As someone who currently works very closely with surgeons and doctors, and is planning to attend PA school soon, I completely agree. Every day I’m in awe and inspired by how much knowledge and expertise our doctors have. It’s very extensive training and there’s no way someone could possibly bypass or “shortcut” that. As a PA I want to help alleviate some of the stress MDs have by taking on more regimented patients while still providing high quality of care, to open up their time for more highly complex cases which we see so much of unfortunately. Ideally, it should be a symbiotic relationship.
this is exactly how NPs and PAs should work....as an RN I just can't wrap my head around how any PA/NP wants to be more responsible with less training....
@@vincentalakija5515he is not saying they have the same amount of training they used the same medical module and it’s a lot harder because you have to learn so much in such a shorter space of time. No one gives PAs the credit they deserve. They have the highest attrition rate than any other medical trained professional. I know a few people who failed out of PA school and made it through medical school. PA school is also by far the most competitive and hardest to get into.
EM physician here. Thanks Kevin for speaking out on such a controversial issue. I am grateful for all my APP colleagues, but in my limited 7 years of experience, I believe patient care is still best delivered as a team with physician oversight.
Is the real difference in the education or the clinical practice (i.e. residency) and it's delivery? I understand that the didactic component of medical school is much more rigorous than that of NP/PA school, but an NP/PA could theoretically study the didatic components of medical school (since it seems like medical curriculums are streamlined through the likes of Khan academy and such). I know a PA who did this and would take mock USMLE exams through U World to help determine his level of clinical knowledge. If an NP/PA were to do this and "pass" their mock step exams what would then be the difference between them and an MD/DO (outside of credentialing)? At this point it seems like it would be their clinical training. But how does residency differ from being a practicing NP/PA as it relates do developing a more comprehensive understanding and not just developing strong pattern recognition? In the hospitals where I've worked (all academic hospitals) it seems like NPs/PAs do the exact same as resident physicians; so how do 4 years of residency make for more qualified providers than say 6 years of NP/PA experience?
I have seen, as an ICU RN deciding between MD/CRNA for career progression, horrible mismanagement of patient care from providers who are not suited to that specific patient. That means APPs and MD/DOs. Heart failure pts managed by cards, stepdown pts managed by APPs, it's all bad and detrimental. That being said, Drs are MD/DOs. More complex pt care must be managed by the best candidate: Drs.
As a PA Student currently on rotations, I couldn't agree more with this. Our professional organizations (whom btw, the advocacy board isn't even run by actual PAs, but by Poli Sci/MBA majors who see financial benefit in expanding scope), are unfortunately seeking to delude newer PAs into thinking their understanding of Pharmacology, Pathophysiology, and Clinical Medicine is just as robust as a Physician's, which is clearly not true. Even now, I very have significant gaps in knowledge compared to resident physicians let alone the attendings. We play a valued role on the healthcare team and I truly cannot wait to do my part to treat patients effectively. But this is something both Midlevels and Physicians need to discuss for the sake of patient safety. I as a PA Student am always clear of my role as a "Physician Assistant Student" and intend to always introduce myself as the Physician Assistant to patients moving forward because as someone who's been a patient myself, I would not be comfortable with someone who is misconstruing their title and level of expertise, so why should I delude anyone else?
I am a FNP who does have a DNP. I will never, EVER, call myself a doctor in a clinical setting, I am not a physician. I do not want to be a physician - if I did, I would have gone to med school. I may use doctor in academic settings, just as someone who has any other academic doctorate, but never EVER would I use it in a clinical setting. It blurs the lines, causes confusion, and is simply inappropriate. DNP's were originally meant to teach health care management as well as teaching skills, but many places are beginning to move towards going straight to a DNP instead of MSN for NPs as a way to blur the line between a physician and midlevels, its entirely wrong in my opinion. I completed my DNP so I could teach part time, not to call myself a doctor to patients. Some people want to be a physician - great! But it is not for everyone, and not everyone wants to do that job, that's where midlevel or RN's come in. We all have our roles to play, and we all are meant to be working together in collaboration. It's really a shame that a lot of younger NPs and PAs are being told that they're "practically a physician."
My dad’s an MD anesthesiologist and my favorite quote by him is that “physicians understand the ‘why’ of disease processes and CRNAs react to vital signs.” This is obviously an over simplification but it points to the difference in understanding and managing complex disease states. He’ll also be the first to tell you that CRNAs play a very critical role in the healthcare system. They, however, are not physicians and don’t possess a physicians level of understanding.
Thank you for talking about this! I appreciate you taking the time to discuss this as a soon to be MD! It feels like many people have neglected this topic in leadership who otherwise should be advocating for us but I am proud you continuously bring this up. I think us young physicians feel very strongly it's important to be physicians that are leaders of the healthcare team and we all work together within our role to better the health of the patient.
This really needs to be a bigger topic. NPs and PAs are great, but their limitations are extensive (which is fine, they aren’t docs), but some in their community are almost brainwashed into thinking bizarre things like they are equivalent, mid level is a derogatory word, or that a doctorate will get them closer to MD/DOs. This type of thinking is propagates by PA schools (especially at Lynchburg). It’s honestly scary to see the lines being blurred, and hospital admin taking advantage of that. This isn’t only scary for the public, but also mid levels themselves. More and more they have incredible high expectations and are put in dangerous situations by their employers, very often as brand new trainees.
It's not brainwashing. A midlevel is basically a permanent resident. If you work as a resident for 10+ years, you're going to know how to practice just like the attending physician. The problem is there is no certification or limitation that distinguishes the 10+ years from the 0 years midlevel. A surgeon for example must log 150 continuing medical education credits and pass an exam every 2 years to maintain their certification, where as a nurse practitioner who's spent 15 years working in psychiatry can swap to surgery tomorrow without any further training.
10+ years acting as a lower level resident, often with no call responsibilities, and little to no surgical experience ( in surgical subspecialties). So no, after 10 years of making lower level decisions they are not at the level of knowledge of an attending. Not to mention all the knowledge outside of that particular specialty that an attending has from their medical school training.
@@VKingMD in the academic setting mid levels who function as “interns” might have the same responsibilities, but they receive none of the challenge. The attending doesn’t challenge mid levels or make them think through plans, think about differentials or evidence based decision making. The seniors and attendings tell the mid level what they would like done and the mid levels complete said tasks. There is no growth. They don’t become seniors and teach interns. They don’t do nights and make calls without backup. They don’t rotate through different specialties to learn the breadth. It’s not the same.
@@Allhailbillcoleman I agree that their experience is very different, and that different experience is the problem. Many PAs, particularly in the academic setting where there are actual trainees, don't have much room for growth. However, PAs in the community setting have the opportunity to adopt more of an apprentice than an assistant role. Given enough experience, if they can demonstrate equivalent competency upon scrutiny and examination, I would be in favor of offering a highly challenging accelerated avenue to become a physician. Afterall the 4 year medical school with mandatory residency is far from an ancient practice.
Yup! This is totally true! So many people apply an illogical way of thinking when it comes to PAs...and I agree with you there is no way right now to test the competency of a PA with 0 experience vs a PA with 10 years of experience
Well said. DO student with a NP student fiancé here. This topic of conversation is not lost on us; most important dimension in my eyes is to strive for honest respect and synergy between our differences in training and education. It is not a competition, we should all be on the same, humble team.
I totally agree with you. I have worked in different hospitals as an imaging technologist(radiology and CT) and honestly I realized how valuable their help is to physicians(partially due to physician shortage) specially in ER and ICU but lobbying to have an independent path and practice is totally wrong. They always should be supervised by physicians. Medicine is an extremely complicated science and that is why medical schools have many years of didactic and clinical courses before letting doctors start practicing.
Partially due to physician shortage is an understatement. They only exist because of the physician shortage. Most countries function without them, but most countriest don't have thousands of MDs who can't find a residency position
While in the Air Force our doctors we see most of the time are NPs. I seen two of them within a week and the both diagnosed me with just a cough. I didn’t feel right and shortly after went somewhere else. I met with a doctor told them what the other NPs told me and he listened to my breathing for less than ten seconds. Without saying anything, he called in a med student to listen to my lungs. The med student within a short span told the doctor it was pneumonia in my left lung and he agreed. Ever since I always held even a med students opinion above that of an NP. I could have gotten worse if not died if I didn’t go see a real doctor.
The problem here is imaging confirmation that shows consolidation. There is no way to diagnose pneumonia by auscultation. It could have been bronchitis. This is why I can’t always agree with MDs either because a lot of them will do anything for money.
Yea, you can't diagnose pneumonia from simply listening. But regardless, things like wheezes and crackles should not be missed. Unfortunately it does happen though. But that is not a reflection of mid-level providers vs MDs. It's a reflection of the NP who missed it. Auscultation is a basic skill that even lower providers are quite proficient at. As a current paramedic, it's not to hard to catch.
One thing I learned going into clinical years of medical school and residency is that practicing medicine is nuanced because often there are more disease processes going on with multiple factors affecting outcome . You need the medical background to understand what is going on and the clinical experience to understand the nuances and problem solve based on the entire clinical picture.
I am a NP, I am very aware I am not on the same level as a MD/DO. I always introduce myself as a NP so there is no confusion. I also am going back to school for my doctorate. In California, we are not allowed to call ourselves doctors in the clinic setting to avoid confusion with patients and staff. There needs to be more collaboration and education. I love the flexibility in my work schedule and it's the reason I chose a different path but still able to provide patient care within my scope of practice.
@@stevenvargas6863 She said she's an NP now but that she was going back to school to get her doctorate. I was asking if she'd expect patients to call her doctor once she gets her doctorate.
You're doing it right! An NP/PA that understands their scope and limitations is an asset to our healthcare system. Those that constantly push to expand the scope beyond its intended limits are a danger!
Ooohh I can speak on this from my personal experience. I am a first year medical student. The volume of material is unimaginable so for my most recent exam, when I was running out of time to study, I overly relied on pattern recognition. Because I did not understand all the nuisance I missed a passing grade by 2 points 😬 I leaned (and I already knew) that pattern recognition is not enough. You can recognize the pattern but you have to understand the pattern. In understanding the details you can make and extrapolate the pattern. Pattern recognition can be memorization which gives a false sense of security. You have to know the WHY so when the pattern doesn’t present and what you are used to, you aren’t confused. The disorder didn’t read the textbook. How you think it’s going to present is not enough to catch it. Every human and every pathogen/disease process is different. There can be some overlap but that’s not always enough to catch it. Those minor details could be the difference between life and death. Literally.
Clinical medicine is a very specific term. Having a PhD and being a clinician are totally different sciences. There is a lot that goes into patient interaction from before you walk into the room to after you leave there are procedures and nuisance. How you handle the patient (laying them down, sitting them up, touching them) is it’s own skill form. Timing of your history and physical exam matters and there is a balance between efficiency and compassion. I’m my medical school there is an entire class of the clinical aspects of medicine because that’s what makes a good doctor. Literally anyone can learn the sciences but there is also an art to medicine. You can be the smartest person in the world and not necessarily a good physician.
This is exactly the kind of public health advocacy that we need. Our patients deserve to be served by the best trained among us, i.e. MD/DOs, not midlevels. Midlevels pursuing independent practice and autonomy puts their self interests above that of the public. It’s disingenuous at best and places greed over patient care. We as a profession need to continue increasing the visibility of this issue to the public and our politicians so we can best protect and serve the health of our communities.
Everytime I go to urgent care to see a doctor, there’s always just a Physician Assistant!!! Most of the time there is no doctor around! Not sure why we pay so much to not even get to see a doctor lol
You should know by now urgent care was not designed with a physician in mind. It was meant as a place to go when you could not get an appointment with your PCP and you have a UTI or sore throat and need medicine. The problem is people come in there thinking that it’s an emergency room because they are sick and want to pay less. Unfortunately, they get sent to the emergency room and end up paying more.
As a new PA-C, I have no problem with the mid-level designation. I know my training has not been as in-depth as that of a physician. I have no desire to step beyond my scope of practice. My desire is to work with a doc who is approachable and willing to share their knowledge for the joint goal of providing high-level care to patients.
Ahhh, this is so satisfying ☺️ the reason why I say this is because Interns or medical students in clinical settings in various countries have to understand they should not rely on NPs or OT-assistants, I’ve often noticed them giving completely wrong information with full confidence to new Interns, whenever you have a question, always ask a physician or a surgeon and don’t shy away from that, that will indeed make you a great doctor true to its core, rather than getting wrong info or being perceived as a junior doctor who just doesn’t know.
Thank you for this video, Kevin! I really enjoy seeing your takes on these controversial and hot topics, glad to see that you're taking the responsibility in making them.
ICU PA here. Also big fan of your content. I think one big thing you missed in this video/your take on this is the fact that a lot of the DMSc stuff has come to fruition simply to try to match the current “DNP” model. PAs have masters degrees. NPs used to as well however their governing body decided to inflate that to a “doctorate”. This was largely to have their education model produce more money. PA education has yet to do this and is now being forced to come up with a solution to match this misguided degree inflation. Most of the PAs who are getting DMSc are doing so because it’s required to teach at PA programs or required in order to move into leadership roles. It does not come with significant pay increase for the most part. I agree that mid levels who don’t recognize that they don’t know everything and have received limited training in comparison to MDs is super dangerous. I wish PA programs did a better job of screening people with these personalities out. Also any PA/NP worth a grain of salt would never go by the term “doctor”. The reality is there is a small minority of midlevels/CRNAs who are actively fucking it up for the rest of us.
Yes the DNP is a joke just making more money for the graduate schools. I’m a NP with a masters degree.., the school will need to pay me to go back for a DNP and write papers for them to grade.
