American Academy of Clinicians

[Rural PA]

I got this letter from our class president in response to the group that was created to unify NPs and PAs. Interesting read. What do you all think? Bob?:




March 10, 2004





Dear fellow AAPA leader:



I want you to know that AAPA is aware of the formation of a new association for PAs and NPs. I know many of you recently received an e-mail announcing its formation. I am writing you because several leaders have asked for the Academy’s views on this new organization.

As you know, PAs and NPs work together side-by-side in clinical settings, Sometimes we work together on projects at the state and national levels when there is a mutual agenda affecting patient care. However, our professions are very different with respect to educational preparation and approaches to team practice. The two professions have unique philosophical views concerning their working relationship with physicians and independent practice, and we work under different laws, rules, and regulatory bodies even when working as a team in the same clinical setting. We sometimes compete for the same employment opportunities.



Presenting both PAs and NPs as members of the same national organization will only serve to create confusion for elected officials, employers, patients, pharmaceutical companies, insurers, reporters, physician groups, and others.. The new organization is also vague about the implementation of its goals and agenda, and what "changes in the health care system" it would advocate. How it will reconcile the divergent philosophical views of NPs and PAs? Existing national PA and NP organizations have a history of serving the patient population utilizing their medical and nursing skills respectively. The focus of this new organization and its commitment to the patient are yet to be seen.



To put both professions together in the same organization will only serve to defeat our significant accomplishments of the last few years in creating a special and unique identity for the PA profession. Our success has depended first and foremost on the dedication and hard work of PAs everywhere; however, our success also has been due to the fact that we have a single national organization representing our profession, speaking with one voice.



We would appreciate any thoughts you may wish to share on this issue.




Sincerely,



Pam Scott, PA-C

President

[MrBob]

Well...the AAPA has never done anything for me personally, while they have for the group I suppose. They refuse to listen to the body at large (re: Name change).....What I think is moot.
I personally intend to support these people and when I am finished with school become active in the organization. In fact I have already corresponded with Dennis Blessing offering my meager help.

Now at running the risk of sounding "sour grapes" I applaud an organization that is willing to address problems and issues common to both of our organizations ( and Lord knows there are some).


What do YOU think Bushman? (My new name for Rural(LOL))
I support 'em.

I have never even HEARD of our president.....have you?? but I have heard of Dennis Blessing, Steve Nunn, Paul Hendrix and many of the other board members of the ACC. and they have a STELLAR track record in our political arena...in fact many of THEM are responsible for our achievements to date...not Pam Scott. at least not that I am aware of.

I am not going to leave the AAPA. There is room for both, but these folks who are involved in the ACC are not a bunch of YAHOOO'S, you know. If I am to be judged by the company I keep then this is a company of professionals I will be proud to be judged with!

BTW...I never recieved such a letter. I see this as an attempt by the AAPA to stem the membership of this organization...wonder why?

[tool man]

We have a president????

shazaam!

[PACMattM]

If Dennis Blessing is running this organization, it will indeed be a success!! He is a former president of the APAP, and has been in the politics of PA's for decades now. He knows his stuff, and he can be trusted by us. He is the equivilant of a civilian colonel if you are military type. When he walks by, people come to attention.

[JHM]

I happen to think PA's and NP's doing something together makes a whole lot more sense then the way things are now. How many of your employers really understand the difference between a PA and NP anyway? I think the fact that two groups of people are qualified to do the same job yet have to function by a different set of rules is ridiculous and makes all mid-levels (a term I have never really liked) seem less professional. I joined the AAC and am hoping something good and logical comes out of it!

JHM

[Rural PA]

In response to Mr. Bob, I actually had not formed a strong opinion of the ACC but am working on it. By the way, it is the American College of Clinicians (I got it wrong but that's okay). I was looking up information on it and found a press release of an interview with cofounder David Mittman. Here is what he had to say about why the organization was formed and following are some of the goals. The group "represents interests that are common to both groups." I think this is great! We are not becoming NPs by joining the group, we are putting our heads together where we have common goals and interests for our respective professions. Here's a tidbit of the article:

http://www.prweb.com/releases/2004/3/prweb109171.htm

When asked why the organization was formed, Mittman responded, “We recognize that the time has come for Physician Assistants and Nurse Practitioners to have a group that represents interests that are common to both groups. We are not here to replace the professional organizations that represent PAs or NPs, but rather it is through the ACC and our collective experience and strength in numbers that we can best promote and serve our mutual interests.”

