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View Full Version : DCs considering PCP via MD/DO vs. PA route ??



CARICOM-MED
01-08-2011, 02:22 PM
DCs considering PCP via MD/DO vs. PA route ??
I am just curious to find out the pros-cons of DCs pursuing expanded scope to become primary care providers.
Input from DCs considering either option PA vs MD/DO routes ?!?!?

=> PA is MUCH shorter program 2 years & PCP Focused
=> MD/DO Route: 7 years of MD/DO route (4 for the MD/DO + 3 years minimum for Residency.)

How many DCs would be interested in getting a PA designation if it was offered as a CE program, i.e. 12 months of intensive basic medical sciences followed by 12 months of hospital internship/rotations.

Cheers :)

AgActual
01-09-2011, 04:41 PM
I would certainly do it but many DC schools and students are not that progressive on this issue. The best bet would probably be to start teaching DC students how to prescribe certain medications. It probably wouldn't be that difficult since it would only be a limited number of meds to learn.





How many DCs would be interested in getting a PA designation if it was offered as a CE program, i.e. 12 months of intensive basic medical sciences followed by 12 months of hospital internship/rotations.

Cheers :)

leadsled
01-09-2011, 05:00 PM
You forget that a PA cannot work autonomously, they must work under a supervising Physician! So what's the point? And what Physician wants to take on the added liabilities of a DC they have to supervise? When is the DC working as a PA and when is he or she working as a DC? For the most part, I don't believe an MD or DO will desire this type of relationship.

Now the DC with additional training for prescriptive practice sounds more reasonable. Another option is to get schooled as a nurse practitioner (NP) who can work autonomously in most states. That may be an option but I doubt it because it takes 2 years to become an RN then 3 to 4 years to become an NP with the new educational requirements.

From a business standpoint, if I were a DC, I would simply hire and pay a licensed and autonomous NP to expand the primary care services offered at the clinic.

AgActual
01-09-2011, 06:23 PM
You forget that a PA cannot work autonomously, they must work under a supervising Physician! So what's the point? And what Physician wants to take on the added liabilities of a DC they have to supervise? When is the DC working as a PA and when is he or she working as a DC? For the most part, I don't believe an MD or DO will desire this type of relationship.


I think there is also the problem of many DC's not seeing themselves as medical doctors and not wanting to be medical doctors. I have to believe if you went up to a bunch of chiropractic students and proposed that they also get PA or NP, it would be very similar to going up to a bunch of med students and saying they should get also get certified as a dental hygienist, that way they can be more like dentists or going to an optometry school and saying everyone should get their OD and a masters in mental health counseling, that they way they could be more like psychologists.

The point is, people go to these schools for a reason and become MDs, chiropractors, podiatrists, dentists, etc. for a reason. Not everyone secretly wants to be something else and not every chiropractor wants to be a medical doctor. That is why i don't think offering a duel degree as a DC/PA or NP would have any sort of widespread appeal. Just like how an MD/RDH and OD/MHC degree programs would also fail.

teratos
01-10-2011, 05:52 AM
I would certainly do it but many DC schools and students are not that progressive on this issue. The best bet would probably be to start teaching DC students how to prescribe certain medications. It probably wouldn't be that difficult since it would only be a limited number of meds to learn.

No, you still need to learn all of the medications, since you need to be aware of interactions etc. That being said, med school doesn't have a ton of pharm.

AgActual
01-10-2011, 12:12 PM
No, you still need to learn all of the medications, since you need to be aware of interactions etc. That being said, med school doesn't have a ton of pharm.

Well yes, and chiropractic programs do already cover pharmaceuticals to some extent. Several courses go over the potential interactions between supplements and prescription medication, so you could probably just build around that. All i am saying is that chiropractors would only need to learn maybe 2 types of medications to actually prescribe, so with a bit of planning, could be done without completely rewriting the curriculum.

CARICOM-MED
01-10-2011, 10:39 PM
PA vs MD for Chiropractors
There are many DCs, that got their MD/DO just for scope purposes, I talked to several in my program, if they had a PA program, they will surely save tons of time, and $$$......Most MDs work in group practices, so by having a PA degree the DC can join a medical group and at least practice PCP, as well as Chiropractic...furthermore, the liability as a PA is FAR less than MD.....thoughts ?


I think there is also the problem of many DC's not seeing themselves as medical doctors and not wanting to be medical doctors. I have to believe if you went up to a bunch of chiropractic students and proposed that they also get PA or NP, it would be very similar to going up to a bunch of med students and saying they should get also get certified as a dental hygienist, that way they can be more like dentists or going to an optometry school and saying everyone should get their OD and a masters in mental health counseling, that they way they could be more like psychologists.

The point is, people go to these schools for a reason and become MDs, chiropractors, podiatrists, dentists, etc. for a reason. Not everyone secretly wants to be something else and not every chiropractor wants to be a medical doctor. That is why i don't think offering a duel degree as a DC/PA or NP would have any sort of widespread appeal. Just like how an MD/RDH and OD/MHC degree programs would also fail.

