Pilot Shortage


According to a recent WSJ article:

A shortage of qualified pilots has hit U.S. airlines sooner and more severely than expected, leading the airlines to accelerate hiring and cut some service. The shortage flows from both a long-anticipated wave of pilot retirements and recently enacted rules that require an increase in training for new pilots and more rest for existing aviators at passenger airlines.

Interesting enough, part of the shortage comes from this:

Under congressional mandate, the Federal Aviation Administration began in August requiring most newly hired pilots to have at least 1,500 hours of prior flight experience, up from the previous minimum of 250 hours.

So I guess we won’t be having any Flight Attendant Practitioners flying us anytime soon.   It seems training and experience does matter.

  54 comments for “Pilot Shortage

  1. Ray
    February 19, 2014 at 8:52 pm

    Wow! I cannot believe this argument is happening. Midlevels claiming superior or equivalent skill set to physicians is “like a martian talking to a fungo” (Crash Davis reference from “Bull Durham”). It doesn’t make any sense. “you are over the line Smokey….mark it zero! Has the whole world gone crazy? (Big Lebowski reference…Thanks Walter). I trained with some pretty good midlevels….they were in my FP residency program, became doctors (spent 4 years in medical school) and went on to suffer for 3 years of living in the hospital learning medicine. They would tell me they cannot believe what they did not know. On call, 36 hour shifts, endless rotations. I am out of med school 20 years now. I bust ass every day. I know what I don’t know. I don’t think med students, midlevels, interns …know what they don’t know. “You are out of your element Donnie!” The dude abides.

    • Randall Sexton, APRN
      February 20, 2014 at 11:48 am

      I don’t think most NPs are claiming superior or equivalent skills. Luckily, I’m in psych so don’t have to do “physical stuff.” As I’ve already mentioned I do the exact same thing the physician prescribers here do, except for one physician who also runs a suboxone clinic and the ones who see children and adolescents. I’ve also mentioned before why that is true. They may be thinking differently based on their education but that also holds true for me. They may be looking in the microscope in a reductionist manner while I’m looking through the other end. I will acknowledge they have more training and education than I do and may still have power point slides of say, CYP450 2D6 inhibitors in their head while me as a right brained person might have to review that material every now and then. The “I don’t know what I don’t know” question is just downright confusing. I know all the medical conditions that might mimic psychiatric conditions.I know most of the medical drugs that might cause psych symptoms but would probably have to look them up to make sure as I don’t try to remember every drug that comes out for every medical condition. I did contact a primary care D.O. recently to ask her if she would try another med for our shared patient’s TMJ instead of Elavil as it was probably the cause of the patient’s tachycardia. I read anything related to my area like a mad man on steroids, including all the research which is hardly worth the glossy paper it’s written on. You and some other physicians like to comment about all the suffering you went through to become a physician. I’m sorry for you. I’m sure that was an effective way to retain information…maybe not as I’ve had residents ask me what IV solution to hang as they were so exhausted they couldn’t remember their name. Or one intern I knew who was up all night covering peds and then had to go straight to her surgery rotation. Give me a break! Maybe instead of going through the Army as an infantryman and then medic I should have gone to Special Forces schooling and then Ranger school to be a “real Soldier.”

      • Pat
        February 22, 2014 at 1:02 am

        Randall, the superficiality of your self-analysis, and the specious final quip, confirms Ray’s point.

        Answer for us a question that no LELT thus far will: if you can do the same job, receiving the same pay, providing the same quality in primary care, then what if anything does the primary care physician offer that you do not?

        Put more succinctly, what in your view, is the point of a primary care physician?

        • Randall Sexton, APRN
          February 24, 2014 at 2:26 pm

          Did you see where I’m in psych, not primary care? I see where nothing was confirmed by you except inability to understand my post. Now, in my specific area, I do the same job as the psychiatrists here as fully explained in previous post, except for seeing kids and running a suboxone clinic. I’m the only prescriber for a morning walk-in clinic and I see patients who need to be seen immediately prior to an initial intake, those returning from an inpatient stay, those who need to be seen after an ED visit, those who are having side effects from meds, etc.. This means I see everyone’s patients so I’m aware of who does what. We also do peer review so we all are aware of each other’s work. This comment still holds and may explain what a physician may offer that I do not: “They may be thinking differently based on their education but that also holds true for me.” I do have to think “primary care” a lot as I did this morning after seeing a patient one of our psychiatrists saw last week with parasomnia. He was positive for 3-4 episodes of olfactory hallucinations. No one had asked about that yet. Was it due to respiratory infection when it happened…TLL…migraines, or just being in Korea? Otherwise I do not care for primary care. I do think NPs going into that field need more clinical time.

