Don't get this at all

[TWR]

The Bryant University PA Program, faculty, staff, and students fully oppose the proposed AAPA policy regarding Full Practice Authority and Responsibility (FPAR) for PAs.  We believe that all aspects of the proposed FPAR policy, with the exception of independent practice created by the proposed elimination of all legal ties to physicians, are already addressed by existing AAPA policy, specifically, the AAPA Model State Legislation for PAs and Guidelines for State Regulation of PAs.

Any current restrictions and limitations on PA Practice that are supposedly addressed by FPAR can be addressed and resolved at the practice level.  Concerns regarding supervision, limitations of scope of practice, remuneration, job satisfaction, and providing excellent team-based patient care should not be dictated by law, and the AAPA Model State Legislation provides for such practice-level management.

We believe that FPAR is simply a clever means for remodeling the PA Profession to be one of independent practice and that the elimination of the long-standing, highly-valued partnership with physicians is detrimental to the profession, patient care, and the proven concept of team-based healthcare delivery.  One of the most significant issues with FPAR is that since PAs practice medicine and our scope is ideally defined at the practice level, FPAR would leave PAs without any definable scope of practice at all.  The legal basis for “practicing medicine” is defined for physicians.  If all legal ties to physicians are severed, PAs will be left with no legal ability to practice.  An entire new legal scope of practice for PAs would have to be forged in every state, passed through the rigorous legislative process, and adopted and accepted by patients, physicians, hospitals, healthcare systems, and medical practices.  It is our belief that this move would set the profession backwards or eliminate it all together, as there would be no legal basis for a PA Profession without physicians.

Some PAs are concerned that APRNs or NPs (Nurse Practitioners) might have job placement advantages because in some states, APRNs are independent practitioners.  However, even though PAs work alongside NPs in many healthcare settings and enjoy the PA/NP teamwork and relationships, NPs practice nursing and PAs practice medicine; this is not an equivalent comparison, and the training is markedly different.  Physicians and healthcare organizations may perceive there to be an advantage in hiring an “independent” practitioner because of the inaccurate belief of not having to bear any responsibility for the actions of the NP while having to bear 100% of the responsibility of the PA’s actions.  It is more accurate to say that each health care provider (physicians, PAs, and APRNs) are already responsible for actions they take in the course of providing patient care.  In fact, there has been no objective evidence presented that NPs are hired preferentially over PAs.  We believe that the AAPA Model Legislation which replaces “supervision” with the more accurate term “collaboration” more accurately describes the physician-PA team and individual liabilities.  Better served efforts would be to enact new AAPA Policy specifically addressing PA liability, physician responsibility, and fair tort reform.

Following the 2016 AAPA House of Delegates Meeting, the discussion of FPAR was referred to a task force, charged with further investigating the implications of FPAR on PAs and healthcare to bring to the 2017 AAPA House of Delegates Meeting in May 2017.  At this time, The AAPA Joint Task Force on the Future of PA Practice Authority has not completed any such investigation and has instead put forth the same statements, backed only by anecdotes and individual PA statements and experiences.  The Task Force has irresponsibly gone forth with very public messages that have been misconstrued by the public, patients, PAs, physicians, physician professional organizations, and others.  Worse, these public discussions about FPAR have made it appear to anyone watching or reading that this is already AAPA Policy and the future of the PA Profession; it is not.  Such statements only serve to alienate our physician partners, cause confusion within the PA Profession, and will only make it more difficult to progress the AAPA Model Legislation through the appropriate processes.

The year 2017 marks the 50th anniversary of the PA Profession.  At this time, we should be seeking ways to strengthen the already excellent Physician-PA collaborative relationship.  Unlike FPAR advocates have stated, there is no basis to believe that PAs have “earned the right” to suddenly become independent practitioners.  Any PA practicing in a supportive state legal environment already enjoys the ability to practice autonomously, to the limit of their PA license and training, as part of a health care team.  The singular goal of both PAs and physicians should be the delivery of outstanding healthcare to our patients.

------------------------------
Bryant University PA Program
Smithfield, RI

[mmiller3]

Awesome. Bryant University wishes to continue pandering to the physicians who turn around and hire NPs because it is easier to do so.

 

And we wonder why we are falling further behind NPs.

[UGoLong]

No evidence of the preferential hiring of NPs? Don't have to look far around here...

 

 

Sent from my iPad using Tapatalk

[SoCalPA]

How long has the Bryant PA Program been around?

