topic Re: Discussion of the role of Physician Assistants in Wellness

Discussion of the role of Physician Assistants

granddi — Tue, 16 Mar 2021 15:24:13 GMT

It has been my impression that Physician Assistants and Nurse Practioners are well educated and trained to assist in providing routine medical care under the supervision of an MD/DO. Most of my experiences have been good but limited to general/routine/primary care such as cold, allergy, cough.

My question is the role of PA/NP in providing care in a speciality setting such as cardiology. I selected a cardiologist based upon excellent academic credentials and patient reviews. I really llike the cardiologist but it seems the very large group tries to divert care to their large staff of PA's.

Yes, I can decline the appointment with a PA but that means waiting months for the MD appointment.

The PA I was appointed to has a degree in psycology and her PA degree. How can this person have the same clinical skills as an board certified cardiologist with 15 years experience. The MD has a degree in biomedical science from Rice University and MD from Stanford.

What has been your experience or opinion about seeing a PA for initial treatment (not follow up) of your specialized medical issue?

Maybe PA's in a speciality practice (not primary care) should have advanced training and certification.

Re: Discussion of the role of Physician Assistants

Trinity11 — Tue, 16 Mar 2021 15:31:04 GMT

@granddi wrote:
It has been my impression that Physician Assistants and Nurse Practioners are well educated and trained to assist in providing routine medical care under the supervision of an MD/DO. Most of my experiences have been good but limited to general/routine/primary care such as cold, allergy, cough.

My question is the role of PA/NP in providing care in a speciality setting such as cardiology. I selected a cardiologist based upon excellent academic credentials and patient reviews. I really llike the cardiologist but it seems the very large group tries to divert care to their large staff of PA's.

Yes, I can decline the appointment with a PA but that means waiting months for the MD appointment.

The PA I was appointed to has a degree in psycology and her PA degree. How can this person have the same clinical skills as an board certified cardiologist with 15 years experience. The MD has a degree in biomedical science from Rice University and MD from Stanford.

What has been your experience or opinion about seeing a PA for initial treatment (not follow up) of your specialized medical issue?
Maybe PA's in a speciality practice (not primary care) should have advanced training and certification.

I saw a PA right before my first heart attack. All she did was keep exclaiming what great shape I was in and asked me for diet tips. LOL. She never ran enough tests to see I was about to have a heart attack.

I guess I had a negative experience. Actually, when I had shingles last year I went to an Emergi-Med. The doctor I expected to see was a PA and missed the correct diagnosis telling me I had an ear infection and prescribed antibiotics. I ended up getting the right diagnosis too late and now have post herpetic neuralgia.

Of course this is anecdotal and I am sure there are some very good Physician Assistants out there. However, my experiences have been awful.

Re: Discussion of the role of Physician Assistants

stevieb — Tue, 16 Mar 2021 15:31:17 GMT

It might not be ideal but is reality for a variety of reasons including that there appear simply not to be enough doctors to go around. Even in ER's, so much of the 'routine' is no longer performed by MD's. A number of years ago, I had to see a neurologist and was sort of surprised that what I actually saw was a PA who did the bulk of the examination. Prior to leaving, I was ushered in for about a five minute visit with the actual doctor. It seems the way it works is if the PA feels there is sufficient need the MD will get involved, otherwise, one might or might not get the sort of perfunctory laying on of hands by the real deal...

Re: Discussion of the role of Physician Assistants

ellaphant — Tue, 16 Mar 2021 15:40:22 GMT

I would never see a PA in place of a MD. Especially in any critical area such as the heart.

Make an appointment with a cardiologist.

Re: Discussion of the role of Physician Assistants

software — Tue, 16 Mar 2021 15:41:00 GMT

My primary doctor doesn't use either.

I see my nephrologist every 3 months.

I see the PA one visit, then the next visit is with the MD.

Not sure if all MDs do this but I know mine reviews the information from my visit with the PA.

A PA is required to complete clinical hours & they are certified in their own Board.

I have personally known RNs who have gone on to be NPs

They are very well qualified, in fact most are qualified when they are an RN

Re: Discussion of the role of Physician Assistants

Nonametoday — Tue, 16 Mar 2021 15:41:32 GMT

PAs are far more and better educated than RNs

Re: Discussion of the role of Physician Assistants

Nonametoday — Tue, 16 Mar 2021 15:42:32 GMT

In the future, secondary to recent health changes over the past 10 years, you will be seeing more CRNPs and PAs than doctors.

Re: Discussion of the role of Physician Assistants

stevieb — Tue, 16 Mar 2021 15:45:21 GMT

Let's face it, patient care is a mixed bag regardless of the professional you see. I've been seen by at least two relatively incompetent supposed 'specialists', so I suppose I'd rather have been seen by a fully competent NP or PA than a physician with his (or her) head up their backside.

Re: Discussion of the role of Physician Assistants

Sooner — Tue, 16 Mar 2021 16:39:17 GMT

If I have the flu I go see my PA, not the dr. If I tell her I need drugs, I get them. He doesn't think I am as bad as I know I am with the flu or bronchitis etc., so I go to her. I usually have to go back in a few days if it's him! LOL!!!

Otherwise he is great and not someone to throw pills at every little thing, but the PA and I KNOW the flu and associated ills and how it goes with ME.

PA's I have known (three) have been fantastic and for things like a flu test I needed quickly, getting in during flu season, etc. they are WONDERFUL!

The Univ. of Oklahoma had a great curriculum for PA's many years ago. They are well trained and can start off at a great salary! They started year one placing every one graduated. . . It's a 2 year program I believe.

Re: Discussion of the role of Physician Assistants

Roscoe the Rascal — Tue, 16 Mar 2021 16:57:41 GMT

I use what is needed. I do my yearly with pa and no big deal. If I had an issue I would follow up with the doctor.

