Guest Paula Posted January 19, 2014 Share Posted January 19, 2014 We are indeed being left behind. If we as a profession do not catch-on, it just a matter of time, we will soon be supervise by DNP. I recently came across a FM PA position where the PA was to report to the MD and the administrator (an NP DNP). I contacted the clinic just for the heck of it. The voice message prompt states: For Dr. Z (an DNP) dial Ext 9, for Dr. X ( an MD) Ext dial 10 and for Mr. Sleepy (a PA) dial 11. The public would soon think DNP >> PA & would rather see a DNP instead NOT a doctor assistant (Physician Assistant). Yeesh...bad, bad, bad! Voice messages like that will continue to muddy the waters and confuse everyone. After reading primadonna's response about "coming from the top" and suggesting med and PA schools start a "stem cell"program, I am inclined to agree. There has got to be a way for PAs to become autonomous providers. It is the supervision and dependent status that is the bug-a-boo and always will be, no matter how good we are in the specialty we practice. Those two little (giant in my mind) words are the ones that damage the profession and have pinned us to the wall every time we try to make changes to our state laws. For example, in Michigan there is a proposal in the senate to amend the public health code. The proposal is for PAs to become autonomous providers who must work in collaboration with a physician, in some form or another, determined at the practice level. It would amend delegation and supervision. It adds in collaboration. The problem with the bill is it also put in that NPs would be held to the same rule (except NPs already have independent practice to act as an NP, but need a physician to prescribe controlled substances). So you see the problem. NPs obviously are against it, even tho the bill would give all PA/NP independent prescribing licenses, while requiring ALL of us to have some type of collaboration with a physician. So in my way of thinking, a stem cell PA-MD/DO program could be an answer if we earn the right to have autonomous non-dependent practices (still working in our SOP, tho) even if we stay on the PA track. I do think somewhere along the line in might happen but not soon. State PA chapters need to step up to the plate and start lobbying for autonomous, collaborative practices and drop dependent, supervised. AAPA and PAEA should start to support this as well in order to see the profession truly become viable on its own. I guess I have a bone to pick being a rural PA and finding out my clinic will no longer hire PAs because of not being EPs for HITECH act and they know they can get reimbursement for that from an NP. Consequently we are not advertising for a PA with the retirement of the NP coming up. PAs need full equity with NPs for billing and to be recognized with all insurance companies as a profession that can bill without any connection to an MD/DO. If I had to do it over, I may have chosen DO school, too, like primadonna, as it kind of fits my personality and background of being a chiropractor's daughter, plus being a dietitian, but at my age it is not realistic or affordable. I have appreciated primadonna's perspective. I support PA doctorates. Just have to get rid of dependent, supervised. Link to comment Share on other sites More sharing options...
skyblu Posted January 19, 2014 Share Posted January 19, 2014 I FULLY support PA to MD bridge programs! I never said I didn't. And I also support PAs getting other doctorates. All I'm saying is that getting a doctorate in medicine, in a way that is different from getting an MD (or DO) muddies the waters further. Instead of a DPAM program, I wish more bridge programs would crop up. And I don't mean that ones that simply shave a year off from the education that any Tom, Dick or Harry can get with a premed undergrad. I mean a bridge that takes into consideration PAs and their HCE both before and after PA school, plus gives credit for all the graduate level classes we took. When many MD programs are thinking of cutting a year anyway, the bridge programs as they exist now are not attractive to me yet. Link to comment Share on other sites More sharing options...
cinntsp Posted January 19, 2014 Share Posted January 19, 2014 JMPA: I think there should be more bridge programs that transition to an MD/DO. I do NOT think there should be a doctorate in physician assistant studies. I there are other ways to reach higher levels than getting a doctorate. That is not the solution in my opinion. I find such comments short-sighted. We all want more advancement options, better practice rights, and better recognition for PAs so I just can't understand that type of sentiment. I think we all recognize that earning a DPAS/PhD/DSc/etc. does not make a PA into a physician BUT it opens up more avenues to enter positions that potentially CAN make those things we want possible. Look at primadonna's example for the truth of it. Her PA-DO bridge creator was a former PA that went on to become a physician and got into an administrative role that allowed him to further the PA profession. That's one way to do it and getting a doctorate is another, as that will allow PAs to acquire higher GS ratings, fill faculty positions, be looked upon more seriously in the government arena, etc. Why should we limit ourselves to only one pathway? We need multiple ways for PAs to join the ranks of the decision-makers. This profession has been left behind for far too long. Link to comment Share on other sites More sharing options...
