Assistant Physician law passed.

[bradtPA]

The typical SDN argument is that a US med school grad who is unmatched can practice at the level of a PA or NP. Historically, 94% of US grads get a residency, and I expect the numbers would be closer to 100% if these grads would plan better and apply for one of the unfilled primary care residency slots instead of for one of the highly competitive high pay specialty slots. Many of those 6% that are left out probably could manage under close supervision just like a new grad PA, who learns on the job. But my concern is that in reality, the bulk of these physicians will be the FMGs, many with marginal training, that couldn't pass the USMLE with a high enough score to be allowed into a residency program and have never practiced as a physician before. To force this type of physician onto the unsuspecting public is negligent at best.

[delco714]

But they will not be practicing as a PA. They'll be at a satellite clinic with 10% chart review... in 30 days after starting

[ventana]

so where is that PA--> DNP program that will take us out from under the BOM?

 

Seriously, I will likely be facing two choices for staying in medicine (as PA gets slowly chipped away and becomes obselete)  Return to med school - ugh, never happen unless then get a much shorter program and residency.  Or 2 - get a NP/DNP

 

I really don't want to do either, but feel like we are loosing the battle.....

 

 

I would do a 1-2 yr DLO program for an NP degree

[db_pavnp]

My intuition suggests a PA->NP will exist when an NP->PA exists.

[Acebecker]

Except that when the NP->PA exists, the NPs will say, "Hey, we got what we wanted.  Let's hang the PAs out to dry..." and there will be no reciprocation.  This is fully what we should expect and anticipate if we ever allow NP->PA. 

 

Not that I dislike NPs.  The NP lobby on the other hand.... 

[db_pavnp]

I should have clarified that my statement was either tongue in cheek or hell freezes over, I hadn't decided at the time.

[GreatChecko]

I do chuckle a bit when the folks over a SDN consider what is in this bill "adequate supervision." If that were true, half the people on this board should be board certified attendings running large academic departments with the amount of supervision they have gotten.

 

I was speaking with a friend who is an IM doc in Missouri. It sounds like every doc he knows thinks this is a bad idea. This is going to fly like a greased turd, just you watch.

 

Maybe next year we can get the PA laws reformed in Missouri since they'll let just about anyone practice medicine in that state...

[KMD16]

It would be interested to see how the implementation of this law plays out since MDs in the state are divided on the law.

[discogenic]

Ventana says "as PA gets slowly chipped away and becomes obsolete".

 

I thought the future was bright for the PA profession??  What about all those articles in Forbes etc?

[Guest Paula]

^^^^^ It's just an illusion. 

[discogenic]

I wonder if the zillion new PA schools feel the same way?

[andersenpa]

I saw the SDN thread, typical responses from keyboard warrior physicians...

 

Funny how none of them act so bold in the hospital with statements against or not in support of midlevels (or the rest of staff).

DON'T USE THE TERM MIDLEVEL!

[db_pavnp]

Some forum softwares have features which auto convert certain phrases to others.

[bnicole]

AAPA will not change the title IMHO.  WIll an AP be able to supervise a PA? 

 

You pose an interesting question. It doesn't make much sense to allow such given that an AP would only have 1.25 years of additional training (consider 1st summer off). 

" The new law requires these doctors to be supervised on site by a "collaborative" physician for 30 days, after which the assistant physician could treat patients without that collaborator's presence in settings 50 mile away. These young assistant physicians will be able to prescribe Schedule III, IV, and IV drugs.

Beyond that 30-day period, the collaborative physician is required to perform chart reviews on 10% of the assistant physician's cases every two weeks, but little else."

 

So they practically skip fp residency huh? At least in the capacity they're allowed to work after 30 days. The next step is allowing them to sit for the fp boards after a few years without residency

This is pretty crazy. What can't they do? As I said above, that is quite interesting that only 1.25 additional years of education (beyond PA) can get you almost complete independence. Given billing issues etc I can't imagine this will be wildly successful or all that common (at least I hope). Thanks all for posting this info! 