Well said! I completely agree with how the amount and intensity of training is unmatched between MD/DO from mid-levels. I don't think people understand or appreciate the level of rigor that is constantly present in med school, and undervaluing the education by comparing it to DMsc or DNP is disrespectful. No hate to anyone, but I think everyone needs to know their respective roles and understand that each role is important in it's own unique way.
The reason I am going for PA is exactly for the limitations in the scope of practice and designation. I don’t mind at all being under the supervision of physicians, I actually want that! I want to be part of a medical team, but I don’t want to have the last word, especially when a case really warrants it. Pretending to be at the level of a physician is disrespectful and narcissistic in nature, IMO.
As challenging as the first two years of medical school have been for me mentally, emotionally, financially, and physically, I am so thankful for the immense amount of KNOWLEDGE I have gained. I have learned so much in these past two years and there is still at minimum 5 more years of training to go before I will be an attending physician. I love your comment on "pattern recognition" and I think if more people recognized that, they would agree that physician does not equal midlevel provider.
That comparison where they say MD has no prerequisites I believe is taken from Duke University (or some other top tier school) but it's so badly out of context because it's only one cherry picked school and if you look at the prerequisites on the PA side, to score an MCAT that would get you into Duke would require you to be a master at all of them. So Duke basically says "we don't have any official prerequisites as long as you get a 520 on the MCAT and have a bachelor degree and compelling story and tons of clinical and volunteer hours and publications." So yeah totally no prerequisites
AMEN BROTHER PREACH IT. DNP to Premed here. Just sat for MCAT and submitted my primary. You don't know what you don't know. This video speaks to my soul and this needs to be broadcasted to every citizen of the US.
My thing is that as a first year Family Medicine attending, I would NOT have been able to handle patient care well right out of medical school. It was upsetting how much I had to learn as a resident and how much I still have to learn just to be a decent doctor. It was weird how weak the correlation between testing and actual practice there was. The issue is that people have gargantuan and often unrealistic expectations of doctors; it's hard to be smart, wise, good with your hands, observant, compassionate and relatable all simultaneously. Some folks balk at anything but this mythical perfect doctor, when in reality with the doctor shortage many providers actually have less experience and aren't DOs or MDs. There should be an expectation of growth and reasonable assistance for doctors, while respecting the scope of midlevel providers. I feel that Midlevels are an excellent resource but their scope should be more defined. ALSO, having more certificates and clearer indications of what a provider knows and can do would help (ex: what procedures they can do, what they tend to treat specifically etc.)
Completely disagree with you. PAs are generalists. Physicians are specialists. If physicians go through so much training, but the end of training their scope of practice is usually narrowed down to specific board certifications and hyper specialities - even if they had more broad exposure in training
Another thing I feel is often neglected in scope creep and midlevel independence is their respective leadership orgs want them to have all the independence, pay, and prestige, and none of the liability that comes with that independence. Soon as shit hits the fan, they need a physician to absorb the legal ramifications. Also, not sure if the AANP has changed their thoughts on this, but when asked whether or not they practice medicine, a previous AANP president has punted the answer by saying NPs "practice healthcare." Rather convenient to assume they should be called "doctors" in clinical settings, say what they do is equivalent to what MDs and DOs do, and they can avoid governance/oversight by state medical boards by hiding behind the fact that they have "nurse" in their true title.
Second year PA student here… I chose PA school to avoid the toxic environment of physician training, knowing I wouldn’t get the depth of pathophys and the ability to treat more challenging cases that my physician colleagues would have. To me, that sacrifice was worth it, however, I have never thought of my future career path outside of direct physician supervision. My state has independent practice for NPs but not PAs. I am scared that the lines will become more blurred soon. I am on clinical rotations with medical students and know that while I have a decent foundation, my clinical knowledge as definite limits. As I begin to look for jobs soon, I am praying that I will have consistent, direct supervision. I have never met a mid level/APP who calls themselves doctor in a clinical setting or thinks of themselves as anywhere near equal to a physician (though I do live in a conservative state). The mindset of my PA colleagues is not what scares me, the improper use of mid levels by medical administration, along w/ the online NP degrees mills is what scares me. I appreciate that my curriculum has been rigorous, but it is not medical school or residency, and I’ve yet to meet someone who would claim them to be the same? It upsets me that there are many aprn programs out there watering down what it means to be a mid level, as well as organizations blurring the lines between me and the colleagues that I literally chose to take on the name “assistant” for.
What has been more discouraging though- has been hearing physicians downgrade mid levels in front of me. I am not sure it is the providers themselves that are to blame, but more so the people behind the scenes trying to make money off of us.
This issue is more of hospital administration or other private practice abusing the role of PA/NPs to boost reimbursement/business while keeping operating costs lower. Midlevels were never planned to be at this point. Used correctly they shouldn’t be practicing outside of their boundaries and only keeping a clear and concise line of communication and discussing assessment & plan with their SP. An extension of an physician rather than an independent practicing entity.
“Dr.” Eric Berg has almost 10 MILLION subscribers on RUclips. Just found his channel the other day and thought it was strange that his credentials were inconspicuous. So I dug. And guess the f what? Bro is a freaking CHIROPRACTOR.
When in practice, I will refer to myself as a “physician”. By law, it’s the only profession that can use this title. Everyone is a “doctor” these days. In fact while in undergrad, I found it inappropriate to call my course instructors “doctor” but instead used professor. I do see similar professional thought patterns between CRNA’s and anesthesiologists. We are all on the same team and we all have strengths and weaknesses. For example, as a DO student, I’d be the first to admit that I think nurses have a greater capacity to provide intimate/personal patient centered care. Physicians do not spend a fraction of the time in the room with the patients in comparison to nurses. They also learn about nursing theory during undergrad. They have their unique skill set and we have ours. Also, if the professional lines become even closer, I won’t be signing off or checking any of NP/PA’s work. If there are an equivalent, they will be treated as such.
And if they’re equivalent they need to pay the same amount of malpractice insurance. One can’t cherry pick the responsibility and have the same title. Only physicians are physicians
Would you also not consult on a case of an MD/DO colleague. In all 50 states APP’s are in fact able to be sued independently of their attending physician. So you’re right I also think APPs should pay the same malpractice…. If their wages get closer to that of physicians
Physician assistant here - I can’t tell you how many times I have corrected patients who call me Dr… Explain the differences over and over again, I always introduce myself with my first name and tell them I am a PA. My opinion is that PAs started to get into the doctoral education only because of doctoral creep… NP‘s , physical therapists, pharmacists, etc. it was an attempt to level the playing field, especially in leader ship roles. All the above have doctoral degrees as their terminal degree. I taught for several years, and our masters prepared PAs had more clinical and didactic hours than the NP‘s physical therapists and pharmacists who were awarded doctoral degrees. Some of the thought was that our students were doing more work and putting in more time, but earning a lesser degree, so perhaps they should also be getting a doctoral degree. I am not aware of any physician assistant who use the title doctor in their clinical practice, rather it is reserved for academia or research titles, etc.. there are some doctoral programs that are clinically-based - but the majority of them are business, research, or leader ship based.- and it is the business, research or leadership roles that prefer doctoral degrees.
If most PA programs are 2 years and a few months, I’m confused how they have more didactic and clinical hours than the other professions? DPT is usually 3.3 years for most programs with a whole year of cadaver dissection and over a year of full time clinical work. Pharmacists go to school for 4 years for their doctorates and have many clinical rotations prior to graduation. I’d be careful assuming these other programs are “easier” or “less intense” than PA. I think they are all pretty damn hard and we still had to go through process of publishing research and give dissertations to earn our doctorates. I think it’s a bit insulting to other professions.
@@cortneyzeiler3785 We usually just refer to them as PA. Physician assistant is a mouthful. Using their actual names also work. But I totally get that it can sound awkward. It’s a matter of getting used to it
@@hollyrogers8793 I don't think OP meant to insult, but could have worded it better. Most PA schools do not have semester breaks, unlike pharm/DPT/NP schools. Also, many NP schools have clinical rotations that are not full time, as often times NP school is designed for nurses who are still working full or at least part time. That does not mean the coursework for any school is easier than any other. Most of the information will compare PA and NP school, but that's what OP is referring to in terms of, on paper, they typically complete fewer hours and credits and are rewarded a doctorate instead of a masters.
Pharmacists are doctors of Pharmacy and specialize in a field that is different than DO/MD’s do we aren’t mid level providers and they focus on completely different tasks such as dispensing and compounding medications. I wouldn’t compare them. A pharmacist couldn’t replace a physician and a physician couldn’t replace a pharmacist.
I agree with you 100 %! Thank you for covering this topic. It’s the huge elephant in the room in the medical field. I believe the name physician should help alleviate some just some of the confusion. I’m concerned about medicine going forward. Isn’t there a specific scope of practice for mid levels? Has it not been defined? This is confusing 😮 and frankly I’m afraid for patients today.
I was an ICU nurse for 5 yrs before I started med school last year. I have never understood why a healthcare provider would want to claim more knowledge and experience than they have. It just makes you look worse when you flounder. The funny thing is, a lot of mid-levels DO own up that they don't have the same expertise as a physician. For example, I worked on a Neuro ICU and we had an NP and PA that helped manage the neurosurgery patients with the team. We had a pt who needed a bronchoscopy and the intensivist immediately looked for the mid-levels to give them a chance to do the bronch. They were both cagey about doing it, but eventually the NP came. She had to be walked through it and had some major bedside confidence issues, but she did it. How would you feel if you had only done a bronchoscopy twice and that was 5yrs ago! The SAME! Of course she didn't have parity with the intensivist.her entire graduate program was the same amount of time as his FELLOWSHIP ALONE! Mid-levels absolutely have a place at the table in healthcare, they are awesome to work with and help fill a critical need. But they don't have the training or experience to be a "doctor"
Ok, i cant speak to NPs, as i have no idea. But im currently a PA student. Maybe the state of Utah is different tgan others, but your perspective here definitely has not been my experience in what PAs think. We do not want the name "associate" to get more autonomy. We want it because its ridiculous that MDs should be held accountable for the work PAs do when the MD isnt even present. We should be accountable to our own decisions. Here in the state of Utah we are can practice on our own, but only after 10,000 hours of experience, which equates to a residency. Please correct me if im wrong on that part. We are also under the umbrella of the American Medical Association and are generally well respected by MDs, at leadt here in Utah. We offload the more routine medical complications so the MDs can put their skill to the more complicated patient cases. We are designed for better patient care and better lives for MDs. And by law, we are required to tell patients our title. Its criminal to not do so. But i do love your point that we are not equal in terms of total experience, training, and knowledge. I very much agree. As a PA, I would definitely be sending my patients to MDs who need more advanced care. But roughly 90% of patient care is routine medical problems that are not advanced. Thats why we are needed so badly. Primary care. And meta analysis shows that the best patient outcome happens when MDs and PAs work together. Second place is MDs alone, and last place is obviously PAs alone.
As always, we continue to love you, because of who you are, Dr. Jubbal! Can this be because pf underpopulation? I.e. there are a lot of demands on the healthcare system so there is more need for healthcare workers (and the system is crunched for time as well, so need to graduate midlevel practitioners since training takes shorter) essentially? Just curious, thanks! (Underpopulation= more older people, less younger people)
Former army medic, currently premed. I worked at a for-profit urgent care where the PA (also owner) forced the medical staff to inform the patients they will be seen by a “provider” - I was fired within a few days of being hired because I didn’t follow along. Pts actually believed they were being seen by a doctor. The new NP there was a CNA 3 years ago and swabbed people for everything under the sun. Oh, and can’t forget a chest X-ray just in case. I’m curious to see where this will all lead to in the coming years.
@kevinjubbalmd I to say this although I am a practicing APRN with a DNP, I don't even use the term "doctor" with patients and colleagues - they just simply call me by my first name or as Mr. ..... I don't ever want to be called "doctor" because my training in no way is equivalent to the training that you and your MD/DO colleagues go through i.e. 4 years undergrad, 4 years MD/DO, and 4-7 years of residency and fellowship, when an NP has roughly 500- 700 hours of clinical training - a miniscule of what you folks go through. Even experience doesn't substitute. One doesn't know what he/she doesn't know. An excellent RN develops his/her critical thinking from repetitive pattern recognition for different disease states and acting upon it, which takes years to develop, but do not have an in-depth understanding of what is going on pathophysiology wise. I agree and support what you do!! Keep it up Dr. Jubbal!!!! I also want to say that I am a practicing nurse practitioner who has been diagnosed with IBD for some time.
Hey! I thought you did a GREAT job on your DO vs MD video. I thought it was 100% accurate. I'm a DO. I'm proud of being a DO. You wouldn't want me to do any osteopathic manipulation on you - since I can't even remember which way to turn the top of a ketchup bottle to open it... but I'm a great geriatrician! It's not the most glamorous doctor field - but it's rewarding and fun for me! As for this video - again - love it. I love working with NPs because it takes a lot of work off me. But ONLY with NPs who want to continuously learn. The biggest problem I have found is exactly what you said. NPs only know what they know. And there is quite a lot that they don't know. In addition, they do not even know how much they don't know. I'm still constantly learning, and I've been a geriatrician for 20plus years. Look what is going on with new medications and diagnostics for Alzheimer's Disease right now! That leads me to the ONE thing you didn't mention in the video that is super important! NPs do NOT have to do any CME! Not a single hour! Well, at least in Florida that is. I believe DOs and MDs have the same CME requirements. About 40 CME hour requirements in the state of Florida every 2 years and an additional 120 hours of CME every 3 years for my board certifications for the AOA! ha ha! This is the way it SHOULD be! One of the NP's I work with told me the truth - to become an independent practitioner - all she had to do was pay the state 250 dollars. And she has NO CME requirements - ever! Scary and bothersome.
