Michigander Posted April 29, 2015 Share Posted April 29, 2015 I'm considering making the move from Michigan to Washington in the next 6-9 months. Michigan is a great state to be a PA. I've done some research about the PA laws in Washington, it looks like there is some chart review but we're allowed to prescribe Schedule II. However, it is an independent practice state for NPs (who I love dearly as individuals) and a lot of jobs I see posted are for NPs. Is that limiting job openings for PAs? I am interested in primary care, internal medicine, geriatrics, which are primarily NP. For licensing, I'm a PA-C (as of 8/2014), do I really need to have my program verify my graduation? Also, does the state contact the hospitals I'm credentialed at to see if I have any complaints? I want to apply for my Washington license so I can start applying for jobs but I don't want to let my jobs know this far ahead of time as there is a lot of upheaval right now. I've read the comments here about Washington being a good state to practice in but there are also threads about it being a difficult state to find a job in. Any comments or PMs welcome. Link to comment Share on other sites More sharing options...
jmj11 Posted April 29, 2015 Share Posted April 29, 2015 The laws, the way written, are confusing. We have been trying to fix that. When you read the laws for a "Physician Assistant" you are actually reading the laws for an un-certified Physician Assistant. A PA-C has a different set of laws that do not require chart review and you can prescribe schedule II ( I actually looked and even non-certified PAs can write scheduled II). Link to comment Share on other sites More sharing options...
Administrator rev ronin Posted April 29, 2015 Administrator Share Posted April 29, 2015 Don't forget you can be an allopathic PA-C, osteopathic PA-C, or both if you want to pay two license fees and report to two boards. I've had no complaints about how WA DOH does things, and switching practices and getting credentialed somewhere new is indeed a lot of paperwork, but I expect it's that way everywhere. Link to comment Share on other sites More sharing options...
rpackelly Posted April 29, 2015 Share Posted April 29, 2015 Michigan up until recently (when you had to be fingerprinted) has the easiest license application of all, and almost no paperwork to start practice. The laws regarding PAs occupy less than 10 pages in the Public Health Code. We are a delegatory state and if something is not absolutely forbidden in a law, you can do it if you and your SP decide it is okay. You cannot sign a death certificate or perform an abortion. You must have a Michigan licensed supervising physician somewhere and a piece of paper in your office delegating you the ability to prescribe drugs (does not have to be approved). The DEA requires a signed statement from the physician in order to issue us DEA numbers. The physician is responsible for verifying that you are indeed a PA and cannot supervise more than 4. That is about it. I had a friend who moved from Cali to Michigan and asked for a copy of the law, when I gave them the several sheets of paper, they were incredulous. As you know in Cali it is a one inch thick book, because everything you can do must be listed. We take the opposite approach in practice and in many other areas. It is just not a regulatory environment. While insurance companies may mandate countersignatures, and/or specific distance limitations, or reimburse only for certain things, the state does not impose further regulation. Although there is a huge lobby to change it, in MI NPs are not even listed in the public health code and as of now, they cannot prescribe schedule II in an ambulatory setting, wheareas we can (they declined to join our last bill). Of course, they are pushing for independent practice, but the law really has not moved substantially forward in 6 years and there is a strong MD/DO lobby against it. Otherwise in practicality they operate the same as PAs. Link to comment Share on other sites More sharing options...
Michigander Posted April 30, 2015 Author Share Posted April 30, 2015 The distinction between allopathic and osteopathic PAs is new to me. I would pick allopathic, I guess. I need to read the law. The licensing board asking for hospital credentialing is intimidating at this step of the process. I work at a small hospital with a small credentialing office and if I stay at this job, I will have to re-credential in the next month or two. It's a sticky situation job-wise with some resignations and another major restructuring. I want to get a jump on getting my state license but maybe I should wait if they need to verify my hospital credentials. Michigan is probably an overlooked state to be a PA. Southeast Michigan is a saturated market but the rest of the state seems to have a lot of postings. I think I have a great scope of practice and my job uses me to the widest scope possible. I prescribe Schedule II, assess capacity, things that the NPs can't do and may lead to hiring PAs over NPs if the laws for NPs don't change because those are very important abilities for a provider in my office. Link to comment Share on other sites More sharing options...
jmj11 Posted May 1, 2015 Share Posted May 1, 2015 Sometimes I wonder if much of the good things about Michigan and PAs could be traced back to the late Ron Nelson. He did a lot to advance the PA profession nationwide and in his home state. Link to comment Share on other sites More sharing options...
rpackelly Posted May 1, 2015 Share Posted May 1, 2015 The relationships that Ron Nelson made were priceless. Link to comment Share on other sites More sharing options...
treejay Posted May 5, 2015 Share Posted May 5, 2015 you would pick allopathic if your sup doc is MD. osteopathic if DO Link to comment Share on other sites More sharing options...