Goals of the ACC include:
• Promoting the concept that the best way to deliver health care is in teams. NPs, PAs, and physicians all are entitled to fair reimbursement and recognition when providing care to our patients. We will advocate these rights.

• Working together whenever appropriate to support each other. Even though NPs and PAs are separate professions with distinct educational backgrounds and responsibilities, we will pursue the common good for both professions.

• Providing affordable continuing education that meets your needs.

• Delivering interprofessional education that highlights PAs and NPs: specifically, how we can help control costs while delivering quality care. We promise within our first year to develop a well-designed, easy-to-read advertisement that will run in some of the best-read physician journals. This ad will accurately inform physicians about what NPs and PAs do, and how working with us will benefit their practice. Thousands of physicians still do not know the benefits of having PAs and NPs work with them as colleagues.

• Educating the pharmaceutical industry and pharmacists that PAs and NPs are full prescribers and need to be recognized as such.

• Informing the health care industry and insurance companies about what we do. Once these institutions understand what’s in it for them and how NPs and PAs can benefit health care, how could they not agree to reimburse us?

• Helping resolve disputes between NPs and PAs when asked. It is time we recognize that the two professions can be colleagues; let's not waste time being in opposition to each other.

Why should YOU become a member of the ACC? Mittman advocated:“There are 150,000 of us and there is surely strength in numbers. We are so closely linked anyway, that we might as well make sure that we use this power correctly. Fighting against each other or even continuing the ignorance that is out there drains our energy. When we agree (as we do on much), the results will come faster and better, working together.”

[Rural PA]

I didn't finish yet!

Mr. Bob, when I first read that article I admit that I was a little worried that our AAPA was not supporitve of this group. I tend to be a little to trusting of anyone who has a strong opinion on something but that's why I posted it. I wanted to see what the "body" had to offer. I am new to this profession (still a greenie in fact) but have worked towards becoming a PA for many years now and am finally a student. The enmity between NPs and PAs is very foreign to me although I have read all the posts on the subject in this forum. Here are some opinions that I have formed from my experience and research.

I have always thought it curious when I hear rantings about how different PAs and NPs are when there are jobs postings that say "hiring a PA/NP. Many physicians apparently see us as having similar clinical skills and we do compete for jobs. Why then do we adamantly strive to polarize ourselves!? This group could be a great thing for the advancement of "midlevel practioners." I am not talking about PAs claiming independence that some may think I am implying when reading this post. I am talking about getting the word spread about what we (PAs and NPs) can do and how we can add to the quality of a healthcare team. It would be nice to have uniform privileges and recognition for PAs across all the states and even internationally.

I also tend to believe that PAs are more similar to NPs than NPs are to Nurses. I know all NPs are nurses but there are nurse PAs as well and I am tired of hearing NPs compared to nurses when their scope of practice tends to be more similar to that of a PA (when comparing specialities NPs and PAs have in common).

Finally, I have stated before that my brother is on target to go to nursing school and wishes to eventually end up as an NP. I have tried to talk him into going into PA school but the only "advantages" I could think of for him to do this were that PAs have a more varied education and therefore more versatility when choosing their specialty after graduation; we don't claim independence from physicians; and slight wage difference. He wasn't too worried about any of that and thinks an NP program would suit him better and he's probably right.

Maybe when I gain more experience working I will see it but now I have no reason to think that NPs and PAs should not be working together where goals are similar for the professions. I agree with Bob. We need to also remember that there is something we can do about getting the AAPA to hear our voice: We can vote for our AAPA officials! I nominate Bob as the next Prez!!

