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Lightspeed

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Everything posted by Lightspeed

  1. Just gotta keep pushing forward! Things have changed considerably since I considered PA years ago. I get the sense that there won’t be much enthusiasm in the future for leaders that don’t have an appropriate vision for the profession, which is awesome for you guys. Back then the AAPA was run almost exclusively by boot lickers who couldn’t or wouldn’t imagine a future without a subservient relationship with physicians. You don’t need that relationship to function, and function well.You can run questions by a colleague without paperwork enforcing a formal relationship to do so. Plenty of employers also have collaboration baked into the work environment. I don’t think it’s helpful for PAs to keep the victim mindset regarding NPs. When I see it, I cringe at the implications of tearing down the people that are leading the way. It creeps into the conversation in almost every thread. Someone says “we are better trained, why are we being excluded?” Well, it’s because you didn’t show up, didn’t ask for the depth of practice rights, or weren’t allowed to do so because of existing barriers that you’ve never worked to remove. Then there are those who think they benefit more from the warm embrace of your overlords. A lot of those folks are your PAs in surgery and specialties, who only know a world where they aren’t the main event, and can’t imagine anything else. I think a past AAPA leadership member was on here quite a bit years ago trying to make the case for the status quo, and he was one of those folks who always had worked in a closely aligned specialty, and it made him feel he had clout within the physician community. There’s no clout with them. The most experienced, best educated PA will always take a distant second place behind any physician.
  2. In that specific circumstance with restraints, there would be two professions allowed to handle the sign off on restraints, and neither of them would be dependent providers because elsewhere in the bill, NPs would be given status as independent providers. That explanation came in the sentence immediately following what you quoted. It could be a big conspiracy by the nursing lobby to specifically exclude PAs, but I think the more likely scenario is that the nursing lobby simply didn’t take steps to include PAs. Dragging PAs along with their efforts would 1) Expend political capital for individuals who are not contributing to the effort, 2) introduce more complication into the nursing lobby’s goals, and 3) might not even be welcome for the folks who for years have insisted that being protectorates of physicians is more comforting. Imagine that nurses selflessly pushed for inclusion of PAs into the restraint language..... what do they do about all of the other statutes that are in place that deal with restrictions on PAs? They don’t have time to worry about PAs other baggage, they are busy clearing out their own so they can advance. But everyone here gets upset and sees this through the lens of a zero sum game. But it’s not. NPs included language in the bill to further reinforce the nature of the independent practice environment that they are trying to provide for the people they represent. Nothing says MAPA can’t come along and do stuff in their own....NOTHING. I said before that if PAs are getting upset at the little pieces of this bill that keep them exactly where they are while NPs advance, they are missing the ENTIRE POINT of what nurses would get out of this kind of effort. It’s not at all about who gets to do restraints. What this is about is nurses including all the ingredients that go into making an INDEPENDENT provider. I didn’t see a whole lot about including things that knock PAs back, but I’ve seen a lot of what moves nurses forward. And following that, I saw responses on here that demonstrate that PAs are upset that NPs didn’t throw you guys a bone. Well, it’s complicated to help someone that doesn’t want to help themselves. Or worse, it’s hard to help someone that is just as likely to screw up what you are working hard to accomplish. As I said before... if NPs tried to help you guys and include favorable language into their projects, it could scuttle their efforts because you guys are joined at the hip to physicians. Why go down with your ship, guys? Unless you guys want independent practice, you aren’t even speaking the same language as NPs, and they can’t use you in their efforts. There are certainly folks here that “get it”, but they are rowing the canoe in a different direction than many of their peers who are caught up on minutiae.
