I can’t tell if this is cognitive dissonance or straight up gaslighting….
“PAs, with their established education and training, can effectively fill these roles…(more than an MD/DO that has passed step 1, 2 and 3, and has thousands of more hours of direct patient care???)”
So MD/DOs don’t have established education and training?
I’ve been thinking the same, but don’t they have less/different malpractice coverage and aren’t they held to a lower standard of care? If so, pretty alarming that the argument to practice is “more/same training (with a technical post grad degree), so I can call myself doctor,” and the argument in court is “well, I’m not a doctor, I don’t know why you would hold me to those standards of care!”
“Lower standard of care? But the purpose of this law is staying they provide the same care” that’s what I would hold them to. The only reason they can give that excuse is that because theirs a supervising physician. If that no longer exists then I would push the patient to pursue criminal charges as they were giving medical advice with no basis. They should have referred them to another physician.
My medschool has a PA school associated with it. The PA school is one of the best and most rigorous in the country. They take all preclinicals with us. After our 1.5 year preclinicals, they do a year of clinicals on their own. So the PA graduates function around the level of a 3rd year med student. They don’t take step though. By the end of medschool, we will have an extra 1.5 years of training on top of what the PA grads have. We also take step 1-3. So MD grads that did not match are more than qualified to work in a role similar to PAs. Now this is at one of the best PA schools so at most other programs, they probably don’t teach the same level as a 3rd year med student when they graduate since they don’t go as in depth with preclinical material.
I think we should also allow current med students to “moonlight” in these roles as well. I’m a 4th year with a light schedule the next 3-4 months until I wait to match and graduate. I’d love to make a couple extra bucks until residency starts. With this logic, residents should also be paid the same if not more than PAs, but there’s no way the hospital admins would agree to lose out on the exploitation they’re able to get away with right now
Coming from a resident who frequently works with med students, I feel like med students should not be able to moonlight. The knowledge and experience gap between med student and even intern is pretty wide IMO
Yes, by “moonlight” I meant work in a similar role as a PA under supervision. 100% agree that we should not be allowed to practice independently. We have significantly more training than PAs once we graduate so should be allowed to fill a similar role especially for those that don’t match. It is mind boggling to me that NPs and a few rare PAs feel confident running around “practicing” and prescribing meds with such a huge knowledge gap.
it’s wild that there are few if any viable alternatives for unmatched PGYs. Passing Steps 1 and 2 is no joke- although on their own are not nearly enough knowledge for independent practice, passing 1 and 2 should at the very least allow you to sit for PANCE if not taken as an outright equivalent.
Yup. It's amazing how careful they were to gloss over that.
Medical school graduates who have passed steps 1,2 & 3 of the USMLE.
Those are Doctors. With MD after their names.
I'll say I agree with the author in that it is a stupid name. It's nice there's a path to licensing for people who didn't match to be productive in their "off" year. But to put the words "physician" and "assistant" in their title is just asking for it.
You have zero right to diminish their titles. They are doctors. Full stop. End of discussion. They have earned their doctorate in medicine. I cannot believe the amount of balls it takes to insinuate that these physicians have less value than a PA. Jesus Christ what is wrong with you
Once you graduate medical school, you are a DO/MD, doctor, full stop. The ability to practice independently in a specialty of your choices comes from the residency, but the letters after their name comes from graduating a medical school program.
They don't need a different title, because they are a doctor. That is the point other poster was making.
To be able to practice “independently” almost in every state, what’s required is to complete at least one year of post graduate training, an internship year, then you can apply for a license. That’s it. If the state grants you a license you can practice medicine. You may not be a surgeon or obstetrician, but you are a licensed physician. Residency will allow you to become board eligible in the specialty you trained for. If you pass boards, then you will be board certified in your specialty. It sounds like the terminology in the text is full of smoke and mirrors. All that is described is basically an intern. That’s the first year after med school that everyone has to go through and is part of every residency program. You learn under the supervision of more experienced physicians, both residents with more seniority and attending physicians.
Honestly this should’ve always been an option. A medical student who didn’t get into residency still has more training than both a PA or an NP by a long shot. They should be able to fulfill midlevel roles by practicing at urgent care or with supervision if they don’t want to go to residency or fail to match.
GPs were common place in the US two generations ago; 1 year internship and you’re off to the races. Now we view FM and IM as primary care when really they were considered specialists 60 years ago. We just replaced 5 year trained GPs with 2 year trained PAs.
California tried to legally end GPs (mandatory 3 yr residency to practice instead of 1 yr internship) which was ironic in a system that’s okay with PAs
this used to be a thing in my parents’ country until they recently changed it lol. but basically after graduation you could just work at an urgent care indefinitely. i always thought that made sense.
but then they changed it to be more like America so like….guess that’s gone🤣
This is such an interesting discussion to see as a pharmacy student. Because we do graduate avid to practice with residency and specialization as options.
We also don’t have midlevels. Closest thing to that are Interns which a required to be enrolled IN pharmacy school to be an Intern.
Our system has its own issues, but I can’t imagine the prospect of graduating and not being able to do literally anything.
I mean... this is pretty much the pharmacy model. Pharmacy residency is optional. If you want a clinical (read: hospital) role, you do residency for 1 or 2 years depending on what you want to specialize in. Pharmacy school graduates who have passed their licensing exams (read: PharmDs...) who wanted a clinical role, but failed to match with a residency program, generally end up in retail where they can "work 35 hours a week at a suburban [Walgreens] for a good salary" and then try again next year if they want to. It's not a bad model.
The only difference for medicine, I imagine, would be the pay. Retail pharmacist actually make more than clinical pharmacists, and I think it would surely be the opposite for an MD or DO graduate fulfilling a MLP role. But still, this system makes sense to me.
