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Physician Assistant from RCSI
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Hypothetically, could a doctor apply to be a physician's assistant and do a job with less hours/responsibility for roughly equal pay?
The difference is that the low paid junior doctor could eventually be a consultant with a salary of €600K. The Physicians Assistant will still be trudging along at €60k.0 -
But why hire a PA when they'll cost the same as a doc anyway?
I think that we are missing the point. A PA gets a bit more than a junior doctor but they are vastly different. A PA should get more pay since they have been doing their procedural job for up to twenty years.
The junior doctor has five years of science and medicine behind him. Who do you think will be better at minor suturing?
I would rather have a PA with years of experience sewing me up than a junior doctor right out of med school.
The PA is not in competition with doctors or junior doctors. They can never rise to the levels that the doctors can. They have a set group of procedures that they can do and they do them well.
Yes, there will be job creep. In the US the nurse practitioners are getting doctorate degrees. Do you call them doctors? I hope not.0 -
The difference is that the low paid junior doctor could eventually be a consultant with a salary of €600K. The Physicians Assistant will still be trudging along at €60k.
'could' being the operative part of that sentence, only 10-20% of junior doctors will become consultants. €600k is also an totally unrealistic salary. According to the DOHC consolidated salary scales for Jan 2010 the absolute highest consultant salary is €284,163, this is the top of the scale for a Type A professor in an academic consultant position. No non-academic serving consultant in any region earns over €200k. Some contracts pay less but allow for private work in addition, even then €600k is a silly figure.Yes, there will be job creep. In the US the nurse practitioners are getting doctorate degrees. Do you call them doctors? I hope not.
This is becoming a huge problem in the US, PAs with PhDs and DNPs are looking to be addressed as 'doctor', some states have been forced to introduce legislation regulating who can call themselves 'doctor' in a clinical setting. I work in medical physics, we have to wear white coats in clinical areas but those with PhDs cannot call themselves doctor, their white coats say Firstname Lastname, PhD to avoid any confusion with medical personel.0 -
The difference is that the low paid junior doctor could eventually be a consultant with a salary of €600K. The Physicians Assistant will still be trudging along at €60k.
"Trudging" along at €60k? Well, it seems that the recession hasn't changed this country as much as it needed to be changed.
How much would you envisage that a starting PA would earn, i.e. one just out of training? Directly out of training I'd choose the doctor for every job every time because they would have had AT LEAST two extra years practicing skills before they're left to themselves in the hospital. Obviously if someone has been doing something for 20 years they'll be better than someone who has been doing for a couple of days regardless of the latter persons training, but even given the choice between a NCHD only on the job a couple of years and a PA on it for 20, I'd have the NCHD suturing me. Why? Because there isn't SO much to it that he/she couldn't be well up to standard quickly AND there is so much that he/she can incidentally pick up on while he/she's at it.0 -
I guess it comes down to experience vs education.
An analogy would be this:
You can either sail the seven seas without a map, or you could sit at home with all of the best maps and plan your trip.
The first option offers a lot of blundering and mistakes, the second produces no results.
Good medicine is a mix of both options.
If you had just eight years of either training or experience which would you choose?0 -
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Wow! This is some great dialogue going back and forth on this topic!
In the interests of full disclosure I'm a 15+ yr PA with Emergency Medicine and Cardiovascular Research as a background.
I think it would be wonderful for the HSE to enhance the healthcare system with PAs as well as NPs!
I've seen lots of conversation about salaries, cost effectiveness of substitution of PAs for Junior Doctors, scope of practice, duration of training, prescribing privileges, etc. Why hire PAs at all? After 15+ years, I think I have a pretty good idea...