[JohnnyM2]

The crucial question about APs is will they be "midlevels", "three quarter levels", 90% levels or what.

 

Let's see: "Hello, I'm Dr. Patel. I'm not actually a real doctor like Dr. Jones. I'm an Assistant Physician, not to be confused with a Physician Assistant, who isn't as smart as me. You see Mr. Smith, our PA when to physician assistant school and then did a one year residency at Baylor. I actually went to a real medical school in the Bahamas but wasn't able to get accepted into a residency program. That's why I'm an assistant Physician. Nevertheless, Mr Smith is just a mid-level, whereas I am more like a three quarter level. So, you see, I will be able to help you. Now, your symptoms are a bit confusing so I have asked Mr Smith to come in and have a look because after 10 years in this practice he has developed a great deal of experience in these matters. Would that be ok?"

 

Sent from my Kindle Fire HDX using Tapatalk 2

 

 

[EMEDPA]

The crucial question about APs is will they be "midlevels", "three quarter levels", 90% levels or what.

 

Let's see: "Hello, I'm Dr. Patel. I'm not actually a real doctor like Dr. Jones. I'm an Assistant Physician, not to be confused with a Physician Assistant, who isn't as smart as me. You see Mr. Smith, our PA went to 3 YEAR FULL TIME physician assistant school AT USC AFTER GRADUTING FIRST IN HIS CLASS FROM HARVARD WITH A DUAL DEGREE IN BIOCHEMISTRY AND MEDICAL ANTHROPOLOGY and then did an 18 MONTH DOCTORAL LEVEL CLINICAL RESIDENCY THROUGH THE ARMY  at Baylor, BUT DON'T CALL HIM A DR BECAUSE HE STILL ISN'T AS GOOD AS I AM DESPITE HAVING MORE TRAINING AND PASSING ALL OF HIS EXAMS. I actually went to a real medical school in the Bahamas but wasn't able to get accepted into a residency program. That's why I'm an assistant Physician. Nevertheless, Mr Smith is just a mid-level, whereas I am more like a three quarter level. So, you see, I will be able to help you. Now, your symptoms are a bit confusing so I have asked Mr Smith(WHO MAKES HALF MY SALARY) to come in and have a look because after 10 years in this practice he has developed a great deal of experience in these matters,ALTHOUGH ONCE I AM UP TO SPEED HERE IN A MONTH WE WILL BE LETTING HIM GO AS WE TRANSITION TO AN ALL PHYSICIAN PRACTICE BECAUSE REAL DOCTORS KNOW AND TRUST ME BETTER BECAUSE I WENT TO MEDICAL SCHOOL LIKE THEY DID.

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see my edits above for the worst case scenario

[whoRyou]

  Pt looking perplexed ...       "Ha?, Sure, ummm OK."

[JohnnyM2]

Still chuckling but I haven't learned how to do those cool animated emoticons like whoRyou.

 

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[KMD16]

The crucial question about APs is will they be "midlevels", "three quarter levels", 90% levels or what.

 

Let's see: "Hello, I'm Dr. Patel. I'm not actually a real doctor like Dr. Jones. I'm an Assistant Physician, not to be confused with a Physician Assistant, who isn't as smart as me. You see Mr. Smith, our PA when to physician assistant school and then did a one year residency at Baylor. I actually went to a real medical school in the Bahamas but wasn't able to get accepted into a residency program. That's why I'm an assistant Physician. Nevertheless, Mr Smith is just a mid-level, whereas I am more like a three quarter level. So, you see, I will be able to help you. Now, your symptoms are a bit confusing so I have asked Mr Smith to come in and have a look because after 10 years in this practice he has developed a great deal of experience in these matters. Would that be ok?"

 

Sent from my Kindle Fire HDX using Tapatalk 2

Very funny.

 

Patients would sense the incompetent Dr. Patel, the Bahamas med Sch grad & will choose to see Mr. Smith next time who clearly is smarter and know his stuff.

