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Greg Cain PA-C

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Everything posted by Greg Cain PA-C

  1. Here's what we are doing in Tennessee. HERE IS WHAT TAPA IS DOING: We are excited to officially launch our Partners for Patients advocacy campaign in conjunction with the filing of Senate Bill 671 by Senator Mike Bell and House Bill 1080 by Representative Jerry Sexton. The legislation, which modernizes the role of Tennessee's PAs, contains three main objectives: 1) Creates a Board of Physician Assistants The newly-formed Board of PAs would consist of seven PAs, one physician (MD or DO) and one consumer member. The formation of this Board will eliminate duplication and delays and allow for self-governance while maintaining reasonable oversight. 2) Modernizes PA practice by eliminating ties between a PA's license and a specific physician's license When these rules were adopted in 1999, many practices were owned by individual physicians or small groups of physicians, so it made sense then to tie a PA's license to the physician employing them. In the decades since, the practice of medicine has changed dramatically. More than half of practices are now owned by hospital systems, and most small practices have gone through mergers to become large practices owned by several dozen physicians. The 1-to-1 model of physician/PA employment rarely exists these days as most PAs are employed by hospital systems and large practices. 3) Eliminates burdensome regulations to allow practices the flexibility of determining collaboration and oversight at the practice level. Under this bill, collaboration regulations such as mandatory percentages of chart review would be eliminated. Instead, it would be up to a PA's employer to determine collaboration and oversight requirements, based upon the PA's experience, training and scope of practice. Updating state regulations allows employers the flexibility to deploy the PA to where their skills are needed, and it promotes a team-based model that is more productive, efficient, and functional. The Partners for Patients advocacy campaign will consist of op-eds, like the one that recently ran in the Memphis Commercial Appeal, and digital ads targeted to state lawmakers (see example below). The goal will be to better define the often misunderstood role and experience of PAs and to explain the need to modernize the role of Tennessee's Physician Assistants. Most importantly, this advocacy campaign also relies on YOU! In addition to registering for our annual Day on the Hill (more details to come on this virtual event), we will also be holding town hall meetings and sending Action Alerts leading up to this legislation being considered. Please heed those e-mail alerts and lend your time in personally delivering the importance of this bill to key legislators. If you have any questions about the legislation or our overall advocacy campaign, please reach out to the TAPA office. https://wapp.capitol.tn.gov/apps/BillInfo/Default.aspx... Tennessee General Assembly Legislation WAPP.CAPITOL.TN.GOV Tennessee General Assembly Legislation WAPP.CAPITOL.TN.GOV Tennessee General Assembly Legislation
  2. Here's what we are doing in Tennessee: HERE IS WHAT TAPA IS DOING: We are excited to officially launch our Partners for Patients advocacy campaign in conjunction with the filing of Senate Bill 671 by Senator Mike Bell and House Bill 1080 by Representative Jerry Sexton. The legislation, which modernizes the role of Tennessee’s PAs, contains three main objectives: 1) Creates a Board of Physician Assistants The newly-formed Board of PAs would consist of seven PAs, one physician (MD or DO) and one consumer member. The formation of this Board will eliminate duplication and delays and allow for self-governance while maintaining reasonable oversight. 2) Modernizes PA practice by eliminating ties between a PA’s license and a specific physician’s license When these rules were adopted in 1999, many practices were owned by individual physicians or small groups of physicians, so it made sense then to tie a PA’s license to the physician employing them. In the decades since, the practice of medicine has changed dramatically. More than half of practices are now owned by hospital systems, and most small practices have gone through mergers to become large practices owned by several dozen physicians. The 1-to-1 model of physician/PA employment rarely exists these days as most PAs are employed by hospital systems and large practices. 3) Eliminates burdensome regulations to allow practices the flexibility of determining collaboration and oversight at the practice level. Under this bill, collaboration regulations such as mandatory percentages of chart review would be eliminated. Instead, it would be up to a PA’s employer to determine collaboration and oversight requirements, based upon the PA’s experience, training and scope of practice. Updating state regulations allows employers the flexibility to deploy the PA to where their skills are needed, and it promotes a team-based model that is more productive, efficient, and functional. The Partners for Patients advocacy campaign will consist of op-eds, like the one that recently ran in the Memphis Commercial Appeal, and digital ads targeted to state lawmakers (see example below). The goal will be to better define the often misunderstood role and experience of PAs and to explain the need to modernize the role of Tennessee’s Physician Assistants. Most importantly, this advocacy campaign also relies on YOU! In addition to registering for our annual Day on the Hill (more details to come on this virtual event), we will also be holding town hall meetings and sending Action Alerts leading up to this legislation being considered. Please heed those e-mail alerts and lend your time in personally delivering the importance of this bill to key legislators. If you have any questions about the legislation or our overall advocacy campaign, please reach out to the TAPA office. https://wapp.capitol.tn.gov/apps/BillInfo/Default.aspx... Tennessee General Assembly Legislation WAPP.CAPITOL.TN.GOV Tennessee General Assembly Legislation WAPP.CAPITOL.TN.GOV Tennessee General Assembly Legislation
  3. I agree, however I'm waiting to see one major AAPA victory while we sit on the sidelines and watch the NPs "go long" complete the hail Mary and then spike the football in the endzone. All of this while we PAs watch from the bench, on the sidelines with our helmets in our hands.
