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More on PA training

Midlevels: adjuncts or attendings?

Keywords: More on training midlevels to work in hospitals

Published in the July 2012 issue of Today's Hospitalist

Asking midlevel providers what they need to function appropriately in the hospital is like asking a nurse how to be a surgeon ("PAs and hospital medicine," May 2012). I would recommend spending between seven and 10 years in medical school and residency.

Thinking that 18 months of "training" equals a third-year resident or even a medical student is ludicrous. We should certainly not have the same level of expectations for midlevels that we do for someone "grilled" day in and day out on their medical knowledge for at least seven years.

If providers need more training, then we should promote medical school. A hospitalist should be defined as an MD/ DO who is board-certified/eligible and has practiced in the hospital for some minimum amount of time. Midlevel providers, if used in the hospital, should be used as an adjunct to the MD/DO, not in lieu of an attending.

Jonathan G. Martin, MD
Knoxville, Tenn.

Haruka Torok, MD, responds: We originally conducted our survey study as part of the needs assessment for developing advanced training for PAs in hospital medicine. Our study revealed that hospitalist PAs are highly interested in additional training to enhance their inpatient skills. The study also discovered wide variations in the ways that midlevels were being utilized.

Given that PAs are likely to become more common in the inpatient setting and that current on-the-job training is haphazard and disorganized, our study suggests that a formal educational process will help their professional growth—and may help them more effectively care for patients.

At our own institution, we have more than 15 years of experience hiring, training and utilizing midlevel providers. Our expectations are very high for those providers under our direction, once appropriately trained. We have been extremely fortunate in that we have been able to hire individuals with excellent clinical skills. They have contributed substantively to the overall success of our group.

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