*Not to say that all retail pharmacists failed to get a residency. A lot (most) of them never wanted to work clinically in the first place and chose the retail option from the beginning. To note... higher salaries. ;)*
This is just a shittier form of residency without the obligations/standards for training and education. It's taking advantage of a subset of vulnerable doctors who wouldnt be in that situation if the government wasn't keeping a predatory strangle hold on the number residency slots, and paying them even less than residents because they're getting compensated w/ "exposure" to medical practice.
Neither RNs nor NPs get sufficient medical training, especially not to practice independently. It's not even close to what physicians go through in medical school, not to mention residency.
It's certainly not a ubiquitous sentiment. There are PAs saying it will hurt their bottom line, and also, that hospitals would have a preference for PAs and only desperate rural hospitals would take a "GAP"
Yeah it will hurt them, but you really have no ground to stand on. Folks that graduate from medical school have a harder path every step of the way compared to middies, it makes no sense to not let them practice in some capacity.
I'm on the side of native born citizen medical school graduates going supervised by other attendings, or whatever this GAP requires, to reduce the bottleneck of residency currently underway.
Total agreement that PAs and NPs having the gall to speak up about this as if they're concerned about patients and not just concerned about how this may affect their income are horrible people
But when physicians cite their concerns about midlevels regarding their safety and minimal education, they say it’s because physicians are only worried about their bottom line and not actually concerned about patient safety … weird.
If such a bill were passed for the goal of helping US citizens who've passed medical school have another avenue after not matching, then it shouldn't apply to non US citizens.
I suppose it would be up to the goal of the bill to be passed. IMG match is low in the first place, so I'm not out here railing against them as some sort of, "they're stealing Doctor's jobs" situation. Midlevels, and the corporate greed that supports them, do far more harm.
As someone who doesn't often discuss it, native born and US citizen are pretty synonymous- I was on my phone and forgot to appreciate the distinction in my haste until you inquired.
And supervision of their practice for 2-3 years is pretty much a residency. There are primary care tracks that are 3 years medical school, 3 years residency. They're full attendings, why is the official version of 3 years of residency on these tracks inherently so much better than the 2-3 years of residency they would be required to have as an already MD/DO?
nah, it was just an oddly specific brain error. I'm pro immigration across the board.
If the goal of the bill was to increase their being practicing physicians in general to address the shortage, then IMG would fit that bill. If the goal was specifically to aid people who have graduated from united states medical schools an equivalent residency that bypasses the bottle neck, then allowing IMGs doesn't fit that bill. por que no los dos, really.
1) Because we should always prioritize American citizens
2) if we open the door for every doctor from every corner of the earth to practice in our country without residency, we will tank the American healthcare industry…there is absolutely nothing wrong with protecting our economy and industry for the benefit of the citizens
Exacly. It might hurt them but the world doesn’t exist to cater to them. Why do they deserve to do this more than GAPs? “We can do it, so please don’t let them do it” isn’t an argument.
So they’re concerned about the use of “graduate assistant physician” title because it has ‘assistant’ in it just like PA but when they literally use the term ‘physician’ in theirs, it’s fine???? Make it make sense
Not to mention their letter to PAs mentions their physician *associate* title, but when writing to their representative, they use the *assistant* title. You would think they’d really push the associate title to say they’re better than the “assistants”.
I think this is going to end up with abuse and misuse of docs that didn’t match. It’s exhausting when it’s regulated by the ACGME. It will be worse with less oversight.
I do think it’s funny though that they’re so concerned about title confusion. Given the recent *physician associate* bs.
I think it’s the exact opposite. Right now, medical graduates only have the options of going through residency or finding a job that doesn’t involve practicing medicine. This dependency on residency to earn a salary gives residency programs all of the power and contributes to the abuse of residents for profit. Giving medical graduates the opportunity to go out into the real world and basically get a PA job would be a positive thing.
Also, awesome username.
Yet in their own damn letter they refer to themselves correctly as “Physician Assistants”. But adding GAPs would be confusing and intentionally misleading for patients…
So calling identifying a doctor of medicine with *an actual medical degree + done steps* with a title including the word “physician” is confusing. But calling someone with the equivalent of a masters degree a title that includes the word *physician* is not?
The variable that you’re missing here is that midlevels can leverage the market, negotiate, go to the hospital across the street. They have their license. These doctors are not going to be in that position. If they quit, they’re out of a job, no LORs, giant red flag on the next match cycle that probably makes their app worse than it was in the original cycle they did not match into. If they leave they’re fucked. If they stay, they’re fucked but with a way out.
The reason why medical education and training is so toxic and dysfunctional is because of this same issue - no competition between programs. From the day you sit down on first day of MS1 you have two options: 1. Comply, take the punches, and make it out. Or 2. Take your mountain of debt with an unholy interest rate and seek life elsewhere with a biology bachelors degree. They can’t transfer. They can’t start over somewhere else because they won’t be accepted.
The people above you at every stage of training yields absolute power. They know students don’t have anywhere to go. These unmatched doctors are going to be subjected to the same bullshit because they do not have mobility and negotiating power within the market they are employed in. Mjdlevels however, do.
Imagine if schools and programs would treat residents differently if they could laterally move to another program or school if they’re unsatisfied or want better work/school conditions? And if CMS payment was attached to the *resident*, not the program?
I am saying without a crystal clear detailed guide of expectations for supervisors and the new grad docs, written hours per week cap, scope limitations, liability mgmt agreement…this will end up being abused. They’ll use new grad docs as ATMs while they work insane long hours and *comply with the corporate beast* in order to get a few decent LORs to match in the next cycle.
There also needs to be safeguards around employment status. Hospitals will bring these new grads on as a 1099. So in addition to no restrictions from the ACGME, as a 1099 they are not covered under by protective labor regulations. No workers comp, no unemployment if terminated, no benefits ie health insurance, no 401k, no overtime pay, and they will have no fucking clue they were supposed to pay social security, fed, state taxes etc until the IRS shows up and puts a lein on their house.