I’m a PA. I didn’t know NPs didn’t have to do CME. I know they don’t need to take another board exam to recertify. That’s a difference between them and us as well. We have to retake our board exam (PANRE) every 10 years. Every 2 years, we have to have 100 hours of CME to renew our licenses. The same hours can be used for our state and national licenses though so we don’t need to do 200 hours to keep them both up.
As a DPT we are taught in school to never call ourselves doctors. Its crazy to me when i see PA, NPs, and chiros refer to themselves as Drs. and even more concerning when they are asked directlty if theyre a medical doctor and give a wishwashy answer that doesnt clarfiy anything to a patient
Thank you, Dr Jubbal! I just matched into residency and I'm glad someone is finally talking about this. NPs and PAs intentionally misleading patients with title inflation is a patient safety and informed consent issue!
@@TheToxicMegacolon bro's mad lolll. He's talking generally, just like Kevin Jubbal is, by commenting on the matter. He didn't say "I know so many NPs and PAs intentionally misleading patients", he was simply commenting on the matter. I assume your are a PA or NP and that hurt you for some reason. Focus on doing actual and useful training first.
PA here. In my training we are taught to remind patients that we are not physicians and to correct patients if they call us Dr. Calling yourself doctor in a clinical setting without being a physician is technically illegal. I def agree in physician led team care, and there should be well designed/thought out mid level to physician bridge programs to ease this seemingly ceaseless competition between them and provide a more straightforward path to doctor-hood for mid levels.
I couldn’t agree more. You have articulated my thoughts much better than I have. I am currently an NP working in the ED. Have been doing it for seven years. I just enrolled in school to finish requirements to take MCAT and get into medical school for all of the reasons you have stated. It is actually scary some of the “new” grad NP coming out. You are correct. They don’t know what they don’t know. I am also not putting my self on a higher step but I am actively trying to change my discontent.
I'm a PA wrapping up my DMSc. My program specifically emphasized that we are NOT to introduce ourselves as "Doctor ____" in the a clinical setting because the courses are NOT clinical base. They are to gain more experience if we decide to pursue a more administrative role. We are allowed to introduce ourselves as so if we are presenting or speaking in an educational setting or whatever. Are some APPs actually introducing themselves as Dr at clinic/hospitals???? Im so confused. However, I do wish they changed the name of degree to be less confusing to employers who read my resume.
@@angelinalionetta685 Of Course! Let me do a little digging, and I’ll post it for you :) It was years ago when I was deciding between PA/MD. Basically, a girl was in HS and her mom got really sick and the provider she interacted with the most was a PA, which inspired her to go to PA school. After PA school, she had six months of training by the MD she worked for. In terms of knowledge, she hit a plateau. The MD told her she knew what she needed to do her job and that if she was really passionate about learning more, she might consider med school. She did and was amazed at how in depth it was compared to PA school. That’s the jist!
At the end of the day, it’s all about patient safety and accountability. If you make a mistake and harm a patient as an NP or PA, you are held to a lower standard in malpractice proceedings than physicians are. As long as that is true, NPs and PAs should not have the same responsibilities as physicians do.
Yes! Thank you! When I was trying to start my own Home Care nursing business, I was getting the run-around as I contacted various nursing resources for accurate information on regulations. This was partly because when I took the course to get my certification for the specialization, the nursing instructor began with, "This is what you say on the test because that's regulation, and this is what you do in real life...". Actually, her first statement was "You will all pass". She was right, all the nurses in the class passed and went out into their various communities NOT practicing regulation and thereby putting their patients at risk. Anyways, one of the nursing organizations finally offered to give my number to a private nurse. To their credit, he finally told me straight. The only reason those organizations existed was to collect money (in the form of registration fees) to pay for extremely inadequate malpractice insurance. I finally left nursing a couple years later. But I still have the debt to show for it.
@@OP-gt3rh I would really encourage you to be strategic about leaving. I kept trying to make nursing pay for itself while trying to avoid the bullying, but ultimately I ended up leaving suddenly, without much of a plan, and it took the better part of a decade below the poverty line to overcome the debt. I had gone into home care to work alone and avoid most of the bullying (my nurse managers still scammed me, but that's another story). I started my own small nursing home care business which was growing. However I had nearly maxed out my credit card to get things started. So when my car suddenly went belly-up, so did my business. My only option was to return to the larger facilities where bullying is at its worst, so I took a full-time job at a plant, and a part-time cleaning job to pay the bills. This is not how I would recommend leaving nursing, but it's how I made my transition. Today, I'm working a part-time job at minimum wage while trying to study full-time, still living at or below the poverty level, but at least I'm finally getting an education. So, please try to be as strategic as possible about leaving nursing - unless your debt is already paid off. I sincerely wish you the best of luck! :)
As a doctor who practiced over 40 years in hospital ORs, ERs, in patient, out patient and private office settings I watched the transition to share patient care with NPs and PAs. As a result of my personal observations I would prefer to be evaluated by a MD for a physical or any issues.
I always thought that the PA profession was made to help out physicians by having people able to take in less complex cases (i.e., common cases), and the rest are left to the physicians. But even then, PAs still have to collaborate with the physicians. I'm pursuing PA school, and I don't expect to have the same scope of practice as physicians once I'm a PA. I don't know why any mid-level providers would even claim to be doctors. It would mislead patients, and so potentially harming them. Patients always have to be informed who is in their care team to avoid confusion.
I wish. I started my first job as a PA in family medicine and I was seeing patients just as complex as the physicians and even more complex sometimes. I barely had any on the job training and started seeing 14 patients of my own after shadowing a NP for 2 days. I wish I could have had the easier patients and let the physicians have the harder ones. I would have felt way more comfortable and I might have stayed at that job. I left after 22 months because I was afraid some of the people I wouldn’t know exactly what to do and may hurt someone. So I moved states (my husband got a job in a different state) and now I am looking for a job and I’m making sure it has good training. Is when you’re looking for a job please ask those questions.
Mid-level scope creep is a symptom, not an underlying issue. The core problem is a shortage of medical care in the United States. If you're worried about PAs and NPs having expanded privileges, then you should advocate for a massive increase in residency spots - more residency spots, more physicians to fill the shortage. If a patient has to wait months to schedule an appointment with a doctor, I can see why he or she would rather see an independently practicing NP.
They don’t want to see the midlevel. They get forced to because of lack of physician availability. Everyone would rather see the doctor let’s be honest
If PAs want to call themselves doctors and some will in fact do so because it’s the same with some teachers, they want to be called Dr because they got a PhD, then we will need a complete overhaul and advertisement campaign to spread awareness that the word Dr only means you studied and got a PhD or equivalent. The title Dr has been confusing ever since physicians started using it as their career name. Anyone in research, teaching setting, or a work environment that requires a PhD have been calling themselves Drs for awhile now. Problem: Public sees title Dr as a Physician Solution: Come up with a simple introduction including Dr for both but differentiating their role.
Public sees doctor as someone who holds a doctorate degree. Only in a hospital do people equate doctor as physician. Even at the dentist, no one thinks their dentist is a physician just because they go by doctor
When I tell you, I went to go see a psych nurse practitioner and she said she would be offended if you called her a nurse because she has her DMP and I just stared and stared and stared. Did I mention I stared? 😂😂😂
No prerequisites for medical school. That is laughable. What does a doctor of health science even do? What are the potential career options? Great potential video for MSI. For all potential students caveat emptor. Research diligently before taking out very real loans that you will have to pay back.
I have a masters of health sciences and I can tell you that I have NEVER used it. I am in medical school to get the real degree of MD. DHS I can only imagine as a longer masters degree but they will not be a physician
exactly why I’m considering going to CRNA school rather than med school to specialize in anesthesiology. I’ve known a couple of CRNAs to make well over 300-400k a year or $ 200-300 dollars an hour easily; which is more than your average family medicine doc makes and about the same as other physicians make being beat out only by the competitive specialties like Neuro, Cardio, Derm & Plastics. Honestly at this point, a part of me feels I would only pursue being a physician for the title and prestige…and I doubt that’d be sustainable in the long run.
That makes me sad because I do feel that providers should get paid more and during their training. It shouldn't be about mid levels vs provider. We should be on the same team to treat the patient.
Though I agree with majority of what you are saying. The issue of being called a doctor in a clincal setting is primarly on the nursing side. DMSc is very very new and intended for admin and educational rolls NOT in the clincal setting to enhance your scope. DMSc is the result of DNPs and lobbying to compete with the midlevel market. Majority of PAs do not have a issue of calling themselfs doctor or thinking they are higher trained than a physcian.
A DNP introducing themself as doctor is absolutely ridiculous. It's equally as bullshitty as someone getting a doctorate in business administration and introducing themself as doctor. So embarrassing.
Here's the real truth. NPs have gained a stranglehold over "mid-level "job markets in certain regions for a multitude of factors which include better market ability with their profession, being backed by the nurses union and therefore a stronger lobbying powers, suboptimal diploma mills spitting out thousands of NPs, an NP can start working immediately under their nursing license while Hospital credentialing/Privilages are processed. What is a sleeve PAs!? Suboptimal lobbying. The impression that we are less educated as our degree is a masters level and nurses are doctorate level. Despite our more rigorous training in the context of medical model didactic and clinical curriculum which emphasizes physician collaboration. Our physician colleagues have been proponents of the PA model and it is becoming more strained the more and more nurse practitioners are requesting continued regulation changes to increase their scope which then places PAs in the predicament to obtain their slice of the pie or be excluded every time nurse practitioners put forth a bill or expand current regulations.
I'm not a physician or mid level. I'm not currently in either school. I've been in the medical field for a few years and I'm applying to medical school next year as as a 38 year old non-traditional student. I completely understand the content that you are discussing and I agree with the content. With that said, I was lectured for a long time by someone with a doctorate in economics. He told me the term doctor was around a lot longer than the physicians who are currently dominating the term doctor. The long and short of his rant was that scholars who were masters of their field were awarded the term doctor. He said physicians were distantly referred to as physicians. I decided to look it up. The term doctor came about in the 1300s and was bestowed upon those who mastered their field. It wasn't until the 17th century physicians started using the term and it eventually became the term used to refer to physicians. He was very salty about it and it turns out he was right. Physicians get very bent out of shape about others using their title an it turns out, it's not even their title to claim ownership of. I don't know the right answer here. Obviously, keeping the patient informed and looking out for their wellbeing is to priority. It needs to be clear to the patient, who they are seeing. It also isn't wrong for the mid-level to introduce themselves as doctor, since they legitimately earned their title the same as any business, economics, history, English, or law graduate did. The honest reality is the physicians took the title from the other scholars, who are seemingly unwilling to stop using the title, the honestly earned. Maybe we need a different designation for physicians, so there isn't any confusion in the clinic? I a don't pretend to know the answer. Again, I'm on your side with the meat and potatoes of your video, but I am not sure how to approach a title that doctor's don't really control.
A doctorate of economics/history/English/law can call themselves doctor in the lecture hall. Not in a medical setting. It means something different in that context. And coming up with new designation just confuses patients further.
Good luck on applying to medical school!! When you get there you’ll understand using the term doctor in a clinical (patient facing) setting. The Latin word doctor means teacher so technically lawyers are “doctors” (juris doctor). The general population doesn’t know Latin and doesn’t have a fancy education so we meet them where they’re at. They understand doctor as medical doctor and by the time they are coming in for help they don’t want a history lesson they just want to feel better. So in a clinical setting someone with a PhD in engineering should not call themselves doctor. Anywhere outside the clinic that’s what they are and can be called Dr. So & So, PhD
@@kevinjubbalmd DMD, DDS, PharmD, PhD of clinical psychology and PhD of microbiology are all examples of people that use doctor in a clinical setting yet you still don’t see people going to their therapist for a tooth ache or to their dentist for a belly ache. Furthermore, PCPs aren’t doing major surgery. Patients don’t seem confused that their “doctor” isn’t the guy performing their surgery. That’s the other doctor who has experience in that field. If we really thought the title doctor would be confusing then we should get rid of it as even MD/DO’s have a wide array of specialties. Maybe that’s how we all should identify ourselves. Not as Dr. but as whatever specialty you are. in the grand scheme of things it wasn’t until within the last century that DO’s gained practice rights as physicians. Medicine is still young and adapting, we can either adapt with it and make it work, increase the training and incentives to continue learning no matter what level you’ve reached to ultimately benefit our patients. Or, we can fight and fight and fight to keep our sacred titles ultimately harming patients in a proverbial genital measuring contest. Yes, there is a controversy. But what are you doing to help. Are you training PAs and NPs to be better clinicians and medical providers? The scope will change.
Exactly lol, I agree mid level creep is an issue but, seriously anyone with a doctorate degree should be given respect for the amount of effort and time they put in for that.
As a PA student, the term “assistant” doesn’t do the profession justice. Especially when you have PA’s in the ER placing central lines, chest tubes, intubating patients, etc.. or those in private practice seeing just as many patients as their supervising physician. The profession is constantly confused with medical assistants. So a name change is justified, however, a different name would have been better. Furthermore, the doctorates for PA’s really only helps them in moving into higher administrative roles in academia. It will not change anything in the clinic. Last but not least, I am fully cognizant of the fact that physicians have more extensive training. If they offered PA’s a minimum 3 year + residency across various specialties the gap in knowledge would be nearly indistinguishable. Regardless, that will likely never be approved for PA’s, so it is what it is.
It's also important to understand that there are so many titles in healthcare. Patients mostly only know "doctor" and "nurse". They don't know anything else unless they're versed in healthcare. Look at Optometrists for example. They are not physicians either yet patients usually call them "doctor". It's silly that only physicians can be called a doctor. BUT I do agree that if used out of context then it can be misleading. I feel like NPs who have a doctorate should clarify in the clinical setting if they want to be referred to as "doctor". "I'm Dr. XYZ, the Nurse Practitioner." So at least patients can also learn that there are other provider types as well.