  3. Sigh.... I’ll use this awesome new link provided by one of the leaders of MAPA: https://journals.lww.com/jaapa/Fulltext/2019/09000/Are_PAs_and_NPs_interchangeable_.2.aspx And again, when direct entry NP programs are much more common than they are, you’ll have more license to use that. As it stands, they actually seem to turn out a pretty good product from what I’ve seen. And similar to Lexapro, I’ve seen some interesting cases of PAs with non pertinent previous experience who did a psyche rotation and then eventually applied to pretty intense psych positions due to market saturation in jobs that they were better suited towards. In essence, these PAs felt they needed a job, and only saw psyche jobs, so they threw their hat in the ring out of desperation. Psyche often requires a specific fit, so they were passed over of course. Getting all of your psyche in one or (maybe) two rotations over a few weeks (or even no specific psyche rotations like I’ve seen in some curriculum) doesn’t quite cut it. However, I’ve seen one job candidate that was a PA that I would have hired on the spot because they had prior psyche tech experience, a psychology undergrad degree, and did a few elective psyche rotations extra beyond the one psyche rotation their program actually required. They also knew how to deal with patients in crisis and had exposure to such patients.
  4. Sweet... evidence that PAs aren’t light years ahead of NPs. Guess we can quit arguing about that. The reason PAs were relegated to 2nd class status in that bill was simply because NPs were seeking to be liberated to be independent providers. With that fact came the exclusion of PAs in the case of restraints because the process would be supervised by either physicians, or else NPs (who would have had independent licenses). It’s just part of the state by state legislative push to become independent. That’s why this freak out seen here is so instructive..... if you guys aren’t ready to push for independence, then get out of the way, because NPs are. By not seeking practice freedom (in full) all you folks are doing is pulling us back down with you guys. My encouragement to you all is to get with it and be aggressive rather than playing spoiler for those who have the guts to push for real independence, not cosmetic changes. Look around on this thread. Who here among the PA set is actually stepping up and saying “the solution is to have PAs become fully independent.” But yet that’s the solution, rather than scrambling around plugging holes in the dike. You all wonder why NPs don’t include you... it’s because you have nothing to offer our movement. Your weakness in self advocacy is actually detrimental to ours because you lack vision. You’d poison our initiative. You have a mindset of scrambling for table scraps. NPs won’t get all of what they want in Massachusetts, I’m sure if it. But it should be instructive to you guys by highlighting that there is a push in every state to have NPs move towards independence. It’s just a given. Now that full independence was extended in all the states that were low hanging fruit, NPs are starting to settle for allowing independence after a period of supervision (that bill actually called for NPs to be allowed to be the ones who supervise instead of just physicians.... which is a key feature that says “we don’t want to need docs for even that requirement”). It’s sad because not only do NPs have to do battle with the haters among the physicians, they then have to deal with Mr. Magoo state PA organizations who come along and interfere with our progress while they flail around aimlessly.
  5. I think that every time PAs are taking up the argument that they are better trained, which is usually where things always go, they look cynical. Instead of going into a defensive mode every time they are put into this situation, they should go on the offensive for once and take a positive tone to their approach. Your profession is reactive and negative rather than proactive and positive. It kills you guys every time. The NPs didn’t so much as do anything to bring you guys down in that bill, they just didn’t include you in their expansion. The PA profession was a NON ENTITY in the whole process. Again... it’s probably all for naught because there’s no way anything that large is passed by the legislators. That destroys their power, so they will break it up into 179 separate pieces of legislation. The stark omen of it all, though, is the complete disregard displayed to PAs. And yeah, everyone is all distraught about the restraints issue. I’d be more distraught that there wasn’t similar language in the bill advocating for PA independence like there was doing it for NPs. But most of you will see it as something where NPs need to be stopped so they don’t get an advantage, rather than trying to SIMPLY PIGGYBACK ON THE BACK OF WHAT NPs WANT TO DO. The PAs there will position themselves as if they are crabs in a pot pulling the NP crabs back in with them. Or you all will revert to complaining about how you guys have better skills and merits to be advancing too. Sorry, but by now you all should know that’s not how you advance... it just makes you feel better while you take your place as the sidekicks yo physicians.
