ventana

ArcPa just needs to keep our standards high. If they can not meet them no accreditation. If they fall below below a level loose accreditation .

Boats. Excellent description and post.

a few thoughts.... 1) Doctor is not a protected term - there are many doctors in the world 2) Physician is a protected word 3) AMA should start a campaign to encourage PHYSICIANS cause the Doctor horse has already left the barn..... I had to laugh my ars off when a new grad DPT tried to talk to be about a complex case and they introduced themselves as doctor..... yeah was pretty funny Anyways, back on topic I honestly hope they take all their licenses away, and charge them with crimes.... I also hope the ANA and the AAPA use info like this to throw back at AMA when they say we practice inferior medicine.....

PLEASE think long and hard about how you choose to describe yourself and your coworkers. you are NOT a midlevel providing midlevel care!! You are a PA and you provide the care the patient needs to the same level as the doc's. By using the term "midlevel" you are putting yourself down and elevating other providers - in fact you are saying that the doc's care is better....... I am only going to say this once......... any you need to listen very very carefully You are committing fraud - of the worst kind. you will most likely loose you license if this ever comes up to a BOM, PA board or other regulatory body. By logging into the doc's account and signing you are impersonating a physician which is beyond stupid. I would absolutely never ever do this EVER and I would likely report anyone that asked me to do this. This is fraud an is working around so many things like supervision, professional respect, professional responsibility, and legality. STOP THIS PRACTICE RIGHT NOW!!!!!!!!!!!!!!!!!!!!!! I really hope this is a troll posting..... cause if it is real it is truly bad.......

Hummmm but from my perspective I would NEVER work for an agency which would mandate anything beyond independent practice, and I would hope others that are experienced would do the same. As well I don't think that people (or admin) want to supervise PA's, but instead just want to hire a highly skilled professional medical provider that wants to help his patients......

Now we just have to get OTP passed, get ride of SP agreements....

Perception is 90% of the battle.... we are "assistant" now so "we have to prove we are better then assistant" every single time.... Add into this that HR and small practices sometimes is so short sighted that they can not (will not/refuse to ) grow with a provider as the skill set increases that they just loose employees. So if we are "providers" and do not stupid, useless meaningless supervision meetings and feedback then they doc's will not get the opportunity to look down on us.... Funny story lately At my primary job the SP is just administrative, does not have clinic, does not see patients..... He refused to back me up on a policy issue where the medical knowledge is changing and we should change protocols..... He said it was not worth it, we don't want to piss off admin, and it was his call..... ahhh no, not on my watch, I will advocate for my patients and what is right medically. Meet with Admin and they appear to have sided with me. And are scheduling a meeting with he and I. I simply can not wait to see the look on his face when he realizes not only was he wrong, but admin is serious about trying to do good medicine and will not likely appreciate that he was unwilling to advocate for the patients....... I might get in more trouble, and I have already contact my own PA Board to make sure I am stepping very carefully. But really, why on gods earth do I need to do this BS? it is a waste of my time and efforts....... (every specialist I have spoken with sides with me) OTP and name change can change this......

PA can never direct bill medicare/medicaid

To be clear - this was intended to be a good thing - this FDA post We now can simply say the FDA says this should be done this way to all the non-medical/admin types that try to unduly influence our prescribing. How can a state BOM say you are doing it wrong when the FDA says it might take up to a year to taper someone off IF it is clinically indicated..... it provides protection to us to do the jobs we are trained to do.

BOP job where you are just doing intakes or the like... something simple and for the fed in a correctional setting - the facility and the medical director will get sued, but not you....

yeah me too.... I truly think that the terminal doctorate will really open up a lot of hospital admin jobs - not more can the nurses say they run the place as it is Nurse and Doctors that matter - well I guess we just join the degree of doctorate......

I hope that is tongue in cheek PA is NOT a step to MD I think the career progression will change drastically with the DMSc degree - honestly think jobs are going to open up across the board....

The above is from the FDA yesterday (4-9-19) This is a huge shift away from the "just stop all opiates" mantra that hurts so many people. It is no longer acceptable to force withdrawal on your patients....