Im very proud to be a nurse but if I earned my DNP and if I did introduce myself as a doctor (unlikely) I would say " Hi im Dr. Ryan, doctor of nursing" My state allows this along as I clarify that I am not a physician. But in reality I would introduce my self as a nurse practitioner, I have to much respect for the doctors I work with.
That’s an overreach of the point he was making. Being called a doctor is valid as long as you hold a doctorate degree like a PhD. Dentists, Pharmacists, Physical Therapists, and Psychologists also go by doctor and so do some lawyers. The difference between the things I’ve listed here and PAs and NPs is that PAs and NPs do a similar job to an MD/DO and work exclusively alongside Physicians so it’s easy to cause confusion and for inappropriate scope creep to occur.
@@environmentalnews6040 In the hospital the only one that called himself/herself the doctor is the physician. When someone said, "is there a doctor in the house?" do you see someone with PhD degree standing up and saying "I am a doctor". Yes, the PhD is a doctor but that is only in the classroom not in the hospital. We are talking about the healthcare environment
Honestly the real issue is there aren’t enough MD/DO’s to keep up with amount of demand. If we had more residencies and more seats in schools to support the ever increasing demand. I believe mid levels was a short term fix to a long term problem.
I’m a PA so I’ll put in my thoughts on this. So yeah, we are not a fan of the name mid level providers. I personally (and I feel the majority) like the name advanced practice providers better if you’re going to lump us with NPs. Although we would rather just be called PAs because most PAs (like me) are very proud of our career. Most of us do not equate ourselves to physicians and do not think we are physicians. PA school interviews actually try to weed out those that are either using PA as a backup plan or do not really want to be a PA (or May want to go to med school later but in that.. why go to PA school. Literally a waste of time and money). I became a PA because I wanted to be a PA. I did not want to be a physician (well I did my first semester in college but that’s because I had never heard of PAs). After I heard of PAs, that’s what I wanted to do. I do want to work collaboratively. I was in family medicine as my first job where I had a lot of autonomy. I saw all of my own patients. I actually was unhappy with that. I had basically no on the job training. They had me shadow a NP for 2 days and then they had me seeing 14 patients of my own the next day.. I was not happy with that because I wanted more supervision and help especially as my first job. That’s why for my next job, I’m making sure I have good training (and not in family medicine). My top is going to be general surgery or hospital medicine. These are because in these fields I feel like there is a lot more teamwork and hopefully I’ll learn a lot. I’ll say about the “doctor” most PAs who get their doctorate are not doing it to be called doctor in clinical setting. Most of it’s for educational purposes in PA programs. My program director had her doctorate. We called her Dr. In our program but she always said that anytime we are in a clinical setting, do not call her doctor. And that’s what I believe too. Only MDs and DOs should be called doctor in the clinical setting. I honestly feel like it’s more the NPs that go into their doctorate to be called doctor in clinic settings (I feel that alot more NPs also get their doctorate - and it seems straight from their BSN to their doctorate instead of their masters first where for PAs you get your masters first and then you can do additional schooling for your doctorate if you want). I’m not saying that’s all NPs either as some NPs do have the same stance as me with only calling doctors “doctor” in clinic. When I’m in office, I always introduce myself as “hi I’m Lisa, the PA”.
PA’s have a scope. Medicine is a collaborative effort. The issue is some people do not want to practice within their scope. After being a PA for 21 years I work very closely with my attending and discuss patients so that I can have the best patient outcomes.
Buddy, I hear you. In my field there is what you would call "mid fields" but at the same rate, the thing that separates us/titles is a couple more years of school and experience. In no way would I consider them less capable of doing my job and I think the same applies to ARNP/PA to MD/DO. given the "midfields" acquire the experience needed to match yours.
I will always see this as an issue of ego. If you've earned a doctorate, you have the right to use the title. That being said, you're correct that the training varies. However, the number of hours can be debated. Your analogy was insightful. I believe an Advanced Practice Provider (APP) is only as effective as the physicians they work with, much like nursing assistants are to nurses. I understand your concern about potentially misleading patients, but whose responsibility is that? Ultimately, "Doctor" is just a title and not exclusive to physicians. Even if that's not your point, one could argue that MDs and DOs contribute to patient confusion by advocating treatments outside their specialties, which I witness often, both professionally and personally. If you call yourself "doctor," it's your responsibility to specify your field, or it's the patient's responsibility to ask-it's called due diligence for a reason. Patients do it all the time when selecting surgeons or avoiding pain medication they're allergic to, except for Dilaudid.
I think that this an important discussion to have because there are a lot of differences in PA/NP school versus DO/MD. As someone who is in nursing school and planning on continuing my education to get by DNP I would not call myself a doctor even though I would have a doctorate. It's important to recognize that all routes are hard and you have to be incredibly dedicated to whatever you do. Just as a Nurse has the nurse practice act based on their training so should NP/PA's and so should MD's. When we work outside of our scope of practice that is when issues arise and patients can get hurt. I think that although getting your MD takes more time and harder doesn't mean that getting your PA/NP is easy though. I personally do not see an issue with the term mid level because it is an accurate description education wise, BSN's typically get around 4 years of education when NP/PA's get around 7 years total and MD's get the most out of the group which is why I understand they get paid the most compared to the others. I will say though Nurses, NP/PA's, and DO/MD's should all be getting paid more in general.
You hit the nail on the head with they are all hard. Being a nurse is NOT easy by any means easy. Comparing their training to physicians training is skewed because something is hard until you do something harder then the comparison seems “easier” but that’s flawed logic. My master’s in health sciences was hard when I was in it. I cried almost every day lol. Now that I can compare it to medical school, there is a significant difference in rigor. If I take my student doctor brain into the master’s program I’d call it lightwork but that’s not fair because those are two different cognitive developments. Third grade math is hard to a first grader but easy to a 10th grader. It’s all relative.
I agree as someone who wants to become a PA. I don’t want the MD/DO responsibility. I however this this needs to be a video more directed at the organizations. AAPA and such. They are pushing for it more than what I see from individuals. Unless they are lying and hiding behind their computer screens.
Currently a NP student at a top rated program I would love to go to med school/med school route if A) residency wasn’t legalized slavery.If residents were paid like mid levels and worked mid level hours. I’d go that route. B) if residency didn’t high jack your entire life where you had to go where residency is for years. I want the further education I’d be be okay being a junior doctor for a decade making midlevel pay graduating upward as I develop into a physician worthy of being an attending. I want to continue to better myself as a provider without directly sacrificing my life to the profession. Proposed change. Med school duration and rigor stays same Graduation pick your specialty apply if you don’t get into it Primary care / apply for another /try again Begin working as essentially a midlevel under an attending To develop your experience and practice. But compensation of a resident being at a RN’s pay with a physicians debt and demanding then do 80 hrs a week is bs. Let them work 40-60 pay them like seasoned midlevel until they finish residency. Residency can extend out more years if the patient care hours need to be obtained.
Kevin, it’s about freaking time you started talking about this. Thank you for speaking out about this issue. Their massive lobbying efforts tend to silence us. We need you.
Excellent video. This is my 13th year in medical training, only so I can provide the best care to my patients after understanding the basic pathophysiology. Don’t tell me that it can be done in 5-6 years because it just cannot be.
I am a medical student, and it is amazing that people would lead the public to believe that there are no pre-requisites for medical school. In addition to taking 300-400 level biology, chemistry, physics, social sciences, and psychology, as pre-meds, we had to have robust leadership, research, volunteer, and clinical resumes. On top of that we had to take the MCAT (PA takes the GED) which was essentially a comprehensive exam of all those upper-level classes we took for the 4 years of undergrad. I don’t say any of this to brag or flex, just to fill in that big empty blank on that one graphic that said there are no pre-requisites for medical school. I feel that it is a very slippery and dangerous slope to allow mid-level providers to refer to themselves as doctors. One reason I believe this is because physicians (DO/MD) complete a 4-year bachelor’s degree, 4 years of medical school then 3-7 years of residency with the option to obtain further training through fellowships and CMEs. So right off the bat, on paper, there is a lot more years of training involved. Secondly, PA curriculum does not go to the same depth when it comes to pathophysiology of disease. Due to time constraints during training, they are mostly taught how to recognize pathology and match that to appropriate treatment but have limited understanding of what is causing the underlying disease and what other factors might contribute. By calling themselves doctors, they are misleading the public into believing that they have that breadth of knowledge when they really do not. I understand that PA applicants are required to have more clinical hours on average than an applying medical student. This stems from the roots of the PA path. From what I understand, the title and licensure for PA was originally designed for medical personnel from the military could enter the medical field at a higher level than a lay person. For example, if someone served in the military for 10 years as a medic and is now leaving the military and looking for a second career, they could fast track into a higher skill position because of their hundreds or even thousands of hours of clinical and even battlefield experience. They may have been middle aged with families or just not wanting to spend 11 years in school to begin their second career, so working as a physician’s assistant with a much shorter educational time frame was perfect. This, I don’t believe, is not the typical PA applicant in 2023. Many, including myself as a premed, consider the decreased liability and shorter training time of PA to be appealing and they opt for that route. It is a sacrifice to go to the additional years of training to become a physician. This is why they get paid more. That, and they shoulder all of the liability of practicing medicine, because ultimately, all decisions made by themselves or the PA working under them, falls on their shoulders.
I have a minor correction. A lot of schools require the GRE (the GRE is what you take to “graduate” high school if you don’t finish high school). Although they have now developed a PACAT which some schools require instead. I think that’s more similar to the MCAT as I think it has sciences in it and such, but it was developed when I got into a PA program so of course i did not take it. I did take the GRE twice. You are correct about the reason the profession was made and going back to the military. I had over 10k hours of direct patient care hours before PA school (5 years full time). I became a PA because I wanted to work as a team, not be a doctor. But I also did not want to be a nurse.
I agree with him 100%, as a DNP. Btw, what's wrong with the term "mid-level"? To be fair, studies show that NPs in primary care settings provide comparable care to physicians. HOWEVER, the same studies also show that NPs unnecessarily order more referals and diagnostic tests that physicians. Of course, this is because we have less training. It's simple.
It seems many mid level providers are very happy with their scope of work and compensation. I graduated undergrad this previous fall and have been taking the spring to work as an ER tech and gain some experience; ask some questions. I personally have never overheard any midlevels portraying to be something they aren’t, if anything I’ve heard them emphasize that they aren’t a doctor. Physicians seem to be the most stressed point of a very flawed system. While on RUclips there are encouraging content creators who are trying to combat the problem… it’s tough seeing and hearing how tired and chewed up the people I know and look to in real life are. I’ve been struggling to answer why I want to go through so much just to join them, more than I’d like to at this point in my journey.
I agree. I think instead of complaining and being threatened by mid-levels they should be advocating or lobbying for more residency positions, and making medical school more accessible to people who want to pursue the career.
This was a good video. I’m a NP with a masters level Education and the DNP degree is a joke. The board of education needs to step in and put a stop to how much money these NP programs make out of students and give every little in return as far as clinical experience goes. + 100K programs and the NP students are left having to find our own preceptors to follow. One of the instructors said it was because there are no federal funding for NP programs like they do for MD programs. My RN school was very structured with hands on training. I can’t tell the same about the NP program especially for the money we spend trying to better ourselves and advance in our career- the programs did not deliver. I did not have the money to go to med school nor was I eligible for federal aid because I was an international student so went to RN school, got my citizenship and after working acute care/burnout left the bedside to work as a NP. NPs are not trained at the same level as a MD. I haven’t met any NPs who think they are… Most Family NP pay is pretty low or on the same pay level as a RN. I admire any nurse who can work the bedside forever.., it’s hard back breaking work. I personally would not recommend my kids going into nursing. 😢
Everyone wants to be a doctor but no one wants to go to med school
Everyone wants to be a doctor but no one wants to do a 40Q random timed block of UWorld.
@@NishantGogna As someone in my dedicated period this hurts HAHA
Yeah buddy
@@NishantGogna dang bro, why’d u have to hurt my feelings like that lol (med student in dedicated rn)
Facts!!!
As someone who currently works very closely with surgeons and doctors, and is planning to attend PA school soon, I completely agree. Every day I’m in awe and inspired by how much knowledge and expertise our doctors have. It’s very extensive training and there’s no way someone could possibly bypass or “shortcut” that. As a PA I want to help alleviate some of the stress MDs have by taking on more regimented patients while still providing high quality of care, to open up their time for more highly complex cases which we see so much of unfortunately. Ideally, it should be a symbiotic relationship.
You have a very mature understanding of the value of PAs and NPs. Good luck and congratulations!
this is exactly how NPs and PAs should work....as an RN I just can't wrap my head around how any PA/NP wants to be more responsible with less training....
You haven’t been to PA school yet. So of course you’re in awe. PA school is like med school condensed into two years instead of 4.
@XYZ-sq7ki PA school is not like physcian school, stop lying. Midlevels will never be on the same level as MD'S/ DO's
@@vincentalakija5515he is not saying they have the same amount of training they used the same medical module and it’s a lot harder because you have to learn so much in such a shorter space of time. No one gives PAs the credit they deserve. They have the highest attrition rate than any other medical trained professional. I know a few people who failed out of PA school and made it through medical school. PA school is also by far the most competitive and hardest to get into.
EM physician here. Thanks Kevin for speaking out on such a controversial issue. I am grateful for all my APP colleagues, but in my limited 7 years of experience, I believe patient care is still best delivered as a team with physician oversight.
PA here and I completely agree.
I may be just an ERT and I completely agree with you on that :).
Is the real difference in the education or the clinical practice (i.e. residency) and it's delivery?
I understand that the didactic component of medical school is much more rigorous than that of NP/PA school, but an NP/PA could theoretically study the didatic components of medical school (since it seems like medical curriculums are streamlined through the likes of Khan academy and such). I know a PA who did this and would take mock USMLE exams through U World to help determine his level of clinical knowledge. If an NP/PA were to do this and "pass" their mock step exams what would then be the difference between them and an MD/DO (outside of credentialing)?