  6. When autocorrect becomes fully aware, it will be more powerful than the Terminator. No, I'm with you on how concerning it is on its surface. I don't even know if the blame can entirely be left at the door of the state chapter. So this kind of bill from a governor hits the legislature and gets butchered (or completely ignored). Panic isn't warranted at this point. I think its fair to say that it highlights what lobbying groups stand out to me as starting from a position of strength. In the cursory glance that I gave the legislation, I didn't see where physicians fit in, so keep in mind that they will get their due. There was a lot of industry mandate, and expect those folks to weigh in and want changes. A bill this big is very unwieldy, and that's a weakness because it makes it easy for a legislature to discover things in it for everyone to hate, which will doom it to failure. I've honestly never personally seen anything this large. The sky is far from farting. Carry on with your daily life as if everything will be OK. As much as I'd like to think that another state will succumb to NP independence, there's too much to bite into with that monster.
  7. I’m fascinated that you responded to the fact that I listed (where I cited Bakers 73% approval rating) by suggesting his ideas aren’t politically sound. I would suggest right back that expert politicians know where their bread is buttered. It might help your PA organization to also learn how to butter bread as well, because being late to the game reveals that they were never taking the time to do the proper advocacy so that this wasn’t a surprise action. In the furniture, the best course of action might include: -Not resting on the laurels of physicians. In this case, they might rally to the cause of tearing down NPs by getting key portions amended out, but their advocacy will be for their interests, not for enhancing yours. -Not being so invisible to policy makers. -Not taking an adversarial tone in press releases. Hire a PR firm. I’m serious. That organization was such a non entity that they were completely ignored from the start... nobody thought to include them. Do they now think that snarky criticism will do anything else to compel their inclusion? At best, the powers that be might call the nurses to see if they know anything regarding what you are talking about.
  8. The letter sounds highly critical of the most popular governor in the US, who pulls in a 73% approval rating in a state dominated by his opposition party. The MAPA couldn’t even put together a press release with a non adversarial approach. That’s not how you are going to get an invite to the conversation. It was a big mopey mess. Those places where PAs are the preferred providers are areas where I would expect them to be the preferred providers, because the physicians are the main event, and their skills are paramount. An APP doesn’t need to have an independent license, because they aren’t going to be running the surgery, or performing the invasive radiological procedures, etc. Physicians there need an assistant. It’s not necessarily a weakness, but I’m not sure it’s a strength. The bill is 179 pages, and everyone else showed up to get their portions included in it. Having PA groups not being aware of it being compiled is akin to missing the effort to get an elephant into a house unseen, and yet they managed to be caught by surprise. The bill, along with its portions containing the NP and other profession specific areas of interest, was not written by legislators or their staff. Consider the ramifications of that statement.
  9. Holy cow! If I’m reading that bill correctly, it grants independent practice rights to NPs and CRNAs, albeit after a supervisory period of two years..... or else after appropriate professional experience in another realm (registered nursing maybe?). The supervisory experience that is required is a period of two years, and can be performed under the supervision of an experienced nurse practitioner, CRNA, or even a physician if need be. So I have to admit, I had a hard time finding places that made mention of physician assistants. Could be that they are hidden somewhere within that 179 page monster bill. Still trying to figure out how to access the search function on my device. Whelp.... gotta hand it to my sistas in the nursing mafia... they get stuff done. When you guys go to complain about this bill, I’m afraid you’ll have to get in line behind all the RNs who are already there delivering cookies and checks to the legislators to get this passed. You all are going to argue with them about ordering restraints while NPs become independent in one more state.
