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We can't practice medicine????


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I have heard both good and bad in Texas and my last experience there was 20 years ago.

 

Back then I spent a lot of time explaining who I was to EVERYONE. Anesthesia, nurses, patients, office managers, billers - anyone and everyone.

 

It took 3 months to get my Cert results by mail - so I worked under a temp license for those months and couldn't use the C.

 

It was slow and sometimes crappy. If I showed up in the ER for a consult - lots of stares and "when is the doctor coming?". First time I tried to order IV sedation to put a shoulder back in by myself - all hell broke loose with the charge nurse. It took a lot of time and work to get everyone to understand my role.

 

Texas has traditionally been about 5 years behind the national (or East Coast) average for practice rights, etc. When I left, we still didn't have Rx privileges. I walked around with a highly illegal pad of signed scripts in my pocket all day. 

 

I wish there were national standards for PA practice and state reciprocity for licensure, a national licensure board that kept up with stuff better than the states and banked important info that could be accessed more easily than state to state. It would make life better for patients and us.

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OP, I really think you should send the form to the Texas PA Board due to its content and wording.

It is not up to snuff with current legislature and verbiage and as a hospital - they should be up to date on stuff like that.

 

You don't have to take the job but send the form the board and say "this is why I am not taking the job".

 

Might help the next person.....

 

Good job on standing your ground and professional standards!

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Still waiting to hear from any PA leadership in TX, but the facility is now saying it won't credential me unless I sign that form. I told them that was fine, if they'd rather lose an experienced ER PA (which is extremely difficult if not impossible to get around here) over a refusal to sign a form saying I will NEVER practice medicine....their loss.

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Sounds like this hospital in East Texas has never credentialed a PA, or never established a credentialing procedure for PAs or NPs.  Thus their only credentialing pathway is the one for allied health.  Texas PAs are allowed to provide "medical services" that are delegated by the supervising physician;  at least that's how I read the current law. 

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Is this "definition" still in effect (see below)?  If so, then you could say that if you signed their form as written, it could be construed as fraud under Texas law since you do indeed practice medicine.  You could then offer to help them rewrite their form.  Their reaction(s) would be interesting anyway.  

 

 

http://www.statutes.legis.state.tx.us/Docs/OC/htm/OC.151.htm

OCCUPATIONS CODE


TITLE 3. HEALTH PROFESSIONS


SUBTITLE B. PHYSICIANS


CHAPTER 151. GENERAL PROVISIONS


SUBCHAPTER A. GENERAL PROVISIONS

 

 

 

(13) "Practicing medicine" means the diagnosis, treatment, or offer to treat a mental or physical disease or disorder or a physical deformity or injury by any system or method, or the attempt to effect cures of those conditions, by a person who:

(A) publicly professes to be a physician or surgeon; or

(B) directly or indirectly charges money or other compensation for those services.

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Fifty years since the first PA class graduated and yet, this kind of thing is still happening. We shouldn't be upset with the Nacodochees Medical Center. We need to be upset with our leadership who allows PAs to be treated like this. It's time for total independence. If the Physician doesn't want to be on a team any more and their lack of cooperation reduces access for patients, then it is time for patients to have increased access to care by authorizing PAs for independent practice. Offering physicians a collaborative environment continues to be met with disrespect. Let's stop offering. NPs wised up along time ago. PAs need to wise up. We need to win independence in one state in order to start a domino effect. Our leadership needs to mount a campaign for one state practice independence. Physicians know that PAs can perform as well or better than a residency trained physician. The attacks by physicians are motivated by fear. They know their wallets will shrink if patients learn that PAs perform superior work for less cost. The time for civility is over.

Personally I think our title does is a disservice. We spent a good chunk of time making sure people/organizations stopped referring to us with the 's because it made us sound like MD secretaries. And now AAPA and NCCPA send out notifications saying not even use "physician assistant" more than once in any correspondence and to only refer to ourselves as and our profession as "PA". They even go as far as to instruct new grads only to define a PA if asked.

 

IMO, I think we should push to change "Assistant" to "Associate" and then move towards independent practice immediately. AAPA is worried about how professionally we're referred to but is half-heartedly recognizing how much the words of our title matters. Professionally speaking for the most part, PAs are both feared and respected for our abilities to deliver excellent care. I completely agree with you that it's about time to use some of that clout.

 

AMD

 

Sent from my SAMSUNG-SM-G900A using Tapatalk

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Had a similar problem in Amarillo.  I our case they were saying NPs can practice medicine and need no co-signatures but PAs did.  The hospital admins (all RNs except for the CMO) based their argument on a position statement posted by the board of nursing that did not recognize PAs.  We fought it with the help of TAPA and the involvement of the TMB.  It still took us a year to get everything straitened out, and I can't say things are perfect but it was a decisive win for us.  Our administration knew very little about PAs.  They knew a lot about NPs (some not always true) due to almost all of our administration consisting of RNs.  Give TAPA some time help out.  We were making little progress until we go them involved.  Good luck!

 

 

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Actually I did present the fact that signing that form would be fraud. I put it to them this way - if something happened and there was a lawsuit and the attorney got that form that says I agreed to NEVER practice medicine - that wouldn't look very good, would it? They said I could submit a request for a change but it would take months to be reviewed. I told them that was fine - I'm still not signing that form.

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Are there any other PAs working at that facility or you know or suspect to have previously signed the same form?  If you want to light a fire under the hospital, suggest that they are daily accruing more liability by having these PAs practice not practicing medicine.  Who insures the facility? Consider going around them and mentioning the liability to the insurance carrier directly.  If they're a larger carrier, not limited to this particular NP-heavy region, then they likely know who PAs are and what they actually do.

 

Be aware, though, if you push too hard, you may get any hypothetical other affected PA's "emergency de-credentialed" as a knee-jerk reaction.  THEY will then have cause to sue over that employment action, but that'll still take food off their plates in the meantime.

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Actually I did present the fact that signing that form would be fraud. I put it to them this way - if something happened and there was a lawsuit and the attorney got that form that says I agreed to NEVER practice medicine - that wouldn't look very good, would it? They said I could submit a request for a change but it would take months to be reviewed. I told them that was fine - I'm still not signing that form.

 

Draft up your own form and sign it with a place for their signature. Use the regs from the state and write up a document encompassing the actual rights and duties of a PA. I once rewrote an entire contract and told the organization that they could sign mine or nothing at all. I ended up working without a contract which was in my favor and helped immensely once I figured out my creepy meter was busted and I had made a huge mistake. A professional regret and unfortunate learning moment.

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