At this point it seems like it would be their clinical training. But how does residency differ from being a practicing NP/PA as it relates do developing a more comprehensive understanding and not just developing strong pattern recognition? In the hospitals where I've worked (all academic hospitals) it seems like NPs/PAs do the exact same as resident physicians; so how do 4 years of residency make for more qualified providers than say 6 years of NP/PA experience?
I have seen, as an ICU RN deciding between MD/CRNA for career progression, horrible mismanagement of patient care from providers who are not suited to that specific patient. That means APPs and MD/DOs. Heart failure pts managed by cards, stepdown pts managed by APPs, it's all bad and detrimental. That being said, Drs are MD/DOs. More complex pt care must be managed by the best candidate: Drs.
As a PA Student currently on rotations, I couldn't agree more with this. Our professional organizations (whom btw, the advocacy board isn't even run by actual PAs, but by Poli Sci/MBA majors who see financial benefit in expanding scope), are unfortunately seeking to delude newer PAs into thinking their understanding of Pharmacology, Pathophysiology, and Clinical Medicine is just as robust as a Physician's, which is clearly not true. Even now, I very have significant gaps in knowledge compared to resident physicians let alone the attendings. We play a valued role on the healthcare team and I truly cannot wait to do my part to treat patients effectively.
But this is something both Midlevels and Physicians need to discuss for the sake of patient safety. I as a PA Student am always clear of my role as a "Physician Assistant Student" and intend to always introduce myself as the Physician Assistant to patients moving forward because as someone who's been a patient myself, I would not be comfortable with someone who is misconstruing their title and level of expertise, so why should I delude anyone else?
Well said.
Glad you have the humility and security to speak the truth. I would hire you as my PA!
Regulation and Board needs to speak out
I am a FNP who does have a DNP. I will never, EVER, call myself a doctor in a clinical setting, I am not a physician. I do not want to be a physician - if I did, I would have gone to med school. I may use doctor in academic settings, just as someone who has any other academic doctorate, but never EVER would I use it in a clinical setting. It blurs the lines, causes confusion, and is simply inappropriate. DNP's were originally meant to teach health care management as well as teaching skills, but many places are beginning to move towards going straight to a DNP instead of MSN for NPs as a way to blur the line between a physician and midlevels, its entirely wrong in my opinion. I completed my DNP so I could teach part time, not to call myself a doctor to patients.
Some people want to be a physician - great! But it is not for everyone, and not everyone wants to do that job, that's where midlevel or RN's come in. We all have our roles to play, and we all are meant to be working together in collaboration. It's really a shame that a lot of younger NPs and PAs are being told that they're "practically a physician."
I'm a PA and I really make it clear to my patients that I am the PA and who my attending physician is.
My dad’s an MD anesthesiologist and my favorite quote by him is that “physicians understand the ‘why’ of disease processes and CRNAs react to vital signs.” This is obviously an over simplification but it points to the difference in understanding and managing complex disease states. He’ll also be the first to tell you that CRNAs play a very critical role in the healthcare system. They, however, are not physicians and don’t possess a physicians level of understanding.
Thank you for talking about this! I appreciate you taking the time to discuss this as a soon to be MD! It feels like many people have neglected this topic in leadership who otherwise should be advocating for us but I am proud you continuously bring this up. I think us young physicians feel very strongly it's important to be physicians that are leaders of the healthcare team and we all work together within our role to better the health of the patient.
This really needs to be a bigger topic. NPs and PAs are great, but their limitations are extensive (which is fine, they aren’t docs), but some in their community are almost brainwashed into thinking bizarre things like they are equivalent, mid level is a derogatory word, or that a doctorate will get them closer to MD/DOs. This type of thinking is propagates by PA schools (especially at Lynchburg). It’s honestly scary to see the lines being blurred, and hospital admin taking advantage of that. This isn’t only scary for the public, but also mid levels themselves. More and more they have incredible high expectations and are put in dangerous situations by their employers, very often as brand new trainees.
It's not brainwashing. A midlevel is basically a permanent resident. If you work as a resident for 10+ years, you're going to know how to practice just like the attending physician. The problem is there is no certification or limitation that distinguishes the 10+ years from the 0 years midlevel. A surgeon for example must log 150 continuing medical education credits and pass an exam every 2 years to maintain their certification, where as a nurse practitioner who's spent 15 years working in psychiatry can swap to surgery tomorrow without any further training.
10+ years acting as a lower level resident, often with no call responsibilities, and little to no surgical experience ( in surgical subspecialties). So no, after 10 years of making lower level decisions they are not at the level of knowledge of an attending. Not to mention all the knowledge outside of that particular specialty that an attending has from their medical school training.
@@VKingMD in the academic setting mid levels who function as “interns” might have the same responsibilities, but they receive none of the challenge. The attending doesn’t challenge mid levels or make them think through plans, think about differentials or evidence based decision making. The seniors and attendings tell the mid level what they would like done and the mid levels complete said tasks. There is no growth. They don’t become seniors and teach interns. They don’t do nights and make calls without backup. They don’t rotate through different specialties to learn the breadth. It’s not the same.
@@Allhailbillcoleman I agree that their experience is very different, and that different experience is the problem. Many PAs, particularly in the academic setting where there are actual trainees, don't have much room for growth. However, PAs in the community setting have the opportunity to adopt more of an apprentice than an assistant role. Given enough experience, if they can demonstrate equivalent competency upon scrutiny and examination, I would be in favor of offering a highly challenging accelerated avenue to become a physician. Afterall the 4 year medical school with mandatory residency is far from an ancient practice.
Yup! This is totally true! So many people apply an illogical way of thinking when it comes to PAs...and I agree with you there is no way right now to test the competency of a PA with 0 experience vs a PA with 10 years of experience
Big shout out to Ronnie Coleman who has a few words to say on this topic around 2 min mark: ruclips.net/video/mu5WzOL8-O8/видео.html
Well said. DO student with a NP student fiancé here.
This topic of conversation is not lost on us; most important dimension in my eyes is to strive for honest respect and synergy between our differences in training and education. It is not a competition, we should all be on the same, humble team.
I totally agree with you. I have worked in different hospitals as an imaging technologist(radiology and CT) and honestly I realized how valuable their help is to physicians(partially due to physician shortage) specially in ER and ICU but lobbying to have an independent path and practice is totally wrong. They always should be supervised by physicians. Medicine is an extremely complicated science and that is why medical schools have many years of didactic and clinical courses before letting doctors start practicing.
Well said
Partially due to physician shortage is an understatement. They only exist because of the physician shortage. Most countries function without them, but most countriest don't have thousands of MDs who can't find a residency position
Believe it or not most PA are in agreement.
While in the Air Force our doctors we see most of the time are NPs. I seen two of them within a week and the both diagnosed me with just a cough. I didn’t feel right and shortly after went somewhere else. I met with a doctor told them what the other NPs told me and he listened to my breathing for less than ten seconds. Without saying anything, he called in a med student to listen to my lungs. The med student within a short span told the doctor it was pneumonia in my left lung and he agreed. Ever since I always held even a med students opinion above that of an NP. I could have gotten worse if not died if I didn’t go see a real doctor.
Pneumonia from auscultation is wild, let me guess they put you on antibiotics 😏?
The problem here is imaging confirmation that shows consolidation. There is no way to diagnose pneumonia by auscultation. It could have been bronchitis. This is why I can’t always agree with MDs either because a lot of them will do anything for money.
Yea, you can't diagnose pneumonia from simply listening.
But regardless, things like wheezes and crackles should not be missed. Unfortunately it does happen though.
But that is not a reflection of mid-level providers vs MDs. It's a reflection of the NP who missed it.
Auscultation is a basic skill that even lower providers are quite proficient at. As a current paramedic, it's not to hard to catch.
One thing I learned going into clinical years of medical school and residency is that practicing medicine is nuanced because often there are more disease processes going on with multiple factors affecting outcome . You need the medical background to understand what is going on and the clinical experience to understand the nuances and problem solve based on the entire clinical picture.
I am a NP, I am very aware I am not on the same level as a MD/DO. I always introduce myself as a NP so there is no confusion. I also am going back to school for my doctorate. In California, we are not allowed to call ourselves doctors in the clinic setting to avoid confusion with patients and staff.
There needs to be more collaboration and education. I love the flexibility in my work schedule and it's the reason I chose a different path but still able to provide patient care within my scope of practice.
Once you get your doctorate, will you be allowed to call yourself doctor to patients?
@@Adductor_Magnusshe said no in the last sentences
Then why bother getting the doctorate if you can’t call yourself doctor… more titles huh
@@stevenvargas6863 She said she's an NP now but that she was going back to school to get her doctorate. I was asking if she'd expect patients to call her doctor once she gets her doctorate.
You're doing it right! An NP/PA that understands their scope and limitations is an asset to our healthcare system.
Those that constantly push to expand the scope beyond its intended limits are a danger!
Ooohh I can speak on this from my personal experience. I am a first year medical student. The volume of material is unimaginable so for my most recent exam, when I was running out of time to study, I overly relied on pattern recognition. Because I did not understand all the nuisance I missed a passing grade by 2 points 😬
I leaned (and I already knew) that pattern recognition is not enough. You can recognize the pattern but you have to understand the pattern. In understanding the details you can make and extrapolate the pattern.
Pattern recognition can be memorization which gives a false sense of security. You have to know the WHY so when the pattern doesn’t present and what you are used to, you aren’t confused.
The disorder didn’t read the textbook. How you think it’s going to present is not enough to catch it. Every human and every pathogen/disease process is different. There can be some overlap but that’s not always enough to catch it. Those minor details could be the difference between life and death. Literally.
Meanwhile, many nursing students describe their courses online as being "fluff" and "busy work", and as an ex-nurse I completely agree.
100% agree with you.
There is no shortcut to becoming a doctor.
It’s too early, I’ll come back 🍿
😂absolutely!!
Did you ever come back
Clinical medicine is a very specific term. Having a PhD and being a clinician are totally different sciences. There is a lot that goes into patient interaction from before you walk into the room to after you leave there are procedures and nuisance. How you handle the patient (laying them down, sitting them up, touching them) is it’s own skill form. Timing of your history and physical exam matters and there is a balance between efficiency and compassion. I’m my medical school there is an entire class of the clinical aspects of medicine because that’s what makes a good doctor. Literally anyone can learn the sciences but there is also an art to medicine. You can be the smartest person in the world and not necessarily a good physician.
This is exactly the kind of public health advocacy that we need. Our patients deserve to be served by the best trained among us, i.e. MD/DOs, not midlevels.
Midlevels pursuing independent practice and autonomy puts their self interests above that of the public. It’s disingenuous at best and places greed over patient care.
We as a profession need to continue increasing the visibility of this issue to the public and our politicians so we can best protect and serve the health of our communities.
Everytime I go to urgent care to see a doctor, there’s always just a Physician Assistant!!! Most of the time there is no doctor around! Not sure why we pay so much to not even get to see a doctor lol
You should know by now urgent care was not designed with a physician in mind. It was meant as a place to go when you could not get an appointment with your PCP and you have a UTI or sore throat and need medicine. The problem is people come in there thinking that it’s an emergency room because they are sick and want to pay less. Unfortunately, they get sent to the emergency room and end up paying more.
As a new PA-C, I have no problem with the mid-level designation. I know my training has not been as in-depth as that of a physician. I have no desire to step beyond my scope of practice. My desire is to work with a doc who is approachable and willing to share their knowledge for the joint goal of providing high-level care to patients.
Ahhh, this is so satisfying ☺️ the reason why I say this is because Interns or medical students in clinical settings in various countries have to understand they should not rely on NPs or OT-assistants, I’ve often noticed them giving completely wrong information with full confidence to new Interns, whenever you have a question, always ask a physician or a surgeon and don’t shy away from that, that will indeed make you a great doctor true to its core, rather than getting wrong info or being perceived as a junior doctor who just doesn’t know.
Thank you for this video, Kevin! I really enjoy seeing your takes on these controversial and hot topics, glad to see that you're taking the responsibility in making them.
Completely agree with your video. Glad to see this is being recognized as a major issue in medicine today.
ICU PA here. Also big fan of your content. I think one big thing you missed in this video/your take on this is the fact that a lot of the DMSc stuff has come to fruition simply to try to match the current “DNP” model. PAs have masters degrees. NPs used to as well however their governing body decided to inflate that to a “doctorate”. This was largely to have their education model produce more money. PA education has yet to do this and is now being forced to come up with a solution to match this misguided degree inflation. Most of the PAs who are getting DMSc are doing so because it’s required to teach at PA programs or required in order to move into leadership roles. It does not come with significant pay increase for the most part. I agree that mid levels who don’t recognize that they don’t know everything and have received limited training in comparison to MDs is super dangerous. I wish PA programs did a better job of screening people with these personalities out. Also any PA/NP worth a grain of salt would never go by the term “doctor”. The reality is there is a small minority of midlevels/CRNAs who are actively fucking it up for the rest of us.
Yes the DNP is a joke just making more money for the graduate schools. I’m a NP with a masters degree.., the school will need to pay me to go back for a DNP and write papers for them to grade.
I'm glad its just a small miniority
Facts.
Well said! I completely agree with how the amount and intensity of training is unmatched between MD/DO from mid-levels. I don't think people understand or appreciate the level of rigor that is constantly present in med school, and undervaluing the education by comparing it to DMsc or DNP is disrespectful. No hate to anyone, but I think everyone needs to know their respective roles and understand that each role is important in it's own unique way.