  2. Bridget Reidy
    February 15, 2014 at 11:20 pm

    I love the midlevel’s comment about being able to do 80% of the things I do as well as me. With a bit of instruction, I could probably pilot an aircraft for 80% of the flight! But you better not trust me with the take off and landing.

    I’ve always been puzzled by the claim that a midlevel has “more time” for the touchy feely stuff. This can only be true if they are given less responsibilities.

    I’ve got a patient on Motrin with a creatinine of 1.8. I look back and see it was 2.4 last year when he had pylo, and the midlevel wrote it in her note, but didn’t address it. She’s very bright and I learn things from her. Now I’m not saying all mid levels would make that mistake. But no doctor would. I’m sure I make mistakes and don’t know it based on things I haven’t been exposed to, but my training and any similar training, even if never all encompassing, would never allow me to make that mistake. No research will find it or say who’s more likely to do it, but those are the mistakes that matter.

    And I can’t understand why I can’t get the NP and PA I’m working with now in primary care, who are both quite bright, interested in the latest research on statins and primary prevention of cardiac disease, or the significance of pre and post test probabilities of disease. (And I do worry that some of my colleagues are the same on that. Maybe we’ve convinced ourselves they’re just as good, and willing to give up what makes us good?)

    And when I ask them when to use high dose amoxicillin, they pull out Epocrates. When I ask the other doc she tells me about the studies of drug concentrations in middle ear effusions which makes me wonder if I should be checking if there ever were any studies on patient oriented outcomes. This contrast in how we think I’ve seen in many places I’ve worked.

    Deferring to Epocrates has it’s place, as does following guidelines without being interested in how or why they changed a few months ago – until some administrator realizes they don’t want to pay for so many lipid panels and makes us change, but if that is how we mostly think and practice, we will all be replaced by computers.

  3. Randall Sexton
    February 13, 2014 at 11:52 am

    “That being said, training and education matter. To say otherwise is dishonest, offensive and embarrassing.”

    Training and educational do matter somewhat, but experience trumps both. Much of the training you went through in medical school and residency may be irrelevant in your chosen specialty, although less so in primary care. I’m glad I didn’t have to waste time and money doing OB, for example. I can learn all I need about pregnant women and psych meds in a few hours verses having to deliver babies for months. I have consulted with OB-GYN docs about meds for patients and haven’t had one yet who hasn’t had to go look it up and get back to me. I already knew BTW and was just covering my butt.

    I’m a Psych NP and I’ve been in healthcare 40 plus years. I’ve also worked in a state that has had independent NP rights for over 20 years and have been the sole provider over a 10 bed inpatient unit for up to 4 days while the unit director was away. I guess that meant I was flying the plane. In addition, I had to do my usual outpatient and med floor consults. I also have medical experience out the yazoo which is why I’m always contacting primary care folks and sending then patients, for example Graves disease that I diagnosed or just yesterday asking a D.O. if she would wean Elavil off the patient she sent me since that was probably the likely reason for her tachycardia. Or placing a patient on Megace, for unexplained (by primary care) weight loss, with subsequent weight gain. This morning I’m exploring why a patient has a 3 week history of excessive fatigue. I’ve ordered labs and if need be, will send her to primary care. I’ve also got a few train wrecks with multiple medical problems in addition to their psych problems. You can study all you want and read every research study but nothing beats years of experience actually treating patients. Half the crap you’re taught is also based on research which isn’t worth the glossy paper it’s written on.

    Yes, we all have a final authority we report to, and even though I’m no longer in an independent practice state, my oversight is just management related.

    “Looks to me like we have an onslaught of LEFTS to this blog. You’ll go away soon; crying and sulking like the others. Training and education matter. Sorry.”

    I’ve spent 6 months in the OR with Denton Cooley…you want to bet money I’ll go away crying and sulking because of you? I can also send you a picture of me walking with Tigers if you think I’m easily intimated. I also spent years living in Bangladesh and Thailand and learned things no one taught me in school. I’ll bet I can make you cry when you run up against somebody you can’t help. I have experience in Chinese medicine, Japanese Zen Shiatsu, Qigong (I teach it to Soldiers who have pain that Western medicine hasn’t helped), Q’ero Indian shamanism, and with Shipibo medicine men and women in the Amazon. When you have no power to run your lab or diagnostic machines let’s see who will have the most success with patients.