Avalon Posted January 19, 2014 Share Posted January 19, 2014 I support bridge programs and encourage their further refinement and developent, but would point out that this is not a practitcal option for many PAs. Speaking for myself (and there are many from similar paths on the Forum), I transitioned in mid-life to my career in medicine. This meant resigning my academic tenure, not working for over two full years, incurring substantive debt, geographically separating from my family, and re-setting my career at an entry level, with the associated reductions in pay, professional status, leadership, and respect that accompany starting over. I cannot imagine being able to attempt this kind of transition for a second time in order to attend a bridge program. If no other solution is advanced to address the professional issues raised by several members on this thread (DNP competition and autonomy, public perception of the PA role, reimbursement inequity), then my future in medicine is looking increasingly uncertain. Link to comment Share on other sites More sharing options...
Guest JMPA Posted January 19, 2014 Share Posted January 19, 2014 I find such comments short-sighted. We all want more advancement options, better practice rights, and better recognition for PAs so I just can't understand that type of sentiment. I think we all recognize that earning a DPAS/PhD/DSc/etc. does not make a PA into a physician BUT it opens up more avenues to enter positions that potentially CAN make those things we want possible. Look at primadonna's example for the truth of it. Her PA-DO bridge creator was a former PA that went on to become a physician and got into an administrative role that allowed him to further the PA profession. That's one way to do it and getting a doctorate is another, as that will allow PAs to acquire higher GS ratings, fill faculty positions, be looked upon more seriously in the government arena, etc. Why should we limit ourselves to only one pathway? We need multiple ways for PAs to join the ranks of the decision-makers. This profession has been left behind for far too long. stop being shortsighted and read comment #47, look before you leap so you dont look foolish Link to comment Share on other sites More sharing options...
cinntsp Posted January 19, 2014 Share Posted January 19, 2014 stop being shortsighted and read comment #47, look before you leap so you dont look foolish My reply didn't quote you and wasn't directed at you, so who looks foolish? Link to comment Share on other sites More sharing options...
KMD16 Posted January 19, 2014 Share Posted January 19, 2014 Folks! Just a reminder. When PA programs started transitioning from BSc to Master level. Lots of us protested. Currently, some employers/job opening requires master degree to apply. To be license in some state, e.g a state like Ohio, you sure must be master level trained. We've got to wake-up & do what our NP friends had done (DNP). I must add that doctorate should be optional. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted January 19, 2014 Moderator Share Posted January 19, 2014 we have discussed this before in other threads but I like the army/baylor model of granting a clinical doctorate after a residency completed by an MS level PA. a pa with a doctorate and specialty residency would have a better leg to stand on when asking for collaborative practice models and equivalent billing to others with this preparation. Link to comment Share on other sites More sharing options...
Moderator ventana Posted January 20, 2014 Moderator Share Posted January 20, 2014 chooo choooo chugg-a-chugggggg hey folks that was the Train leaving the station on this topic five years ago when NPs went to DNP's. The only intriguing thing that I see in this conversation is the idea of truly developing an efficient bridge program. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted January 20, 2014 Moderator Share Posted January 20, 2014 "an efficient bridge program" would only be 2 years long. current accreditation rules require a min of 3. the only way I can see to get around this is dually accrediting PA coursework as MD/DO coursework by having PAs and docs take courses together with the same requirements and expectations. this would limit pa programs to places that also offer md/do programs. Link to comment Share on other sites More sharing options...