An important item missing here is the defined and stated role of the PA. The scope of practice of a PA is the scope of practice of his / her supervising physician. While PAs often function in practice very independently, that is primarily a product of the relationship developed between the supervising physician and the PA. That means the PA is truly a 'physician extender', understanding the practice patterns of the supervising physician, and yes, in Emergency Medicine this may mean being familiar with > 10 different supervising physicians. That's the way life is as a PA. You are NOT an independent practitioner. Nurse Practitioners maintain an independent status as an independent practitioner, unfortunately this is often what also makes some physicians nervous about 'creep' and they sometimes prefer the more directly stated hierarchical structure strongly and consistently advocated by the PA profession. Where NPs have their strengths in Family Practice and Internal Medicine because their training is based on the nursing model of training; PAs have their strengths in their flexibility and adaptability to the multitude of sub-disciplines and surgical specialties because their training is based on the medical model of training.
Regarding salary parity with Junior Doctors, well let me just say that a Consultant MD trains a PA once, he trains a new Junior Doctor every year... from scratch. A PA can maximize the efficiency, quality of care and patient access for a consultant MD far beyond anything that can be realized by a Junior Doctor.
That being said, being a PA requires a level of maturity to realize that you are an extension of your supervising physician, represent him or her in all matters and understand your limits defined by the professional relationship established between the PA and supervising MD. This applies also to prescribing privileges. An Ortho PA doesn't prescribe Psychiatry meds, because that is not the scope of practice of the supervising physician; even if that PA has years and years of previous experience in Psychiatry!
So I hope I've added something to the dialogue and will look forward to reading further comments!!0 -
shanraghPA wrote: »I think it would be wonderful for the HSE to enhance the healthcare system with PAs as well as NPs!
I think it would be a better idea for them to ensure that there are sufficient numbers of doctors working in it first, before "enhancing it" with other forms of staff.shanraghPA wrote: »An important item missing here is the defined and stated role of the PA. The scope of practice of a PA is the scope of practice of his / her supervising physician.
This is the same for doctors.shanraghPA wrote: »Regarding salary parity with Junior Doctors, well let me just say that a Consultant MD trains a PA once, he trains a new Junior Doctor every year... from scratch.
Once? How would the new PAs be trained? Same way as NCHDs are trained I'm sure. Even if it were true, how would it justify hiring a PA for the same cost as a doctor?shanraghPA wrote: »A PA can maximize the efficiency, quality of care and patient access for a consultant MD far beyond anything that can be realized by a Junior Doctor.
How? That sounds like a marketing spiel.0 -
Greetings Orly;
My aim was to provide some additional information about what PAs provide in the clinical area, and how they can be a valued addition to the healthcare team, especially in the Irish healthcare system that is struggling to maintain quality services to a dispersed population, largely in rural areas.
I agree that it would be lovely to have access to the consultant physician in the area of specialty desired available with a minimal weight, unfortunately that's not a reality that has been solved in any health system throughout the world. That's why we see the emergence of healthcare teams that can function well together.
There are many issues that go into setting salary parity, you refer primarily to internal parity with Junior Doctors, you also need to look at the value add the PA is able to bring to the practice with patient visits, procedures and decompression of the consultant's schedule. An experienced PA can do this well, a junior doctor is just learning and will shortly be moving on to the next therapeutic area to help them gain a broad perspective and choose their future path.
Maximizing efficiency, quality of care and expanding patient access is the farthest thing from a marketing spiel, this is the purpose of my life. I can maximize the efficiency of my supervising physician by performing initial and followup patient evaluations focusing his attention on those that need the most urgent intervention, enabling him/her to concentrate on those issues that 'need a doctor'. I can improve quality of care by both through developed expertise and having the time to educate the patient, build relationships and ensure proper followup instructions are understood. Finally I can improve access by opening the schedule for conducting initial H&Ps, initial lab / rad evaluation and efficiently integrate and develop the plan of care with the consulting MD.0 -
shanraghPA wrote: »Greetings Orly;
My aim was to provide some additional information about what PAs provide in the clinical area, and how they can be a valued addition to the healthcare team, especially in the Irish healthcare system that is struggling to maintain quality services to a dispersed population, largely in rural areas.