[UofKYPA]

My initial thoughts regarding this new organization for "midlevel providers" were positive. After all, how could it hurt for the two professions to come together and work toward a common goal? After a little more reflection, however, I think it could be potentially dangerous for PAs to allow themselves to be "lumped" with NPs. Here are my reasons: First, physicians need to be aware that PAs are not seeking independent practice. In my experience, this is a biggie! Several physicians that I have worked with before going to PA school cite this as the biggest difference in choosing whom they hire. They don't see that PAs are as big a threat as NPs...we aren't out to take primary care away from the docs. Second, I feel that it is important to continue drawing a distinction between the PA profession and the NP profession. PAs practice MEDICINE and NPs practice ADVANCED NURSING. Even though we might end up doing much of the same things, it does not change the fact that there are very distinct differences in the professions. Third, since the beginning of the PA profession, we have embraced the idea of "physician supervision." I cannot say that NPs have done the same. Many believe we have achieved great advances by aligning ourselves with the MDs and DOs in such a "dependent" manner. Why risk losing that by being lumped with nurses??? We all know that nurses already have a VERY strong union with great political pull...just ask PAs practicing in states like Louisiana or Mississippi! In short, I think many physicians are becoming increasingly agitated with the perceived nursing agenda. I am not convinced that aligning closely with that agenda is a smart move for PAs.

[MrBob]

There seems to be this "blinders on" focus about independent practice and being worried about being lumped in with NPs because of that. That is only ONE of many many issues. I haven't seen anything in the ACC literature to indicate that THEY are even advocating that. They are looking at common practice issues, reimbursment issues, my gosh folks...we have a LOT in common with NP's. Sure, some of us may not agree with the independent practice business but there are other problems we share that a unified body could certainly help us with.


I still say support 'em. UofKYPA we need folks who are able to express their ideas in this new organization. I am not in any way affiliated with but do support them. I am a member just like you would be. A voice...

I would, if asked, be an active part but for now am tied up in school, otherwise I plan to be active when that's done.

[UofKYPA]

I certainly hope my previous posting did not give the impression that I had "blinders on" regarding independent practice. It may certainly be only one issue out of many, but I think it is a huge issue that has allowed the PA profession to distinguish itself from the NP profession, and I can't help but think that it has helped to define the way physicians view PAs. As stated previously, my personal experience with physicians has reinforced that idea for me...it may not be fair or accurate, but it has just been my observation over several years.
As far as allowing different ideas to be expressed, I'm all for it! As someone expressing my own thoughts/opinions, I would only expect that others be allowed to do the same. Anyone has the right to join the American Academy of Clinicians and express any ideas/opinions they wish. I, however, have a right to question their agenda, listen to their ideas, and make up my own mind. The jury is still out regarding my opinion of the organization. I think they will need to clarify their agendas and their strategies to accomplish those agendas. After I hear more opinions/ideas I will make an informed decision as to whether or not I will join or support the organization.

[MrBob]

I apoplgize UofK....didn't mean to come off like that......
Everyone has a right to their opinion for sure......that's what makes this forum successful!

[Flash]

We need to fix the AAPA leadership not dilute our PA resources on another non-specialty national group.

If we align with NP's it will cut the reasons why PA's are loved over NP's. And we are the ones with the most to lose. We need to strengthen our own leadership - seriously, not rely and piggyback on NP issues which are not ours. I chose PA school for a reason, and do not want the benefits of PA's to vanish because we are so let down by our AAPA leadership that we open the door to dilute our resources with new associations. We need to get our main one right if we are to judged as a real force in medicine. We don't need or want NP issues like autonomy - but better Rx privaledges to help our supervisors as they need us, proper first assistant insurance payment, and an appropriate name that does not need to be explained each time we see a patient that often takes longer than the H&P itself. Heed my words my PA family - we need each other, let's not let each other down or go outside of PA's for leadership.

PA's and NP's roles are not the same, their lobby is not the same, their platforms and reason for existing within the medical community are very different. To muddy the waters that easily show the differences is bad for the PA profession and how MD's view PA's. I could not be more certain of this working on boards with MD's. MD's prefer us because we are with them. If we do the ACC, they will not think of us as family and we will get creamed. We can get the name change to physician associate if we stay PA's and lobby as PA's (dependent practitioners). If we lobby as with NP's who are so different than us, MD's not only won't support us, but will have real fuel to be against us. We can assure our MD's that our partnership with the NP's in no way means that we want what they want until we are blue in the face and red in the checkbook, but the proof is in the public relations pudding, and what will be seen most is a new alliance with the NP's - not the subtle and major differences.

