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Opinion piece by an ER doc suggesting PAs/NPs shouldn't have same prescription authority as physicians


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horse is already out of the barn on that one. we win. he loses.

Haha good way to put it. I thought the piece seemed more sensitive to not being exclusive more than a true concern. Granted, its an opinion but he has no data to back up his comments. Just seems to be using the internet as an outlet to more or less whine. 

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This is classic.

-resentment that he had to go military->RN->MD and spend all that time to accomplish his goals and someone took a different path to reach the same level of auhority

-resentment that physicians are no longer "at the top of the corporate health care structure"

 

and the laughable statement that NPs should not be qualified to place art and CV lines

 

NO evidence

NO data

ALL egocentrism

 

it is true

nurses eat their young!

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Scroll down to the comments section.

G. Raines, past SEMPA president has a great response in the comments.

Bit disappointing that ACEP ran this but there is free press and he likely is a member.

Would be worthwhile to see if his EM physician colleagues feel the same way.

But this article needs to served with some nice cheese and crackers.

G Brothers PA-C

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I had been checking to see if there were any comments; it looks like I need to check again.

 

I couldn't come up with anything professionally appropriate to say. Just posting that image from the Simpsons, with the newspaper photo of Grampa Simpson and the headline OLD MAN YELLS AT CLOUD seemed like it would fit, but didn't seem like it would strike quite the proper tone for ACEP's esteemed publication.

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I think him ensuring all his degrees are there is due to insecurity on his behalf as well as a point that he's now "better" than his nurse friends (if he actually had any)...wonder if he went back to the same ED he worked in as a nurse - sure he's well liked there by the RN staff :-)

 

Edit for spelling oops.

 

SK

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The PICC team at my hospital consists of PAs and specialized RNs. RNs and RTs place art lines in our ICUs (we have 7 not including NICU).

 

It seems super bizarre that this guy wants to reacquire line placement as an MD role.  Let's give him venipuncture back, too, see how long that lasts.

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Gregory Raines' response merits re-posting here, for anyone who hasn't had a chance to check it at the original link.  When I first saw the article, there were zero comments - glad to see folks stepping up to take this guy's rant to task, as ineffectual as it was!

 

"Dr. Menowsky,

 

Your “letter to the editor”/opinion piece is no more than a call to arms to attempt to disarm a group of health care professionals who too have spent many years training and working in medicine, usually in partnership with physicians, providing access to people where physicians won’t go. Your solution is to attempt to roll back the clock and make access for them more difficult? How exactly does that benefit patients? It doesn’t.

 

Do you have any data showing advanced practice providers (mid-level providers is a DEA designation for non-physican providers, not an official designation assigned to PAs or NPs) are inappropriately misprescribing medications? Do you have any data at all showing worsening abuse potential by PAs and NPs when prescribing medications? We can look at the disciplinary complaints of various medical boards and compare apples to apples – when you do, you’ll find its physicians who abuse their prescription rights moreso than PAS and NPs.

 

Do you have any data showing that PAs and NPs have higher complication rates associated with placements of central lines, intubating patients, placing arterial lines, or doing other advanced procedures? You don’t. The only literature that is available looks at ICU use of PAs and comparative outcomes of PA-run ICUs (under physician supervision of course) vs. traditional ICUs. You won’t like the data – the PA ICUs have better outcome rates.

 

So at a time when there aren’t enough health care providers, PAs already prescribing in all 50 states (some have schedule limitations – again, no data to support this nonsensical handcuffing of providers), and NPs are trying to attain prescribing rights so they too can care for patients to their fullest capability, what is it exactly that you are protesting? And why? You want to stay at the top of the medical food chain – that’s the only thing I glean from your article.

 

This retrograde approach to the practice of medicine had no basis in fact, is nothing more than a call to arms to “protect turf” against other providers, and smacks of elitism. Even as an opinion piece, I am surprised this was allowed to be published in ACEP Now as EM PAs have been nothing but supportive of our physician colleagues and supportive of ACEP itself. Be careful in how you choose to lump PAs and NPs together – PAs have always supported the team approach to care, with physicians as the lead provider, but if you are going to pick a fight with other providers, perhaps PAs themselves would be better off aligning with NPs or declaring themselves independent providers and push for changes in legislation to that end.

 

As this is in response to an “opinion” piece, I will state that this is just my “opinion” as well. But be careful in how you catalog PAs – we support the Physician-led team approach. We do not support inhibition to access to care.

 

Sincerely,

Gregory Raines, PA-C
Immediate Past President
Society of Emergency Medicine Physician Assistants"

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I had been checking to see if there were any comments; it looks like I need to check again.

 

I couldn't come up with anything professionally appropriate to say. Just posting that image from the Simpsons, with the newspaper photo of Grampa Simpson and the headline OLD MAN YELLS AT CLOUD seemed like it would fit, but didn't seem like it would strike quite the proper tone for ACEP's esteemed publication.

If that is the kind of unsubstantiated, petty trash they are going to publish, I think image macros and memes may be quite appropriate for their standards.

 

 

Seriously though, Mr Raines's reply was spot on and well written.

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Humm
Interesting thoughts

Problem that I see with it is it is just an opinion.

I have watched MD/DO over prescribe narcotics purely for the profit and the inability to say “no” to patients, or other misguided reasons.

PA/NP are still a FAR minority in the prescribing world and yet we are facing a catastrophic situation with over prescribing of narcotics – which is almost 100% at the hands of the PHYSICIANS – I believe that ANYONE carrying a DEA number should have to attend specific training on narcotics to so we “first do no harm” and I think if you look into this it is your profession which has created this.