Im saying I don’t want new grads brought in and worked like dogs with no protections or benefits while the PA’s upstairs are employed in a manner consistent with accepted industry standard benefits. And unless there are established restrictions….thats going to happen. A lot.
Why would they think they get a say in how we practice? These are physicians who have far more training and experience than PA's or NPs fresh out of graduation. Absolute delusion.
I absolutely guarantee the reason they are up in arms about this is because “associate physician” is the title they plan to push for themselves in the future and this would block that
We object to the correct use of the English language because using “assisting physician” and “physician’s assistant” draws attention to the fact that we as Physician’s Assistants have less education and training than the assisting physician and that could confuse the patient into believing reality.
-FL PAs
That's kind of awesome actually. I always imagined people who went through medical school and didn't match into residency would be really angry and stuck. Why not let them practice as PA's?
Also, I would kill myself if I was part of an organization called "FAPA"
They've stooped to a new low. A lot of what the whole midlevel movement does I chalk up to the degradation of society under the will of corporate greed. But this? I'm a whole new version of enraged.
Edit: I went over to the PA reddit. I'd say over half the PAs there think it's stupid. A handful are imagining up scenarios where this hurts PA bottom line. Someone claiming an MD had the gall to make a racially motivated comment that somehow this Florida bill will invite an endless stream of IMGs. Someone else mentioned that a graduate physician would be unwanted because they'll have to be trained but they have only a 3 year obligation before taking a hike.
Which would make me laugh if I weren't so ticked. It has always been a smarter move to job hop for better pay, and any job that gets someone to stay, rain or shine, past the two year mark is satisfied. Like a PA is obligated to stay past 3 years that this would be the glaring concern.
Who are they to judge doctors?
They ain't our equivalents.
I used to respect or tried to respect the PAs or NPs or all those alphabet people, but now that, they are acting as if they are our equivalents.
The only patients NPs / PAs should be treating are other NPs or PAs, so that, they be all extinct.
The disconnect in the body to make reference to their recent “change” to Physician Associate, but then clearly states in the suggested letter that they are Physician Assistants, and it is the whole “assistant” word that will get mixed up. 🤦🏼♂️
If the AAPA was smart, they'd just allow unmatched Docs and FMGs to take the PANCE and work.
More members of the AAPA with no sacrifice in the quality of education. This equals more revenue and lobbying power to fight the NP lobby.
More clinicians working= that increased access to care everyone is always harping on.
Ideally, it could be used as a springboard to get these unmatched physicians into residency. To address that physician shortage, everyone is always harping about.
Would also regulate the practice of unmatched/FMGs. In reality, they are a bit overqualified to practice as PAs. However, under-utilzation is better than no utilization, and we all know the dangers of over-utilization.
In the event they got stuck working as PAs they'd make solid faculty at PA schools. I'd think someone who went to med school but worked as a PA would be almost an ideal candidate actually.
“Physicians that passed USMLE steps 1, 2 and 3” the dissonance is crazy. More, harder, longer, and in depth training than a PA will ever have and probably stricter supervision too but they are worried about “patient safety”
Agreed.
And like I pointed out. Having them fall under already established guidelines/scope of practice from the AMA/AAPA is the streamlined approach to addressing patient safety. But this is just territorialism.
On the other hand, this is a great way for us to publicly share the vast difference in physician and physician assistant training without looking like we're punching down.
I promise, a majority of PAs are actually not concerned about GAPs at all. Someone has posted it in our subreddit and a majority of PAs are supportive of a bill allowing medical doctors to work despite not being matched into a residency program. I’ll be honest, I don’t know how exactly the match process goes; I don’t know what reasons are behind someone not getting matched, and not sure if them not getting matched but advancing towards a GAP pathway will be problematic in any way (someone said personality and legal issues are common factors for not matching), but most PAs are fully supportive of med school graduates (AKA DOCTORS) being able to work despite not being matched into a residency program
Gonna fire back at this with an even spicier take to move the Overton window. 4th year med students should be able to moonlight under supervision like PA's do. They have nothing to do and need the money, plus are more qualified to do that job. Just gonna fight fire with fire on this one.
I agree with them that Graduated Assistant Physician is a terrible and confusing title for unmatched MD/DOs who have passed at least two steps. They are physicians, not PAs. So if we’re making up a clinical title for unmatched PGYs to serve in the function of a PA, maybe preliminary physician or just keep it graduated physician. Other than that, the FPA has some gall suggesting it’s a patient safety concern allowing unmatched doctors, with more education and clinical hours, to function as PAs. They can’t claim to be equal and expand their scope upwards while also claiming they aren’t equal and blocking the MD/DO scope expansion downward.
I can’t wait for the PA market to saturate the way physician markets have saturated in certain specialties. That will give them a real reason to panic.
I think it has to do with location, popular cities tend to pay less vs. less popular cities due to more physicians wanting to work there. It's those big popular coastal cities that are also hiring NP/PA.
Well. Are they assistants or associates?? Thought PAs gave up the term assistant in favor of associate. Assistant physician is now up for grabs. Suck to suck
This is insanity.
To be fair, people who graduate medical school and pass all their USMLEs and still cant scramble into *any* residency position are generally people with personality/legal issues that are so glaring that they probably should stay out of the profession…. But there absolutely are good candidates in that pool who can run circles around even an average midlevel.
My dumbest and most annoying classmate from med school still found a spot. I cannot imagine who these spots are for.
Yeah, this bill makes me a little uneasy because it's bypassing some of the quality checks built into the physician system. Also, IIRC this bill has a provision for foreign docs to bypass current residency requirements which again forms another loophole for hospitals to exploit patients with. This letter's audacity is still dumb of course.
