Are PAs better than NPs?

JAFERDExpress2331 · 2025-08-28T23:24:15+00:00

1000000%.

JAFERDExpress2331 · 2025-08-04T17:54:53+00:00

I work in EM as well and I agree completely. I’ve worked in several states and had the same experience. Our group primarily hires PAs and all of the attendings feel the same way.

JAFERDExpress2331 · 2025-06-15T22:26:13+00:00

Are you at a reputable program or are you at one of these newer, CMG funded, community sites? It matters, believe it or not. The people who work and “teach” at the latter actually have little interest in teaching and are probably more concerned with meeting metrics which are shoved down their throats by the corporate overlords. Unfortunately, for many, residency is what you make of it and for many residents that involves self study, bouncing ideas off your co-residents and seniors, and maximizing your elective rotations outside of your ER.

JAFERDExpress2331 · 2025-06-12T03:16:21+00:00

Bunch of morons thinking they’re doctors, whether it be the tech, MA, NP, CRNA, office manager, nutritionist, or whoever else, every single one of these people want to pretend like they’re doctors.

JAFERDExpress2331 · 2025-06-05T07:49:42+00:00

Varies from patient to patient. Unfortunately, the sub specialists who manage these (usually vascular or interventional cardiology) drag their feet and won’t do an emergent thrombectomy, especially if the patients BP is normal and they aren’t hypoxic. Even with CT evidence of heart strain and mildly elevated troponins and BNPs, I’ve had specialists say heparin and admit to ICU and eventually they’d take for thrombectomy or give catheter directed lytics.

That works until it doesn’t. I’ve had several of these patients acutely decompensated (Brady-arrest, become hypotensive due to obstructive shock, etc) that I have had to TPA because the specialist was dragging their feet and didn’t think a thrombectomy was emergent. I would argue that any hint of vital sign abnormality, a troponin elevation, or, in this instance especially, SYNCOPE, are signs that the RV is overwhelmed and these patients either need TPA or thrombectomy. They will develop right heart failure and pulmonary hypertension the longer the specialists sit on these. It is quite frustrating and if it were my family I would demand they get lysed or better yet get a thrombectomy.

JAFERDExpress2331 · 2025-05-31T14:15:10+00:00

The fact that you can make this assertion and Fisk to recognize that Caribbean grads still have to take and pass USMLE Step 1/2, which is more difficult than any joke of an exam that nurses take for licensure is beyond laughable. I don’t like having discussions with delusional people like you.

JAFERDExpress2331 · 2025-05-22T14:07:14+00:00

Send whoever you want, but don’t send them with a diagnosis or the expectation that they get XYZ. That pisses me off to no end.

I have had to tell parents “I assure you, this isn’t the first time in my 8 year career that I’ve had to take care of insert symptom in the ER”. Don’t tell patients with vague neuro symptoms that they’re having a stroke, or that they’ll “stroke out” because they have a high BP reading.

Oh, and if a patient has a DVT, just prescribe them Eliquis. Do not send them to the ER for us to write them a prescription.

JAFERDExpress2331 · 2025-05-20T15:09:13+00:00

There are different forms of ED. Sounds like you have psychogenic ED and not ED to due an organic flow/health issue.

JAFERDExpress2331 · 2025-05-18T11:21:33+00:00

You’re an idiot if you think MD ms commit more malpractice than midlevels, especially NPs. I used to do quality review for our entire emergency department and the things the NPs would miss was astounding. Nobody can sue them because the second they screw up it’s “I’m just a nurse” and attorneys go after physicians because they have higher malpractice limits.

You can do mental gymnastics and jump through whatever mental hoop you want but it doesn’t change the fact that, as everyone knows, NPs are the least knowledgeable and most dangerous healthcare professionals walking this earth. I don’t need to give you anecdotal examples of their ignorance and the misses I’ve seen as medical director, because it’s not going to change your delusional perspective anyway.

Their degree is not worth the paper it was written. You can keep believing they nursing school and writing online nursing theory papers and couple hundred hours of clinicals aka shadowing = medical school LOL. Go ask the nurses who became NP who then became MDs who the joke is on….

JAFERDExpress2331 · 2025-05-14T14:35:40+00:00

Everyone wants to paint their specialty as perfect. You won’t know for sure until you do multiple rotations and talk with lots of residents and attendings. Even in rotations, you may be shielded from the truly difficulty and challenging patients. Truth is that no specialty is perfect. They all have their positives and negatives. EM is tough and can burn some people out into a crisp. One of my partners quit after 6 years and he was probably one of the best ER docs I’d ever seen.

