[NPInfo] A few other blog comments-my second posting.

[David Mittman]

I love when they say we are all important, even the janitor.

Dave: It’s the way of the world for individuals to validate their  
worth & stature by putting other individuals down. Doc’s above  
irrelevant (& not-at-all based in experience or reality) swipe at  
osteopathic medical education is yet another example on a very long  
list.Those who think they’re better than you are don’t care to hear  
evidence that might change their view. I’m new to the field but have  
found that being highly competent is the best approach to gaining  
respect from those who think DOs are always lesser than MDs. A PA once  
told me she knew competent varieties of MDs, DOs, FMGs, PAs, & NPs, as  
well as incompetent varieties of each. I’ve found that to be the case.  
MD/DO training does differ from NP/PA training and our respective  
roles reflect those differences. But those with limited self- 
confidence will always look to see how they can feel better than  
others. They don’t want to hear that I scored significantly higher on  
allopathic board exams than they did, that my physical diagnosis  
skills might be superior to theirs (I’ve been touching patients since  
day 1 of my training), nor that my clinical problem-solving skills  
might be on par with or more advanced than theirs. They don’t want to  
hear that MDs consistently state that they are impressed by my level  
of knowledge & skill. And none of that matters much because I know the  
second I think I’m beyond reproach will be one second before I make a  
mistake. So I keep my eyes ahead toward learning everything I can to  
provide the most effective & up-to-date patient care possible and most  
b.s. comes out in the wash. No point in wasting my time trying to  
convince anyone with anything more than being relentless in my pursuit  
of excellence.
Comment by medicine girl - August 9, 2008 at 1:51 pm
Why a “Chief of Medicine,” would make an unsupported remark comparing  
NPs and PAs to Caribean FMGs is bewildering. Even more confusing is  
that, PAs and NPs played no part in the situation being discussed. I  
do not wish to argue unsubstantiated remarks. I would request that he  
(or she) cite any referenced studies that support the statements made  
in his response. Since I am unaware of any such evidence, I am  
suggesting that the Chief contact me, or Dave Mittman, so that we can  
initiate such an evidence based undertaking that might help support  
or, refute his personal feelings.
Sincerely, B. Kalin, PA-C
bkalin at njdpa.org
Comment by Bruce Kalin, PA-C NJDPA President - August 9, 2008 at 2:25 pm
I went to a top med school, AOA and all that jazz, did a residency in  
the UC system, and a fellowship at JHU. When in residency (surgical  
specialty), we rotated through a large military hospital and had a  
residency exchange program with a military residency that had sizable  
percentage as D.O. graduates, and a few “fifth pathway” guys. In my  
view, there wasn’t any difference in the performance level. How good  
you get to be in medicine is more a function of your final level of  
training and board certification than what got you to the point of  
passing a basic licensure exam.
Comment by MD Texas - August 9, 2008 at 3:25 pm
It is highly ironic that Dave Mittman (PA) insinuated that PA’s were  
somehow superior to SGU grads, when it is painfully obvious that the  
educational requirements for an MD (Caribbean or not) unquestionably  
overshadow that of a PA (both in basic sciences and post-graduate  
training).
PA’s play their integral part, as do nurses, NP’s and even the  
custodial staff (no negative associations intended). That does not  
change the fact that MD’s (and DO’s) have final say over patient care  
due to the extensive knowledge and training that is required to pass  
the USMLE exams and complete 3-5 years of specialty training.
In terms of SGU grads vs. LCME grads, it is dependent on the person  
and considering that we all have to pass the USMLE exams and go  
through ACGME training programs to attain a license, any potential  
qualitative differences in education (which haven’t been proven to  
exist) are eclipsed by each physician’s ability to apply his knowledge  
and to satisfy her patient’s needs.
I applaud SGU for securing training positions for their students. They  
will be the majority of the increasingly necessary primary care  
physicians for America’s aging population. Plus, as more LCME schools  
expand their class sizes, less of those Americans will go to SGU  
because they have a place in an LCME school.
Comment by Observer - August 9, 2008 at 4:09 pm
Observer.
You don’t have a clue.
Read the post above yours. Although Medicine girl seems to be a  
physician, she gets it. I would be on her team anytime.
I AM NOT and let me repeat, I AM NOT saying that PAs or NPs are better  
than physicians. What I did insinuate, and only insinuate is that we  
would do very well on the same tests that others take. I want the half  
as**ed swipes at who NPs and PAs are and the job we do to end.If you  
think we are so ill trained, do the study I suggested. I surely have  
read worse things studied. If “The Chief” can arrange it, do you want  
a piece of the action on the scores?
This was about a swipe. One that I responded to. One where I  
insinuated that we can all tell each other how “badly trained” all the  
other professions are all day or dismiss each other because we went to  
the wrong school, or have the wrong initials after our name or  
whatever. It won’t work anymore.
If making you the captain of the ship, is passing some boards, then  
the ship will sink. What a real Captain does is take responsibility  
for the good of the entire crew. The captain looks for members of the  
crew to do more, to become more, and someday actually to take over  
another craft as a captain themselves. The Captain put their crew  
ahead of themselves.
Let me tell you Sir, believe what you want. The Emperor has no clothes  
and many agree on this one. Our healthcare boat is sinking.
Mr. Observer I have been in healthcare a whole lot longer than you and  
if we don’t want it to sink completely we had better start working  
together. Don’t placate NPs and PAs by saying we are “all” important,  
even as the janitors also are. We make life and death decisions every  
day. I am sure you don’t like it as only the Captains should do that.  
Sorry.
You know this is about power and money and certain students being kept  
out of rotations by others in the same profession.
I don’t really care, just don’t put down my profession or NPs whom I  
think are great.
Let’s start working together.
Dave
Comment by Dave Mittman, PA - August 9, 2008 at 4:46 pm