What has rural got to do with it? Every village has a GP in or very close to it. There is expected to be a shortage of GPs on the way, but there is no shortage of people wanting to become GPs. If these people get the opportunity to train as GPs there is no need for PAs in the community setting.shanraghPA wrote: »An experienced PA can do this well, a junior doctor is just learning and will shortly be moving on to the next therapeutic area to help them gain a broad perspective and choose their future path.
A NCHD is not "just learning", NCHDs do most of the work in the hospital, while also learning. You think a rheumatology registrar can't handle what a PA can? Honestly, I can't see any "added value" of a PA.shanraghPA wrote: »I can maximize the efficiency of my supervising physician by performing initial and followup patient evaluations focusing his attention on those that need the most urgent intervention, enabling him/her to concentrate on those issues that 'need a doctor'.
What? When someone gets sick, they "need a doctor". Firstly a GP. The GP sees a patient and decides if they can be treated there and then or don't need treatment at all or if they need admission to the hospital or a GI, psych, rheumatology etc. referral.0 -
The world is full of nay-sayers and armchair critics who will tell you why your proposal won't work and have nothing more substantive to offer to the dialogue other than to extract soundbites to debate. Most of these critics have no idea of what it means to take care of a waiting room full of patients, attending to the needs of the patient, family, documentation and billing.
PAs are not a panacea or cure-all for the Irish healthcare system, but they are an alternative to improve access, quality and patient care whether you would like to consider it as a personal option or not.
Are you honestly proposing that the number of GPs and specialists are sufficient to meet current need, the training ranks are sufficient to meet future need, and that alternatives to expand access should not be considered? Have you read the headlines about ED waits, long waits for orthopedic referrals and access to primary care?0 -
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shanraghPA wrote: »The world is full of nay-sayers and armchair critics who will tell you why your proposal won't work and have nothing more substantive to offer to the dialogue other than to extract soundbites to debate. Most of these critics have no idea of what it means to take care of a waiting room full of patients, attending to the needs of the patient, family, documentation and billing.
PAs are not a panacea or cure-all for the Irish healthcare system, but they are an alternative to improve access, quality and patient care whether you would like to consider it as a personal option or not.
Are you honestly proposing that the number of GPs and specialists are sufficient to meet current need, the training ranks are sufficient to meet future need, and that alternatives to expand access should not be considered? Have you read the headlines about ED waits, long waits for orthopedic referrals and access to primary care?
Billing? Seriously? How does that come in to things at all. Isn't that the receptionists job at the GP and the accounts dept in the hospital.
On your questions, the number of GPs and specialists is not sufficient, especially specialists. To fix that, we'll need to get more specialists.
The training ranks, well if you mean med students, yes, there are enough of these to meet Irelands needs. If you mean NCHDs well, there would be enough if the conditions here weren't driving them away.
I'm not sure what you mean by waits for access to primary care. I don't get that. The longest I've ever had to wait for a GP appointment was until the next day.
Yes, the queues in A+E and for referrals are a serious problem, probably best solved by opening up more consultant positions and by retaining the doctors that we educate, not by continuing to drive them abroad, wasting the money we as a nation spent training them and then spending more money training more people to do jobs that wouldn't even need doing if we hadn't driven the doctors away.0 -
Whether you have personally experienced it or not, there are very often delays in accessing primary care as well as specialist care. My mom had care deferred for 3 days with no urine output because she couldn't get into her GP - she ended up with renal failure and dialysis for the remainder of her days.
Unfortunately the data doesn't exactly support your concern over the overwhelming exodus of trained physicians to other parts of the world...http://www.cso.ie/releasespublications/documents/population/current/popmig.pdf
However, I do agree that much more needs to be done to enable physicians to be successful in their practice, to enable them to achieve a balance of professional and personal satisfaction. How do we do this? Give them some help. PAs can make a difference, I've lived it. Its not just a theory.
