Hello Chris,
I enjoyed reading your discussion post this week. You did an excellent job highlighting he
qualities of each profession. In my discussion post I also talked about Physician Assistant but
compared to Nurse Practitioners, but you gave some additional insight information. Healthcare
as a whole has have been experiencing significant transformation regarding the way we care for
patients. We have improved our Systems, and we have introduced the use of technological
advances to improve the quality of Care. "Physician plays a central role by evaluating a patient's
health conditions, diagnosing abnormalities, and prescribing treatment" (Shi & Singh, 2017, p.
83). "Physician Assistants (PA) assist physicians in the delivery of care to patients. The major
services provided by PAs included evaluating, monitoring, diagnosing, therapeutics, counseling,
and referral" (Shi & Singh, 2017, p. 97) PA and Physician have a very similar work environment
and training focus.
From what I gather from your discussion, both professions are trained under the Pathology
model with the primary focus on how to cure diseases. The difference comes in regarding the
level of education expected for each of this profession. Scientific advances, open information
access, and evolving health-care economics are disrupting extant models of health-care delivery.
Physicians increasingly practice as team members, accountable to payers and patients, with
improved efficiency, value, and quality. This change along with a greater focus on population
health affects how systems of care are structured and delivered.
Pathologists are not immune to these disruptors and, in fact, may be one of the most affected
medical specialties. In the coming decades, it is likely that the number of practicing pathologists
will decline, requiring each pathologist to serve more and often sicker patients. The demand for
increasingly sophisticated yet broader diagnostic skills will continue to grow. This will require
pathologists to acquire appropriate professional training and interpersonal skills. Today’s
pathology training programs are ill designed to prepare such practitioners. The time to practice
for most pathology trainees is typically 5 to 6 years. Yet, trainees often lack sufficient experience
to practice independently and effectively.
Many studies have recognized these challenges suggesting that more effective training for this
new century can be implemented. Building on the strengths of existing programs, we propose a
redesign of pathology residency training that will meet (and encourage) a continuing evolution of
American Board of Pathology and Accreditation Council for Graduate Medical Education
requirements, reduce the time to readiness for practice, and produce more effective, interactive,
and adaptable pathologists. The essence of this new model is clear definition and acquisition of
core knowledge and practice skills that span the anatomic and clinical pathology continuum
during the first 2 years, assessed by competency-based metrics with emphasis on critical thinking
and skill acquisition, followed by individualized modular training with intensively progressive
responsibility during the final years of training.
Aging populations experience more illness. Advancing scientific and medical knowledge
expands the repertoire of diagnostic tests and treatment options. Economics requires these to be
used appropriately and effectively on a patient-by-patient basis. Coupled with widespread
adoption of electronic medical records, this drives medicine toward standardized, evidence-
driven practice in large systems, by health-care teams including generalists managing health
maintenance and routine care, specialists managing disease or organ system–specific care, and
other specialists (including pathologists and radiologists) providing diagnostic expertise.
Patients are followed longitudinally as they receive preventive care and wellness management,
interspersed with episodic care for acute illness and management of chronic disease, disability,
and comorbidity. Patients fall into cohorts allowing well-designed health-care systems to tailor
patient-specific and condition-specific diagnostic and treatment plans based on accurate
diagnosis and data analytics.
Patients and physicians alike have instant access to the world’s information. No longer is access
to the “facts” the privileged resource of the trained professional. This reality is already
transforming pedagogy in our universities and medical schools, where the emphasis of education
has shifted from assimilating facts to an emphasis on critical thinking and effective and
appropriate use of the vast information resources instantly available. It is also rapidly
transforming the patient–physician relationship. Patients now expect to be fully informed of their
conditions, are increasingly aware of health risks and treatment options, and are better equipped
to shop for “optimal” treatment. The individual patient acquires “agency,”6 with more control
over care than in times past.