  10. Nobody really brought up ethics until you first did, so I’m not sure the deep dive into the well of philosophy gets to the essence of what the OP is asking, nor what most of the comments address. Ethics exist in regard to right and wrong. If you don’t see a violation of the law as an ethical lapse, then so be it, but the practical argument really comes down to how this would play out in the regulatory environment as it currently exists. Yeah, change the law, and all of a sudden what was once illegal (and arguably unethical by extension) instantly becomes legal, and arguably ethical. The physicians that are haters will whine that it could still be “unethical” to offer “substandard care” by practicing independent of them because that’s usually the track they run on when they attack anyone who is not a physician. You guys often suggest this when you rail on NPs, too. Its not up to individuals in your profession (or mine) to decide on an individual basis to disregard the standards of the profession on your own accord, and be insulated from the consequences. We are usually biased in our own favor, and often overestimate our abilities, so that’s one good reason to pursue a legal remedy. And yes, in practical terms, it’s a nightmare scenario in regards to legality, insurability, transparency, licensure, oversight. It is also a selfish act that puts you in violation of regulations you agreed to in order to provide you with personal benefit. Like SAS said, your jury won’t be of your peers, it will be a group of people that are far from disinterested parties. They will base their decision about your fate upon how closely you aligned your practice to the standards you agreed to practice under.
  11. In your situation, you only need to get in touch with how you feel about it. It’s up to you what it means to function optimally, and whether or not you want that. If I were in your position, I’d try my best to get to the core of why I am for or against taking the medication. Try to get past any stigma that has influenced you, even what you might have felt subconsciously or indirectly. It wouldn’t hurt to consider how you think other people are affected by your condition. But at the core, it really comes down to how you want to feel and perform in any given day. Id suggest that if ADHD meds make your life better, take note and act on it. If it makes you feel worse, take not and act on that. If it does nothing, take note as well, and act in that. I spend quite a bit of time as a psyche NP trying to break through stigma that my patients have incorporated into their beliefs... all with the intention that they be equipped to feel better about their lives. Even though I’d love for them all to function better, the real goal is to find a solution that they can live with. I’m convinced that in most cases, what a patient wants, and what works best for functioning in the world we live in, can be obtainable. If there isn’t perfect congruence, then I still feel like the patient is best served by helping them decide which area (feeling better or functioning better) that they would like to compromise a bit on. Most will compromise a bit of both, or often will choose better function over optimal happiness. The only point I want to press is that you should do what is best for you. One thing to incorporate into your decision is how the consequences of your decision will affect your happiness as well... ie, if you aren’t working up to par at work when you aren’t on the medication. It won’t feel good to be censured if you aren’t practicing up to a high standard because you are distracted. So feeling good can mean different things to different people.
  12. Statute doesn’t change just by willing yourself to practice according to your own training and not someone else’s, no matter how anyone feels about it. Multiple entities might care about that arrangement under the right circumstances... insurance companies, commercial loan originators, malpractice lawyers....even in the absence of state regulations to the contrary. I’d suggest that at the point where you have to consult a physician outside of their scope of specialty, it’s actually ethics that dictate whether you remain on or off course.
  13. At first I felt like shadowing was potentially reasonable and benign vs them seeing you in action. But I loved the mention above regarding the potential liability of simply being out in their work environment and risking something happening that makes the practice liable for your safety. Even the disclosure of confidential information potentially complicates the circumstances for you. If a patient revealed something that implicated someone else in a crime, you’d be a witness to that revelation. If a patient made an accusation or filed a lawsuit based on anything they perceived, then you are a party to it. I was going to shadow an autopsy a long time ago, and opted out when I came to the realization that I could have future plans affected due to a summons, even years later, just for being in the room. As part of a job, that’s fine... that possibility is inherent to the role. For an interview....nope. And that can be your way out of you feel the job market is just too tight to stand up to them on other grounds. The answer is “as much as I’d like to, I just feel like it opens you guys up to liability, and it opens me up to having to get in on confidential patient information that I’m not officially sanctioned to be privy to”.