And if you think billing is the sole purview of the front office staff, LOL, that perspective is just...incorrect.
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shanraghPA wrote: »Whether you have personally experienced it or not, there are very often delays in accessing primary care as well as specialist care. My mom had care deferred for 3 days with no urine output because she couldn't get into her GP - she ended up with renal failure and dialysis for the remainder of her days.
In Ireland?shanraghPA wrote: »Unfortunately the data doesn't exactly support your concern over the overwhelming exodus of trained physicians to other parts of the world...http://www.cso.ie/releasespublications/documents/population/current/popmig.pdf
What are you talking about specifically? That sprawling document doesn't seem to contain anything to refute my claim that lots of doctors are leaving Ireland.shanraghPA wrote: »And if you think billing is the sole purview of the front office staff, LOL, that perspective is just...incorrect.
Are you talking about the US here?0 -
In Ireland? Yes, that is the name of the forum.
You're worried about my refuting your claim? I offered you data showing overall low immigration, do you have anything that supports your claim of a professional exodus? Other than.. looks like, feels like, must be....0 -
shanraghPA wrote: »In Ireland? Yes, that is the name of the forum.
You're worried about my refuting your claim? I offered you data showing overall low immigration, do you have anything that supports your claim of a professional exodus? Other than.. looks like, feels like, must be....
Overall low immigration? Firstly, I was talking about emigration.
Secondly, IF it transpired that overall emigration was low, this would not be indicative of the number of doctors leaving.
Thirdly, in your own document the very first heading is "Resumption of net outward migration". It says that there has been an increase of 40% in emmigration.
Now the reason I questioned where the events you were talking about took place is because you say you are a PA, so I assume you practice in the States. You're terminiology is also American. On the billing procedures, you're talking from an American perspective, this is Ireland. You're talking from a PA perspective in America, a country where enabling everybody who needed one to see a doctor was never high up on the agenda anyway.0 -
Orly; I'd be happy to discuss with you how PAs could help, but you appear to simply want to discuss how to make the idea go away, or wasn't even necessary in the first place. I'm quite certain no one has been able to voice a progressive idea in your company for quite some time. You're good at criticism and casting aspersions, but I haven't heard one constructive idea.0
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shanraghPA wrote: »Orly; I'd be happy to discuss with you how PAs could help, but you appear to simply want to discuss how to make the idea go away, or wasn't even necessary in the first place. I'm quite certain no one has been able to voice a progressive idea in your company for quite some time. You're good at criticism and casting aspersions, but I haven't heard one constructive idea.
You've been ignoring what I've been saying then. Let me clarify.
IMO, the entire structure of the health service needs to be reorganised onto a shift basis. This alone would save untold amounts of money in on-call and overtime and let everyone get more work done.
Also, we need more doctors doing less hours instead of fewer doctors doing more hours. We have the graduates, it's the organisation that's missing.
I have criticised the American healthcare system but I have to say that the training model they have their seems excellent and I would love to see something like it over here.
I'd also like to see better implementation and integration of IT systems.
But essentially, you've got one thing right, with all of the things that need to get done with the Irish healthcare system I do think that PAs would be a waste of money and a waste of time. Essentially, I think it's a bad idea. But, I'm here to be convinced, it's just going to take the right kind of argument to convince me.0 -
if its a waste of money why do so many hospitals/private group practices in america hire PA's, NP's and AA's?, im sure they'd want to save all the money they can, so why spend it on mid-level practitioners? they have a place in the practice, thats why, if an anesthesiologist makes 500k a year an AA or NA only makes 1/5th of that at most... its about time ireland found a place to employ similar staff and cut over worked NCHDs some slackEssentially, I think it's a bad idea. But, I'm here to be convinced, it's just going to take the right kind of argument to convince me.0 -
imported_guy wrote: »if its a waste of money why do so many hospitals/private group practices in america hire PA's, NP's and AA's?, im sure they'd want to save all the money they can, so why spend it on mid-level practitioners? they have a place in the practice, thats why, if an anesthesiologist makes 500k a year an AA or NA only makes 1/5th of that at most... its about time ireland found a place to employ similar staff and cut over worked NCHDs some slack
This is Ireland. We don't have mid-level practitioners or anaesthesiologists.