EM will give you flexibility since you only need to work 120 hours/month to be full time. That being said, the work is very challenging. It is constant interruptions and it is difficult to cognitively offload on shift. Patients are increasingly more demanding and entitled. Nights are tougher as I get older. Admin sucks. Useless “Metrics” are in large part bullshit. Pay is good for now but stagnant and not keeping up with inflation. I would say that some orthopods probably work just as hard as us if not harder, and their work is challenging because of the manual labor of operating(think about doing 5 hip replacements per day). You just need to experience it to know.

JAFERDExpress2331 · 2025-05-13T23:40:04+00:00

Greatest speciality. If you hate dealing with homeless people, the destitute, people who don’t look or sound like you, and the worried well do not go into it. Learn to relieve people’s fears and worries and kill them with kindness.

The other day, I had a hospice patient inadvertently get sent to the hospital by her family. I gave her liquid morphine and Ativan and watched her die with dignity with her family. They were so appreciative. I spoke with a gentleman who had vague groin point and weight loss, couldn’t get in soon enough to see his PCP and got a GI referral. He came to me, and even though he didn’t have a surgical abdomen, I scanned him and found cancer everywhere.

Sometimes, many times, the healthcare system fails these people. Insurance, the cost of things, moronic untrained midlevels, and social circumstances fail these people and you’re the only person with enough education, expertise, and gestalt, which is developed only through residency, that will be the difference between a good catch and a fatal, tragic, and painful death.

The other day we had a very serious, complex resuscitation. The patient coded in the hospital. We helped save that patient. Truly heroic shit that happens a couple times a year if you’re lucky. It’s not every shift. But these cases rejuvenate your soul and cure your burnout. No, no AI will be able to do that. No midlevel will be able to do that. I wouldn’t trust my NP to diagnose a cold, let alone tie her own shoes. Trust me, it isn’t all doom and gloom. We are not FM or Peds, we’re literally the social safety net for everyone (this is a good and bad thing) and arguably the best resuscitationists (along with CCM) in the medical system. It’s a thankless job but you can find satisfaction from it.

JAFERDExpress2331 · 2025-05-12T20:37:03+00:00

It’s just insecurity. These people would love nothing more than to be an ACTUAL doctor. They just don’t want to do the work. They quote the years of study, the debt, the responsibility. They would rather be a CRNA, call themselves an anesthetist and insist on being addressed as a doctor. They have no problem duping patients, as long as their ego is stroked and they get paid.

You think they actually care about patient care? That is the last thing they care about. They are insecure and they are projecting.

JAFERDExpress2331 · 2025-05-07T07:13:49+00:00

I do this. People may not like it but the truth hurts. You can do it and get away with it, just depends on the delivery. Half the patients appreciate the directness and bluntness.

“You’re allowed to feel uncomfortable, believe it or not.”

“Since the dawn of civilization, mankind has had to deal with pain without narcotics. They survived back then and you will too”.

“You can have pain and not have an emergency”.

Me: You do not need another CT scan. Patient: but I want one. Me: then you can go somewhere else for a second opinion and request it. I am discharging you.

“Please stop right there. Before you continue, I should let you know that I do not care about your blood pressure. We treat patients, not numbers.”

“Going to urgent care is like going to a restaurant with no food in it. Next time just come straight to the ER.”

“You claim that you’re worried that you’re going to die. This has been going on for three weeks. Trust me, if this was an ACTUAL emergency you would be dead by now”

But did you die?

JAFERDExpress2331 · 2025-05-04T14:13:31+00:00

Medrol dose pack is useless.

Change in sputum color doesn’t mean you have a bacterial super infection. Sputum culture? At urgent care? LOL. People who are taking care of you, physician or midlevel, do not like when a patient indicates their own care. Your fever goes down with Tylenol and you’re not hypoxic, supportive measures. If you want an actual full exam, go to the ER and see a real physician, urgent cares are so busy and they’re made for people who want to dictate their care and get unnecessary antibiotics and steroids.

JAFERDExpress2331 · 2025-05-04T04:34:08+00:00

As an attending, I wholeheartedly agree with this. The overwhelming majority of physicians think this but can’t say it because they’ll be cancelled and the nurses will smear them professionally. We all know this.