https://www.fda.gov/Drugs/DrugSafety/ucm635038.htm FDA identifies harm reported from sudden discontinuation of opioid pain medicines and requires label changes to guide prescribers on gradual, individualized tapering SHARE TWEET LINKEDIN PIN IT EMAIL PRINT Safety Announcement [4-9-2019] The U.S. Food and Drug Administration (FDA) has received reports of serious harm in patients who are physically dependent on opioid pain medicines suddenly having these medicines discontinued or the dose rapidly decreased. These include serious withdrawal symptoms, uncontrolled pain, psychological distress, and suicide. While we continue to track this safety concern as part of our ongoing monitoring of risks associated with opioid pain medicines, we are requiring changes to the prescribing information for these medicines that are intended for use in the outpatient setting. These changes will provide expanded guidance to health care professionals on how to safely decrease the dose in patients who are physically dependent on opioid pain medicines when the dose is to be decreased or the medicine is to be discontinued. Rapid discontinuation can result in uncontrolled pain or withdrawal symptoms. In turn, these symptoms can lead patients to seek other sources of opioid pain medicines, which may be confused with drug-seeking for abuse. Patients may attempt to treat their pain or withdrawal symptoms with illicit opioids, such as heroin, and other substances. Opioids are a class of powerful prescription medicines that are used to manage pain when other treatments and medicines cannot be taken or are not able to provide enough pain relief. They have serious risks, including abuse, addiction, overdose, and death. Examples of common opioids include codeine, fentanyl, hydrocodone, hydromorphone, morphine, oxycodone, and oxymorphone. Health care professionals should not abruptly discontinue opioids in a patient who is physically dependent. When you and your patient have agreed to taper the dose of opioid analgesic, consider a variety of factors, including the dose of the drug, the duration of treatment, the type of pain being treated, and the physical and psychological attributes of the patient. No standard opioid tapering schedule exists that is suitable for all patients. Create a patient-specific plan to gradually taper the dose of the opioid and ensure ongoing monitoring and support, as needed, to avoid serious withdrawal symptoms, worsening of the patient’s pain, or psychological distress (For tapering and additional recommendations, see Additional Information for Health Care Professionals). Patients taking opioid pain medicines long-term should not suddenly stop taking your medicine without first discussing with your health care professional a plan for how to slowly decrease the dose of the opioid and continue to manage your pain. Even when the opioid dose is decreased gradually, you may experience symptoms of withdrawal (See Additional Information for Patients). Contact your health care professional if you experience increased pain, withdrawal symptoms, changes in your mood, or thoughts of suicide. We are continuing to monitor this safety concern and will update the public if we have new information. Because we are constantly monitoring the safety of opioid pain medicines, we are also including new prescribing information on other side effects including central sleep apnea and drug interactions. We are also updating information on proper storage and disposal of these medicines that is currently available on our Disposal of Unused Medicines webpage. To help FDA track safety issues with medicines, we urge patients and health care professionals to report side effects involving opioids or other medicines to the FDA Me Additional Information for Health Care Professionals Do not abruptly discontinue opioid analgesics in patients physically dependent on opioids. Counsel patients not to discontinue their opioids without first discussing the need for a gradual tapering regimen. Abrupt or inappropriately rapid discontinuation of opioids in patients who are physically dependent has been associated with serious withdrawal symptoms, uncontrolled pain, and suicide. Abrupt or rapid discontinuation has also been associated with attempts to find other sources of opioid analgesics, which may be confused with drug-seeking for abuse. Patients may also attempt to treat their pain or withdrawal symptoms with illicit opioids, such as heroin, and other substances. It is important to ensure ongoing care of the patient and to agree on an appropriate tapering schedule and follow-up plan so that patient and provider goals and expectations are clear and realistic. When deciding how to discontinue or decrease therapy in an opioid-dependent patient, consider a variety of factors, including the dose of the opioid analgesic the patient has been taking, the duration of treatment, the type of pain being treated, and the physical and psychological attributes of the patient. There are no standard opioid tapering schedules that are suitable for all patients. A patient-specific plan should be used to taper the dose of the opioid gradually. In general, for patients who are physically dependent on opioids, taper by an increment of no more than 10 percent to 25 percent every 2 to 4 weeks. It may be necessary to provide the patient with lower dosage strengths to accomplish a successful taper. If the patient is experiencing increased pain or serious withdrawal symptoms, it may be necessary to pause the taper for a period of time, raise the opioid analgesic to the previous dose, and then once stable, proceed with a more gradual taper. When managing patients taking opioid analgesics, particularly those who have been treated for a long duration and/or with high doses for chronic pain, ensure that a multimodal approach to pain management, including mental health support (if needed), is in place prior to initiating an opioid analgesic taper. A multimodal approach to pain management may optimize the treatment of chronic pain, as well as assist with the successful tapering of the opioid analgesic. Patients who have been taking opioids for shorter time periods may tolerate a more rapid taper. Frequent follow-up with patients is important. Reassess the patient regularly to manage pain and withdrawal symptoms that emerge. Common withdrawal symptoms include: Restlessness Lacrimation Rhinorrhea Yawning Perspiration Chills Myalgia Other symptoms also may develop, including: Irritability Anxiety Insomnia Backache Joint pain Weakness Abdominal cramps Anorexia Nausea Vomiting Diarrhea Increased blood pressure or heart rate Increased breathing rate Patients should also be monitored for suicidal thoughts, use of other substances, or any changes in mood. When opioid analgesics are being discontinued due to a suspected substance use disorder, evaluate and treat the patient, or refer him/her for evaluation and treatment of the substance use disorder. Treatment should include evidence-based approaches such as medication assisted treatment of opioid use disorder. Complex patients with comorbid pain and substance use disorders may benefit from referral to a specialist. To help FDA track safety issues with medicines, report adverse events involving opioids or other medicines to the FDA MedWatch program, using the information in the "Contact FDA" box at the bottom of this page.