KMD16 Posted January 20, 2014 Share Posted January 20, 2014 I fear that a bridge program would invalidate the integrity of the profession. Instead, I advocate for optional PA doctorate and better scope of practice for those of us who had been in business before you and I were born. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted January 20, 2014 Moderator Share Posted January 20, 2014 I fear that a bridge program would invalidate the integrity of the profession. Instead, I advocate for optional PA doctorate and better scope of practice for those of us who had been in business before you and I were born. I think it would improve the integrity of the profession. docs training alongside PAs would know we were learning the same stuff and in many instances a PA might do better in a given class than an md/do track student. PA and MD/DO students would study together. an entire generation of docs would stop the current line of "PAs don't learn the same stuff we do. they learn algorithmic medicine and not a complete approach to medicine and disease". you know how many times I have heard that from a clueless doc? do they really think they take a hx or do a physical exam any differently than a PA? do you know how many docs think they learn special medical secrets that are md/do level only and not imparted to lesser beings like PAs?. don't know what you meant by this: "better scope of practice for those of us who had been in business before you and I were born.". There is a name for most PAs in practice before I was born. that name is retired. I'm guessing there are less than 10 PAs in the entire country who were in practice the day I was born who are still in practice today. we're talking about the first and second class at Duke. Link to comment Share on other sites More sharing options...
Guest JMPA Posted January 20, 2014 Share Posted January 20, 2014 My reply didn't quote you and wasn't directed at you, so who looks foolish? post #53 quotes me and is directed at my comments. I will not stoop to a level of bickering. On another note, IMHO i do no feel that a bridge program takes away from the profession in any way, rather it opens up opportunity to those whom choose to go a step further while preserving the medical model. As stated earlier, if a doctorate is of benefit in any way than i am all for it but i would prefer to see a solid bridge to MD for those qualified. And i believe that it can be accomplished with entry exams and minimal extended education for seasoned PAs. Link to comment Share on other sites More sharing options...
KMD16 Posted January 20, 2014 Share Posted January 20, 2014 I think it would improve the integrity of the profession. docs training alongside PAs would know we were learning the same stuff and in many instances a PA might do better in a given class than an md/do track student. PA and MD/DO students would study together. an entire generation of docs would stop the current line of "PAs don't learn the same stuff we do. they learn algorithmic medicine and not a complete approach to medicine and disease". you know how many times I have heard that from a clueless doc? do they really think they take a hx or do a physical exam any differently than a PA? do you know how many docs think they learn special medical secrets that are md/do level only and not imparted to lesser beings like PAs?. don't know what you meant by this: "better scope of practice for those of us who had been in business before you and I were born.". There is a name for most PAs in practice before I was born. that name is retired. I'm guessing there are less than 10 PAs in the entire country who were in practice the day I was born who are still in practice today. we're talking about the first and second class at Duke. Very quickly. Excuse my idiomatic expression. I'm referring to those if us who had been PA 7+years and above. Link to comment Share on other sites More sharing options...
cinntsp Posted January 20, 2014 Share Posted January 20, 2014 post #53 quotes me and is directed at my comments. I will not stoop to a level of bickering. We don't have to bicker. I've provided an annotated image to help you. Link to comment Share on other sites More sharing options...
Moderator True Anomaly Posted January 20, 2014 Moderator Share Posted January 20, 2014 ^ | | Brilliant Link to comment Share on other sites More sharing options...
Guest JMPA Posted January 20, 2014 Share Posted January 20, 2014 We don't have to bicker. I've provided an annotated image to help you. you really are mentally challenged and undeserving of my attention. Clearly you are quoting me in another persons post. Go away troll Link to comment Share on other sites More sharing options...
Guest Paula Posted January 20, 2014 Share Posted January 20, 2014 Ok, guys. let's get back to the topic which has probably run out of anything more to say about it anyway. Was fun! Link to comment Share on other sites More sharing options...
