PA Profession: Where are we going?

[DelusionalEnthusiasm]

PA profession: where are we going?

 

Four years ago I started out in my first PA role in neurosurgery, prior to PA school I had been a paramedic and worked in various medical jobs. I thought becoming a PA was perfect mix. The autonomy, knowledge, procedures, and good pay without the hassle of running a practice or going to medical school. I've always been one who has been motivated to do it all, to work at the limits of my license, and granted I've done well with where I'm at now. But now that I've learned what I know I have begun to realize how limited we as PAs are, and by looking at peers, how much variability there is between jobs, compensation, and overall limitations put in place by our supervising physicians, and a lot of times by the PAs themselves. It seems more and more I see colleagues who are content with running scut, PAs who really have no motivation or desire to advance themselves in their field and all I can think is are these PAs changing the expectations of what physician assistants scope of practice and role within the practice should be? It also seems that most of these are the ones who roll though high school into college and PA school and roll right into a comfortable non aggressive job and become content with where they are. Whereas, it seems that PAs with prior medical experience have that drive to do more? I think I've gone off topic.

 

I've spent months reading and reflecting on my job, other opportunities, furthering education with a doctorate or returning to medical school, and on various posts from experienced PAs on this board. I think it's very telling that even EMEDPA, as experienced as he is, would still take up an opportunity to go to a residency and that he has had to change as many jobs as he has in order to get to where he is now. Tying that in with my previous thoughts, how have sub par unmotivated PAs made achieving that dream job all the more difficult?

 

It seems as if the only way one can gain that respect and negotiating power is to return to a residency, but how does that help the thousands of PAs who are already settled with families? While residencies sound like a great option for new graduates (even more so for those without prior healthcare experience) shouldn't there be an equivalent system in place for those who are already working and established? The main components of a residency are education and hands on experience. Why haven't their been any online education programs developed (perhaps by the societies like SEMPA) that cover all the didactic that is taught in residency. There's no reason why PAs in their current jobs couldn't approach their supervising physician with a list of procedures or cases that needed to be completed in order to gain that certification. In essence, why can't we achieve a distance Ed residency program with on the job mentoring and give the same recognition for it?

 

Going further with this, why are we not continuing to expand our scope of practice. How many years ago was it that Duke PAs were doing diagnostic cardiac angiograms and had better performance than fellows. Or that recent article about the PA who was doing solo lung surgeries better than fellows. Why is it that we stagnate ourselves in our profession and have become cash cows and scut monkeys for our supervising physicians. These excellent PAs should be the standard and goal, not a rarity. All I can hear about is name changes and doctorates, which albeit are important, what about driving positive change in the profession and working to establish a new "norm" of what a PA means?

[CAAdmission]

If PAFT can't save us, I know where we are going:

 

[EMEDPA]

a distance residency would not work for several reasons:

1. most docs wouldn't allow PAs to create their own scope of practice ( " I want to start doing central lines and chest tubes").

2. a residency allows for focused off service rotations. how would you do this as a full time PA? you can't just take a week off to spend in the O.R. doing precepted intubations.

3. the goal of an employer at a job is for the PA to move the meat, not to improve their clinical acumen to get a better job elsewhere.

 

the didactic portion could certainly be done online and many places ( like W. VA) offer an online certificate in adv. emergency medicine, but without the practical rotations it will not make you a better provider. reading about putting in chest tubes is not the same as putting in 10 on a trauma surgery rotation. reading about sepsis is not the same as seeing someone crash in front of you and having to intervene.

I think a good option for those without an em background is to become paramedics through the Creighton cme program that trains PAs with emt certs to be medics in a few weeks. spendy, but great skills training and exposure to really sick folks. (you can become an emt online fairly quickly and show up just for a few in-person skills sessions to be eligible for this program).

[DelusionalEnthusiasm]

E-

I can certainly see your point of view in our current environment.  However, I think that if there was an overall push for all PAs to be moving towards completing a residency everything could change, especially if it became quasi -"mandated" by specialty societies.  As far as learning more clinical acumen to leave for a "better" job, I think this is the overall point - there are too many PAs now working in the trenches at the lowest levels of their degrees.  In ER, they are in the fast tracks and have no hope of getting out to the main ER.  In neurosurgery they are stuck rounding the floors with no investment in procedures or first assisting.  I think there are huge differences in the variability of PAs in these fields vs. PAs in cardiothoracic surgery, where they all seem to be highly experienced in assisting, ICU care, vein harvesting, etc.  My point is CTS PAs really are practicing well at the top of their license (most of the time) while PAs in other fields are really struggling to do so.  Maybe a distance ed residency could be an answer to this, maybe not.  Maybe specialty societies need to get involved to enhance the function of PAs in their specialty across the board.  The whole goal isn't to move to a better job, it is to improve your status in your current job, or leave, and if all PAs were doing the same, eventually that job would need to change to reflect the skills of the PA market.

 

In regard to distance residencies.  If professional societies truly developed a great online curriculum, I see no reason why a PA at their current job couldn't work towards completing those procedures if the employer knew they were increasing their PAs education and making them more valuable and useful to the practice.  If they were opposed to this, then the obvious reason is the PA should leave that job anyway as it is exactly as mentioned.  

 

An alternative to this would be to schedule your own rotations, either while working part time, or to quit and take up your own rotations perhaps at a local trauma or academic medical center.  You could do this by hitching up with a precepting PA at that site, and volunteering your time, or by being hired at a low wage.  The precepting PA at that site could work with the PA specialty society to be a leader in this arena as someone who is experienced (maybe >10 years in the field).  I don't see why I should have to fly to Texas, take a year off of work, get paid 40k a year to complete a neurosurgery rotation when I could go to a local trauma center (which I am credentialed at already, but rarely go to) to throw in a few EVDs and check that off my list.  I agree this type of thing is not EASY to implement as opposed to just signing on the line and flying to a residency, but for most PAs it would be easier than moving their family, selling or renting their house, having their spouse and kids find a new job / friends / school etc.  

 

Overall the point is PAs should be functioning at the top of their licenses across the board, interventional cardiology PAs should have the option of learning how to do diagnostic catheterizations (although I can see this being completed at a PA "fellowship" program given its unique challenge).  I only bring this up because we as PAs are hyper focused on the DNP movement, and are considering doctorate degrees, but we are not considering advancing ourselves clinically way past the NPs, which I think is where our field has an advantage.  

[DelusionalEnthusiasm]

by the way I think this type of program should replace this CAQ we have now.  I think its misleading to be qualified as an "expert" in emergency med with a CAQ when you only work in fast track.

[EMEDPA]

by the way I think this type of program should replace this CAQ we have now.  I think its misleading to be qualified as an "expert" in emergency med with a CAQ when you only work in fast track.

you have to get signed off on chest tubes, central lines, intubations, atls, difficult airway, etc to sit for the caq, although I agree, some folks have fudged it a bit...I know most of the PAs in my area who have passed the CAQ and they all work solo in rural settings or in alaska.

at one of my rural jobs we have 2 out of 5 of us with both a doctorate and em CAQ. I'm guessing that is the highest % in the nation with that prep....:)