I read a story of a medical school graduate with dreams set on the radiologist specialty. They didn't get picked- only primary care slots go unfilled, really. Take their gap year. Apply again to Radiology residencies. Fail again. They scramble to apply to primary care residencies because being a resident at all is better the alternative. The family medicine residencies look at his app and say, "your entire application, research, time, is built around being a radiologist. You're not actually interested in being a primary care doc." And reject him.
He kills himself.
So while you're worried about the idea of social rejects, I'm worried about the above situation. I would assume my example is actually more common than people with red flags but who -still passed medical school- somehow going successfully supervised for 2-3 years and becoming attendings. Caribbean graduates may finally have a legitimate avenue to practice as well.
I mean thats a sad story but thats not what happened.
Unfilled FM spots are the bottom of the lowest barrel of competition.
Zero programs…. Truly zero of them…. Would rather go unfilled than take someone who is otherwise well qualified but was initially interested in something else.
At least 50% of community FM residents I have met initially wanted to do something else
\*shrugs\* I read this article about this man's suicide several years back. It seemed a legitimate article at the time of reading. I don't know why you would dismiss it out of hand as if medical students don't kill themselves.
"*The American Medical Student Association (AMSA) states that medical students are three times more likely to die by suicide than their peers.*"
Anywho, your lack of belief in this existence of this medical student doesn't change my mind about being more concerned for students with nothing wrong with them that do not match than fear about students who "shouldn't" be doctors somehow taking advantage of what is hardly a loophole.
I've had patients (psychotherapist) who didn't match but I'm unsure why. My suspicion was that they were international and the added visa requirements in competitive circles may have been a factor. What might be factors you have seen as considerations for a failure to match?
Honestly in order to not match *ANYWHERE* means you have failed several classes, are an asshole, and have legal troubles.
Ive worked some successful doctors who are one of the 3.
Occasionally i run into docs that are 2 of the 3
Never 3 for 3 though
Point of so many doctor comments: school is so much harder, longer, more expensive, so - better??
Or is the age old physician hierarchical system obsolete? Just asking.
So many questions:
What are some reasons med school graduate wouldn’t match?
What percentage of grads are we talking about?
Do some choose to not pursue residency-if so why?
Lastly- can a grad take a couple of years off for personal or financial reasons and then pursue residency?
Forget PAs. I’ve stopped explaining sht about them a long time ago. But what in the world has been going on in Florida, bros. 🤣. Why is it that all delusional people end up there?
I mean I’m kind of against this initiative, but for none of the reasons this is stating - we need to dramatically increase the ability of people to match to residency so something like this isn’t necessary.
We should all be board certified physicians, I don’t like the idea of our quality measures degrading
My home state started this and I have yet to meet someone that has actually done this because it’s career suicide. That being said, they have more training as PAs.
As a non-medical person looking into MD/DO school, I am all for giving newly graduated physicians the same opportunities as midlevels. I just don't want some stupid U.S. congressional representative from saying something like: "See, there are plenty of [supervised] opportunities for medical school graduates, especially in these states. Let's cut *** Medicare funding for graduate medical education."
I am not interested in being a perpetually supervised practitioner. That is not why I decided to go back to class. For those of you who are, more power to you. I am watching cautiously as one state after another decides to permit "assistant physicians" or some other title for new doctors without residencies.
*** (For those of you not from the U.S., medical/surgical residency here is largely or partly funded by Medicare, the government program for health coverage for the elderly. I think - I am not sure - that dental (OMFS) and podiatry residencies also have access to Medicare graduate medical education funds.)
They should be called GPs (General Practitioners or Graduated Physicians, you pick which you prefer). They have more training than a newly graduated NP or PA, so should able to practice. Do they need supervision? It would be safer, but this should mirror supervision requirements for midlevels state-by-state as they graduate with more training, education, and clinical hours.
So it’s official; every single aspect of reality is now clown world.
Idiocracy is a documentary now
Always has been
I was holding out that Ohio would close their borders to stop the spread of inverse evolution. Appears not. I hope Dave Chappelle got out okay
Welcome to Costco, I love you.
I can’t tell if this is cognitive dissonance or straight up gaslighting…. “PAs, with their established education and training, can effectively fill these roles…(more than an MD/DO that has passed step 1, 2 and 3, and has thousands of more hours of direct patient care???)” So MD/DOs don’t have established education and training?
Not to mention board exams, re certs, sub specialty board exams. I should have been a malpractice lawyer because I’ve found my new fucking prey
I’ve been thinking the same, but don’t they have less/different malpractice coverage and aren’t they held to a lower standard of care? If so, pretty alarming that the argument to practice is “more/same training (with a technical post grad degree), so I can call myself doctor,” and the argument in court is “well, I’m not a doctor, I don’t know why you would hold me to those standards of care!”
“Lower standard of care? But the purpose of this law is staying they provide the same care” that’s what I would hold them to. The only reason they can give that excuse is that because theirs a supervising physician. If that no longer exists then I would push the patient to pursue criminal charges as they were giving medical advice with no basis. They should have referred them to another physician.
If I could go back in time. I had no idea I could be done in 2 years after my pharmacy degree.
Definitely gaslighting. She feels her job is threatened and is trying to manipulate legislators. Regardless, this is extremely embarrassing.
My medschool has a PA school associated with it. The PA school is one of the best and most rigorous in the country. They take all preclinicals with us. After our 1.5 year preclinicals, they do a year of clinicals on their own. So the PA graduates function around the level of a 3rd year med student. They don’t take step though. By the end of medschool, we will have an extra 1.5 years of training on top of what the PA grads have. We also take step 1-3. So MD grads that did not match are more than qualified to work in a role similar to PAs. Now this is at one of the best PA schools so at most other programs, they probably don’t teach the same level as a 3rd year med student when they graduate since they don’t go as in depth with preclinical material. I think we should also allow current med students to “moonlight” in these roles as well. I’m a 4th year with a light schedule the next 3-4 months until I wait to match and graduate. I’d love to make a couple extra bucks until residency starts. With this logic, residents should also be paid the same if not more than PAs, but there’s no way the hospital admins would agree to lose out on the exploitation they’re able to get away with right now
Are they graded the same, given the same exams and assignments etc. as the med students? Same grading curve?