An anaesthetist should not be making 500k a year. If that kind of non-sense had not been allowed to go unchecked in the first place, the health of a great many of the poorer people in the States wouldn't be so neglected.
I'm not really too concerned about America. They have their vision of health "care". I think it would be great to train there but their whole system of health care provision is something I could do without in the long run and given their differences it's not really possible to look at America and just copy something they've done.0 -
This is Ireland. We don't have anaesthesiologists.
how much do you think a consultant in ireland makes? most of them earn between 200k-280k or so a year excluding call and private practice, pay is justified given the years of training, importance of the job and how often physicians get sued every year in ireland and other major headaches
bottom line, you havent added anything constructive to the argument and are trolling.0 -
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imported_guy wrote: »if its a waste of money why do so many hospitals/private group practices in america hire PA's, NP's and AA's?, im sure they'd want to save all the money they can, so why spend it on mid-level practitioners? they have a place in the practice, thats why, if an anesthesiologist makes 500k a year an AA or NA only makes 1/5th of that at most... its about time ireland found a place to employ similar staff and cut over worked NCHDs some slack
Because if you are in private practice in the US you don't generally have access to residents, therefore you employ PAs to function in that capacity for you.0 -
imported_guy wrote: »
how much do you think a consultant in ireland makes? most of them earn between 200k-280k or so a year excluding call and private practice, pay is justified given the years of training, importance of the job and how often physicians get sued every year in ireland and other major headaches
280k a year is the top of the consultant salary scale, the vast majority earn under 200k. And it's a salary so nothing extra for call/weekends etc.0 -
are you saying they dont have PA's/AA's/NA's in teaching/community hospitals with residents? lol.lonestargirl wrote: »Because if you are in private practice in the US you don't generally have access to residents, therefore you employ PAs to function in that capacity for you.0 -
imported_guy wrote: »are you saying they dont have PA's/AA's/NA's in teaching/community hospitals with residents? lol.
No, she didn't say that. Try reading her post instead of impotently trying to belittle it.
Also, this is a place for relatively seriously discussion. Perhaps you should save the "funny" pics for afterhours.0 -
imported_guy wrote: »are you saying they dont have PA's/AA's/NA's in teaching/community hospitals with residents? lol.
They do, but they are far less common and generally function in a number of specific roles.
1) My local A+E has a PA section where non-urgent cases are triaged to. I think this is a very appropriate use of PAs as it lets the residents deal with the more emergent stuff (and in this A+E 20+ surgery shocks per shift with 1 attending and 2 interns are not uncommon - it's a madhouse). However these patients really shouldn't be going to A+E in the first place and are only there as they don't have a primary care physician because they don't have insurance and they know the A+E is obligated to treat them. In the Irish system we have provision for basic healthcare for those less well off.
2) Residency in the US works differently from training in Ireland, residents spend 4-6 weeks per rotation. Therefore on very specialist services the PA is more exerienced than any of the trainee doctors as they are permenently in this role. Go back a few pages and read where I discussed this issue specifically with regard to a peadiatric cardiovascular surgery rotation that my husband was on at the time. Again training in Ireland works differently, you usually spend 6-12 months per consultant allowing you to become more familiar with their area of expertise.
Also remember that a teaching hospital that has many residents may also have private physicians working there, these physician simply pay the hospital for office space and access to theatres but are entirely responsible for their own patients and usually can't use the residents. The use of PAs in the US is also driven partly by the insurance companies, for many minor surgeries they will not pay out for an MD to assist only for a PA.