RURALMED Posted December 26, 2015 Share Posted December 26, 2015 The laws, the way written, are confusing. We have been trying to fix that. When you read the laws for a "Physician Assistant" you are actually reading the laws for an un-certified Physician Assistant. A PA-C has a different set of laws that do not require chart review and you can prescribe schedule II ( I actually looked and even non-certified PAs can write scheduled II). I looked at these laws, but it still appears that osteopathic PA-C require 10% of charts reviewed while allopathic PA-C do not. Is this an error in interpretation or language? "Must an osteopathic physician review and countersign chart entries made by the osteopathic PA? Yes, to some degree. The osteopathic PA and supervising osteopathic physician must ensure that the supervising osteopathic physician timely reviews all reports of abnormalities and significant deviations, including the patients’ charts. The supervising osteopathic physician or designated alternate must review and countersign all charts of a licensed osteopathic PA within 7 working days for the first 30 days of practice. Thereafter, the supervising osteopathic physician or designated alternate must review and countersign 10% of the charts of the osteopathic PA within 7 working days. Every chart of a holder of an interim permit must be reviewed and countersigned by the supervising osteopathic physician or designated alternate within 2 working days." Link to comment Share on other sites More sharing options...
jmj11 Posted December 26, 2015 Share Posted December 26, 2015 I looked at these laws, but it still appears that osteopathic PA-C require 10% of charts reviewed while allopathic PA-C do not. Is this an error in interpretation or language? "Must an osteopathic physician review and countersign chart entries made by the osteopathic PA? Yes, to some degree. The osteopathic PA and supervising osteopathic physician must ensure that the supervising osteopathic physician timely reviews all reports of abnormalities and significant deviations, including the patients’ charts. The supervising osteopathic physician or designated alternate must review and countersign all charts of a licensed osteopathic PA within 7 working days for the first 30 days of practice. Thereafter, the supervising osteopathic physician or designated alternate must review and countersign 10% of the charts of the osteopathic PA within 7 working days. Every chart of a holder of an interim permit must be reviewed and countersigned by the supervising osteopathic physician or designated alternate within 2 working days." I don't have an updated copy of the requirements so take what I say with a grain of salt. Three years ago I was part of a committee to modernize the state laws. After the attention of the group (just one member of the group, a malpractice attorney) came after me for being a practice owner, I became distracted with that fight and left the main group. One of the things they were trying to do was to make a unified law for all PAs, but I don't think they reached that objective. The confusing thing about Washington state laws is that they have three sets for PAs. They have 1) Certified Physician Assistant that are supervised by allopathic physicians, 2) Physician Assistants (grandfathered in or non-certified) and 3) Osteopathic Physician Assistants. The #1 above does not require any chart review. The #2, #3 do. So when you read the laws, and if you don't plan on working with a DO, make sure you are reading "Certified Physician Assistant" laws. Link to comment Share on other sites More sharing options...
Reality Check 2 Posted December 27, 2015 Share Posted December 27, 2015 I have been a PA in Washington state for 15 years. I started out as an allopathic PA but never really knew there was a difference between osteopathic and allopathic until I went to work for a DO this year. It took seven weeks to take a 15 year allopathic PA state license with a whole new application to get authorized to work with a DO. It was insane. DOs and MDs work side-by-side and I find no clinical difference in working with them. I cannot see why there are two classifications of certified PAs in the state of Washington and find the whole system cumbersome and useless. Now I have to keep both licenses in order to moonlight in an ER when I might be working with an M.D. or to prevent from having to re-create the wheel should I have a change of supervising physician. Somehow, it is acceptable to be an osteopathic PA in the state of Washington and have an M.D. as an alternate supervising physician. This totally contradicts all their crappy rules. I firmly believe that it is time for a national licensing system that keeps records on the PAs in all the states and makes it more streamlined to get your application processed. having to verify my education from over 25 years ago in order to get an osteopathic PA license when I had a fully functional allopathic PA license was a complete waste of time. Also as an osteopathic PA in the state of Washington, my supervising physician had to review all charts for the first 30 days of my licensure. He was so offended and peeved - not at me - at the system. If I am fingerprinted in several states, have an NPI number, and have a long track record that is easily traceable, I don't see the reason for any state to have to go through some horrific vetting process to get me a functional license. My own opinion Link to comment Share on other sites More sharing options...
Guest Paula Posted December 27, 2015 Share Posted December 27, 2015 The DO and MD professions in Washington must have had a disagreement somewhere in history??? Do they have separate boards? The DO who is peeved might be primed to help the WAPA go to the legislature to get this all changed to one licensing process for PAs. Link to comment Share on other sites More sharing options...
Administrator rev ronin Posted December 27, 2015 Administrator Share Posted December 27, 2015 The DO and MD professions in Washington must have had a disagreement somewhere in history??? Do they have separate boards? Yes, exactly. Link to comment Share on other sites More sharing options...
RURALMED Posted January 9, 2016 Share Posted January 9, 2016 I spoke to Linda Krause of WAPA and she advised that the allopathic and osteopathic boards are fully aligned now. So there is no chart review required for certified PAs. I asked one of the institutions that I am rotating through why they still require a 2 chart/day review, and they said its just part of their policy. They have no similar requirement for NPs. I truly believe the difference is that we have "assistant" in our title. Link to comment Share on other sites More sharing options...
Reality Check 2 Posted January 9, 2016 Share Posted January 9, 2016 The boards are nowhere near aligned when it takes nearly 2 months to make a long term allopathic PA into a licensed Osteopathic PA. The amount of information required and the delays and the indifference to a currently WA licensed PA and any timely turnaround is a detriment to practice and insult to professionalism and education. Paying to keep BOTH licenses "just in case" is a financial drain and further insult. The process needs a complete overhaul and soon. Just check my DNA and put a chip in my neck. I need to work. My very old 2 cents Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted January 9, 2016 Moderator Share Posted January 9, 2016 2 months? wow. I got my WA license in 1 week! sent out Monday, had back Saturday. (Of course my original WA site was a free clinic. that may have helped....) Link to comment Share on other sites More sharing options...
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