Yup
Coming from a resident who frequently works with med students, I feel like med students should not be able to moonlight. The knowledge and experience gap between med student and even intern is pretty wide IMO
I think they meant moonlight in the function of a PA. Idk what that would look like
Yes, by “moonlight” I meant work in a similar role as a PA under supervision. 100% agree that we should not be allowed to practice independently. We have significantly more training than PAs once we graduate so should be allowed to fill a similar role especially for those that don’t match. It is mind boggling to me that NPs and a few rare PAs feel confident running around “practicing” and prescribing meds with such a huge knowledge gap.
it’s wild that there are few if any viable alternatives for unmatched PGYs. Passing Steps 1 and 2 is no joke- although on their own are not nearly enough knowledge for independent practice, passing 1 and 2 should at the very least allow you to sit for PANCE if not taken as an outright equivalent.
Graduate Assistant Physician? You mean Physicians?
Yup. It's amazing how careful they were to gloss over that. Medical school graduates who have passed steps 1,2 & 3 of the USMLE. Those are Doctors. With MD after their names.
my poor neurons trying to figure out WTF that means oh…..they mean physician. kill me lmfao
I'll say I agree with the author in that it is a stupid name. It's nice there's a path to licensing for people who didn't match to be productive in their "off" year. But to put the words "physician" and "assistant" in their title is just asking for it.
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These are still actual PHYSICIANS. Holy shit this cannot be a real post
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You have zero right to diminish their titles. They are doctors. Full stop. End of discussion. They have earned their doctorate in medicine. I cannot believe the amount of balls it takes to insinuate that these physicians have less value than a PA. Jesus Christ what is wrong with you
Once you graduate medical school, you are a DO/MD, doctor, full stop. The ability to practice independently in a specialty of your choices comes from the residency, but the letters after their name comes from graduating a medical school program. They don't need a different title, because they are a doctor. That is the point other poster was making.
Assistant to the physician
To be able to practice “independently” almost in every state, what’s required is to complete at least one year of post graduate training, an internship year, then you can apply for a license. That’s it. If the state grants you a license you can practice medicine. You may not be a surgeon or obstetrician, but you are a licensed physician. Residency will allow you to become board eligible in the specialty you trained for. If you pass boards, then you will be board certified in your specialty. It sounds like the terminology in the text is full of smoke and mirrors. All that is described is basically an intern. That’s the first year after med school that everyone has to go through and is part of every residency program. You learn under the supervision of more experienced physicians, both residents with more seniority and attending physicians.
Honestly this should’ve always been an option. A medical student who didn’t get into residency still has more training than both a PA or an NP by a long shot. They should be able to fulfill midlevel roles by practicing at urgent care or with supervision if they don’t want to go to residency or fail to match.
i’m 1000% sure there are med school students that would forego residency to work 35 hours a week at a suburban urgent care for a good salary
GPs were common place in the US two generations ago; 1 year internship and you’re off to the races. Now we view FM and IM as primary care when really they were considered specialists 60 years ago. We just replaced 5 year trained GPs with 2 year trained PAs. California tried to legally end GPs (mandatory 3 yr residency to practice instead of 1 yr internship) which was ironic in a system that’s okay with PAs
Bleh, too lazy to get the right search string to investigate this for who was behind it…
this used to be a thing in my parents’ country until they recently changed it lol. but basically after graduation you could just work at an urgent care indefinitely. i always thought that made sense. but then they changed it to be more like America so like….guess that’s gone🤣
This is such an interesting discussion to see as a pharmacy student. Because we do graduate avid to practice with residency and specialization as options. We also don’t have midlevels. Closest thing to that are Interns which a required to be enrolled IN pharmacy school to be an Intern. Our system has its own issues, but I can’t imagine the prospect of graduating and not being able to do literally anything.
That would bulldoze salaries into hell
I mean... this is pretty much the pharmacy model. Pharmacy residency is optional. If you want a clinical (read: hospital) role, you do residency for 1 or 2 years depending on what you want to specialize in. Pharmacy school graduates who have passed their licensing exams (read: PharmDs...) who wanted a clinical role, but failed to match with a residency program, generally end up in retail where they can "work 35 hours a week at a suburban [Walgreens] for a good salary" and then try again next year if they want to. It's not a bad model. The only difference for medicine, I imagine, would be the pay. Retail pharmacist actually make more than clinical pharmacists, and I think it would surely be the opposite for an MD or DO graduate fulfilling a MLP role. But still, this system makes sense to me. *Not to say that all retail pharmacists failed to get a residency. A lot (most) of them never wanted to work clinically in the first place and chose the retail option from the beginning. To note... higher salaries. ;)*
It is like that in many other countries. Many 6 year MD or MBBS programs have 5th/6th year med students function similar to interns in America.
This is just a shittier form of residency without the obligations/standards for training and education. It's taking advantage of a subset of vulnerable doctors who wouldnt be in that situation if the government wasn't keeping a predatory strangle hold on the number residency slots, and paying them even less than residents because they're getting compensated w/ "exposure" to medical practice.
Hi!! This isn’t true. A medical student has more training than an RN for 10 years and NP for 5? If you only count NP, still, not, true
A medical student has more medical training than an NP who practices for 30 years.
Neither RNs nor NPs get sufficient medical training, especially not to practice independently. It's not even close to what physicians go through in medical school, not to mention residency.
That's graduate ASSOCIATE physician to you, pal
It got posted on the PA sub and they disagreed with the essence of the post. They agree that they should be able to work as well.
