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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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I'm reading the comments section here and I'm asking anyone reading this:

CHECK YOUR SPELLING AND GRAMMAR!

PLEASE!

 

We are trying to make a point as a group of providers, and I'm telling you that every doc reading this is shaking his/her head and laughing at things like "Crebs Cycle"

 

We need to go the extra mile in how we present ourselves in this important debate.

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My letter to him:

 

To the editor:

 

I am writing in response to the piece you published “Opinion: Nurse Practitioners, Physician Assistants Should Not Have Same Drug Prescribing Authority as Physicians”.

I am a PA practicing in Cardiothoracic Surgery, and have intimate familiarity with the two issues Dr. Menkowsky raises: prescribing authority and invasive procedures.

 

I understand that this is an opinion piece, and not an official statement of the ACEP or ACEP Now. As a medical professional I am asking that ACEP Now do a more thorough evaluation of the validity of what it publishes.

 

Your response to an issue with a separate, previously published opinion:

 

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.

 

The key term here is “valid opinion”. Where in the realm of medicine is it “valid” to make denigrating remarks which have no evidence basis? Dr. Menkowsky makes no mention of supporting data that PAs or NPs are untrained or unqualified to prescribe medications, or perform procedures. Both professions are proven competent in those areas, and their scope of practice continues to grow state by state. Instead, he offers a stream of opinion whose purpose is to protect his place in the hierarchy of organized medicine.

 

Emergency Medicine has a strong national PA/NP presence. The staff overseeing the publication of this opinion are expected to know the proven track record of Emergency Medicine PAs and NPs. I am disappointed that ACEP and its publication do not take greater ownership of the opinions they chose to publish. It is always important for there to be a free market of ideas, but ACEP must use a greater measure of intelligence in determining the validity of opinions which are so strongly contradicted by available evidence.

 

Respectfully,

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Aww, I'm at work and the Web-nanny software doesn't like ACEP's site because it's "a parked domain." I've opened a ticket.

 

Anyway, here's what I have been working on between patients today:

I'm writing in response to the opinion piece by Dr. Menowsky, published in the xxxxxx issue.

 

As many of my colleagues have already pointed out, this brief essay presents an opinion comprised of nothing but

assertions -- which Dr. Menowsky supports with absolutely no evidence. As a piece of persuasive writing, it doesn't

impress. Dr. Menowsky's commitment to quality medical care and patient safety is obvious, and commendable, but he simply

fails on a basic level to connect the dots. I would be very interested to know if there is any evidence to support his

opinions. As others have noted before me, anecdotes are not data, and a 'bad apple' in any role on the healthcare team

should not be assumed to be a representative for their degree level or title as a whole.

 

I wouldn't suggest that Dr. Menowsky represents any particular segment of the MD population, and indeed the overwhelming

majority of my MD and DO colleagues, particularly in emergency medicine, have been vocal supporters of the PAs on their

teams. Part of the reason I chose to become a PA and not an MD (and yes, I believe I did have that choice) was because of

the advice of academic EM leaders I came to trust and respect, as I worked alongside them as an ER tech. I'm sure

practicing medicine today is in some ways very unlike what it was even 10 or 15 years ago, and I know many of those

changes are frustrating, but I think Dr. xxx conflates correlation with causation. We PAs are part of the system now, more

than ever, it's true, but we are here to help, and the evidence I've seen - much of it published by ACEP - strongly

suggests that we do.

 

Here's an anecdote: my state medical license number happens to be recycled. I've noticed that other PAs have similarly low

numbers compared to the MDs who are licensed and credentialed in the same general time period, and it seems it is not

uncommon for my state's medical board to reuse numbers that have been retired. I looked it up, and a license with the same

number as mine was held by an MD who graduated medical school in 1943. I suspect his courses may have been accelerated

somewhat, as that was common during WWII. A little more Web-searching, and I came to learn that immediately after

graduating, he was named Assistant Ship's Surgeon on a US Navy vessel. He held the license until his retirement in 1985.

 

When Dr. Eugene Stead was putting together the nation's first PA program at Duke University in the late 1960s, it's my

understanding that one of the influences on the design of the cirriculum was the kind of accelerated training that WWII-

era doctors had done. I don't know if the previous holder of my license completed a residency in the traditional sense,

after the war, but he was definitely reporting to his Ship's Surgeon right after graduation. I don't think it's too much

of a stretch to say he was functioning very much like a modern-day PA, at least for a period of time. To suggest that my

spiritual 'forebear' was any less a competent clinician because of the unusual timing and circumstances of his training

would, I venture to guess, be insulting to Dr. Menowsky, and rightly so.

 

We are all professionals. I can't speak for my NP colleagues, but PAs practice the same kind of medicine as MDs and DOs,

because we learned it from them, and we practice it alongside them. We are not "the same as" or "equivalent to" MDs and

DOs in many ways, but on a fundamental level we are members of the same team, and responsible to one another. That is in fact the entire point, and I find it troubling to see that even after 45 years of the PA profession, that point can be so

spectacularly missed.

 

I still need to run it through spell-check and proofread. Maybe I'll send it tonight.

 

I also couldn't help but facepalm at the PA who wrote in all proud of the word "ASSISTANT" in all-caps. Ugh, not really helping but thanks, kid.

 

Since I can't see the site now, have we gotten any backup from MDs at this point, or is it still a feeding frenzy of righteously wrathful PAs?

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