    I’m not an arrogant, narcissist NP, but I do know my stuff. Anytime I have a question I’ll look it up or find someone with more experience who might know the answer. It probably won’t be you though since you can’t even come up with a better analogy than pilots.

    • Doug Farrago
      February 13, 2014 at 1:20 pm

      You sound like a smart guy, Randy. You would have been a great doc with the proper training and education. But, alas, you didn’t.

      • Randall Sexton, APRN
        February 13, 2014 at 2:09 pm

        Yep and here I sat, doing the exact same job as all the others in this group, except for the one doing a suboxone clinic and a couple treating child/adolescent dependents. They do make 75-100K more than I do but I make well into 100K and only had a 10K student loan. (1st masters in psych nursing was totally paid for). Not that I didn’t ever entertain the idea of going the medical route. However, I chose life experiences instead. I didn’t want to be like the retired thoracic surgeon who went to business school with me who said he was useless outside the OR.

        • Doug Farrago
          February 13, 2014 at 2:51 pm

          Good for you. You chose the path of least resistance. And such, do not get the spoils. “Exact” is a very tricky word but you go ahead and believe that.

    • private doc
      February 14, 2014 at 11:38 pm

      I’m sorry Randall but your comments above clearly make you the perfect example of “you don’t know what you don’t know”. You don’t have a clue when it comes to physician training. For your information residency is years of experience and education in your field so none of it is “irrelevant” as you so mistakenly think. As for looking things up we all should because with enough education you too would realize that doses, indications, warnings and contraindications change so frequently that it’s always good to double check something that you haven’t used in a while. The difference in you and docs (besides education and training) is that I know I have less education and training in neurosurgery than a neurosurgeon and am not afraid to admit that nor do I want to claim I can treat neurosurgical problems “as good as them” because I went to med school with them and even did many of those procedures under their supervision as a resident.

  4. Fred Powell
    February 13, 2014 at 7:54 am

    More training is always superior to less. If someone wants to do what a doctor does, independently, then go to medical school. That’s what it’s there for.
    Unfortunately, the cat’s out of the bag already, so to speak. Thousands of “noctors” have either been OTJ trained by docs (who only do that so they can line their pockets with the $ that they make off the NPs and PAs) or have their wanna-be degree in hand, and now can be turned loose on the public.
    The only way I see to resolve this is: Let them practice. Hold them financially responsible for any damage done to any patient (instead of hanging the doc who supervises them). It’s going to be a great time to be a malpractice attorney. And yes, I have seen the self-serving BS journal articles that claim safer care by mid levels than docs and take them for the garbage they are worth.

    • Doug Farrago
      February 13, 2014 at 9:41 am

      Spot on, Fred, and thanks for commenting.

    • Steven Gilles
      February 13, 2014 at 11:05 am

      Not spot on Fred. PAs go through training in medical schools along side physicians. I took gross anatomy, exam skills, professional skills and did the same clinical rotations my physician counterparts did. Soooo, not true.

      In addition, we have our own liability insurance and coverage as PAs. We are under the same liability our “supervising” physicians are. I could get sued for poor practice. Not the physician that signs a chart here and there.

      • Fred Powell
        February 13, 2014 at 12:18 pm

        Just because you got to rub elbows with the docs in training doesnt make your training an equivalent. You did not take the same examinations that the medical students did and to attempt to sell it as that is disingenuous. What chance do you think you’d have in passing the board certification for physicians in internal medicine? Buy one of the board examination prep books and see how detailed it is. It’s mind blowing.
        The ones of you who say primary care is easy are fooling yourselves. You don’t know what you don’t know. Youre missing a huge number of diagnoses and just have no idea what just passed before you. Medicine is mastered by very few. So if you think it’s easy, God help your patients.

        • Randall Sexton
          February 13, 2014 at 12:45 pm

          I’ve taught in nursing school as an Associate professor so have some knowledge of exam creation. I also have a special education wife who is up with th elatest in education. When I was training my mento psychiatrist gave me his boards books to read. In addition, I have right here in my office a “Deja Review” book, a Case Files: Psychiatry” book, a “First Aid for the Psychiatry Clerkship” and several others. They are not rocket science level, although IM might be. Last week our civilian psychiatrist boss took his recertification boards (very expensive) and said it was “the worse, antiquated, out of touch test created by some ivory tower shrinks.” It’s a money-making scam. In comparision, I don’t have to take an exam but must re-certify every 5 yrs and prove practive hours in my speciality, CME including an un-Godly number of psychopharm. I can also do grand round presentations…done 5 this year to meet that requirement, and can do research or take courses. Multiple exam tests are the poorest way to measure knowledge. I could probably pass one in astrophysics.