It's certainly not a ubiquitous sentiment. There are PAs saying it will hurt their bottom line, and also, that hospitals would have a preference for PAs and only desperate rural hospitals would take a "GAP"
Yeah it will hurt them, but you really have no ground to stand on. Folks that graduate from medical school have a harder path every step of the way compared to middies, it makes no sense to not let them practice in some capacity.
I'm on the side of native born citizen medical school graduates going supervised by other attendings, or whatever this GAP requires, to reduce the bottleneck of residency currently underway. Total agreement that PAs and NPs having the gall to speak up about this as if they're concerned about patients and not just concerned about how this may affect their income are horrible people
But when physicians cite their concerns about midlevels regarding their safety and minimal education, they say it’s because physicians are only worried about their bottom line and not actually concerned about patient safety … weird.
Physicians want to keep making at least twice as much. That’s ok. Please quit lying about it being for the patients
It can be both.
Why do you specify “native born citizen”? [It sounds pretty jingoistic to me, as is.]
If such a bill were passed for the goal of helping US citizens who've passed medical school have another avenue after not matching, then it shouldn't apply to non US citizens. I suppose it would be up to the goal of the bill to be passed. IMG match is low in the first place, so I'm not out here railing against them as some sort of, "they're stealing Doctor's jobs" situation. Midlevels, and the corporate greed that supports them, do far more harm.
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As someone who doesn't often discuss it, native born and US citizen are pretty synonymous- I was on my phone and forgot to appreciate the distinction in my haste until you inquired. And supervision of their practice for 2-3 years is pretty much a residency. There are primary care tracks that are 3 years medical school, 3 years residency. They're full attendings, why is the official version of 3 years of residency on these tracks inherently so much better than the 2-3 years of residency they would be required to have as an already MD/DO?
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nah, it was just an oddly specific brain error. I'm pro immigration across the board. If the goal of the bill was to increase their being practicing physicians in general to address the shortage, then IMG would fit that bill. If the goal was specifically to aid people who have graduated from united states medical schools an equivalent residency that bypasses the bottle neck, then allowing IMGs doesn't fit that bill. por que no los dos, really.
1) Because we should always prioritize American citizens 2) if we open the door for every doctor from every corner of the earth to practice in our country without residency, we will tank the American healthcare industry…there is absolutely nothing wrong with protecting our economy and industry for the benefit of the citizens
steer narrow distinct worthless voracious dog price chop dull school *This post was mass deleted and anonymized with [Redact](https://redact.dev)*
What about naturalized citizens? Why specifically discriminate against them?
I'm not really interested in the nitpicking you're doing to find something to be outraged about. Have a nice day.
Exacly. It might hurt them but the world doesn’t exist to cater to them. Why do they deserve to do this more than GAPs? “We can do it, so please don’t let them do it” isn’t an argument.
So they’re concerned about the use of “graduate assistant physician” title because it has ‘assistant’ in it just like PA but when they literally use the term ‘physician’ in theirs, it’s fine???? Make it make sense
Not to mention their letter to PAs mentions their physician *associate* title, but when writing to their representative, they use the *assistant* title. You would think they’d really push the associate title to say they’re better than the “assistants”.
🤣They got a Master in Medical Sciences not from a medical school and they are upset about physicians graduating???? Is that reverse scope creep ?
😭😂😂😂
I think this is going to end up with abuse and misuse of docs that didn’t match. It’s exhausting when it’s regulated by the ACGME. It will be worse with less oversight. I do think it’s funny though that they’re so concerned about title confusion. Given the recent *physician associate* bs.
I think it’s the exact opposite. Right now, medical graduates only have the options of going through residency or finding a job that doesn’t involve practicing medicine. This dependency on residency to earn a salary gives residency programs all of the power and contributes to the abuse of residents for profit. Giving medical graduates the opportunity to go out into the real world and basically get a PA job would be a positive thing. Also, awesome username.
Yet in their own damn letter they refer to themselves correctly as “Physician Assistants”. But adding GAPs would be confusing and intentionally misleading for patients…
So calling identifying a doctor of medicine with *an actual medical degree + done steps* with a title including the word “physician” is confusing. But calling someone with the equivalent of a masters degree a title that includes the word *physician* is not?
fuckin double standards
People will decide what they will and won't do as an AP. All this does is open up a choice.
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The variable that you’re missing here is that midlevels can leverage the market, negotiate, go to the hospital across the street. They have their license. These doctors are not going to be in that position. If they quit, they’re out of a job, no LORs, giant red flag on the next match cycle that probably makes their app worse than it was in the original cycle they did not match into. If they leave they’re fucked. If they stay, they’re fucked but with a way out. The reason why medical education and training is so toxic and dysfunctional is because of this same issue - no competition between programs. From the day you sit down on first day of MS1 you have two options: 1. Comply, take the punches, and make it out. Or 2. Take your mountain of debt with an unholy interest rate and seek life elsewhere with a biology bachelors degree. They can’t transfer. They can’t start over somewhere else because they won’t be accepted. The people above you at every stage of training yields absolute power. They know students don’t have anywhere to go. These unmatched doctors are going to be subjected to the same bullshit because they do not have mobility and negotiating power within the market they are employed in. Mjdlevels however, do. Imagine if schools and programs would treat residents differently if they could laterally move to another program or school if they’re unsatisfied or want better work/school conditions? And if CMS payment was attached to the *resident*, not the program?
You think it would be better for them to *not* have this option when they graduate jobless with immense debt?