  14. Yep. And an interview or two with the admin and other providers should solve the mystery as to whether you interact well with others, without the pettiness of participating in that entire exercise... new grad or not. To have to go out and demonstrate anything to them in action is humiliating for a provider. Even as an RN, I’d have shown myself out. I’m embarrassed for any NP or PA forced to do that. How do you think a physician (even fresh out of residency) would feel if they made that a condition of the hiring process? They’d keep looking, because it would reflect bad on the practice. But a practice would never do that to a physician. The temptation for me would be to go in, perform their test, have them realize I’m a great fit for the job and make me an offer, and then turn them down after letting them know that they failed my test for them regarding treating me as a potential valued employee. No... if they want me to practice treating a patient, I’ll want them to practice paying me and dealing with me appropriately. The moment that an organization asks me to do that instead of figuring things out through their interview process, they’ve failed my test for them. That’s the point where you politely thank them for their time and decline to waste any more of it.
  15. You aren’t trained on their EMR system, so you probably won’t need to be do anything other than interact, assess, plan, and communicate that to the provider that’s going to be with you in the room. It’s most likely they want to make sure you aren’t a weirdo with their patients, and get a glimpse at your skills. I’d pass. It’s offensive to me that anyone would “test me”, and I’d decline and move on....if I even gave them any further conversation at all. I’d be fine telling them how I feel about that too. That’s even as a new grad.
  16. A good rule of thumb that I was given when I first got out of school and was choosing among different jobs.... call contract (if possible) should be negotiated separately. Understandably, in your case there are so many moving parts to what is happening around you that it’s different than a new hire negotiating. In my case, the employer requesting me to do call had already compartmentalized the different aspects of the offers (there was a component of call, inpatient, and clinic work... all presented and negotiated separately). So that’s how it should be done if possible. This was a while ago, but my recollection was the clinic was salary, the inpatient was hourly, and the call was a hybrid of some fraction of the hourly wage of the inpatient portion, and then paid through the 48 hour weekend. Telephone only, but I’d have to come in to sign any paperwork generated from orders like restraints (which require prompt observation if still in place, or else physically signed orders within a certain period of time regardless). Weekday call was the same formula, but less hours because it just covered through the night. Not counting incidental coverage of a provider who could have me cover a vacation or illness (which would be rare due to them planning ahead or working call through their illness), just my scheduled call time alone would come to over $20,000. It might seem high to some considering call is often foisted upon people without much additional wage increase, if at all. To me it was a bit low considering the time commitment and the comparison to the overall wage package the physicians were certainly generating for themselves. But had I taken it, I wouldn’t have looked that gift horse in the mouth. Having it laid out all separately like that was helpful to me, even though it was all part of one job offer. I didn’t get the sense that much of the individual parts were very negotiable... they seemed very satisfied with their offer. I imagine that it gives an employer more control and opacity to try to lump everything together, but these folks didn’t seem to care. It could have been that it was legally required to do so I guess, but we didn’t talk about why it was this way for them. I took a job that didn’t ask for call and paid less. Call sucks. It wasn’t the only part of the job offer that I didn’t love, but it was perhaps the biggest.
  17. Maybe not urgent care so much, but getting reimbursed.....
  18. Well, that’s the thing... I felt really self conscious at the time about asking a PA that was trying to help me with my clinical rotations to be hassled with my school’s requirement. I didn’t really know much about why they needed it to be that way, either. I backed out of what could have been a great rotation.
  19. Could be bias. My program didn’t seem to care, we just had to include the physician in the agreement and petition for permission if we wanted to precept with PAs. I’m not even sure now if it was a insurance issue or I misinterpreted and it was simply a requirement with the preceptor contract as a way to ensure the SP was in the loop and informed of what was going on with the PA. All my PD said was it was a requirement for the “contract”, so I assumed it was for the insurance, but that was only part of the whole process. Having not precepted anyone myself, I’m still ill informed.
  20. 48/72 is probably the best bet for a firefighter schedule with a side gig.
