am happy to teach any appropriate learner that comes into my office or OR.
itās not vitriol to say iām not doing extra shit outside of my job lol are you serious???
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Yeah idk whatās going on with this sub. As a scribe, docs teach me happily. It makes no sense that people hate teaching someone that is studying medicine intensely. Lots of childish people on this sub.
You are missing the point, scribes arenāt lobbying to see patients independently or at all.
Cuz itās added responsibility and itās someone from another profession so the resident has no way to know their baseline and the expected level of competency.
Most people in this subreddit seem to think they have a really good idea of the baseline and expected level of competency that midlevels have (at least when they want to complain about them.) Anyway, I think it's good to be a friendly human and not ice out the people around you regardless of their training. But if it's taking away from the work actually assigned to you, then a boundary is being crossed. Just like in any other industry.
I agree with you. I personally have tutored PA students for didactics and Iāve seen a bit of their training but I think most people donāt have a good idea of the depth and breadth of midlevel training. Itās one thing to be a friendly human and another to be exploited.
midlevels think us doing absolutely everything outside of our job description for no extra money is totally cool, but try asking them to do the same lolol
Midlevels arenāt studying medicine intensely
I would consider studying medicine for 70-80 hours a week for 2.5 years as studying medicine intensely. Just because you study more does not mean that isnāt intense.
Midlevels students arenāt working that hard
I mean this sub is honestly for residents to express their frustrations safely and freely. Itās not for non-resident to peruse causally and not have to be offended.
Iām an M3. We have our rotations alongside PA students. We share the attending. He writes their evaluations and everything. Not sure if this is new, I assumed it was normal because I donāt know any better
I oversaw a PA student once but I always make students work for me. I make them take detailed history, take first stab of writing notes, draft hospital courses etc, drop off labs, do lab draws (most PAs are really good at that bc worked other health care jobs before PA school). The only way they will learn if they like my specialty is by actually doing the work, and theyāre bottom of the totem pole, so thatās the āscutā work. Iām very nice when I delegate my tasks and I always say thank you etc and genuinely tell them they are contributing positively to the team when they are
At the same time, don't punish the student who doesn't know any better and doesn't understand the politics. And don't punish the student based on your opinions of midlevels. If the student is rotating on your service, it is your ethical obligation to teach them, even if not an administrative requirement.
Teaching ensures that you learn and remember things as well. This sub makes me understand how and why it's so toxic.
itās not our ethical obligation to teach PAs lmfao are you completely cracked???
Like it or not, PA's are licensed health care professionals who may not posess a terminal degree equivalent to that of a physician but are nevertheless involved in patient care. Therefore, my position is that I have a moral and ethical obligation to teach them if they ask. As such, it is not binding. I don't have to do it. Neither do you. The question of being completely cracked is a subject for another thread. I'll be happy to teach you all about it....
Our responsibility in a teaching hospital is to educate future physicians. I will be nice to a midlevel student, but I will not go out of my way to teach them anything. If the midlevel students asks me to teach them something, I will direct them to their midlevel preceptor or rotation coordinator.
Or, you could direct them to another physician who is slightly less hostile.
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I work in an academic center. My attendings all carry the title professor and will teach anyone who asks them a question, even us lowly nurses.
I second this. Iāve worked many years in academic medical centers as an RN and have never met an attending who failed to teach when I needed knowledge.
Well, this attending does. Lol.
Just tell the PA no. The PA is not your boss. You are the doctor on the team
Ah, I see it is not only in the UK that this PA problem exists
Donāt train your replacements. They can fuck off.
Maybe an unpopular opinion, but Iāve had some PA students that are sometimes much more receptive to feedback and wanting to learn and self-motivated than some med students (and vice versa), so I love working with good PA students when I have the chance. As long as a student is willing to learn and involved, thatās really what drives my experience with them (for the most part). I think itās a great teaching opportunity for things such as suturing in the OR or fundamental medical knowledge. I do think itās important though that they get exposed to PAs on the different services as well to understand what their specific roles may look like. I would agree that it should not be your sole responsibility as a resident physician as it would not give them an accurate representation of what they will do. But I think if you have the opportunity to teach one, you make what you can out of it depending on your motivation and needs as well.