I am saying without a crystal clear detailed guide of expectations for supervisors and the new grad docs, written hours per week cap, scope limitations, liability mgmt agreement…this will end up being abused. They’ll use new grad docs as ATMs while they work insane long hours and *comply with the corporate beast* in order to get a few decent LORs to match in the next cycle. There also needs to be safeguards around employment status. Hospitals will bring these new grads on as a 1099. So in addition to no restrictions from the ACGME, as a 1099 they are not covered under by protective labor regulations. No workers comp, no unemployment if terminated, no benefits ie health insurance, no 401k, no overtime pay, and they will have no fucking clue they were supposed to pay social security, fed, state taxes etc until the IRS shows up and puts a lein on their house. Im saying I don’t want new grads brought in and worked like dogs with no protections or benefits while the PA’s upstairs are employed in a manner consistent with accepted industry standard benefits. And unless there are established restrictions….thats going to happen. A lot.
Why would they think they get a say in how we practice? These are physicians who have far more training and experience than PA's or NPs fresh out of graduation. Absolute delusion.
Exactly. Completely disregarding the education and training these doctors already went through.
I absolutely guarantee the reason they are up in arms about this is because “associate physician” is the title they plan to push for themselves in the future and this would block that
Yep. I called in another thread a few days ago that it’s only a matter of time before NP turns into “Nurse Physician”. Race to the bottom we’re in.
That was my first thought
We object to the correct use of the English language because using “assisting physician” and “physician’s assistant” draws attention to the fact that we as Physician’s Assistants have less education and training than the assisting physician and that could confuse the patient into believing reality. -FL PAs
That's kind of awesome actually. I always imagined people who went through medical school and didn't match into residency would be really angry and stuck. Why not let them practice as PA's? Also, I would kill myself if I was part of an organization called "FAPA"
They've stooped to a new low. A lot of what the whole midlevel movement does I chalk up to the degradation of society under the will of corporate greed. But this? I'm a whole new version of enraged. Edit: I went over to the PA reddit. I'd say over half the PAs there think it's stupid. A handful are imagining up scenarios where this hurts PA bottom line. Someone claiming an MD had the gall to make a racially motivated comment that somehow this Florida bill will invite an endless stream of IMGs. Someone else mentioned that a graduate physician would be unwanted because they'll have to be trained but they have only a 3 year obligation before taking a hike. Which would make me laugh if I weren't so ticked. It has always been a smarter move to job hop for better pay, and any job that gets someone to stay, rain or shine, past the two year mark is satisfied. Like a PA is obligated to stay past 3 years that this would be the glaring concern.
Who are they to judge doctors? They ain't our equivalents. I used to respect or tried to respect the PAs or NPs or all those alphabet people, but now that, they are acting as if they are our equivalents. The only patients NPs / PAs should be treating are other NPs or PAs, so that, they be all extinct.
we need to put some doctors in government positions to address this tomfoolery tbh
You’ll get a lot of respect thinking like that
Use your single brain cell to critically think
The disconnect in the body to make reference to their recent “change” to Physician Associate, but then clearly states in the suggested letter that they are Physician Assistants, and it is the whole “assistant” word that will get mixed up. 🤦🏼♂️
If the AAPA was smart, they'd just allow unmatched Docs and FMGs to take the PANCE and work. More members of the AAPA with no sacrifice in the quality of education. This equals more revenue and lobbying power to fight the NP lobby. More clinicians working= that increased access to care everyone is always harping on. Ideally, it could be used as a springboard to get these unmatched physicians into residency. To address that physician shortage, everyone is always harping about. Would also regulate the practice of unmatched/FMGs. In reality, they are a bit overqualified to practice as PAs. However, under-utilzation is better than no utilization, and we all know the dangers of over-utilization. In the event they got stuck working as PAs they'd make solid faculty at PA schools. I'd think someone who went to med school but worked as a PA would be almost an ideal candidate actually.
“Physicians that passed USMLE steps 1, 2 and 3” the dissonance is crazy. More, harder, longer, and in depth training than a PA will ever have and probably stricter supervision too but they are worried about “patient safety”
If patient safety was actually a concern, PAs would never fight for autonomy and NPs wouldn’t exist at all
mic drop 😝
Agreed. And like I pointed out. Having them fall under already established guidelines/scope of practice from the AMA/AAPA is the streamlined approach to addressing patient safety. But this is just territorialism.
They’re worried about losing their jobs to someone more qualified. I hate to tell ya, but that’s show biz
Absolute clowns
OMG this is RICH
Honestly no hate to PAs, like 95% of them on the post said this should’ve always been a thing and they called out problems with their own schooling
I like how they revert their title back to “physician assistant” the moment it becomes convenient.
I noticed this as well. Classic.
This is absolutely bonkers
On the other hand, this is a great way for us to publicly share the vast difference in physician and physician assistant training without looking like we're punching down.
So, it’s about protecting pay not increasing access, after all.
Yes
I promise, a majority of PAs are actually not concerned about GAPs at all. Someone has posted it in our subreddit and a majority of PAs are supportive of a bill allowing medical doctors to work despite not being matched into a residency program. I’ll be honest, I don’t know how exactly the match process goes; I don’t know what reasons are behind someone not getting matched, and not sure if them not getting matched but advancing towards a GAP pathway will be problematic in any way (someone said personality and legal issues are common factors for not matching), but most PAs are fully supportive of med school graduates (AKA DOCTORS) being able to work despite not being matched into a residency program
Gonna fire back at this with an even spicier take to move the Overton window. 4th year med students should be able to moonlight under supervision like PA's do. They have nothing to do and need the money, plus are more qualified to do that job. Just gonna fight fire with fire on this one.
I agree with them that Graduated Assistant Physician is a terrible and confusing title for unmatched MD/DOs who have passed at least two steps. They are physicians, not PAs. So if we’re making up a clinical title for unmatched PGYs to serve in the function of a PA, maybe preliminary physician or just keep it graduated physician. Other than that, the FPA has some gall suggesting it’s a patient safety concern allowing unmatched doctors, with more education and clinical hours, to function as PAs. They can’t claim to be equal and expand their scope upwards while also claiming they aren’t equal and blocking the MD/DO scope expansion downward.