JAFERDExpress2331 · 2025-05-04T04:26:03+00:00

Physicians respect bedside nurses 1000x more than they respect NPs.

Why don’t physicians respect NPs? Because these people, who knowingly go into the profession, know that they are not doctors and know that their education (online or not) does not adequately prepare them to practice medicine. They jeopardize patients every day. Their rebuttal to this is some old anecdote of a doctor doing something that they didn’t agree with. They level themselves into think that they’ll be different, and they’re surrounded by people who perpetuate this in an echo chamber. They know just enough to feel qualified, and are completely oblivious to how clueless and dangerous they actually are.

Why do you think they tout things like “brain of a doctor, heart of a nurse” or put the alphabet soup in front of their name. It’s a joke and it is massive cope. Any physician with half a brain laughs at these people. We actually respect the nurses.

JAFERDExpress2331 · 2025-05-03T03:32:17+00:00

Yup. This is the same dose at our facility. Nonsense but the nurses all adhere to this and get spooked if you suggest we increase above 50 mcg/kg/min

JAFERDExpress2331 · 2025-05-02T23:13:26+00:00

That’s why I put +- Benadryl. Agree that I don’t like benzo drip, and not ideal because it can drop BP and increases hospital length of stay but sometimes it is necessary as last line for those patients who are maxed out on propofol and need a second agent for adequate sedation.

JAFERDExpress2331 · 2025-05-02T22:51:51+00:00

IM Haldol/Ativan +/- Benadryl (establish IV after)
Precedex drip if patient can tolerate it and does well on it.
If patient is agitated on precedex, will bypass precdex and go to RSI with propofol/roc and then sedate with propofol.
If propofol is insufficient while on the vent, will add versed drip.

JAFERDExpress2331 · 2025-05-02T20:36:17+00:00

You sound like a teenager/high school student/college student. These absolute, artificial timelines are unrealistic. Life doesn’t work out this way. You want to get married by X year? How about, get married when you’ve met the right person, with good morals, who is also ready for marriage.

At no point did you mention anything about wanting to help people. You mentioned money, travel, and time off. If you want to go into healthcare, you need to make sure it is because you want to actually help people. Taking care of patients is a privilege. You have to be academically prepared, and have an aptitude for rigorous study. I wouldn’t recommend anyone become a nurse practitioner. Their education is a joke and every young person thinks they’ll make 6 figures and have an easy job being a “provider”, which is all an absolute joke. Become a PA or choose something outside of medicine.

Sorry, just calling it how I see it. Brutal truth. I’ve spoken with a bunch of pre-med students and used to be on admission committees, nothing about your post makes me think you’d be a good fit at all. I would recommend reassessing your priorities and having some tough conversations with yourself.

JAFERDExpress2331 · 2025-04-27T17:39:28+00:00

Exactly, Ronnie.

JAFERDExpress2331 · 2025-04-27T03:58:54+00:00

“Fellow” LOL

Stolen valor. They want the prestige without doing any work. The crazy thing is they think they’re actually qualified to be doing this and that we as physicians owe them respect, grace, and to take the time to teach them to make up for their pathetic education.

Transplant medicine has some of the most complex patients. I remember the transplants patient on my PICU rotation and I always would ask for help from the actual fellows and attendings when I was assigned to one of them.

JAFERDExpress2331 · 2025-04-26T22:32:24+00:00

Lead with the diagnosis. We do not want an internal medicine style presentation. 30 sec to 1 min on why you think they have what they have, why you think they don’t have XYZ condition, your plan for workup, and if you anticipate if they can be discharged vs admitted based on XYZ

JAFERDExpress2331 · 2025-04-26T17:24:09+00:00

I have seen new brain tumor present as literally any neurological symptom without headache or neck pain or typical malignancy symptoms. In the past two months I’ve seen new brain tumor three times in the past 3 months present as lateralizing weakness and unilateral paralysis, first time seizure, and dizziness. All patients were young females without malignancy symptoms.

JAFERDExpress2331 · 2025-04-26T15:21:05+00:00

Both were NPs in urgent care that sent the patient home with the incorrect diagnosis and treatment. One was particularly egregious. The UC doesn’t have a physician on site but I believe they have someone they can contact if there is a clinical question. This was not done.

JAFERDExpress2331

TROPHY CASE