2234leej Posted January 20, 2014 Share Posted January 20, 2014 We don't have to bicker. I've provided an annotated image to help you. @Wutthechris: I can totally understand where you are coming from. That's definitely the flipside of the coin and your points are valid. The crux of the situation is that a PA does exactly what an MD/DO does. Same school of thought. Same philosophy. Same/similar type of classes. I think more than anything, PA's need to strengthen their lobbying power rather than focusing on a doctorate degree. There needs to be more communication between physicians until they acknowledge that your training is vastly superior to that of an NP. I've looked into NP and PA...I've considered doing both but I know which education system I like better (it's not even close in my opinion, in general). Isn't that the predicament? NP's are vastly superior lobbyists than PA's are they not? They shouldn't have the power/autonomy that they do but they still have it. If NP's with masters degrees could previously hold more autonomy there is no reason why PA's with master's degrees can't either (with increased training). Bridge programs are a great idea and increased autonomy with increased experience is the best avenue (in my opinion) to success. It would also save money for the newer students as well. Link to comment Share on other sites More sharing options...
SocialMedicine Posted January 20, 2014 Share Posted January 20, 2014 I agree with KMD a bridge program will reveal PA to be a stepping stone/inferior position. It will make it more difficult for PAs with heavy experience and skill to advance autonomy. It is much like the name title ... Physician Assistant ... it suggests things about the profession that are untrue. Link to comment Share on other sites More sharing options...
KMD16 Posted January 20, 2014 Share Posted January 20, 2014 Yes. We should hit hard & join forces on attaining better scope of practice whether you call it independent practice or what not, and establishing an optional PA doctorate like our NP colleague. This I believe put us at a better position for generation of PA to come. A bridge program is not the solution IMHO. Link to comment Share on other sites More sharing options...
Guest JMPA Posted January 20, 2014 Share Posted January 20, 2014 A bridge program does not take away from the profession, it only adds to it. for a pa to have the option to bridge to MD would further reinforce the fact that we are trained in the medical model. NPs can keep their doctorate in nursing. to muddy the water with yet a third doctorate of assisting is monotonous to others (pt, NP, ect.) But considering other options, if bridging is to difficult do to opposition from mds than im all for doctorate. either way, yes lets "Move Forward" Link to comment Share on other sites More sharing options...
jdtpac Posted January 21, 2014 Share Posted January 21, 2014 Taking PA Education To The Next Level If there is going to be a doctoral degree for the PA profession the Army program should be a model for developing future clinical doctoral degrees for PAs. I was on the Academy's Board of Directors in 2006 when Maj. Gruppo gave us an overview of the history and development of this program. Most importantly, to be eligible for this program you have to be an Army PA with more than 2 years experience. The purpose of the program was not only to fill the need for highly trained emergency medicine and orthopedic PAs but also to help those individuals who had aspirations to make the Army a career to have the opportunity to gain an advantage for further promotions. It is also an 18 month program with both didactic and rigorous clinical training and not 9 months added after completing a masters program. I agree with someone who said how can you develop a doctoral program in PA program which has not even been established to date. I think the Lynchburg program needs to get established first before trying to attempt to create a doctoral program.With that said, if this type of program is the next level of PA education, it may be the first steps in addressing medical education reform in total. I've always said that I believe our profession has proven that it doesn't take 4 years of undergraduate, 4 years of medical school and a 3 year residency to provide high-quality, cost-effective primary care medical services. If all PA education were to convert to the Lynchburg model, we could change the title to Doctor of Primary Care Medicine (DPCM), eliminate the PA profession and title completely, and take over the delivery primary care. I could go into more detail it is not appropriate for this forum. Link to comment Share on other sites More sharing options...
primadonna22274 Posted January 21, 2014 Share Posted January 21, 2014 ^^^^Whoa to all of the above. I'm interested to know more.... I've always been impressed by the Army-Baylor doctorate for PAs. It's rigorous and IMO looks like what I expect a clinical doctorate to look like--unlike many DNP programs. Hmmmmm. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted January 21, 2014 Moderator Share Posted January 21, 2014 I'm guessing the primary care MD/DO folks out there might have a problem with PAs taking over primary care....what makes more sense as mentioned above is an increase in the # of programs following the army/baylor method. PAs are interested in specialties outside of primary care. I have spoken with Maj. Gruppo in person about his program and last time we spoke there were no plans to allow civilians entry into any doctoral programs overseen by the army. Link to comment Share on other sites More sharing options...
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