          • Fred Powell
            February 13, 2014 at 2:22 pm

            Recert examinations are not representative of the initial one. They are much easier.

        • Sir Lance-a-Lot
          February 13, 2014 at 2:56 pm

          “Recert examinations are not representative of the initial one. They are much easier.”

          On what planet?

          The FM recert is the same exam as the one you take after residency.

          • Fred Powell
            February 13, 2014 at 7:08 pm

            For anesthesiology, it’s not the same as the initial one. Must be specialty specific.

        • Steven Gilles
          February 13, 2014 at 6:43 pm

          Funny you mention that Fred. I use the Family Physician review books for my boards. I’ve taken the practice exams. I’ve passed them. “Rub elbows” suggests I was merely sitting next to them rather than doing early morning rounds, presenting on patients we worked up together or sitting in lecture or working a cadaver with them.

          I’m not saying I’m a physician. I’m not saying I will replace a physician. However, don’t belittle the education I have just because you don’t understand it and refuse to do so.

          • Fred Powell
            February 13, 2014 at 7:05 pm

            Practice exams vary widely. Passing them means nothing. You were suggesting that because you rounded with the medical student that your education was equivalent. And we all know it’s not.
            This is a grand pissing contest. The only way to settle something like this is for everyone to take the same examination. Believe me when I tell you that I would have loved to compete academically with the people I know who became PAs and NPs.

      • Doug Farrago
        February 13, 2014 at 1:27 pm

        It’s the deeper pocket that gets sued. Spot on, Fred.

  5. elayne desimone
    February 12, 2014 at 7:41 pm

    argue your opinions all you want. The outcome data speak volumes. Astronauts are not needed in primary care.

    • Doug Farrago
      February 13, 2014 at 12:01 am

      I agree. You can treat sore throats pretty well. LOL.

      • crnp2001
        February 13, 2014 at 5:20 pm

        With all due respect, your ignorance is showing. We Advanced Practice Clinicians (the CORRECT title for us Nurse Practitioners and Physician Assistants/Associates, BTW) do a heck of a lot more than treat sore throats. Our studies show that we have equal or BETTER outcomes than physicians in many cases…something which many — not ALL — physicians acknowledge. Since apparently you are lacking in this knowledge, here’s a website with some research FYI: http://www.aanp.org/images/documents/publications/qualityofpractice.pdf

        Funny how those who have so little confidence in their own abilities are quick to belittle the others who also treat patients in an appropriate, sound, clinically-based, and APPROPRIATE manner, just as our physician colleagues do. What, are you that threatened by APCs that you have to tear down every other profession?

        Please…give me a break. I work with many other physicians who appreciate my skills, as other APCs, and do NOT share your limited views on our professions.

        Get with the viewpoint in the real world, please, and stop showing your true viewpoint, which is actually that you are threatened that someone other than a PHYSICIAN (gasp) can do what you do most of the time…in a safe, sound, COMPETENT manner. It’s all about the money and threat to your livelihood. Face it…there are more than enough patients to go around. We all know physicians (and, yes, APCs) who are not competent. But to belittle us APCs as unworthy compared to the “holy physician” is not only ridiculous, but makes you look pathetic.

        I fully expect one of your retorts as you posted above. Bring it on. Just shows your true colors.

        • Doug Farrago
          February 13, 2014 at 6:27 pm

          Wow, a website from the AANP. No bias there, huh? I do find it sad that those with low self-esteem, like yourself, need to believe they are equal in abilities without the training or education. I appreciate almost all of the NPs and PAs I have worked with. I’m just offended by the insinuation that my higher education and training doesn’t matter. So, let me get this straight, because I am honest about the FACTS (less education and less training), that is threatening to you? How is listing the FACTS (less education and less training) not real? Oh, I agree that it is about the money and the threat to my livelihood. I have always been honest about that and have said that many times if you have ever read this blog. Administrations want to use midlevels to replace me ONLY because YOU ARE CHEAPER. There is no holiness going on here. This is just my true colors revealing the facts and those facts piss you off. Deal with it.