So, stop throwing stones if you are living in a glass house.

As for PA and NP prescribing habits. I see nothing particular about them, nor have I ever read any studies or evidence that the care delivered is inferior o MD/DO – and in fact have read a few which state the opposite – ie NP provide BETTER Diabetes education.

Every is entitled to an opinion, even if it is wrong……

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It seems super bizarre that this guy wants to reacquire line placement as an MD role. Let's give him venipuncture back, too, see how long that lasts.

No kidding. I did a triple lumen on one of my ICU pts today and the 45 minutes it took to get consent from next of kin, find the US, get set up, do the line and confirm placement on CXR set me back all afternoon. Had to get back to the ED for 3 more geriatric admissions and just finished my day at 830pm finishing clinic notes only to start all over again at 7am tomorrow.
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Doesn't the ACEP take any ownership of publishing such misinformation? PAs and docs in EM have such a close professional alignment. Perhaps this merits a letter to the editor of "ACEP Now". (perhaps one of you EM guys has this in the works?????)

 

I don't buy the argument that this is just an opinion and ACEP doesn't have to assume some responsibility for what they publish.....

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Doesn't the ACEP take any ownership of publishing such misinformation? PAs and docs in EM have such a close professional alignment. Perhaps this merits a letter to the editor of "ACEP Now". (perhaps one of you EM guys has this in the works?????)

 

I don't buy the argument that this is just an opinion and ACEP doesn't have to assume some responsibility for what they publish.....

 

 

This is what ticked me off the most.  It's not an actual editorial from their staff, but it is a letter from a reader that the editors chose to publish.  Unless their goal was simply to generate clickbait, that seemed a pretty disingenuous dodge to me as it's still coming out under the banner of ACEP Now.  

 

I am starting to wonder if collaborative, dependent practice is truly the compass we need to be following the more and more stuff like this I see or run into in my own experience :(

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ACEP does proudly promote ACEP Now as “The Official Voice of Emergency Medicine,” and takes that responsibility seriously and in the most literal sense. Our vision is to offer the most appropriate, unbiased forum possible for the discussion, deliberation, and airing of any issues impacting our specialty, especially the most complex and controversial of those issues. In doing so, we must allow diversity of opinion to be heard and, from a specialty society perspective and journalistic perspective, it would be inappropriate to avoid difficult topics and more importantly, it would be inappropriate, and even unethical, to censor valid opinions, whether or not they support ACEP policy or not. Our belief is that ACEP cannot be a credible leader in our specialty or in the house of medicine without such integrity. Interestingly, and historically, ACEP and ACEP News were formally criticized for the perception of such censorship.

Kevin M. Klauer, DO, EJD, FACEP
Medical Editor-in-Chief

 

Apparently, Dr Klauer believes this is a valid opinion.

 

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ACEP does proudly promote ACEP Now as “The Official Voice of Emergency Medicine,” and takes that responsibility seriously and in the most literal sense. Our vision is to offer the most appropriate, unbiased forum possible for the discussion, deliberation, and airing of any issues impacting our specialty, especially the most complex and controversial of those issues. In doing so, we must allow diversity of opinion to be heard and, from a specialty society perspective and journalistic perspective, it would be inappropriate to avoid difficult topics and more importantly, it would be inappropriate, and even unethical, to censor valid opinions, whether or not they support ACEP policy or not. Our belief is that ACEP cannot be a credible leader in our specialty or in the house of medicine without such integrity. Interestingly, and historically, ACEP and ACEP News were formally criticized for the perception of such censorship.

Kevin M. Klauer, DO, EJD, FACEP

Medical Editor-in-Chief

 

Apparently, Dr Klauer believes this is a valid opinion.

 

 

That reply isn't from the same opinion piece that is being discussed in this thread.

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I guess he needs to look at the data.  I work with 2 other PAs and we place 90 % of all the lines at my hospital.  PICC, CVL, Dialysis/Tunneled - and our infection rates are lower than the ones the hospitalists and surgery residents place.  Usually we end up troubleshooting/fixing the lines that they put in that are placed wrong.  Our targeted biopsy results are roughly equal to that of our Radiologists in body imaging as well.  That is one of the things that our Rad group and the hospital wanted to compair.  But to be fair we always touch base with the rad on body imaging and let them know our plan of attack. 

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ACEP does proudly promote ACEP Now as “The Official Voice of Emergency Medicine,” and takes that responsibility seriously and in the most literal sense. Our vision is to offer the most appropriate, unbiased forum possible for the discussion, deliberation, and airing of any issues impacting our specialty, especially the most complex and controversial of those issues. In doing so, we must allow diversity of opinion to be heard and, from a specialty society perspective and journalistic perspective, it would be inappropriate to avoid difficult topics and more importantly, it would be inappropriate, and even unethical, to censor valid opinions, whether or not they support ACEP policy or not. Our belief is that ACEP cannot be a credible leader in our specialty or in the house of medicine without such integrity. Interestingly, and historically, ACEP and ACEP News were formally criticized for the perception of such censorship.

Kevin M. Klauer, DO, EJD, FACEP

Medical Editor-in-Chief

 

Apparently, Dr Klauer believes this is a valid opinion.

 

 

They key term here is "valid opinion". If they are wide open then they should allow letters or opinion which endorses quarantining HIV+ patients from the general population, or other antiquated notions which have no evidence basis. 

 

The opinion in question here has no validity.

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