Thank you for continually speaking out about this, you’re one of the only real big media personalities who says it as it is
The reason I am going for PA is exactly for the limitations in the scope of practice and designation. I don’t mind at all being under the supervision of physicians, I actually want that! I want to be part of a medical team, but I don’t want to have the last word, especially when a case really warrants it. Pretending to be at the level of a physician is disrespectful and narcissistic in nature, IMO.
As challenging as the first two years of medical school have been for me mentally, emotionally, financially, and physically, I am so thankful for the immense amount of KNOWLEDGE I have gained. I have learned so much in these past two years and there is still at minimum 5 more years of training to go before I will be an attending physician.
I love your comment on "pattern recognition" and I think if more people recognized that, they would agree that physician does not equal midlevel provider.
That comparison where they say MD has no prerequisites I believe is taken from Duke University (or some other top tier school) but it's so badly out of context because it's only one cherry picked school and if you look at the prerequisites on the PA side, to score an MCAT that would get you into Duke would require you to be a master at all of them. So Duke basically says "we don't have any official prerequisites as long as you get a 520 on the MCAT and have a bachelor degree and compelling story and tons of clinical and volunteer hours and publications." So yeah totally no prerequisites
We are facing the same problem of scope creep here in the UK. Mind if I share this around?
Please and thank you !
AMEN BROTHER PREACH IT. DNP to Premed here. Just sat for MCAT and submitted my primary. You don't know what you don't know. This video speaks to my soul and this needs to be broadcasted to every citizen of the US.
My thing is that as a first year Family Medicine attending, I would NOT have been able to handle patient care well right out of medical school. It was upsetting how much I had to learn as a resident and how much I still have to learn just to be a decent doctor. It was weird how weak the correlation between testing and actual practice there was.
The issue is that people have gargantuan and often unrealistic expectations of doctors; it's hard to be smart, wise, good with your hands, observant, compassionate and relatable all simultaneously. Some folks balk at anything but this mythical perfect doctor, when in reality with the doctor shortage many providers actually have less experience and aren't DOs or MDs. There should be an expectation of growth and reasonable assistance for doctors, while respecting the scope of midlevel providers.
I feel that Midlevels are an excellent resource but their scope should be more defined. ALSO, having more certificates and clearer indications of what a provider knows and can do would help (ex: what procedures they can do, what they tend to treat specifically etc.)
Completely disagree with you. PAs are generalists. Physicians are specialists. If physicians go through so much training, but the end of training their scope of practice is usually narrowed down to specific board certifications and hyper specialities - even if they had more broad exposure in training
Another thing I feel is often neglected in scope creep and midlevel independence is their respective leadership orgs want them to have all the independence, pay, and prestige, and none of the liability that comes with that independence. Soon as shit hits the fan, they need a physician to absorb the legal ramifications. Also, not sure if the AANP has changed their thoughts on this, but when asked whether or not they practice medicine, a previous AANP president has punted the answer by saying NPs "practice healthcare." Rather convenient to assume they should be called "doctors" in clinical settings, say what they do is equivalent to what MDs and DOs do, and they can avoid governance/oversight by state medical boards by hiding behind the fact that they have "nurse" in their true title.
Second year PA student here… I chose PA school to avoid the toxic environment of physician training, knowing I wouldn’t get the depth of pathophys and the ability to treat more challenging cases that my physician colleagues would have. To me, that sacrifice was worth it, however, I have never thought of my future career path outside of direct physician supervision. My state has independent practice for NPs but not PAs. I am scared that the lines will become more blurred soon. I am on clinical rotations with medical students and know that while I have a decent foundation, my clinical knowledge as definite limits. As I begin to look for jobs soon, I am praying that I will have consistent, direct supervision. I have never met a mid level/APP who calls themselves doctor in a clinical setting or thinks of themselves as anywhere near equal to a physician (though I do live in a conservative state). The mindset of my PA colleagues is not what scares me, the improper use of mid levels by medical administration, along w/ the online NP degrees mills is what scares me. I appreciate that my curriculum has been rigorous, but it is not medical school or residency, and I’ve yet to meet someone who would claim them to be the same? It upsets me that there are many aprn programs out there watering down what it means to be a mid level, as well as organizations blurring the lines between me and the colleagues that I literally chose to take on the name “assistant” for.
What has been more discouraging though- has been hearing physicians downgrade mid levels in front of me. I am not sure it is the providers themselves that are to blame, but more so the people behind the scenes trying to make money off of us.
This issue is more of hospital administration or other private practice abusing the role of PA/NPs to boost reimbursement/business while keeping operating costs lower. Midlevels were never planned to be at this point. Used correctly they shouldn’t be practicing outside of their boundaries and only keeping a clear and concise line of communication and discussing assessment & plan with their SP. An extension of an physician rather than an independent practicing entity.
“Dr.” Eric Berg has almost 10 MILLION subscribers on RUclips. Just found his channel the other day and thought it was strange that his credentials were inconspicuous. So I dug. And guess the f what? Bro is a freaking CHIROPRACTOR.
Wait what ?! I thought Dr berg was an Md all along 🤔
When in practice, I will refer to myself as a “physician”. By law, it’s the only profession that can use this title. Everyone is a “doctor” these days. In fact while in undergrad, I found it inappropriate to call my course instructors “doctor” but instead used professor. I do see similar professional thought patterns between CRNA’s and anesthesiologists. We are all on the same team and we all have strengths and weaknesses. For example, as a DO student, I’d be the first to admit that I think nurses have a greater capacity to provide intimate/personal patient centered care. Physicians do not spend a fraction of the time in the room with the patients in comparison to nurses. They also learn about nursing theory during undergrad. They have their unique skill set and we have ours. Also, if the professional lines become even closer, I won’t be signing off or checking any of NP/PA’s work. If there are an equivalent, they will be treated as such.
And if they’re equivalent they need to pay the same amount of malpractice insurance. One can’t cherry pick the responsibility and have the same title. Only physicians are physicians
Would you also not consult on a case of an MD/DO colleague. In all 50 states APP’s are in fact able to be sued independently of their attending physician. So you’re right I also think APPs should pay the same malpractice…. If their wages get closer to that of physicians
Yeah I went in for a physical exam and they had this person in that was a “Doctor” but was just a nurse practitioner getting a PHD
It’s not to say that NPs aren’t hard workers and smart- it’s just a different kinda thing
Physician assistant here - I can’t tell you how many times I have corrected patients who call me Dr… Explain the differences over and over again, I always introduce myself with my first name and tell them I am a PA. My opinion is that PAs started to get into the doctoral education only because of doctoral creep… NP‘s , physical therapists, pharmacists, etc. it was an attempt to level the playing field, especially in leader ship roles. All the above have doctoral degrees as their terminal degree. I taught for several years, and our masters prepared PAs had more clinical and didactic hours than the NP‘s physical therapists and pharmacists who were awarded doctoral degrees. Some of the thought was that our students were doing more work and putting in more time, but earning a lesser degree, so perhaps they should also be getting a doctoral degree. I am not aware of any physician assistant who use the title doctor in their clinical practice, rather it is reserved for academia or research titles, etc.. there are some doctoral programs that are clinically-based - but the majority of them are business, research, or leader ship based.- and it is the business, research or leadership roles that prefer doctoral degrees.
It’s just awkward to say, “excuse me physician assistant so and so..”. “Doc” is easier, lol. I’m saying this as a patient tho.
If most PA programs are 2 years and a few months, I’m confused how they have more didactic and clinical hours than the other professions? DPT is usually 3.3 years for most programs with a whole year of cadaver dissection and over a year of full time clinical work. Pharmacists go to school for 4 years for their doctorates and have many clinical rotations prior to graduation. I’d be careful assuming these other programs are “easier” or “less intense” than PA. I think they are all pretty damn hard and we still had to go through process of publishing research and give dissertations to earn our doctorates. I think it’s a bit insulting to other professions.
@@cortneyzeiler3785 We usually just refer to them as PA. Physician assistant is a mouthful. Using their actual names also work. But I totally get that it can sound awkward. It’s a matter of getting used to it
@@hollyrogers8793 I don't think OP meant to insult, but could have worded it better. Most PA schools do not have semester breaks, unlike pharm/DPT/NP schools. Also, many NP schools have clinical rotations that are not full time, as often times NP school is designed for nurses who are still working full or at least part time. That does not mean the coursework for any school is easier than any other. Most of the information will compare PA and NP school, but that's what OP is referring to in terms of, on paper, they typically complete fewer hours and credits and are rewarded a doctorate instead of a masters.
Pharmacists are doctors of Pharmacy and specialize in a field that is different than DO/MD’s do we aren’t mid level providers and they focus on completely different tasks such as dispensing and compounding medications. I wouldn’t compare them. A pharmacist couldn’t replace a physician and a physician couldn’t replace a pharmacist.
I agree with you 100 %! Thank you for covering this topic. It’s the huge elephant in the room in the medical field. I believe the name physician should help alleviate some just some of the confusion. I’m concerned about medicine going forward. Isn’t there a specific scope of practice for mid levels? Has it not been defined? This is confusing 😮 and frankly I’m afraid for patients today.
PA here. I completely agree with the points in this video. Training is vastly different.
I was an ICU nurse for 5 yrs before I started med school last year. I have never understood why a healthcare provider would want to claim more knowledge and experience than they have. It just makes you look worse when you flounder. The funny thing is, a lot of mid-levels DO own up that they don't have the same expertise as a physician.
For example, I worked on a Neuro ICU and we had an NP and PA that helped manage the neurosurgery patients with the team. We had a pt who needed a bronchoscopy and the intensivist immediately looked for the mid-levels to give them a chance to do the bronch. They were both cagey about doing it, but eventually the NP came. She had to be walked through it and had some major bedside confidence issues, but she did it. How would you feel if you had only done a bronchoscopy twice and that was 5yrs ago! The SAME! Of course she didn't have parity with the intensivist.her entire graduate program was the same amount of time as his FELLOWSHIP ALONE!
Mid-levels absolutely have a place at the table in healthcare, they are awesome to work with and help fill a critical need. But they don't have the training or experience to be a "doctor"
How's med school going for you?
Ok, i cant speak to NPs, as i have no idea. But im currently a PA student.
Maybe the state of Utah is different tgan others, but your perspective here definitely has not been my experience in what PAs think.
We do not want the name "associate" to get more autonomy. We want it because its ridiculous that MDs should be held accountable for the work PAs do when the MD isnt even present. We should be accountable to our own decisions.
Here in the state of Utah we are can practice on our own, but only after 10,000 hours of experience, which equates to a residency. Please correct me if im wrong on that part.
We are also under the umbrella of the American Medical Association and are generally well respected by MDs, at leadt here in Utah. We offload the more routine medical complications so the MDs can put their skill to the more complicated patient cases. We are designed for better patient care and better lives for MDs.
And by law, we are required to tell patients our title. Its criminal to not do so.
But i do love your point that we are not equal in terms of total experience, training, and knowledge. I very much agree. As a PA, I would definitely be sending my patients to MDs who need more advanced care.
But roughly 90% of patient care is routine medical problems that are not advanced. Thats why we are needed so badly.
Primary care.
And meta analysis shows that the best patient outcome happens when MDs and PAs work together. Second place is MDs alone, and last place is obviously PAs alone.
As always, we continue to love you, because of who you are, Dr. Jubbal! Can this be because pf underpopulation? I.e. there are a lot of demands on the healthcare system so there is more need for healthcare workers (and the system is crunched for time as well, so need to graduate midlevel practitioners since training takes shorter) essentially? Just curious, thanks! (Underpopulation= more older people, less younger people)
Former army medic, currently premed. I worked at a for-profit urgent care where the PA (also owner) forced the medical staff to inform the patients they will be seen by a “provider” - I was fired within a few days of being hired because I didn’t follow along. Pts actually believed they were being seen by a doctor. The new NP there was a CNA 3 years ago and swabbed people for everything under the sun. Oh, and can’t forget a chest X-ray just in case. I’m curious to see where this will all lead to in the coming years.
Giving a X-ray without clinical indication exposes the patient to unnecessary radiation SMH
YIKES
@@HoangTran-eu7eu - And COST to the medical system.
😮
Thank you. I'm an RN and I was confused about where to go next. I think med school will be better
@kevinjubbalmd I to say this although I am a practicing APRN with a DNP, I don't even use the term "doctor" with patients and colleagues - they just simply call me by my first name or as Mr. ..... I don't ever want to be called "doctor" because my training in no way is equivalent to the training that you and your MD/DO colleagues go through i.e. 4 years undergrad, 4 years MD/DO, and 4-7 years of residency and fellowship, when an NP has roughly 500- 700 hours of clinical training - a miniscule of what you folks go through. Even experience doesn't substitute. One doesn't know what he/she doesn't know. An excellent RN develops his/her critical thinking from repetitive pattern recognition for different disease states and acting upon it, which takes years to develop, but do not have an in-depth understanding of what is going on pathophysiology wise. I agree and support what you do!! Keep it up Dr. Jubbal!!!!
I also want to say that I am a practicing nurse practitioner who has been diagnosed with IBD for some time.
Hey! I thought you did a GREAT job on your DO vs MD video. I thought it was 100% accurate. I'm a DO. I'm proud of being a DO. You wouldn't want me to do any osteopathic manipulation on you - since I can't even remember which way to turn the top of a ketchup bottle to open it... but I'm a great geriatrician! It's not the most glamorous doctor field - but it's rewarding and fun for me!
As for this video - again - love it. I love working with NPs because it takes a lot of work off me. But ONLY with NPs who want to continuously learn. The biggest problem I have found is exactly what you said. NPs only know what they know. And there is quite a lot that they don't know. In addition, they do not even know how much they don't know. I'm still constantly learning, and I've been a geriatrician for 20plus years. Look what is going on with new medications and diagnostics for Alzheimer's Disease right now!