          • Fred Powell
            February 13, 2014 at 7:10 pm

            I am going to enjoy being an expert witness for the plaintiff in these cases of “noctor knows best”.

        • Pat
          February 13, 2014 at 11:48 pm

          So crnp, apc, or whatever new title you compose: are you saying there is no need for a physician to do what you do? If so, is there any need for a physician? If so, then what?

          Could an RN with enough time in the clinic or ER do “most” of what YOU do? Wouldn’t it be okay then to turn over your hours to really sharp RN’s, since formal education is not a hard standard? Let us know please!

  6. Dave Mittman, PA, DFAAPA
    February 12, 2014 at 11:17 am

    Keep thinking this way. It shows that physicians minimize the value totally of NPs and I would presume PAs. It is disappointing to see and just keeps pushing us father away. I can not understand why you would want to do that? Anyway…
    Point is PAs have been flying planes for years, with an excellent track record DOING WHAT WE DO QUITE WELL. For example, we have been doing the same things physicians do including prescribing across the country for almost 50 years. I can tell you as a former NY State PA president that the complaints are few and far between (yes, even to the medical board). We might not have had astronaut training but that’s usually not needed to fly to the cities we fly to. To compare NPs and PAs to flight attendants is not the same and you know it. Unless the flight attendants fly the planes while the pilots are off in the Bahamas for two weeks or at a CME conference and all is great when they return. Then I guess it’s the same.
    Doug, I am surprised at you.

    • Doug Farrago
      February 12, 2014 at 12:18 pm

      Stand by my blog entry 100%

      • Bob Blumm, PA-C
        February 12, 2014 at 9:30 pm

        I appreciate your enthusiasm doctor but your analogies are incorrect, demeaning and far from contemporary. If you and your family were in a plane crash like the founder of ATLS and you had a ATLS trained PA or NP, you would get exactly the same standard of care as you would from the director of an emergency facility and far better care than you would from most physicians who have not taken time from their busy schedules to attend the two day program. This holds true for our military officers serving in harms way in the Middle East. They are battalion surgeons and hold pay grades up to full Colonel. As the brother in law of a major airline pilot ( Caotaun) let me add the study from British Airways concerning the number of pilots who set the controls on automatic during trans-Atlantic flights only to awaken and find their co-pilot asleep also. A title dies not make you the best practitioner in any field.

        • Doug Farrago
          February 13, 2014 at 12:00 am

          Looks to me like we have an onslaught of LELTS to this blog. You’ll go away soon; crying and sulking like the others. Training and education matter. Sorry.

          • Steven Gilles
            February 13, 2014 at 11:17 am

            We aren’t going away soon. And none of us are sulking and crying.

            I agree that training and education matter. As I’ve said before, I feel badly for family medicine physicians who are disrespected by more highly trained internal medicine physicians and pediatricians who refuse to let their patients see family practice docs. FP Docs are LELTS in the eyes of an IM or PEDs doc. Right? Am I wrong on that?

            We know well that FP is the new kid on the block and the red headed step child of medicine, underpaid, under appreciated. I agree with that 100%.

            Can I get a response from you on this one that is something more than your usual hollow rhetoric? Maybe an actual response that has some intelligence built into it that speaks to the issues at hand that we are ALL faced with together?

            Or would you rather keep name calling and jabbering with furvor and bluster as a means to distract from the real issues we as a group of highly trained clinicians (PA/MD) are faced with?

            I’m expecting name calling and jabbering.

          • Doug Farrago
            February 13, 2014 at 1:36 pm

            I have responded to you over and over again. Midlevels are not doctors. We can work collaboratively but it was the NPs who took it to the competitive level so, as I have said in other responses to you, GAME ON. Oh, and one more thing, training and education still matter. I will keep saying this over and over again. Did I call you a name? No. The fact that you ONLY put a comment in when I slam midlevels proves you’re ignorance. You want me to speak about issue at hand that we all face together? I blog every day on that. But it is only when you’re esteem is challenged that you dare to comment. Trust me, go away, and I could care less.

        • Pat
          February 13, 2014 at 1:22 am

          What in the world do battalion surgeons and their pay grades have to do with anything? So the co-pilot falling asleep invalidates the pilot as the one ultimately responsible? How does the attempt at name dropping – ATLS – and sneering at the busy schedules of some physicians in any way confirm PA’s or NP’s as equal to physicians?