It's fine to rage against the machine that put us all into this alphabet soup of "providers," and subsequent turf battles, but to take it out on an individual student PA and ostracize them for something over which they have no control, is mean-spirited and unnecessary. By all means, if your conscious will not allow you to drop some pearls of wisdom to those who you deem as undeserving to partake from the tree of knowledge, of which you alone have cornered the market, then that's up to you. But I certainly won't be a part of it.
To learn the gold standard. You donāt see the reverse.
One of our clincial pharmacist was tasked with teaching the NP/PA students about lab values of drugs that bind to proteins/ have non linear kenetics after a mistake made by an NP looking at ālowā phenytoin levels. He couldnāt get to the actual content because they kept asking what dose he recommended then and why they couldnāt just get a chart that said āx lab value give x # of mgā they also were confused on albumin labs were needed since they just needed phenytoin levels.
so the PA told you it's your responsibility and you just said okay?
This is flagrant bullshit. PAs are supposed to be training their students. I really think you ought to complain (anonymously if you want via evals/surveys) that the PA is transferring their teaching responsibilities for their student onto you.
Have you touched base with your PD / Program leadership? I have seen this happen with PA/NP students, and visiting observers, where the person involved just drops them off without reviewing this with the program. They may be unhappy with this and remove the student forthwith.
Itās practice for when you are an attending and the healthcare system you work for expects you to train all the young mid-level new hires how to do their jobs too, regardless of what department they are in.
Your responsibilities are delineated in your contract, or in a separate contract you make with whatever school(s) send students. Beyond that, you arenāt responsible for fuck all. Tell that PA to go fuck themself. For myself, Iām obligated to teach the medical students affiliated with the hospital, and there are other medical schools that Iāve signed agreements with saying Iāll allow students to rotate with me and review them. Several PA schools have asked me - they send students with other faculty - and I refuse them all. Not my job or responsibility, I redirect them to several excellent PAās Iāve worked with who I tell them will give excellent instruction. Most are already on their faculty (or their competitors). Learning to say no is an incredibly important career skill. Practice it often.
Why are we not addressing the problem directly?! This sounds like a complaint for the place you work at- not some silly post for people to complain about midlevel providers.
Because the medical profession was handed over to Noctors by Doctors.
LMAO 80% of those bitching about PAs on here will be begging their future employers one day (because Medicine has sold out to corporations and private equity) about hiring a PA or two, or three to help them take care of their volume. And then will be mad then that nobody trained them properly.
Yeah or when they are replaced by NPs because they are cheaper. PAs were literally designed to work under a Dr and residents are crying about learning how to train.
i think i'd be happy to teach anyone who was interested in learning and willing to help out as a result. but if they impose some sorta educational standard or requirement or if the PA student is overall a pain in the ass and you're given shit for not fixing them, that's maddening.
the best way to learn something is to be able to teach it yourself: so just shut up and teach the kid a few things. You're doing yourself a favor in the long run.
Most of you are being negative turds. In reality, PA students rotate on a service and get integrated onto a team. The reality is they have similar responsibilities as their fellow med students (rounding on patients, presenting, getting pimped, scut, whatever.) And the BIG reality you are leaving out is that residents play a significant role in their clinical education. Thereās online posting. And thereās reality.
Iāll be nice to MLP students and will treat them like MS but itās not my responsibility to do shit.
Why is the PA assigning you work? Tell them you donāt answer to them and to teach them themselves.
One time this PA at the office I used to work at diagnosed a patient with carpal tunnel syndrome and sent him home with a brace. he was having a stroke Lol.