Health-care services provided for the benefit of the patient must thus be aligned with the
patient’s expectations and consent. Health-care providers must learn to communicate, both with
each other in a health-care team across the electronic interface and with patients.7 The role of
physicians, and particularly pathologists, in this new environment will increasingly center on
their success as “critical thinkers” who apply wisdom and skill in optimally guiding diagnostic
and treatment decisions and as communicators to clinical colleagues and patients. Thus, the
pathologist’s primary obligation will be as an expert consultant to the patient, directly and/or as a
member of the patient’s health-care team. Currently, residents interact directly with the patient
and health-care team in a variety of areas including the following: cytopathology (fine needle
aspiration), transfusion medicine (apheresis and donor services), microbiology,
hematology/coagulation, genetics, and tumor board.
Patients have access to information from the Internet, social media, friends, and family as well as
their health-care team. This information shapes the communication with their team, which can be
face-to-face, or via the electronic medical record, which patients can access via a “patient
portal.” Because patients have access to so much information and relatively limited ability to
evaluate it, the challenge for the team is to explain medical information to the patient efficiently
and effectively to achieve an optimal course of care for the patient.
The health-care team consists of the primary care clinician, treating and diagnostic specialists,
and other health-care workers. The pathologist, a member of the team, advises on diagnostic test
selection, ensures test accuracy, and communicates the results to the treating professionals; at
times, the pathologist explains the test results directly to the patient. The pathologist contributes
to the medical literature through investigation and communication that advance evidence-based
medicine. In addition, the pathologist educates the health-care team and disseminates
information through the Internet and social media.
Although hard to generalize, 5 shortcomings of our existing training programs are commonly
recognized: (1) they take too long, (2) their graduates are often not fully ready for independent
practice, (3) their curriculum is fragmented into a series of narrow subspecialties, (4) they lack
sufficient training in communication skills and teamwork reflective of how modern medicine is
practiced, and (5) they need to provide more opportunity for residents to gain direct experience
as a consultant.
The pathway to practice across all medical specialties has been a residency, typically followed
by subspecialty fellowship. The American Board of Pathology (ABP) recognizes 4 primary
certification tracks: dual certification in anatomic and clinical pathology (AP/CP) or AP and
neuropathology or single certification in AP or CP. The dual certification tracks are both 4-year
residencies; the single certification tracks are both 3-year residencies. Approximately, 85% of
pathology residents pursue dual certification in AP/CP.
Physician, on the one hand, is required to complete a Bachelor's Degree in biology, Chemistry or
Phycology to be well prepared to take the Medical College Admission Test (MCAT). They must
also get a competitive score to be considered for an interview and possible admission. Then four
year of Medical school which will include clinical rotation component and those two to three
years of Residency program depending on the specialty selected.
There is a total of 12-13 years of education to receive your medical. PA typically completes a
three-year graduate program with clinical rotation. PA has the option to receive a Master's
Degree in Physician Assistant Studies (MPAS), Master of Health Sciences (MHS) or Master of
Medical Science (MMS). One of the significant differences between Physician and Physician
assistant is the ability to work autonomously. The physician can work in many different settings
including having their practice. In contrast, PAs are always required to work under the license of
a physician as they are not able to practice on their own. Most Physician Assistants work under
Surgeon or Physicians in Hospitals or Doctor's offices.
PA and physician are two professions that work hand-in-hand. I firmly believe that hospitals that
have a good ration of Physician and Physician assistants have a better capacity to provide better
care to patients. In Mark 6:7, "Calling the Twelve to him, he began to send them out two by two
and gave them authority over impure spirits," the Bible teaches us that Jesus sent his disciples in
pair of twos. Just as Jesus disciples needed to work in unity and trust each other on the journey,
Physician and PA must demonstrate the same level of confidence and trust in the field.
References
Shea, A. K. (2017). Physician Assistants and Nurse Practitioners, Moderate and Deep Sedation
in Clinical Practice. Cambridge University Press, 120-125. Retrieved from https://www-
cambridge-org.ezproxy.liberty.edu/core/books/moderate-and-deep-sedation-in-clinical-
practice/physician-assistants-and-nurse-
actitioners/033EC60230DF1AD322ABA8E253351D9C/core-reader.
Shi, L., & Singh, D. A. (2017). Essentials of the U.S. Health Care Systems. Burlington: Jones &
Bartlett Learning.