  4. A word to the wise. I was evidently kicked out of the AAPA for voicing my concerns about the AAPA with regard to their failure on the VA Full Practice Authority issue. When I tried to log in to Huddle this afternoon I was notified that "your account has been disabled." Good riddance, they were a waste of dues money anyway if they are so sensitive as to get their collective feelings hurt that easily and ban me rather than engage in open discussion and debate. If the AAPA were to go after the NP lobby as aggressively as their own members then they might actually get something done and win one of these battles instead of lose every time as if that was the intent.
  5. A word to the wise. I was evidently kicked out of the AAPA for voicing my concerns about the AAPA with regard to their failure on the VA Full Practice Authority issue. When I tried to log in to Huddle this afternoon I was notified that "your account has been disabled." Good riddance, they were a waste of dues money anyway if they are so sensitive as to get their collective feelings hurt that easily and ban me rather than engage in open discussion and debate. If the AAPA were to go after the NP lobby as aggressively as their own members then they might actually get something done and win one of these battles instead of lose every time as if that was the intent.
  6. A word to the wise. I was evidently kicked out of the AAPA for voicing my concerns about the AAPA with regard to their failure on the VA Full Practice Authority issue. When I tried to log in to Huddle this afternoon I was notified that "your account has been disabled." Good riddance, they were a waste of dues money anyway if they are so sensitive as to get their collective feelings hurt that easily and ban me rather than engage in open discussion and debate.
  7. YES - because we are not NPs!! https://www.va.gov/opa/pressrel/pressrelease.cfm?id=2847 http://huddle.aapa.org/communities/community-home/digestviewer/viewthread?MessageKey=8cff9d0b-5143-4c55-93b7-1771ad67a764&CommunityKey=e54b07fe-0e40-4c0c-a8e4-25d744d979b5&tab=digestviewer Once again we lost. At this point we are like the Cleveland Browns, we field a team every year thinking "this is the year" "it's going to be different this time" and the NPs just keep beating our brains out and we lose like we were born to lose while they win for simply showing up.