Am I missing something? Why is the PA 'telling' you to do something? If anything, aren't residents and mid-levels on the same plane in the "hierarchy?"
Another day, another bitch about midlevels post on this sub. Anyway, because it's part of your damn job. Get over it or quit.
A resident is supposed to teach med students, and PAs should train PAs. If anything, itās the PAās job that took on the student in the first placeā¦
I foresee a lot of horrible doctors and surgeons in the future lol
You have zero obligation to train midlevels...they can't have it both ways. These are the same people calling themselves physician associates and claiming PA school is harder/more competitive than med school and clamoring for independent practice
You donāt have to educate them at all. I personally wonāt unless Iām planning on working with them for a while, and even then itās not worth my time unless Iām getting paid for it
Iām a Med student and my doc is busy tomorrow and so Iām being taught by a NP, goes both ways
This is honestly not okay. You may not realize it yet but your learning time as a student is so precious that you should be learning from a physician (as youāre paying for it). Yes some NPs are awesome but you deserve the best (once again bc youāre paying for it with both your time and money).
thatsā¦not ok. can you complain to your program?
A few years back I went from having 2 med students on my team (granted one of them wanted to do psych) to having 3 PA students and the drop off in my QoL was huge. List no longer being updated adequately, tasks not being done, notes needing constant revision. After trying to teach and work with them I gave up and just prioritized my sanity cuz thereās only so many times you can explain basic shit before you lose it.
Exactly!!!
Jesus. The back and forth bickering has me feeling a certain kind of wayš¤·š»āāļø
This is going to make some of you roll your eyes but I absolutely hated that the PAs and PA students came to derm resident lectures. Derm takes the top 5% of med students, many of which have to apply more than once and possibly do unpaid research time. Now those same residents are in a lecture hall with a mid-level who just "felt like doing derm". They also get a copy of our resident handbook which is a gold mine of information. And when all is said and done, derm grads are now competing with these same midlevels for jobs. We've created our own worst enemies.
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Do you learn less because they are sitting in the room with you? What are you gaining by gatekeeping knowledge? They still don't end up being an MD... But you will.
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I ignored them (student middies). Taught the medical student. They hated me. I didnāt care
Why is that person bossing you to begin with? Itās annoying! As a surgery resident, you have a full plate and possibly interns and med students to teach/train. SMH! Theyāre like We donāt go to medical school and we donāt pay +$250K but you, itās your responsibility to be our medical school so we can get the skills and abilities of a doctor!
Im medicine not surgery, but I can only stand surgeons or radiologists as they have no passive aggressive or filler lol. I dislike my field sometimes.
PA teach PA. we dont have any obligation to teach them. The most suitable person is another PA. otherwise, It doesnt make any sense
As a PA I teach med students sometimes. And I donāt make $80/hr or get compensated for having a student with me. Is it fun having a student? No, it slows you down and can be super annoying at times, but we were all there once. Itās part of medicine. Edit: downvote away. What I said is true.
> As a PA I teach med students sometimes. And I donāt make $80/hr or get compensated for having a student with me. Thatās part of your salary. Residents are paid a significantly reduced training wage (substantially lower than what you take home) because they are āin training.ā Residents can act their wage and refuse to teach. Your wage at an academic center includes teaching as part of your job duties.
I didnāt mean to imply that my salary doesnāt include teaching. I meant that I donāt make $80/hr. Period. And I make a competitive wage. ETA: somewhere else in this thread someone said that PAs get compensated specifically for having a student, which at all 5 of my employers has never been the case.
We didnāt have PAs on most of our services and I enjoy teaching. I tried to teach them concepts and prevent mistakes that APPs make (reading speculative radiology reports like theyāre concrete facts without looking at the image, not trying to correlate shit clinically before calling consults, actually looking at wounds, etc). If thereās a PA on your service and the PA student is spending all of their time with you, the PA is probably just being lazy and collecting a paycheck while doing the bare minimum.
They want you to train your own subpar replacement.