          If you want to do away with physicians then have the guts to say so. Either you are subordinate i.e. not equal, or there is no reason for a primary/generalist physician to exist.

          But you can’t be that honest …what you wannabes really want is for tired, ripped off, threatened primary docs to acquiesce and provide some sort of moral cover for you to claim to be what you are not. You need physicians to agree to the ultimate irrationality, to assist in their own destruction.

          • Fred Powell
            February 13, 2014 at 12:24 pm


        • Sir Lance-a-Lot
          February 13, 2014 at 11:52 am

          ATLS? So what? I had to take it as a paramedic. Lots of people in emergency med have to take it, including docs, nurses, and techs, along with ACLS, PALS, and NRP.
          These are basic courses that don’t even require significant outside medical training to complete, and that serve to put the entire staff on a footing of common knowledge for when fast, confusing events happen. The point of these courses is that they are designed for all levels of the medical “team” to take together, so that they all have a common base of knowledge, not that they are in any way special or advanced.

          If you are trained in emergency medicine, of any variety, of course you will be the most proficient at providing it in an emergency situation. Duh.
          I wouldn’t expect a psychiatrist to do a great job at it, or a psychiatric social worker, or an internist, or an internist’s PA.

          The fact that you brought up the information you did, in the way that you did, in response to the comments that you did, speaks volumes, and really makes Doug’s case for him.
          You are focused narrowly on your own sub-field, and are looking at a much broader question through your narrow field of vision.
          I’m certain that you are an excellent clinician in your own narrow field, but take you out of it and you’re lost.

          If you tell that psychiatrist in that plane crash to stop that arterial bleed, elevate the patient’s legs, and then go check on those other people’s breathing, reposition their airways once, and if they don’t start breathing, red tag them, he (or she)’ll know what to do. It the ER doc or the paramedic on board tells the Family Nurse Practitioner to do the same things, she’ll probably start to shake and cry.

    • Sir Lance-a-Lot
      February 12, 2014 at 12:24 pm

      “It is disappointing to see and just keeps pushing us father away.”

      See, this is the thing. That is a borderline threat.
      We just keep pushing you further away.
      Away to what?
      Away to oblivion? That’s not the implication.
      Away to independence? Could be, or at least to an attempt to be independent.
      Away to enmity? Sure sounds like what you mean.

      You are Physicians’ ASSISTANTS. If you are our assistants, how is it that we can be pushing you (collectively) away? And where, exactly, are we pushing you?
      That is, unless you no longer believe that you are our assistants, and believe, instead that you are independently qualified to work.

      Using the airplane analogy introduced by Doug, if we are the pilots, then you are the copilots.
      The copilot can fly the plane, with the captain in the cockpit, or immediately available, but s/he cannot operate the plane without the pilot, because the pilot has more experience and training.
      Now, in the airplane analogy, the copilot is, or can be, a transitional job on the way to gaining the experience to become a pilot, while in the medical field the PA is an entirely different career line, but nobody is saying that the copilots should be flying airliners on their own, or that the pilots are “pushing them away” by preventing them from flying alone.

      And the Bahamas quip was just plain ridiculous. That crap went out with dug reps sampling controlled substances.
      I WISH someone would pay me to go away for a holiday to do CME. I do my CME at the kitchen table.

      • Dave Mittman, PA, DFAAPA
        February 12, 2014 at 1:16 pm

        We (I) do not feel the way you suggested.
        Pushing us away from being a valued member of the team, from being all we can be. Valued to the point where we feel we need to be valued. That place you will never see or realize. It’s not about being alone or independent-but being part of the same team. That is a pipe dream though. Would you let me into the medical society as a full member?
        We know that there are things we do excellently. We know we can provide good care. You as a person or Doug or many physicians will never see that or agree. I know how good PAs are. There is no threat here.
        Even the ASSISTANT thing you threw back at me/us is because the AMA made us change our title. They were threatened. I graduated as did almost all PAs of my day as Physician Associates. That was our professional title nationally. Seems you still don’t want us as associates. Look up the meaning. After 50 years of providing great care PAs deserve something more than “you are an assistant”.
        Things change and evolve.
        Thanks for clarifying PA don’t, at least in your eyes

        • Pat
          February 12, 2014 at 1:32 pm

          Dave you are jousting with euphemisms. You say “associate” when you clearly imply “colleague”, without all that troublesome med school and residency baggage. Not even a nice try.

