Who doesn’t want to ride a donkey backward? Can’t say that I do. Can’t say that I’ve ever thought about it. But reading this story on Reddit made me think about it today. This article is a story about:
PA student cared for 2-year-old with lethargy and vomiting post fall. Patient was never assessed by PA. Hospitals risk management okays this because a “PA student reporting to a PA is like a resident reporting to an attending “
This article is about a nurse that had a horrendous experience with care of their child who never saw a physician or even a licensed PA. This involved a head injury, subsequent sequela, symptoms, and an inappropriate discharge at the hands of a PA student. The complainant described an email they receive from the hospital risk management section that (hospital) “are a teaching hospital, we do allow a spectrum of autonomy.” So, let’s see – a head injury, neuro symptoms, and “I am still concerned. I am starting to realize that a doctor isn’t coming.” How in 2021 can this take place? Actually….. maybe it’s more like that in 2021 it’s more likely to happen than in other times. The incident took place at Phoenix Children’s Hospital.
I’m no expert on PA’s or PA students, I but did practice as a mid-level NP for years before med school. While in 3rd year surgery clerkship, we did have 2nd year PA students rotating with us. It’ not derogatory or demeaning to point out that a 3rd yr. med student at this juncture has 2 yrs. of in-depth basic sciences and clinical knowledge versus 1 year for the PA. It’s not a bad thing. It’s just a different thing. It’s like one is training to be an apple, and the other training to be an orange. Both may be fruit, but the training is different. It’s meant to be because of the different roles. It’s not a bad thing. It’s like in the nursing realm where you have licensed practical nurses versus registered nurses. Again, not a bad thing, just a different thing.
This brings me to a point of contention I have on the topic. A PA or even NP (with which I’m more intimately familiar) can practice and even in some states have full practice authority (FPA). Where here I am as an unmatched MD, and I can’t. I have 4 yrs. of med school which is 2 yrs. longer than the NP and PA with each phase of the didactic and clinical portions being a year longer, and I can’t. I’ve passes all USMLE steps – Step 1, Step 2CK, Step 2CS (before they canceled it), and Step 3 and still can’t practice as an MD. And I might point out also that even resident physicians still have attending physician oversight. As it should be. Part of me is grateful for this that medicine is held to the higher standard. I don’t think we should lower this standard. I think we should raise the standard of the NP/PA. But the irony is, I could reinstate my NP license and practice with FPA but can’t do a darn thing as an MD.