 

Sent from my SM-G925P using Tapatalk

[FamousAmos]

I interviewed at Bryant this year, and this was the tone set throughout the entire interview day. At times it even felt hostile. If an interviewee felt that the profession could benefit from independent practice, you were made to feel wrong and out of place. Certainly the vibe that I got at least. It definitely gave me a better feel for how much of a "fit" that program was for me.

[8404PA]

That's a lot of words just to point out how they prefer laying on their back

[UGoLong]

Don't know the school or anything about it. From some googling:

 

1. Brant is a private Rhode Island university. Total enrollment is about 3500.

 

2. Apparently the Rhode Island Academy of PAs put out a similar ant-FPAR statement, which is also posted on the Bryant program's page. 

 

3. The Brant PA program apparently admitted its first class in January 2015 and they will graduate this spring.

[steve.bannon]

An entire statement of abundant, wild, sweeping, and unsubstantiated claims.  Sounds half hysterical and draws a line in the sand between members of the same profession.

[Boatswain2PA]

"Pandering", "Laying on their back", and "hysterical"...
 

....not words we should be using to refer to other PAs simply because they hold opposing positions on this.


I generally disagree with full independence as well, and I guarantee you I'm not pandering, laying on my back, nor hysterical.  As I type this I'm the sole provider in a 24 bed hospital covering the hospital and the ED for the weekend.  I doubt I will call my SP (who I've never met) all weekend.  I don't know many PAs who have my independence or scope of practice....yet I'm against full independence for PAs (and damn well against full independence for NPs).

We can disagree, but let's disagree respectfully.

[steve.bannon]

"Sounds half hysterical" is a critique of the content of the message, not in reference to human beings.  If you aren't prone to writing in hysterics, I guess they should have hired you to write it.

[papub]

I posted this on the Huddle.

Ok, Bryant University as we are people based in science, let's take a look at the evidence.
1. All major healthcare funding foundations and all major healthcare consumer groups feel that NPs deserve full practice by virtue of their education. Even the Institute of Medicine, a full physician group says they do. I would presume if asked that the same groups would agree that we do unless our PA graduates are inferior to the NP graduate? Do you believe this is so? If you do in what way?
2. Full practice, if you have been listening is much about being able to regulate and govern ourselves without another profession interfering in that governance. Do you agree with that? Have we not earned the right to have what every other profession has?
3. FPAR is also about PAs being responsible for what they do and having a scope of practice we own. Again, every profession has one. We can not give an injection unless we have a supervising doc "delegate" that. Do you agree PAs should be able to do things like physicals
and give shots on our own license? If not, why not?
4. A study was done on the grassroots PAs feelings on this subject. You could have waited for this piece of evidence to study? Did you not feel the rank and file PAs mattered in the
context of finding out if some of the things we
have been hearing about and you seem to doubt like PA jobs going to NPs. Let's see if it is a nationwide trend? Thank G-d it's not in Rhode Islsnd. Good for you guys!
Lastly, can you back up your assertion that the physician-PA relationship would be harmed if PAs practiced being responsible for what we did? Please do. Show me evidence as it's never happened.
I can tell you that many state physician groups were against NPs obtaining this right to self regulation and once it passed
the physicians went right back to business as usual. They did not even tell their members not to hire NPs? Please show me if they did? And where? I want the evidence. As we speak there are 4 NP bills going through state legislatures I know of for FPA. Let's see what the docs do there when they pass.
One thing did change, the administrators hired more NPs because the barriers for PAs were much more burdensome.
Have you looked at the countries where PAs have FPAR and reviewed how the physicians and the PAs get along?
I expect an answer to the above questions as they fill in the blacks that we need to further this discussion.
The above represents my own opinion but clearly I am passionate about where we should go in the future.
Dave Mittman,PA, DFAAPA

[papub]

Sorry the above should start out Bryant University, not Lock Haven. Not sure why I wrote thet but don't know how to edit it.

Dave

[ventana]

The Brant PA program apparently admitted its first class in January 2015 and they will graduate this spring.

 

 

 

Wow so we have a bunch of BRAND new PA's and PA-s in a BRAND new program, tell a 50 year establishment lead by some amazingly talented folks that they are wrong??

 

 

 

The thing that people just don't understand - please name just one other field that functions as independent providers, but then is under the beck and call of a Doc.

I am strongly for FULL PRACTICE AUTHORITY and at the same time believe we should be training our own -ie stage learning and independence.  Just like Speech Language Pathologist do.....

A new grad should be formally mentored for a year  -  or  -  complete a fellowship.