        • Sir Lance-a-Lot
          February 12, 2014 at 2:12 pm

          I agree with Pat: You say “Associate,” I say “Assistant.”
          These days “Associate” is what no-benefit, minimum-wage workers at WalMart are called.

          I actually do value the PAs I work with every day . I am lucky to have some great ones.
          That’s not the point, though. The point is that this whole independent practice concept is not appropriate if we physicians are to keep our own jobs, and was never what was intended originally.

          I would suggest that if you want to be valued, you get in line: right behind doctors and nurses. Don’t worry, as soon as we are valued by the system, we’ll make sure that you are, too. If things continue in the current direction, though, and we are never valued as we should be by the MBAs and other criminal co-conspirators, then don’t worry – your value will drop right along with ours.

          Remember, doctors are not your enemy, any more than PAs are (though PAs in independent practice most certainly are). We want what’s best for the patient, the system, our valued colleagues, coworkers, and associates, and, yes, you, too. We just don;t think that squeezing us out of a job is what’s best for any of those groups.

          • Steven Gilles
            February 13, 2014 at 11:10 am

            Sir Lance
            I always like reading your posts. You are a bit more fair and balanced that Doug is. At least you acknowledge the realities a bit better than he does.

            That being said, you are correct, we want to fight the fight for respect and proper management of our training in the same way physicians do. I would rather see us stand side by side then behind you in line, but I get your point.

            The other point, that if physicians are respected, that will result in PA/NP respect is unlikely true, though I wish it were the case.

            I agree that doctors are not our enemy. But people like Doug seem to think that PAs are the enemy. We are not the enemy. Doug wants to demonize us and marginalize us and try to imply that we are part of the problem that is causing physicians to have such a bad time.

            As I’ve said before we are faced with many of the EXACT same struggles physicians are faced with. Why make us an enemy by making up a name for us (LELT) when we could work with physicians to fight back against the things in medicine we don’t like?

            I prefer your approach Sir-Lance. You at least can talk with a level head.

          • Doug Farrago
            February 13, 2014 at 1:30 pm

            Hey, Steve-0, if you don’t like my approach then don’t read this blog. I only point out the obvious. You demonize yourself when you embarrass yourself by thinking you are equal to doctors. You’re not. You offend me by pretending that you are not doing this. So…go away if you don’t like it.

    • Pat
      February 12, 2014 at 12:49 pm

      Dave, you are sidestepping the point. Before medicine, I did two Med cruises off an aircraft carrier as a naval flight officer, in charge of navigation, weapons systems, and communications. When I gained enough time and experience I was promoted to mission commander, with final say over the tactical employment of our aircraft, BUT! – I was not a pilot (damned eyeglasses). There was only, ever one pilot-in-command. Even though he might be my junior and under my orders for the mission, he had the final say over the physical safety of flight for the aircraft. Because…he was the pilot.

      Same thing goes in the ER. Any number of times I’ve heard a good idea that I hadn’t thought of, or had a physical finding or piece of history given me by a sharp nurse or P.A. Never threatened me a bit, and still doesn’t. On rare occasions I’ve had those junior members of the team disagree with my call on a case, and without fail we always talk about it. I’m all about the teamwork, but…it’s my call, and only my call, ever. PA’s might have a perfect track record in treating what they do, but it does not make them the final authority on a case. This is more of the leveling, egalitarian nonsense that has wrought so much damage in this society in the push to give every soccer kid a trophy. Insidious arguments for “independent practice” seek to inflate one’s value by deflating the value of physicians.

      I have worked in both environments and Doug’s analogy is dead-on. The PA’s and NP’s are increasingly unwilling to recognize an objective final authority on medical decision-making, and are doing so dishonestly.

  7. tom walsh
    February 12, 2014 at 10:42 am

    Just out of curiosity, where will they get all this “prior flight experience”?

  8. Robert
    February 12, 2014 at 8:14 am

    What effect will this have on the Flyer Centered Aviation Home movement?

    • Doug Farrago
      February 12, 2014 at 8:58 am


      • Robert
        February 12, 2014 at 10:11 am

        To deal with the enormous problems of waste and fraud in the aviation industry, the government is mandating the formation of ATOs (Accountable Transportation Organizations): the airlines will be financially rewarded for any savings achieved by cancelling flights and refusing to provide other services.

  9. Sir-Lance-a-Lot
    February 12, 2014 at 6:06 am

    Salary’s got something to do with it as well.