That leads me to the ONE thing you didn't mention in the video that is super important! NPs do NOT have to do any CME! Not a single hour! Well, at least in Florida that is. I believe DOs and MDs have the same CME requirements. About 40 CME hour requirements in the state of Florida every 2 years and an additional 120 hours of CME every 3 years for my board certifications for the AOA! ha ha! This is the way it SHOULD be! One of the NP's I work with told me the truth - to become an independent practitioner - all she had to do was pay the state 250 dollars. And she has NO CME requirements - ever! Scary and bothersome.
I’m a PA. I didn’t know NPs didn’t have to do CME. I know they don’t need to take another board exam to recertify. That’s a difference between them and us as well. We have to retake our board exam (PANRE) every 10 years. Every 2 years, we have to have 100 hours of CME to renew our licenses. The same hours can be used for our state and national licenses though so we don’t need to do 200 hours to keep them both up.
Great video, thank you for speaking up against this craziness
As a DPT we are taught in school to never call ourselves doctors. Its crazy to me when i see PA, NPs, and chiros refer to themselves as Drs. and even more concerning when they are asked directlty if theyre a medical doctor and give a wishwashy answer that doesnt clarfiy anything to a patient
Truly intelligent people know their limitations..
Thank you, Dr Jubbal! I just matched into residency and I'm glad someone is finally talking about this. NPs and PAs intentionally misleading patients with title inflation is a patient safety and informed consent issue!
I love this! Ha ha ha!
Lies lies and more lies
@@TheToxicMegacolon bro's mad lolll. He's talking generally, just like Kevin Jubbal is, by commenting on the matter. He didn't say "I know so many NPs and PAs intentionally misleading patients", he was simply commenting on the matter. I assume your are a PA or NP and that hurt you for some reason. Focus on doing actual and useful training first.
PA here. In my training we are taught to remind patients that we are not physicians and to correct patients if they call us Dr. Calling yourself doctor in a clinical setting without being a physician is technically illegal. I def agree in physician led team care, and there should be well designed/thought out mid level to physician bridge programs to ease this seemingly ceaseless competition between them and provide a more straightforward path to doctor-hood for mid levels.
I’ve been point out this problem in healthcare for YEARS now…
I couldn’t agree more. You have articulated my thoughts much better than I have. I am currently an NP working in the ED. Have been doing it for seven years. I just enrolled in school to finish requirements to take MCAT and get into medical school for all of the reasons you have stated. It is actually scary some of the “new” grad NP coming out. You are correct. They don’t know what they don’t know. I am also not putting my self on a higher step but I am actively trying to change my discontent.
I'm a PA wrapping up my DMSc. My program specifically emphasized that we are NOT to introduce ourselves as "Doctor ____" in the a clinical setting because the courses are NOT clinical base. They are to gain more experience if we decide to pursue a more administrative role. We are allowed to introduce ourselves as so if we are presenting or speaking in an educational setting or whatever. Are some APPs actually introducing themselves as Dr at clinic/hospitals???? Im so confused. However, I do wish they changed the name of degree to be less confusing to employers who read my resume.
I’ve read blogs from current MDs (former PAs) their perspective on differences in training is very interesting.
Any links? I'd love to read!
@@angelinalionetta685 Of Course! Let me do a little digging, and I’ll post it for you :)
It was years ago when I was deciding between PA/MD. Basically, a girl was in HS and her mom got really sick and the provider she interacted with the most was a PA, which inspired her to go to PA school.
After PA school, she had six months of training by the MD she worked for. In terms of knowledge, she hit a plateau. The MD told her she knew what she needed to do her job and that if she was really passionate about learning more, she might consider med school.
She did and was amazed at how in depth it was compared to PA school.
That’s the jist!
@@cortneyzeiler3785 Thank you!
At the end of the day, it’s all about patient safety and accountability. If you make a mistake and harm a patient as an NP or PA, you are held to a lower standard in malpractice proceedings than physicians are. As long as that is true, NPs and PAs should not have the same responsibilities as physicians do.
That is not true. PAs and NPs in all 50 states can be sued independently on their supervising physician and under just as much scrutiny.
Yes! Thank you! When I was trying to start my own Home Care nursing business, I was getting the run-around as I contacted various nursing resources for accurate information on regulations. This was partly because when I took the course to get my certification for the specialization, the nursing instructor began with, "This is what you say on the test because that's regulation, and this is what you do in real life...". Actually, her first statement was "You will all pass". She was right, all the nurses in the class passed and went out into their various communities NOT practicing regulation and thereby putting their patients at risk. Anyways, one of the nursing organizations finally offered to give my number to a private nurse. To their credit, he finally told me straight. The only reason those organizations existed was to collect money (in the form of registration fees) to pay for extremely inadequate malpractice insurance. I finally left nursing a couple years later. But I still have the debt to show for it.
@@elverdad6805 good for you for leaving nursing… my goal is to leave it too.
@@OP-gt3rh I would really encourage you to be strategic about leaving. I kept trying to make nursing pay for itself while trying to avoid the bullying, but ultimately I ended up leaving suddenly, without much of a plan, and it took the better part of a decade below the poverty line to overcome the debt. I had gone into home care to work alone and avoid most of the bullying (my nurse managers still scammed me, but that's another story). I started my own small nursing home care business which was growing. However I had nearly maxed out my credit card to get things started. So when my car suddenly went belly-up, so did my business. My only option was to return to the larger facilities where bullying is at its worst, so I took a full-time job at a plant, and a part-time cleaning job to pay the bills. This is not how I would recommend leaving nursing, but it's how I made my transition. Today, I'm working a part-time job at minimum wage while trying to study full-time, still living at or below the poverty level, but at least I'm finally getting an education. So, please try to be as strategic as possible about leaving nursing - unless your debt is already paid off.
I sincerely wish you the best of luck!
:)
As a doctor who practiced over 40 years in hospital ORs, ERs, in patient, out patient and private office settings I watched the transition to share patient care with NPs and PAs. As a result of my personal observations I would prefer to be evaluated by a MD for a physical or any issues.
I always thought that the PA profession was made to help out physicians by having people able to take in less complex cases (i.e., common cases), and the rest are left to the physicians. But even then, PAs still have to collaborate with the physicians. I'm pursuing PA school, and I don't expect to have the same scope of practice as physicians once I'm a PA. I don't know why any mid-level providers would even claim to be doctors. It would mislead patients, and so potentially harming them. Patients always have to be informed who is in their care team to avoid confusion.
I wish. I started my first job as a PA in family medicine and I was seeing patients just as complex as the physicians and even more complex sometimes. I barely had any on the job training and started seeing 14 patients of my own after shadowing a NP for 2 days. I wish I could have had the easier patients and let the physicians have the harder ones. I would have felt way more comfortable and I might have stayed at that job. I left after 22 months because I was afraid some of the people I wouldn’t know exactly what to do and may hurt someone. So I moved states (my husband got a job in a different state) and now I am looking for a job and I’m making sure it has good training. Is when you’re looking for a job please ask those questions.
Mid-level scope creep is a symptom, not an underlying issue. The core problem is a shortage of medical care in the United States. If you're worried about PAs and NPs having expanded privileges, then you should advocate for a massive increase in residency spots - more residency spots, more physicians to fill the shortage. If a patient has to wait months to schedule an appointment with a doctor, I can see why he or she would rather see an independently practicing NP.
They don’t want to see the midlevel. They get forced to because of lack of physician availability. Everyone would rather see the doctor let’s be honest
If PAs want to call themselves doctors and some will in fact do so because it’s the same with some teachers, they want to be called Dr because they got a PhD, then we will need a complete overhaul and advertisement campaign to spread awareness that the word Dr only means you studied and got a PhD or equivalent.
The title Dr has been confusing ever since physicians started using it as their career name. Anyone in research, teaching setting, or a work environment that requires a PhD have been calling themselves Drs for awhile now.
Problem: Public sees title Dr as a Physician
Solution: Come up with a simple introduction including Dr for both but differentiating their role.
Public sees doctor as someone who holds a doctorate degree. Only in a hospital do people equate doctor as physician. Even at the dentist, no one thinks their dentist is a physician just because they go by doctor
When I tell you, I went to go see a psych nurse practitioner and she said she would be offended if you called her a nurse because she has her DMP and I just stared and stared and stared. Did I mention I stared? 😂😂😂
Experience does not replace training, and training does not replace experience.
No prerequisites for medical school. That is laughable. What does a doctor of health science even do? What are the potential career options? Great potential video for MSI. For all potential students caveat emptor. Research diligently before taking out very real loans that you will have to pay back.
I have a masters of health sciences and I can tell you that I have NEVER used it. I am in medical school to get the real degree of MD. DHS I can only imagine as a longer masters degree but they will not be a physician
exactly why I’m considering going to CRNA school rather than med school to specialize in anesthesiology. I’ve known a couple of CRNAs to make well over 300-400k a year or $ 200-300 dollars an hour easily; which is more than your average family medicine doc makes and about the same as other physicians make being beat out only by the competitive specialties like Neuro, Cardio, Derm & Plastics.
Honestly at this point, a part of me feels I would only pursue being a physician for the title and prestige…and I doubt that’d be sustainable in the long run.
That makes me sad because I do feel that providers should get paid more and during their training. It shouldn't be about mid levels vs provider. We should be on the same team to treat the patient.
Though I agree with majority of what you are saying. The issue of being called a doctor in a clincal setting is primarly on the nursing side. DMSc is very very new and intended for admin and educational rolls NOT in the clincal setting to enhance your scope. DMSc is the result of DNPs and lobbying to compete with the midlevel market. Majority of PAs do not have a issue of calling themselfs doctor or thinking they are higher trained than a physcian.
A DNP introducing themself as doctor is absolutely ridiculous. It's equally as bullshitty as someone getting a doctorate in business administration and introducing themself as doctor. So embarrassing.
Here's the real truth.
NPs have gained a stranglehold over "mid-level "job markets in certain regions for a multitude of factors which include better market ability with their profession, being backed by the nurses union and therefore a stronger lobbying powers, suboptimal diploma mills spitting out thousands of NPs, an NP can start working immediately under their nursing license while Hospital credentialing/Privilages are processed.
What is a sleeve PAs!?
Suboptimal lobbying.
The impression that we are less educated as our degree is a masters level and nurses are doctorate level. Despite our more rigorous training in the context of medical model didactic and clinical curriculum which emphasizes physician collaboration.
Our physician colleagues have been proponents of the PA model and it is becoming more strained the more and more nurse practitioners are requesting continued regulation changes to increase their scope which then places PAs in the predicament to obtain their slice of the pie or be excluded every time nurse practitioners put forth a bill or expand current regulations.
Can we also say that doctors from countries with less training required will also be less knowledgeable than from countries with more training
I'm not a physician or mid level. I'm not currently in either school. I've been in the medical field for a few years and I'm applying to medical school next year as as a 38 year old non-traditional student.
I completely understand the content that you are discussing and I agree with the content. With that said, I was lectured for a long time by someone with a doctorate in economics. He told me the term doctor was around a lot longer than the physicians who are currently dominating the term doctor. The long and short of his rant was that scholars who were masters of their field were awarded the term doctor. He said physicians were distantly referred to as physicians.
I decided to look it up. The term doctor came about in the 1300s and was bestowed upon those who mastered their field. It wasn't until the 17th century physicians started using the term and it eventually became the term used to refer to physicians. He was very salty about it and it turns out he was right. Physicians get very bent out of shape about others using their title an it turns out, it's not even their title to claim ownership of.
I don't know the right answer here. Obviously, keeping the patient informed and looking out for their wellbeing is to priority. It needs to be clear to the patient, who they are seeing. It also isn't wrong for the mid-level to introduce themselves as doctor, since they legitimately earned their title the same as any business, economics, history, English, or law graduate did. The honest reality is the physicians took the title from the other scholars, who are seemingly unwilling to stop using the title, the honestly earned.
Maybe we need a different designation for physicians, so there isn't any confusion in the clinic? I a don't pretend to know the answer.
Again, I'm on your side with the meat and potatoes of your video, but I am not sure how to approach a title that doctor's don't really control.
Doctor in the clinical setting has a meaning
A doctorate of economics/history/English/law can call themselves doctor in the lecture hall. Not in a medical setting. It means something different in that context. And coming up with new designation just confuses patients further.
Good luck on applying to medical school!!
When you get there you’ll understand using the term doctor in a clinical (patient facing) setting. The Latin word doctor means teacher so technically lawyers are “doctors” (juris doctor).
The general population doesn’t know Latin and doesn’t have a fancy education so we meet them where they’re at. They understand doctor as medical doctor and by the time they are coming in for help they don’t want a history lesson they just want to feel better. So in a clinical setting someone with a PhD in engineering should not call themselves doctor. Anywhere outside the clinic that’s what they are and can be called Dr. So & So, PhD
@@kevinjubbalmd DMD, DDS, PharmD, PhD of clinical psychology and PhD of microbiology are all examples of people that use doctor in a clinical setting yet you still don’t see people going to their therapist for a tooth ache or to their dentist for a belly ache. Furthermore, PCPs aren’t doing major surgery. Patients don’t seem confused that their “doctor” isn’t the guy performing their surgery. That’s the other doctor who has experience in that field. If we really thought the title doctor would be confusing then we should get rid of it as even MD/DO’s have a wide array of specialties. Maybe that’s how we all should identify ourselves. Not as Dr. but as whatever specialty you are.
in the grand scheme of things it wasn’t until within the last century that DO’s gained practice rights as physicians. Medicine is still young and adapting, we can either adapt with it and make it work, increase the training and incentives to continue learning no matter what level you’ve reached to ultimately benefit our patients. Or, we can fight and fight and fight to keep our sacred titles ultimately harming patients in a proverbial genital measuring contest.
Yes, there is a controversy. But what are you doing to help. Are you training PAs and NPs to be better clinicians and medical providers? The scope will change.