 

But we in no way be 100% controlled by another profession.  Think about it - if they started pumping out to many docs - docs would simply refuse to supervise us and the profession would die - ins spite of it's amazing contributions....

 

We need to stand on our own professional feet - and remember NO ONE practices medicine independently (unless you are nuts!)

[overthehorizen]

I say again with an even greater degree of confidence that the PA profession will not be in existence in ten years. We are dying a slow death by a thousand cuts inflicted by three groups; the AAPA, the NCCPA and the PA Programs. Unless and until we eliminate reboarding and win 50 state independent practice, the PA will fall further behind the NP. Already, NPs have independence in 22 states (Bryant University characterizes 22 of 50 as 'some') and PAs have 0. NPs have independent practice at the VA. PAs remain dependent practitioners at the VA. We cannot change the thinking of the Bryant University PA program but we can stop assisting them in destroying the profession. I would encourage all of the PAs in the the nation to REFUSE TO ACCEPT STUDENTS FROM THE Bryant PA PROGRAM for clinical rotations as long as the PA program leadership insists on undermining efforts to advance the interest of the PA. When new applicants find out that they are paying a lot of tuition and nobody will take their students for rotation, they will abandon the school and revenues will dry up. Stick it to them where it hurts and they will heel. 

[Boatswain2PA]

Death by thousand cuts huh. Kinda hard to believe that when I grossed $220k last year, and I routinely turn down 10-12 shifts a month....not to mention the dozens of full time job openings I get in my email.

[Reality Check 2]

I say again with an even greater degree of confidence that the PA profession will not be in existence in ten years. We are dying a slow death by a thousand cuts inflicted by three groups; the AAPA, the NCCPA and the PA Programs. Unless and until we eliminate reboarding and win 50 state independent practice, the PA will fall further behind the NP. Already, NPs have independence in 22 states (Bryant University characterizes 22 of 50 as 'some') and PAs have 0. NPs have independent practice at the VA. PAs remain dependent practitioners at the VA. We cannot change the thinking of the Bryant University PA program but we can stop assisting them in destroying the profession. I would encourage all of the PAs in the the nation to REFUSE TO ACCEPT STUDENTS FROM THE Bryant PA PROGRAM for clinical rotations as long as the PA program leadership insists on undermining efforts to advance the interest of the PA. When new applicants find out that they are paying a lot of tuition and nobody will take their students for rotation, they will abandon the school and revenues will dry up. Stick it to them where it hurts and they will heel. 

 

Seriously - go find another career - please.

Your gloom and doom and gnawing and gnashing are just too much.

[True Anomaly]

"Pandering", "Laying on their back", and "hysterical"...

 

....not words we should be using to refer to other PAs simply because they hold opposing positions on this.

 

 

I generally disagree with full independence as well, and I guarantee you I'm not pandering, laying on my back, nor hysterical.  As I type this I'm the sole provider in a 24 bed hospital covering the hospital and the ED for the weekend.  I doubt I will call my SP (who I've never met) all weekend.  I don't know many PAs who have my independence or scope of practice....yet I'm against full independence for PAs (and damn well against full independence for NPs).

 

We can disagree, but let's disagree respectfully.

 

This, a thousand times this.

 

There's been this disturbing trend I'm seeing in the profession as a whole for the past several months, since the idea of FPAR started to gain momentum- and that is, "If you're not for us, you're against us".  It is the tone of the message that seems to spread from the AAPA, drowning out the voices of anyone in opposition, almost in vitriolic disgust against those who dare to have a different opinion.

 

I personally have no idea where I fall on this whole concept.  I easily see both sides of it.  But one thing that certainly would make a strong effort to sway me away from it is the venom that I see pro-FPAR PAs spit towards those who stand in opposition.

 

Be kind in your opinion, especially if you're trying to push forward an entirely new concept that may make many of your colleagues a bit uncomfortable

[overthehorizen]

Be kind in your opinion, especially if you're trying to push forward an entirely new concept that may make many of your colleagues a bit uncomfortable

A new concept? Independent practice in a new concept? Physicians have enjoyed independent practice since their creation. NPs now have independent practice in 22 states and the Department of Veteran Affairs. What is "new" about independent practice? The language has been measured given the assault on our profession. There is no space for PAs who don't know where they stand. The issue has been analysed ad nauseum. To suggest that one doesn't know where they stand and sees both sides is the equivalent of saying that you are still an undecided on the day before the Presidential election. Undecideds are actually decided but they want to feel special by being part of the political discourse.  I would be pleased if the PAs who are asked to take the Bryant students on rotation simply refuse outright. If they are forced to take them, make sure they get a substandard training so future applicants are dissuaded from applying to the program.