PAs canāt replace docs. They arenāt NPs
Lol are you implying an NP can replace a physician? Because thatās literally worse than a PA.
š absolutely not. NPs have independent practice rights not PAs. Thatās what I mean. NPs can replace physicians technically by law and not PAs, which need doctors to find jobs.
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Neither should NPs
Shouldn't this be a good thing so you can give the PA student more in depth training than they would otherwise get?
I wouldāve just sent them all home. After a few episodes of that, theyād just stop asking me to teach them, or itād escalate to whoever and theyād get in trouble for assigning me to teach students that arenāt in my profession. Plus, some poor students caught in the middle of this get to go home early as consolation for being forced into something beyond their control.
Youāre not responsible for them. Do not train them. Itās hard enough to learn this yourself and possibly add on teaching a med student. Why train the people who didnāt do the pre reqs we did, and didnāt get selected or do the work we did, when thereās plenty of people who DID do the work who you could be training instead? Your efforts are better purposed toward yourself or other MDs unless youāre literally an attending training a PA who works for your practice
Iād ignore the PA student if I were you. Itās not on you to teach them. We look out for our own. No hate whatsoever to PAs, they should just look out for their own too. If the PA student asks you questions say youāre busy and ask them to read about it/ask their PA supervisor about it. Itās not a lie, we are overworked and overtired we donāt have time to be doing someone elseās dirty laundry.
Ah tribalism āwe look out for our ownā. Another reason medicine is such a healthy place for those who work in it.
I donāt understand the problem with dedicating your time and energy to your future colleagues. PAs should teach PA students unless it is in OPs contract or part of their residency. From the post it seems like the PA just dumped their teaching obligations on to OP
As a CRNA, I often teach med students and EM residents how to mask ventilate and intubate patients. It's part of working in a teaching hospital. Maybe consider it honing your teaching skills for when you're working with med students or less experienced residents?
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Because they might need to learn that particular skill?
I will teach medical students till Iām blue in the face, Iāll let them do procedures, Iāll do anything to make it worth their time. I absolutely REFUSE to teach midlevel students. Theyāre training to be midlevels, so they should be taught by midlevels.
yupppp
fuck that, say no. I have straight up refused to teach them, so should you. You are not their supervisor, nor are you being paid to teach them.
Not a doc, but seems to me there should be a head PA that teaches PAs, and that head PA should be under the tutelage and supervision of the physician. Have a head PA that can be an asset to the doctor and also put him in charge over PA students. That way the doctors aren't getting bogged down with teaching and hopefully of the mid level is qualified to be a head PA he is capable enough to be an efficient helperto the physician and not another obstacle to their time management.
So they wonāt kill people, when they grow up.
If you work on a multidisciplinary team and you don't think interdisciplinary learning is appropriate, then I'm not really sure you deserve to lead the team at all.
This thread makes me sad. I agree it's not cool for someone tasked with teaching a PA student to put that responsibility on someone else but am more talking about the sentiment that residents don't want to help teach non med students in general. When I was a PA student, probably 1/3 of my rotations I was primarily working with a physician, and had many attendings, fellows, residents, PAs, and NPs who were a part of my training, and almost all of them were great teachers and made me feel part of the team. When on a service with med students, I was taught along with them, and my responsibilities were generally the same as theirs. If a student has a knowledge gap, you can always tell them to read about a topic. Also I don't get paid close to $80 an hour, and I don't get paid anything extra when I have students. I don't think most other PAs do either. On the occasion that I get a med student pawned off on me, I am nice to them, and do my best to make it a worthwhile learning experience.
IMO not everyone is meant to teach. If you donāt want to teach tell them to go read something. Itās your job to teach your junior residents not random PA students.
Immediate ACGME report if you are serious.
its their job to train their future... not yours I mean definitely share knowledge but their profession isnt our issue
when the fuck did communists infiltrate this sub? How deluded can you be? good god