My husband has a cardiologist for his heart and that is the way I would go. If I need a doctor in a specialized field then that is what I find to be the best.

We have had some experiences and that is what I base my opinion on.

Re: Discussion of the role of Physician Assistants

GenXmuse — Tue, 16 Mar 2021 17:00:30 GMT

I see midlevels in speciality clinics all the time and have been very pleased.

Re: Discussion of the role of Physician Assistants

ECBG — Tue, 16 Mar 2021 17:07:09 GMT

I have only seen a PA once and needed to be seen that day.

I wonder if "PA issue" has fueled the development of "Concierge doctors"?

Re: Discussion of the role of Physician Assistants

Pook — Tue, 16 Mar 2021 17:09:36 GMT

I have had really good experiences with PAs. I have found that I have a better chance to get to explain things to a PA and get real explanations since most doctors try to get you in and out and on the the next appointment. I have been misdiagnosed by doctors many times. I was treated for asthma for over 15 years and kept telling both my doctor and the doctors in the ER that breathing treatments were not helping and that since my oxygen levels were not down there had to be something else going on. Finally when I was out of breath really bad I went to a 24 hour health center and saw a PA who actually listened and referred me to an asthma and allergy specialist who confirmed no asthma bit vocal chord dysfunction. I would rather see a PA or nurse practioner.

Re: Discussion of the role of Physician Assistants

Nonametoday — Tue, 16 Mar 2021 17:12:30 GMT

@Sooner wrote:
If I have the flu I go see my PA, not the dr. If I tell her I need drugs, I get them. He doesn't think I am as bad as I know I am with the flu or bronchitis etc., so I go to her. I usually have to go back in a few days if it's him! LOL!!!

Otherwise he is great and not someone to throw pills at every little thing, but the PA and I KNOW the flu and associated ills and how it goes with ME.

PA's I have known (three) have been fantastic and for things like a flu test I needed quickly, getting in during flu season, etc. they are WONDERFUL!

The Univ. of Oklahoma had a great curriculum for PA's many years ago. They are well trained and can start off at a great salary! They started year one placing every one graduated. . . It's a 2 year program I believe.

@Sooner

It used to be a 4-year-plus internsthip program but I don't know now. Everything in educated is abbreviated.

Re: Discussion of the role of Physician Assistants

michmi — Tue, 16 Mar 2021 17:15:48 GMT

Personally, I've found the PAs and NPs I've dealt with in specialty settings as good as or better than dealing with the physician supervising them.

A physician's license # is attached to the supervision of these people. If they aren't properly supervised the license is at stake and it also opens them up to lawsuits. A good doctor will have good people working for him/her.

Re: Discussion of the role of Physician Assistants

haddon9 — Tue, 16 Mar 2021 17:19:29 GMT

@Nonametoday wrote:
PAs are far more and better educated than RNs

Agreed! When my DH had to see a specialist concerning Lyme we went to see someone who was many months backed up with patients. This was a long drive and we stayed overnight.

The PA that we saw spent 5 hours (yes you heard right!) with DH going over fine details regarding his health issues. I was very impressed with how intelligent and educated this man was....more knowledgeable than many MDs. The actual specialist did pop in for about 10 minutes to go over a few things.

Of course it's really up to the individual and your comfort level. You could see the PA and still make an appointment down the road to see the cardiologist.

Re: Discussion of the role of Physician Assistants

Hoovermom — Tue, 16 Mar 2021 17:31:14 GMT

A PA literally had a part in saving my life. She saw me when I could not get into my regular MD for a problem I thought was very serious. She sent me to the emergency room, telling me not to get into an accident on the way there........little did I know at that time what she was talking about. I saw my regular MD after this incident and would take the PA anyday over her.

Re: Discussion of the role of Physician Assistants

jlkz — Tue, 16 Mar 2021 17:33:11 GMT

My doctor is a sole practitioner and doesn't have a PA while DH's cardiologist and ablation doctors have cardiology PA's.

Appointments with the PA's are for routine follow-ups. Those with the specialist doctor are usually preceded with PA's who take routine tests and review prescriptions and ask if there are any issues. Then the specialist comes in and takes over the appointment. It's a better use of the physician's time.

For me, I went to an urgent care site and instead of getting treated for bronchitis, got meds for sinus. By the time I got to my PCP, the bronchitis was very severe. Went back and complained to the staff: they noted that I was only to see a doctor if I ever returned.

For my dermatology appointment, I will only get an appt with the doctor...even if I have to wait.

Re: Discussion of the role of Physician Assistants

ScrapHappy — Tue, 16 Mar 2021 17:54:42 GMT

It has been my experience that if a PA or NP within a speciality group has education/ccertification within that speciality (cardiology, pulmonary, etc.) I also prefer an appointment with an MD, especially a first appointment. Going forward, I'm usually okay with a NP/PA within reason. I left my daughter's pediatrician office because in the 4 years we were going there, my daughter saw her pediatrician once. Could never get an appointment. Would always have to be with a NP or PA. Once we did have an appointment months in advance, and a week before they called me and said she was out of the office. Shortly after that we changed doctors and we're very happy with new one. When looking at doctors, I look at their staff. If they have a lot of PA's and NP's, I don't go there because you just can't get appointment with MD.

Re: Discussion of the role of Physician Assistants

froggy — Tue, 16 Mar 2021 18:34:14 GMT

While I was undergoing chemo treatments for cancer I saw the NP about as many times as I saw my Medical Ocologist. I always found her to be just as knowedgeable, sometimes more, about my many complaints of side effects. She went way out of her way to address any concerns. Of course the MD was always available if I wanted to see her.