    The old retiring generation was able to make well over 100K, with good working conditions, but after years of givebacks, many new pilots are making in the 20s to 30s, are assigned flights many hours’ travel from where they work, and are only paid for time actually flying (layovers are unpaid), so many people who would be interested have instead chosen other lines of work.

    It’s actually got a lot of parallels to medicine, and shows where we are headed if the MBAs have their way.

    • tad hominem
      February 12, 2014 at 11:23 pm

      Lance: that is the first cogent observation I’ve seen here. there ARE parallels with the airline “industry” and the medical “industry” and lessons to be learned.
      BTW, I have had MS for 20 years and thus a “high-end” consumer of the medical industry’s services, and here to see a lot of changes that have taken place. I have had, mostly, great doctors whose KNOWLEDGE AND TRAINING were supplemented and complemented by the NPs and PAs who provided the personal touch and hand-holding when needed AS WELL AS the return phone calls and explained the stuff the doctor didn’t have time 4 or have the personality 4.
      to treat the NPs and PAs as adversaries is a mistake and disservice, foisted upon u by the “suits” and MBAs who want u to run ur profession like a business.

      • James C
        February 13, 2014 at 7:10 am

        Well…I agree and disagree with the points made.
        First the pilot in command/aircraft commander is also a role that is not always based upon rank, education but proficiency and currency. Yes the junior co-pilot could progress to a/c commander although not being required (less pay and authority). The co-pilot like PAs perform their critical role on the team expertly otherwise the a/c would not fly. The ability and precision of the a/c commander would be limited without the co-pilot. The PA CAN fly the plane and in some instances takes the plane solo. The complexity of the plane or case determines the two pilot requirement. Certain medical practice scenarios as do aircraft would safely and effectively allow for “solo” flight. Proficiency combined with technology can make this possible while not compromising what matters most, quality health care for the patient. Medicine and airlines/pilots share a few similarities while lacking in others. Airline pilots have unions, do physicians or PAs? Crew resource management DEMANDS certain behaviors regardless of role on the team, think Ocenana airlines crash. Lastly, organized medicine has prevented PAs from progressing to the left seat in a thoughtful and constructive manner. Organized medicine’s response is go back to flight school because the flying that you learned is different than what we have learned so it must be wrong. just a few thoughts as Commander, pilot, aviation medical officer, and yes PA.

        • Doug Farrago
          February 13, 2014 at 7:20 am

          That being said, training and education matter. To say otherwise is dishonest, offensive and embarrassing.

          • james C
            February 13, 2014 at 8:35 pm

            Does training and education ensure competency? Why the changes in the ABMS certification? The answer is partly to better evaluate competency through self assessment and performance improvement in addition to what is already being done. Further, how many physicians, PAs, or NPs take check rides on a routine basis? How many are really subjected to peer review as a matter of routine? My point is that everyone has limitations and cannot do everything at the 99th percentile regardless of the years of training and education. Training and education, I hope makes one more informed and insightful. I am a PA and will never be a physician, I have an academic doctorate (with a real dissertation) and this does not make me a physician either. What my education and training in medicine, policy, finance, and management (what seems to be the most important currency here) tells me is that the real meaning of “authenticity” and honesty is being missed in this blog question.

            How can we make the most ideal workforce that best serves our patients needs, while preserving quality, access, and experience of care? I do not believe the physicians have all the answers, and nor do the PAs or NPs. Teams can work if roles are defined. Leaders could be the physician, PA, NP, or social work, etc. It really depends on the case complexities, setting, and wishes of the patient.

            Our children cannot continue to consume healthcare that eats up 18% of the GDP.

            I think it is time to put the egos aside and put our patients first, this might include something different than what we are doing now.

          • Doug Farrago
            February 13, 2014 at 9:01 pm

            You make some good points but I will reiterate, for the last time, that training and education matter. Those two facts, which I had to create an acronym (LELT) because I had to repeat it over and over so many times, are indisputable. So, I am not going to approve any more responses that get off topic. The midlevel movement, to their credit, jump in on any article or blog that questions them. At least they stick together, unlike doctors. Unfortunately, they are wrong on this but it doesn’t stop them from going to town, hammering the author or other people who comment. See the NYT article this July on this same topic. This is my playground and my ball so I have decided to not let any more PAs or NPs continue to say the same thing over and over again. I won’t let them use misdirection and put words in my mouth so they can play the victim. So, since I own the space, it’s my rules. I will delete the repetitive crap if it keeps coming in.

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