 

I'm afraid Dr. Patel will soon be fire as patient have chosen not to see him and the practice are losing money.

[EMEDPA]

Very funny.

 

Patients would sense the incompetent Dr. Patel, the Bahamas med Sch grad & will choose to see Mr. Smith next time who clearly is smarter and know his stuff.

 

I'm afraid Dr. Patel will soon be fire as patient have chosen not to see him and the practice are losing money.

UNLESS THE PRACTICE FIRES SMITH BECAUSE HE ISN'T A REAL DR...

[Lemon Bars]

This actually doesn't sound all that crazy to me.

 

1)     Medical school is typically four years long and includes clinical rotations while PA school is only typically only 2.5 years long including rotations. Therefore a medical student before residency should be as well trained as a PA. I know some (and not all) physician assistants had many years of prior health care experience, but so did some doctors.

 

2)     I'm sure at least some foreign medical graduates are qualified to practice medicine. It's BS that they would have to redo three years of residency if they already did that in their home country. They should have to pass the normal medical school tests, though, I think, as well as some sort of supervised rotations, to weed out those who don't know their stuff.

 

3)     The current three year residency requirement for primary care doctors is not working out very well. Primary care does not pay enough to compensate doctors for their time and pay back their loans. That's a big reason why there is a shortage of primary care doctors. Turning MD's into PA's frees them from being underpaid for three years.

 

Personally I like the idea of a stepped system where all providers (MD/DO/PA/NP) are referred to as Physician I, Physician II, Physician III and have the opportunity to move up the ladder with additional schooling and training, gaining more privileges with experience and training. We should all be mentored by more experienced providers, as happens normally in most professions. All these arguments just sound like turf wars to me, probably motivated by money more than patient care.

[DiggySRNA]

The crucial question about APs is will they be "midlevels", "three quarter levels", 90% levels or what.

 

Let's see: "Hello, I'm Dr. Patel. I'm not actually a real doctor like Dr. Jones. I'm an Assistant Physician, not to be confused with a Physician Assistant, who isn't as smart as me. You see Mr. Smith, our PA when to physician assistant school and then did a one year residency at Baylor. I actually went to a real medical school in the Bahamas but wasn't able to get accepted into a residency program. That's why I'm an assistant Physician. Nevertheless, Mr Smith is just a mid-level, whereas I am more like a three quarter level. So, you see, I will be able to help you. Now, your symptoms are a bit confusing so I have asked Mr Smith to come in and have a look because after 10 years in this practice he has developed a great deal of experience in these matters. Would that be ok?"

 

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LMAO....I had to laugh even tho this is a serious matter.

[whoRyou]

UNLESS THE PRACTICE FIRES SMITH BECAUSE HE ISN'T A REAL DR...

In all honesty I think "some" people wouldn't care if a person is a PA (or AP or whatever they want to call us ), MD, DO, RN, NP, PhD or even a MA etc. Just as long as there is someone taking care of their needs or "assisting" their needs they wouldn't care one way or another. This is what scares me.

I know what I would pick, the question is would they care or know the difference? 

[delco714]

Just thinking... we haven't heard anything about AP compensation, but I'll bet you it won't be the same as entry level BC primary doc

[PACdan]

Just thinking... we haven't heard anything about AP compensation, but I'll bet you it won't be the same as entry level BC primary doc

I'd be surprised if it was much more than resident salary. They have some of these unmatched people between a rock and a hard place. And I would imagine traditional residents would be PO'd if some of their compatriots could be making 80k right out the door.

 

The thinking over on Voldemort forum looks like the AP position will be used as a one or two year stepping stone to try and apply for open residency spots. So if that's true, APs should have a high turnover rate. I'm sure most would still desire to be real (should I say full?) physicians anyway.

 

The interesting dynamic will come when some choose the AP path as a career (or can never match). If this program is successful for that long, I can imagine APs demanding full, independent physician status after 10 years of practice or something. Claiming that they no longer require an SP. ...then experienced PAs can be like "excuse me?". :)