[KC881]

I would encourage all of the PAs in the the nation to REFUSE TO ACCEPT STUDENTS FROM THE Bryant PA PROGRAM for clinical rotations as long as the PA program leadership insists on undermining efforts to advance the interest of the PA. 

 

 

To suggest that no PAs take Bryant students based on a statement put out by Bryant faculty is childish and unprofessional. Your abrasive and despotic statements regarding an opinion different than your own certainly raises red flags in regards to being part of a healthcare team. Perhaps you are doing the PA profession a favor in "refusing to accept" any potential students from rotating with you, especially with your statements on offering "substandard training" to anyone who dares to challenge your viewpoint.

[Boatswain2PA]

I would be pleased if the PAs who are asked to take the Bryant students on rotation simply refuse outright. If they are forced to take them, make sure they get a substandard training so future applicants are dissuaded from applying to the program.

This is the same mentality of the juvenile snowflakes who trash neighborhoods and college campuses when they don't get their way, or to shut down the speech of someone they disagree with. It is idiotic has led to our current level of political intolerance.

 

If any PA student gets a poor education because of your asinine idea, imagine one day soon you wake up in the ICU to find them at the foot of your bed adjusting your pressors.

 

We are Americans (even counting the Canucks who post here). We should celebrate our TRUE diversity of thoughts, ideas, backgrounds, and cultures. You don't have to think the way I do, but I damn well don't have to think like you do.

[steve.bannon]

Boo hoo, someone exercises their right to preferentially precept students who reflect their values and you wish them an ICU stay.  Are you, in fact, the snowflake?

[ventana]

In spite of the harsh responses. Overthehorizon brings up a valid point. If you do not support their opposition to full practice authority then simply do not support that school. There is nothing that says you have to accept students from any program, and this is reasonable.

 

I cringe with the horrid responses that are so devisive. We need to accept others view points for their face value, but we don't need to support them.

 

I don't believe that an academic TRAINING program should be making political statements, the should just educate the medicine!

 

 

I support FPA but live no where near Bryant college so it is a moot point. But if the institution called me up and asked me to preceptor i would politely and professionally decline and tell them why - that my political goals for the profession clearly do not align with theirs. As such I doubt I would be able to provide the subserviant type of education they are looking to provide. I would be teaching the PA-s how to be an independent thinking medical provider, which clearly they do not want.

[Guest JMPA]

This is the same mentality of the juvenile snowflakes who trash neighborhoods and college campuses when they don't get their way, or to shut down the speech of someone they disagree with. It is idiotic has led to our current level of political intolerance.

 

If any PA student gets a poor education because of your asinine idea, imagine one day soon you wake up in the ICU to find them at the foot of your bed adjusting your pressors.

 

We are Americans (even counting the Canucks who post here). We should celebrate our TRUE diversity of thoughts, ideas, backgrounds, and cultures. You don't have to think the way I do, but I damn well don't have to think like you do.

you do not sound like you are celebrating the diversity of the OPs thoughts/ideas/backround/culture. Why is there so fervent a push for self destruction? Clearly the Bryant program is anti-PA with a statement like that. Allowing our profession to be devoured by nursing is unconscionable.

[Boatswain2PA]

Vent - nobody should be forced to precept. If you or OTH want to decline precepting because of their desire to retain the status-quo, then that's your call. Or you could take students and expose them to your thoughts on the profession. But to suggest purposefully giving them a poor educational experience is uselessly damaging.

 

JM - push for self destruction? Come on....just because I don't see the doom and gloom "NURSES ARE GONNA PUT US OUT OF BUSINESS!!!!" that OTH screams incessantly doesn't mean I'm pushing for self-destruction.

 

There are areas where NPS predominate. There are areas where PAs predominate.

 

I completely understand the arguments for independent practice.

 

However I wouldn't want my wife, kids or grand kids to see an inexperienced PA (or especially NP) who didn't have some kind of medical oversight by a physician.

[OneDayAPA_Maybe]

you do not sound like you are celebrating the diversity of the OPs thoughts/ideas/backround/culture. Why is there so fervent a push for self destruction? Clearly the Bryant program is anti-PA with a statement like that. Allowing our profession to be devoured by nursing is unconscionable.

 

Anti-PA seems a little harsh. Thats a lot of work and money to put up to go through accreditation to serve the sole purpose of destroying a profession.