Having said all that I am not opposed to the introduction of PAs into the Irish system, specifically I think they could be of use in smaller community hospitals that don't provide the volume of work to adequately train doctors and also in private hospitals who do not have doctors-in-training. As I said earlier in the thread as well there is currently no legislative provision for the introduction of PAs into the Irish system and with that in mind I wouldn't advise anybody to particpate in a course that qualifies you to be one.0 -
imported_guy wrote: »...bottom line, you havent added anything constructive to the argument and are trolling.No, she didn't say that. Try reading her post instead of impotently trying to belittle it.
Also, this is a place for relatively seriously discussion. Perhaps you should save the "funny" pics for afterhours.
Both of you: Please use the report post button if you think another poster is trolling (or if you have another problem with a post). Don't feed the troll!
Imported Guy: Orly has a point. You've been asked before not to put sarcastic little videos in your posts here. The same applies to sarcastic little pictures. One more and you'll be getting a little enforced holiday from this forum.
Also, Orly has posted about 15 times in this thread, and is contributing to the debate. You had one good post at the beginning, and then disappeared for a month til you came back with your 3 in quick succession tonight.
It's a bit rich of you to pop up and accuse Orly of trolling. IMO, you're closer to a troll than Orly is.
Now, everybody, back on topic please!0 -
I stopped by the University of Birmingham to look at their PA programme. I talked with David Kuhn who is running that programme for them. He is a PA from the US.
This is relevant to the Irish programme as Emeka Obereke from RCSI is working with David to design the PA curriculum here in Ireland.
In Birmingham the PA students take the same courses as the medical students. Both programmes are in the classroom at the same time. The PA students also meet together in small Problem Based Learning groups.
I was impressed with the programme and hope that RCSI has a similar set up. The UK programme is cheaper by half. The RCSI is looking at €8000 tuition per annum. I would imagine that it would also be more expensive to live in Dublin for two years.0 -
I stopped by the University of Birmingham to look at their PA programme. I talked with David Kuhn who is running that programme for them. He is a PA from the US.
This is relevant to the Irish programme as Emeka Obereke from RCSI is working with David to design the PA curriculum here in Ireland.
In Birmingham the PA students take the same courses as the medical students. Both programmes are in the classroom at the same time. The PA students also meet together in small Problem Based Learning groups.
Have they graduated anybody yet in Birmingham? I would be interested to hear how people coming out of the course fared in the job market. Also, did they discuss how the role of the PA had been defined in the UK in terms of legislating for prescribing rights etc?0 -
lonestargirl wrote: »Have they graduated anybody yet in Birmingham?
Yes! They have two cohorts out working in the NHS. 14 for the first year 18 for the second. All but three of these students are working as PAs in the UK. Of the three that are not working two have chosen to take time off and I don't remember what David said about the third student.
He hopes to have 30 students start in January 2011.
He also said that he has talked with several hospitals in Ireland who said that they would be happy to hire PAs as soon as they graduate.
You can email him yourself. d.h.kuhns@bham.ac.uk
I am not saying that PAs will be welcomed with open arms here in Ireland. When they first started in the US in the 1970s it was a hard fight to get recognition.
My personal interests are based on the fact that the absolute best GP I ever had in the US was a PA. He had by far a lot more time to talk with me and listen to my history. MDs in the US have an average of 5 minutes per patient. PAs don't have that time constraint, and just like any MD if I ask a question that (s)he doesn't know they will turf me off to a specialist for further followup.0 -
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Yes! They have two cohorts out working in the NHS. 14 for the first year 18 for the second. All but three of these students are working as PAs in the UK. Of the three that are not working two have chosen to take time off and I don't remember what David said about the third student.
He hopes to have 30 students start in January 2011.
He also said that he has talked with several hospitals in Ireland who said that they would be happy to hire PAs as soon as they graduate.
Presumably these PAs are working primarily as surgical assists? Or have the UK made provision for prescribing rights already?0
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