  21. Ok. So... side hustle..... You asked about non clinical, but I’ll first touch upon a semi non clinical one... Botox! You could look to nursing for inspiration. Nursing is like the ultimate job to offer modest income and benefits support to a side hustle due to scheduling flexibility. A part timer can qualify for benefits, and part time is two shifts per week. If you work Sunday and Monday, or Friday and Saturday, that can leave a lot of time to do the other job that doesn’t have as steady of an outlook, but can still be lucrative. I know a nurse contradiction contractor, nurse farmers, nurse realtors, nurse home builders, a nurse home inspector, a nurse gunsmith, nurse personal trainers/fitness fiends, a nurse tattoo artist, a nurse outdoor guide... lots of different side gigs. What gets interesting is when nursing becomes the side gig after the side gig gets lucrative. Sometimes you get to see folks shed nursing to concentrate fully on the non nursing gig. Or return to nursing when the side gig falls through. I think most of us providers would have a little harder time thinking outside the box and stepping away from the security that is offered to us by our clinical work. There’s just enough money to keep temptation at bay, and stifle our courage. Nurses have less of that because they make less. But for me, a side gig would have to have a really good payout to justify integrating it into my life at the expense of more hours working psyche shifts. The folks who seem to really be into side gigs are the firefighters. Most of them seem invested in the trades. I known a lot of trades guys who did trades until firefighting panned out, so maybe being a tradesman is a feeder career.
  22. True. To their detriment. Mine allowed it. I would have trained with a PA in a heartbeat, and had one lined up that was kind enough to be willing to come through for me when I needed it. The way I had it explained to me why PAs were a bit more complicated had to do with what my program director said was the student malpractice insurance. So according to the PD, the SP needed to be involved for the contract to be valid, because the legal “buck” would stop with the docs? So I could have trained with the PA, but it would have needed to be signed off on by the physician. I was able to sail past those complications by training under physicians, and NPs. I didn’t pay much attention to the nuts and bolts of that process.
  23. Precept... maybe take some NP students under your wing and show them how it’s done like a PA would do it! That might be a hill to high to climb, so maybe just stick with your youngling PAs. Nobody would hold it against you if you wanted to keep the wealth in the family.
  24. No worries. In most places, that’s exceedingly rare, simply because of lack of beds. But I’ve seen it happen as well with severe cases... the kind of cases where ‘swain shouldn’t be complaining about the “patients not getting better”. Of course they wouldn’t tend to be getting better... they would be the extreme high acuity of the sort that would allow them to jump to the head of the line. He was fumbling to get some kind of dig in by suggesting I’m a poor medical provider I guess, but it fell flat. To be honest, I have no idea how he expects that to be a burn. When you are dealing with the sickest of the sick that get sent through the system in quick fashion, they will tend to be the ones that are most difficult to fix. So he’s either ignorant of what those patients are up against, or else he really doesn’t send many people directly to his state hospital. Most of the time, ERs find it more reasonable to admit patients to an inpatient medical unit hospital bed, or to an in house mental health unit, or third party behavioral health unit, or forensic unit until a state hospital slot can open up. But the real indictment of ‘Swain is simply his ignorance of the human condition. If it was easy to treat psychiatric conditions he’d be doing it.
  25. Good advice. That doesn't seem to come up very much on here when having the burnout conversation. Everyone seems resigned to a fate of roaming among the urgent care's and ER fast track's of the nation. All the folks here have a generalist degree... take advantage of it. Most people dream of that kind of career latitude. I've met physicians that certainly do. Another good solution is to find something outside of work that you really enjoy... that you can't get enough of. Something that isn't simply tied to the joy of paying bills. Think big, and find something totally optional. Having that in your life makes it much more appealing to keep showing up to a job that seems monotonous. I'd use my money on that rather than take a pay cut, because you might not find the new job is all that interesting once you are back into a new routine.
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