Exactly lol, I agree mid level creep is an issue but, seriously anyone with a doctorate degree should be given respect for the amount of effort and time they put in for that.
Cannot wait to come read the comments later tonight
Everyone wants to be an (x) but no one wants to lift these heavy ass books
As a PA student, the term “assistant” doesn’t do the profession justice. Especially when you have PA’s in the ER placing central lines, chest tubes, intubating patients, etc.. or those in private practice seeing just as many patients as their supervising physician. The profession is constantly confused with medical assistants. So a name change is justified, however, a different name would have been better.
Furthermore, the doctorates for PA’s really only helps them in moving into higher administrative roles in academia. It will not change anything in the clinic.
Last but not least, I am fully cognizant of the fact that physicians have more extensive training. If they offered PA’s a minimum 3 year + residency across various specialties the gap in knowledge would be nearly indistinguishable. Regardless, that will likely never be approved for PA’s, so it is what it is.
doctorate for PA in administrative roles is an attempt to blur the line
It's also important to understand that there are so many titles in healthcare. Patients mostly only know "doctor" and "nurse". They don't know anything else unless they're versed in healthcare. Look at Optometrists for example. They are not physicians either yet patients usually call them "doctor". It's silly that only physicians can be called a doctor. BUT I do agree that if used out of context then it can be misleading. I feel like NPs who have a doctorate should clarify in the clinical setting if they want to be referred to as "doctor". "I'm Dr. XYZ, the Nurse Practitioner." So at least patients can also learn that there are other provider types as well.
Im very proud to be a nurse but if I earned my DNP and if I did introduce myself as a doctor (unlikely) I would say " Hi im Dr. Ryan, doctor of nursing" My state allows this along as I clarify that I am not a physician. But in reality I would introduce my self as a nurse practitioner, I have to much respect for the doctors I work with.
Totally agree, I said that many time, if you want to be called as a Doctor, then go to medical schools
That’s an overreach of the point he was making. Being called a doctor is valid as long as you hold a doctorate degree like a PhD. Dentists, Pharmacists, Physical Therapists, and Psychologists also go by doctor and so do some lawyers. The difference between the things I’ve listed here and PAs and NPs is that PAs and NPs do a similar job to an MD/DO and work exclusively alongside Physicians so it’s easy to cause confusion and for inappropriate scope creep to occur.
@@environmentalnews6040 In the hospital the only one that called himself/herself the doctor is the physician. When someone said, "is there a doctor in the house?" do you see someone with PhD degree standing up and saying "I am a doctor". Yes, the PhD is a doctor but that is only in the classroom not in the hospital. We are talking about the healthcare environment
Wow! Thanks for this video.
Honestly the real issue is there aren’t enough MD/DO’s to keep up with amount of demand. If we had more residencies and more seats in schools to support the ever increasing demand. I believe mid levels was a short term fix to a long term problem.
I’m a PA so I’ll put in my thoughts on this. So yeah, we are not a fan of the name mid level providers. I personally (and I feel the majority) like the name advanced practice providers better if you’re going to lump us with NPs. Although we would rather just be called PAs because most PAs (like me) are very proud of our career. Most of us do not equate ourselves to physicians and do not think we are physicians. PA school interviews actually try to weed out those that are either using PA as a backup plan or do not really want to be a PA (or May want to go to med school later but in that.. why go to PA school. Literally a waste of time and money). I became a PA because I wanted to be a PA. I did not want to be a physician (well I did my first semester in college but that’s because I had never heard of PAs). After I heard of PAs, that’s what I wanted to do. I do want to work collaboratively. I was in family medicine as my first job where I had a lot of autonomy. I saw all of my own patients. I actually was unhappy with that. I had basically no on the job training. They had me shadow a NP for 2 days and then they had me seeing 14 patients of my own the next day.. I was not happy with that because I wanted more supervision and help especially as my first job. That’s why for my next job, I’m making sure I have good training (and not in family medicine). My top is going to be general surgery or hospital medicine. These are because in these fields I feel like there is a lot more teamwork and hopefully I’ll learn a lot. I’ll say about the “doctor” most PAs who get their doctorate are not doing it to be called doctor in clinical setting. Most of it’s for educational purposes in PA programs. My program director had her doctorate. We called her Dr. In our program but she always said that anytime we are in a clinical setting, do not call her doctor. And that’s what I believe too. Only MDs and DOs should be called doctor in the clinical setting. I honestly feel like it’s more the NPs that go into their doctorate to be called doctor in clinic settings (I feel that alot more NPs also get their doctorate - and it seems straight from their BSN to their doctorate instead of their masters first where for PAs you get your masters first and then you can do additional schooling for your doctorate if you want). I’m not saying that’s all NPs either as some NPs do have the same stance as me with only calling doctors “doctor” in clinic. When I’m in office, I always introduce myself as “hi I’m Lisa, the PA”.
This is a comment section, not a journal
PA’s have a scope. Medicine is a collaborative effort. The issue is some people do not want to practice within their scope. After being a PA for 21 years I work very closely with my attending and discuss patients so that I can have the best patient outcomes.
Buddy, I hear you. In my field there is what you would call "mid fields" but at the same rate, the thing that separates us/titles is a couple more years of school and experience. In no way would I consider them less capable of doing my job and I think the same applies to ARNP/PA to MD/DO. given the "midfields" acquire the experience needed to match yours.
Thank you, Dr. Jubbal, for being a voice of truth and reason! Keep up the good work!
I will always see this as an issue of ego. If you've earned a doctorate, you have the right to use the title. That being said, you're correct that the training varies. However, the number of hours can be debated. Your analogy was insightful. I believe an Advanced Practice Provider (APP) is only as effective as the physicians they work with, much like nursing assistants are to nurses. I understand your concern about potentially misleading patients, but whose responsibility is that? Ultimately, "Doctor" is just a title and not exclusive to physicians. Even if that's not your point, one could argue that MDs and DOs contribute to patient confusion by advocating treatments outside their specialties, which I witness often, both professionally and personally. If you call yourself "doctor," it's your responsibility to specify your field, or it's the patient's responsibility to ask-it's called due diligence for a reason. Patients do it all the time when selecting surgeons or avoiding pain medication they're allergic to, except for Dilaudid.
I think that this an important discussion to have because there are a lot of differences in PA/NP school versus DO/MD. As someone who is in nursing school and planning on continuing my education to get by DNP I would not call myself a doctor even though I would have a doctorate. It's important to recognize that all routes are hard and you have to be incredibly dedicated to whatever you do. Just as a Nurse has the nurse practice act based on their training so should NP/PA's and so should MD's. When we work outside of our scope of practice that is when issues arise and patients can get hurt. I think that although getting your MD takes more time and harder doesn't mean that getting your PA/NP is easy though. I personally do not see an issue with the term mid level because it is an accurate description education wise, BSN's typically get around 4 years of education when NP/PA's get around 7 years total and MD's get the most out of the group which is why I understand they get paid the most compared to the others. I will say though Nurses, NP/PA's, and DO/MD's should all be getting paid more in general.
You hit the nail on the head with they are all hard. Being a nurse is NOT easy by any means easy. Comparing their training to physicians training is skewed because something is hard until you do something harder then the comparison seems “easier” but that’s flawed logic.
My master’s in health sciences was hard when I was in it. I cried almost every day lol. Now that I can compare it to medical school, there is a significant difference in rigor. If I take my student doctor brain into the master’s program I’d call it lightwork but that’s not fair because those are two different cognitive developments.
Third grade math is hard to a first grader but easy to a 10th grader. It’s all relative.
Based MCAT merchant.
Jokes aside- appreciate you using your platform for this.
I agree as someone who wants to become a PA. I don’t want the MD/DO responsibility. I however this this needs to be a video more directed at the organizations. AAPA and such. They are pushing for it more than what I see from individuals. Unless they are lying and hiding behind their computer screens.
The comparison of PAs and NPs are night and day education wise also......
Currently a NP student at a top rated program
I would love to go to med school/med school route if
A) residency wasn’t legalized slavery.If residents were paid like mid levels and worked mid level hours. I’d go that route.
B) if residency didn’t high jack your entire life where you had to go where residency is for years.
I want the further education I’d be be okay being a junior doctor for a decade making midlevel pay graduating upward as I develop into a physician worthy of being an attending.
I want to continue to better myself as a provider without directly sacrificing my life to the profession.
Proposed change.
Med school duration and rigor stays same
Graduation pick your specialty apply if you don’t get into it
Primary care / apply for another /try again
Begin working as essentially a midlevel under an attending
To develop your experience and practice.
But compensation of a resident being at a RN’s pay with a physicians debt and demanding then do 80 hrs a week is bs.
Let them work 40-60 pay them like seasoned midlevel until they finish residency.
Residency can extend out more years if the patient care hours need to be obtained.
Just look at the amount of training that goes into becoming a true medical professional (physician) v.s. a crna/pa etc. Totally different jobs.
Kevin, it’s about freaking time you started talking about this. Thank you for speaking out about this issue. Their massive lobbying efforts tend to silence us. We need you.
Excellent video. This is my 13th year in medical training, only so I can provide the best care to my patients after understanding the basic pathophysiology. Don’t tell me that it can be done in 5-6 years because it just cannot be.
I am a medical student, and it is amazing that people would lead the public to believe that there are no pre-requisites for medical school. In addition to taking 300-400 level biology, chemistry, physics, social sciences, and psychology, as pre-meds, we had to have robust leadership, research, volunteer, and clinical resumes. On top of that we had to take the MCAT (PA takes the GED) which was essentially a comprehensive exam of all those upper-level classes we took for the 4 years of undergrad. I don’t say any of this to brag or flex, just to fill in that big empty blank on that one graphic that said there are no pre-requisites for medical school. I feel that it is a very slippery and dangerous slope to allow mid-level providers to refer to themselves as doctors. One reason I believe this is because physicians (DO/MD) complete a 4-year bachelor’s degree, 4 years of medical school then 3-7 years of residency with the option to obtain further training through fellowships and CMEs. So right off the bat, on paper, there is a lot more years of training involved. Secondly, PA curriculum does not go to the same depth when it comes to pathophysiology of disease. Due to time constraints during training, they are mostly taught how to recognize pathology and match that to appropriate treatment but have limited understanding of what is causing the underlying disease and what other factors might contribute. By calling themselves doctors, they are misleading the public into believing that they have that breadth of knowledge when they really do not. I understand that PA applicants are required to have more clinical hours on average than an applying medical student. This stems from the roots of the PA path. From what I understand, the title and licensure for PA was originally designed for medical personnel from the military could enter the medical field at a higher level than a lay person. For example, if someone served in the military for 10 years as a medic and is now leaving the military and looking for a second career, they could fast track into a higher skill position because of their hundreds or even thousands of hours of clinical and even battlefield experience. They may have been middle aged with families or just not wanting to spend 11 years in school to begin their second career, so working as a physician’s assistant with a much shorter educational time frame was perfect. This, I don’t believe, is not the typical PA applicant in 2023. Many, including myself as a premed, consider the decreased liability and shorter training time of PA to be appealing and they opt for that route. It is a sacrifice to go to the additional years of training to become a physician. This is why they get paid more. That, and they shoulder all of the liability of practicing medicine, because ultimately, all decisions made by themselves or the PA working under them, falls on their shoulders.
I have a minor correction. A lot of schools require the GRE (the GRE is what you take to “graduate” high school if you don’t finish high school). Although they have now developed a PACAT which some schools require instead. I think that’s more similar to the MCAT as I think it has sciences in it and such, but it was developed when I got into a PA program so of course i did not take it. I did take the GRE twice. You are correct about the reason the profession was made and going back to the military. I had over 10k hours of direct patient care hours before PA school (5 years full time). I became a PA because I wanted to work as a team, not be a doctor. But I also did not want to be a nurse.
I agree with him 100%, as a DNP. Btw, what's wrong with the term "mid-level"?
To be fair, studies show that NPs in primary care settings provide comparable care to physicians. HOWEVER, the same studies also show that NPs unnecessarily order more referals and diagnostic tests that physicians. Of course, this is because we have less training. It's simple.
lets be real, its 2023
Hahhaa best sentence ever
It seems many mid level providers are very happy with their scope of work and compensation. I graduated undergrad this previous fall and have been taking the spring to work as an ER tech and gain some experience; ask some questions. I personally have never overheard any midlevels portraying to be something they aren’t, if anything I’ve heard them emphasize that they aren’t a doctor. Physicians seem to be the most stressed point of a very flawed system. While on RUclips there are encouraging content creators who are trying to combat the problem… it’s tough seeing and hearing how tired and chewed up the people I know and look to in real life are. I’ve been struggling to answer why I want to go through so much just to join them, more than I’d like to at this point in my journey.
I agree. I think instead of complaining and being threatened by mid-levels they should be advocating or lobbying for more residency positions, and making medical school more accessible to people who want to pursue the career.
NP and PA CRNA are much needed and so are DPM, DDS. We need more info on ND.
This was a good video. I’m a NP with a masters level Education and the DNP degree is a joke. The board of education needs to step in and put a stop to how much money these NP programs make out of students and give every little in return as far as clinical experience goes. + 100K programs and the NP students are left having to find our own preceptors to follow.
One of the instructors said it was because there are no federal funding for NP programs like they do for MD programs. My RN school was very structured with hands on training. I can’t tell the same about the NP program especially for the money we spend trying to better ourselves and advance in our career- the programs did not deliver.
I did not have the money to go to med school nor was I eligible for federal aid because I was an international student so went to RN school, got my citizenship and after working acute care/burnout left the bedside to work as a NP.
NPs are not trained at the same level as a MD. I haven’t met any NPs who think they are…
Most Family NP pay is pretty low or on the same pay level as a RN.
I admire any nurse who can work the bedside forever.., it’s hard back breaking work. I personally would not recommend my kids going into nursing. 😢