  8. Turns out we don't have to worry about any of this. The NPs march forward at breakneck speed and we are stuck in the 1970s. https://www.va.gov/opa/pressrel/pressrelease.cfm?id=2847 See below posted on AAPA Huddle: Posted 3 hours ago REPLY TO DISCUSSIONOPTIONS DROPDOWN Dear Colleagues, I wanted to provide some additional information about the important development at the U.S. Department of Veterans Affairs. As we shared last night, the VA has finalized a rule that gives advanced practice registered nurses, with the exception of nurse anesthetists, full practice authority within the VA. In written comments submitted in July, AAPA strongly urged the VA to include PAs in this rule. We believe that PAs should be on equal footing with our nurse colleagues and will continue to work to achieve parity with other practitioners in the VA. The Federal Register noted, “Several commenters stated that VA should include physician assistants (PA) in the final rule and grant them full practice authority as well. Other commenters were opposed to the granting of full practice authority to PAs. We similarly received comments requesting that we include pharmacist practitioners in the rule. The granting of full practice authority to PAs and pharmacist practitioners was not addressed in the proposed rule and granting such authority in this final rule is beyond the scope of the proposed rule. VA would only be able to address the granting of full practice authority to PAs and pharmacist assistants in a future rulemaking.” AAPA will continue to push for a rule giving PAs full practice authority in the VA. Decisions like this dramatically demonstrate why AAPA’s Joint Task Force on the Future of PA Practice Authority has been working so hard on this issue and why it is soliciting feedback from you. We continue to hear stories from PAs about jobs going to NPs because they have full practice authority and PAs do not. If PAs are to remain competitive, the profession must pursue that authority. Please visit AAPA’s News Centerto read about the efforts of the Joint Task Force on PA Practice Authority, and send your comments to fparfeedback@aapa.org. Thank you, ------------------------------ Josanne K. Pagel, MPAS, PA-C, Karuna®RMT, DFAAPA President and Chair, Board of Directors, AAPA Executive Director Cleveland Clinic North Ridgeville OH Here's the link: http://huddle.aapa.org/communities/community-home/digestviewer/viewthread?MessageKey=8cff9d0b-5143-4c55-93b7-1771ad67a764&CommunityKey=e54b07fe-0e40-4c0c-a8e4-25d744d979b5&tab=digestviewer
  9. The AAPA was "supposed" to have gotten PAs included in the original language. Obviously they failed at that. It would have been 100x easier if they had done so but now the AAPA will have to start from ground zero and start the process for the very beginning for PAs. If the AAPA couldn't get PAs added to the language of this rule then how on earth will they be able to get an entire separate rule enacted for PAs? I'll be shocked if in a year from now they have gotten PAs included. In fact, I'll bet that I could enroll in NP school and graduate quicker than the AAPA gets this fixed.
  10. New grad is a different story, but with 1 year + experience in IM or FP (as a practice owner) if you can't see 20+ patients a day then I don't need you as an employee. If we assume a salary of $100k then it takes an average volume of 12-14 patients per day simply to cover your salary, work comp ins., payroll taxes, malpractice ins, etc (this doesn't include your share of the building/facility expense, nursing expenses, supplies, or billing costs which are generally 6-8% of gross receivables). At 20 patients a day you are making roughly $30-$40k profit for the practice a year. You are making much more off of your labor than anyone else. If you begrudge that profit then I would encourage you to break free of the bonds of employment and start your own practice. This is not meant to sound or be antagonistic, but rather just simply the facts. The only reason anyone will ever hire you as a cashier at Walmart, a PA, an MD or the CEO of Walmart is with the tacit expectation that you will generate more revenue than than you consume (not just in salary but ancillary expenses as well and in the PA world that total number is $250-$300k per year including your salary). I know these numbers intimately because I write the checks every month and have analyzed the numbers to the moon and back looking for cost savings. Addendum: The above applies only to a small private internal medicine practice that sees mostly commercial patients in a rural setting. I have no idea how these numbers might apply to urban, hospital, specialty or large multi-specialty groups.
  11. I couldn't disagree more with the above statement. I opened my own practice 5 years ago and fought with all of my might to get it going and keep it going for the first two years. When we finally turned the corner at the 2 year mark we have thrived and have not looked back. At the 3 year mark I hired my best friend from PA school and we grew even more. About a year later we opened a second location and hired a third PA, now that location is starting to thrive as well. In Feb I purchased a new 6,000 square foot facility, new ultrasound machine, new x-ray machine, started a new CLIA lab ($350,000 worth of lab equipment and analyzers) and am getting read to hire our 4th and 5th PA. Small practices are dying because not many docs have the business acumen to make it work or are lured away by the cash that hospitals wave in front of them. The CEO of one of the big hospital systems came by to meet with me as well and offered to buy me out too. I never let him finish his thought before I shut him down and I wasn't interested before he could ever get the dollar amount. I'm not saying it's easy, you have to have a knack for business as well as medicine and be willing to take on a crushing amount of responsibility secondary to both, but it can be done and you can be successful. Just know that IT WILL BE HARD, but it can be very rewarding!!
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