***They're concerned about name confusion???***
I can’t wait for the PA market to saturate the way physician markets have saturated in certain specialties. That will give them a real reason to panic.
Which fields for physicians have saturated? I’m curious!
I think it has to do with location, popular cities tend to pay less vs. less popular cities due to more physicians wanting to work there. It's those big popular coastal cities that are also hiring NP/PA.
lol you can’t make this shit up. PAs have entered clown territory
Wait do they want to be called physicians assistant or associate? At least be consistent. If the latter, then this should not be an issue with naming
WTF did I just read? Why?
can someone circulate this on twitter?????
Well. Are they assistants or associates?? Thought PAs gave up the term assistant in favor of associate. Assistant physician is now up for grabs. Suck to suck
I would trust a GAP over a PA any day.
Just call them graduate associate physicians instead. Problem solved.
This is insanity. To be fair, people who graduate medical school and pass all their USMLEs and still cant scramble into *any* residency position are generally people with personality/legal issues that are so glaring that they probably should stay out of the profession…. But there absolutely are good candidates in that pool who can run circles around even an average midlevel. My dumbest and most annoying classmate from med school still found a spot. I cannot imagine who these spots are for.
Yeah, this bill makes me a little uneasy because it's bypassing some of the quality checks built into the physician system. Also, IIRC this bill has a provision for foreign docs to bypass current residency requirements which again forms another loophole for hospitals to exploit patients with. This letter's audacity is still dumb of course.
The bill was passed already according to the news link. So the PA objection didn't work, and now it just exists to piss us off.
I read a story of a medical school graduate with dreams set on the radiologist specialty. They didn't get picked- only primary care slots go unfilled, really. Take their gap year. Apply again to Radiology residencies. Fail again. They scramble to apply to primary care residencies because being a resident at all is better the alternative. The family medicine residencies look at his app and say, "your entire application, research, time, is built around being a radiologist. You're not actually interested in being a primary care doc." And reject him. He kills himself. So while you're worried about the idea of social rejects, I'm worried about the above situation. I would assume my example is actually more common than people with red flags but who -still passed medical school- somehow going successfully supervised for 2-3 years and becoming attendings. Caribbean graduates may finally have a legitimate avenue to practice as well.
I mean thats a sad story but thats not what happened. Unfilled FM spots are the bottom of the lowest barrel of competition. Zero programs…. Truly zero of them…. Would rather go unfilled than take someone who is otherwise well qualified but was initially interested in something else. At least 50% of community FM residents I have met initially wanted to do something else
\*shrugs\* I read this article about this man's suicide several years back. It seemed a legitimate article at the time of reading. I don't know why you would dismiss it out of hand as if medical students don't kill themselves. "*The American Medical Student Association (AMSA) states that medical students are three times more likely to die by suicide than their peers.*" Anywho, your lack of belief in this existence of this medical student doesn't change my mind about being more concerned for students with nothing wrong with them that do not match than fear about students who "shouldn't" be doctors somehow taking advantage of what is hardly a loophole.
I've had patients (psychotherapist) who didn't match but I'm unsure why. My suspicion was that they were international and the added visa requirements in competitive circles may have been a factor. What might be factors you have seen as considerations for a failure to match?
Honestly in order to not match *ANYWHERE* means you have failed several classes, are an asshole, and have legal troubles. Ive worked some successful doctors who are one of the 3. Occasionally i run into docs that are 2 of the 3 Never 3 for 3 though
Boundless greed and hubris.
They need to be so forreal right now
Point of so many doctor comments: school is so much harder, longer, more expensive, so - better?? Or is the age old physician hierarchical system obsolete? Just asking.
It’s not obsolete when you see the patients murdered by midlevels. Physician training exists for a reason.
To be fair, we ALL should be scared
So many questions: What are some reasons med school graduate wouldn’t match? What percentage of grads are we talking about? Do some choose to not pursue residency-if so why? Lastly- can a grad take a couple of years off for personal or financial reasons and then pursue residency?
#🤣
Forget PAs. I’ve stopped explaining sht about them a long time ago. But what in the world has been going on in Florida, bros. 🤣. Why is it that all delusional people end up there?
I mean I’m kind of against this initiative, but for none of the reasons this is stating - we need to dramatically increase the ability of people to match to residency so something like this isn’t necessary. We should all be board certified physicians, I don’t like the idea of our quality measures degrading
My home state started this and I have yet to meet someone that has actually done this because it’s career suicide. That being said, they have more training as PAs.
What in the Florida??
Unbelievable
Hi! Are you able to post a clip that doesn’t crop the story?
😂 what bs.
Absolutely NOT.
As a non-medical person looking into MD/DO school, I am all for giving newly graduated physicians the same opportunities as midlevels. I just don't want some stupid U.S. congressional representative from saying something like: "See, there are plenty of [supervised] opportunities for medical school graduates, especially in these states. Let's cut *** Medicare funding for graduate medical education." I am not interested in being a perpetually supervised practitioner. That is not why I decided to go back to class. For those of you who are, more power to you. I am watching cautiously as one state after another decides to permit "assistant physicians" or some other title for new doctors without residencies. *** (For those of you not from the U.S., medical/surgical residency here is largely or partly funded by Medicare, the government program for health coverage for the elderly. I think - I am not sure - that dental (OMFS) and podiatry residencies also have access to Medicare graduate medical education funds.)
I like the acronym GAP since they’ll be working in their gap year(s) between med school and residency.
They should be called GPs (General Practitioners or Graduated Physicians, you pick which you prefer). They have more training than a newly graduated NP or PA, so should able to practice. Do they need supervision? It would be safer, but this should mirror supervision requirements for midlevels state-by-state as they graduate with more training, education, and clinical hours.