Below are some excellent quotes from members on this PA forum from another thread on this topic:

quote:
[From TheMadMedic] From what I have seen, PAs are viewed differently from NPs by physicians...not just because we are trained to "think like they do"...

I work at a large Ortho practice where both PAs and NPs are employed. The physicians seem to interact differently with the PAs and the NPs. The NPs here work as "advanced practice nurses". They don't read X-rays. They don't go to the OR...etc.

We (NPs and PAs) are quite different. Although we have some similar issues (midlevel reimbursement, etc) we must maintain this difference and be careful when 'joining forces'.

We also need to keep in mind that we can do a lot and have a lot of "independance" while being dependent practioners...

quote:
[From Moe103]I totally agree that we should, as a group, try to impress upon the medical community how we are different from the NP/nursing world. Some of the more senior contributors to this forum had originally espoused the American College of Clinicians. I would like to know if they still feel the same way. Please don't take this remark as flippant or critical. On the contrary, I am looking for insight from the more senior PAs out there who have seen the ups and downs of our field for 15+ years. Does this recent move by one NP school show a trend in the nursing world or is it just an idea thought up by an isolated group of nurses. If this is a trend I think we as PAs should distance ourselves from any association with the NPs including the ACC.


quote:
[From Rob77] As for this NP nonsense I think the PA profession should distance themselves as far away as possible. Now is the time to remind MD organizations that PA's wish to remain dependant practitioners and ally ourselves with them not the NP's. In my opinion the PA profession will grow not by legislation or making doctorate programs but rather by building trusting relationships with our physician colleagues/supervisors.

[Moe 103]

Flash

I am flattered that you quoted me. It is an interesting point you make about siding with the MDs and steering clear of the ACC. The one point I feel needs to be addressed by the MD world is, where is their support for us. It is the medical boards in most states that dictates our Rx privileges. If the docs love us over NPs why is there such resistance to give PAs Rx rights for equal to NPs who use these drugs for nursing. If the AAPA can't forward our cause, I'm not sure that joining the ACC is a bad idea. While I too am worried about muddying the waters, I am more concerned with being able to have better Rx rights and maybe less required chart checking by supervising MDs. This would make PAs more attractive to potential employers who are considering the PA/NP route. I can feel the wrath of MD/PhD but I feel that as dependent practitioners the MDs have let us down in these areas and fallen asleep at the switch by allowing the nurses so much power that they could create the NP. How can a nurse medically treat a pt if they aren't trained in medicine?
This is just my two cents, but I am interested to hear the input of the more senior members of our forum.

[Flash]

Moe - I saw again, and for the last time on this thread, that we need to get the right leaders into the AAPA, than to run to join the ACC. How do we even know that is what the ACC wants to do - or is in the process of seriously doing. Great, now we may have some NP's on board with our lobby. That does us no good at best and harm most likely - as it is the medical baords we need to convince not the nursing boards NP's deal with. If you want those things you said in your post, then work on them through our national group, not a splinter spin off. We are too small a group to have spin-offs that can gain enough momentum.

Again I caution against jumping the big ship in a desperate state, because the current AAPA is not representing us well. Because making decisions in a desperate state increases the chance that any of us won't take in the entire picture. I say to everyone - lets try to unite and fix the leadership of the AAPA.

This is my final posting on this thread.

[themadmedic]

I agree something needs to be done.

I feel that NPs are not evil, and certainly not the enemy...but they aren't "us".

We need stronger leadership in the AAPA. We need stronger state organizations. I would feel much happier if it were the AAPA working with NPs on our issues instead of a 'lump sum' organization.

Honestly, I haven't made a firm decision on the ACC as my first instinct was "Hey, let's work together and get some things done," but I also fear guilt by association if the ACC strays to issues out of our lane that are pertinent to PAs.

I feel like I have Bob on one shoulder and MD/PhD on the other, both making vaild points...still yet to figure out who has the halo and who has the horns...