TXDC2bMD
01-22-2011, 11:24 AM
This is the delimma i am having at this time....Im a chiro in Dallas, practicing since 2007 when i first joined, got accepted to Ross, but decided to open my first clinic and declined the offer. I am 28 now, on my second go at running a clinic and I am tired of all this disrespect i get from the community, the less reimbursement from insurance companies and i always seem to get paid last and not enough. I am looking to go back to school, but i cant figure out which one to do...i guess time is really of the essence. Do I save the time and become a PA and start working (whats their avg salary) or spend more time and more money....i dont know, i dont know.....HELP!

AgActual
01-22-2011, 05:34 PM
This is the delimma i am having at this time....Im a chiro in Dallas, practicing since 2007 when i first joined, got accepted to Ross, but decided to open my first clinic and declined the offer. I am 28 now, on my second go at running a clinic and I am tired of all this disrespect i get from the community, the less reimbursement from insurance companies and i always seem to get paid last and not enough. I am looking to go back to school, but i cant figure out which one to do...i guess time is really of the essence. Do I save the time and become a PA and start working (whats their avg salary) or spend more time and more money....i dont know, i dont know.....HELP!

Have you looked into becoming a nurse practitioner? It would be faster and probably cheaper than med school or becoming a PA but you would be able to do pretty much the same things as an MD or PA. Plus you can earn an NP part time, unlike those other two degrees. If you practice as a DC/NP then you would have a very wide scope of practice and could pretty much end up in the same place as a DO practicing as a family physician.

CARICOM-MED
01-23-2011, 02:15 PM
NP is the nursing route, NPs follow the RN training log
PA is the Physician route, PAs follow the MD/DO training log

If you are a DC, why bother going through the "nursing" route, it is a totally different animal, if you are concerned with issues of "respect" then PA are more "respected" than nurses, at least in most Med groups I've been involved with...As PAs are usually Apprentices of MDs & DOs....Most Physicians feel more comfortable hiring PAs than NPs....

Cheers,

leadsled
01-23-2011, 02:36 PM
Have you looked into becoming a nurse practitioner? It would be faster and probably cheaper than med school or becoming a PA but you would be able to do pretty much the same things as an MD or PA. Plus you can earn an NP part time, unlike those other two degrees. If you practice as a DC/NP then you would have a very wide scope of practice and could pretty much end up in the same place as a DO practicing as a family physician.


The problem with becoming a NP is you need to go to RN school first which is too much of a hassle. However, I do agree that the NP is > than PA because of the ability to work autonomously (without MD/DO supervision) in many states. Hence, a DC/NP would be the best route especially since Family NPs pay about $1500 a year for malpractice insurance. I think my solution of a DC hiring a NP to work in the clinic is clearly the most productive solution to offering a broader scope of services while the DC does what he/she does best!

Drgeosprint
01-23-2011, 02:45 PM
Great discourse folks........Thanks for the ideas and concerns from different professions. I too agree the autonomy would be hard to give up with the PA restrictions. PA's here in Alaska hit around 70k+. Of note, at a educational seminar an informal poll was taken with the question being: How many people here would prefer to work in a independent multidisciplinary clinic? About 80% of the folks raised their hands. This seminar had 15-20% pt's and the rest chiros. Gotta go where your heart is folks!!!!

khiro
01-24-2011, 08:38 AM
The problem with becoming a NP is you need to go to RN school first which is too much of a hassle. However, I do agree that the NP is > than PA because of the ability to work autonomously (without MD/DO supervision) in many states. Hence, a DC/NP would be the best route especially since Family NPs pay about $1500 a year for malpractice insurance. I think my solution of a DC hiring a NP to work in the clinic is clearly the most productive solution to offering a broader scope of services while the DC does what he/she does best!

in fla the NP still has to operate under an MD; lets use the word sponsor. a NP can not go out and hang up a sign and practice like they are an MD/DO. we all know that but i thought i would type it out anyway. so a DC could hire a NP but what MD is going to be obligated to view her charts knowing she is working for a DC. btw, the MD does not review charts cheaply so the NP is not going to work for you but rather for the MD (she doesn't need you, she needs the MD.

khiro

khiro

leadsled
01-24-2011, 09:20 AM
"in fla the NP still has to operate under an MD; lets use the word sponsor. a NP can not go out and hang up a sign and practice like they are an MD/DO. we all know that but i thought i would type it out anyway. so a DC could hire a NP but what MD is going to be obligated to view her charts knowing she is working for a DC. btw, the MD does not review charts cheaply so the NP is not going to work for you but rather for the MD (she doesn't need you, she needs the MD.

khiro"


Good point!

FYI: link for state by state NP scope:

http://www.acnpweb.org/files/public/UCSF_Chart_2007.pdf

khiro
01-24-2011, 03:43 PM
good chart leadsled. i had no idea what the other states did with their NPs. fla NPs have pretty much free range of practice but with oversight from MD/DO. having seen the great power of the florida med assoc (FMA) in action, I knew that there was no way for NPs to act completely independent in fla. thanks for the chart.







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