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LT_Oneal_PAC

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LT_Oneal_PAC last won the day on March 10

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About LT_Oneal_PAC

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    Physician Associate

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  1. My solo coverage sites have taken a hit, but percentage wise doesn’t seem to be nearly as much as big centers. The local level one has been a ghost town. My census dropped from 8-12 to about 5-8. Same stupid coming in for the same stupid stuff again and again. Can’t take a hint.
  2. Lets get the thread back on the subject of an anesthesia residency. I don’t want it turn into a RN prerequisite discussion. Some schools have tough requirements and some don’t and a lot of it isn’t needed for clinical medicine. to bring the thread back, I will say an understanding of some physic concepts are essential, but you can teach all one needs to know about physics related to the machine and physiology pretty quickly.
  3. I was surprised to hear this since my old program was about 75 hours. It look to me that some school are not including the clinics credit hours in their calculations, which is definitely the case for case western when I looked. My old program is now a DNP program and requires >100 credit hours. Random google search shows many programs >80 hours. correct. Very few RN programs require higher level science, though many if not most CRNA programs do. oh I don’t think it would be a bad idea. I think it would be a very good idea. I just think you’re going to run into some of the same road blocks. Don’t misunderstand my lack of optimism And concerns for opposition. I can’t remember which states specifically bar it, but this article notes eleven that do not allow for sedation or general anesthesia. It is slightly outdated as we having prescribing rights in Florida and Kentucky now. Maybe it has changed slightly, but doubt all eleven have significantly changed. I remember recently in Washington an expansion of scope bill was shot down by CRNAs because it MIGHT let us do anesthesia. They will make an argument that they are already filling that void and that there isn’t a need for more providers where anesthesiologists already practice. https://pubmed.ncbi.nlm.nih.gov/25453855/ I agree, with the backing of specialty groups it would be easier to remove these regulations rather than introduce a new profession. A similar but was tried in Texas, labeling AAs as PAs in legislation. It was blocked however as we were afraid that restrictions placed on AAs, limiting them to practice with physician in house would ultimately be applied to us. They, in Texas, didn’t want to get in the middle of a turf war that may come back to bite us. @sas5814 probably remember me this better than me. So some assurances would have to be made that rural providers wouldn’t be affected by stringent supervisory requirements. like I said, I’m all for it if implemented correctly. Would be happy to help overcome barriers, which I just want to highlight at this juncture.
  4. You aren’t looking at the right places if you think CRNA coursework is half of AA. I’ve been in it, and it is one of the toughest programs around. The problem with getting AAs implemented in a state is because there isn’t a shortage where AAs can practice. It’s true. Currently an AA can only practice with an anesthesiologist in the building and the shortages are primarily where there are not anesthesiologists. This is why many rural hospitals only have CRNAs because either a) it’s hard to attract an anesthesiologist to a rural area b) the volume might be too low to support a market competitive salary. So if you can’t attract an anesthesiologist, then you can’t hire an AA. Which if this residency doesn’t allow for more remote work, then it’ll run into the same problems.
  5. I believe I’ve answered your same question on reddit. as possibly the only person who has attended nurse anesthesia (that I left because I didn’t want to only do anesthesia any more) and a PA program, I think I can provide a lot of insight on this. first, absolutely you could take a PA straight out of school and put them in a 18 month program to create a good anesthesia clinician. I think this would make a pretty awesome clinician. i think there would be great interest. I would certainly be interested, so I could do the OR and ER at my CAH, both very low volume and hard to attract good clinicians. I mean, this would be way better than going back to school and spend even more tuition money, instead getting paid a stipend. I mean, who wouldn’t be interested. there are many problems to this. First, many states specifically prohibit PAs from performing anesthesia. This would have to be overturned and CRNAs would fight tooth and nail. You probably would have AAs fighting this too. I also worry about the intention behind this. Could you explain the reasoning? Is this a way to undermine CRNAs and have an “assistant” that you aren’t competing with? Would you allow these anesthesia trained PAs to work at CAH that don’t have anesthesiologists? Otherwise we won’t be able to compete with CRNAs and admin won’t hire us. I’m fine with competing against CRNAs, I’m not okay with being a political tool. lastly, you probably know this, you’re going to find a lot of physician pushback. Anesthesiologists in particular feel pretty burnt on CRNAs. I think you would find it difficult to have them on board
  6. I see your point, but most selfish medical decisions do not have an impact on others. Same reason we don’t let people smoke in the hospital. It would be more analogous to say that you can make the decision to not vaccinate, but you will be quarantined from society. I don’t deride these people in my practice, but similar to how I tell parents their smoking is going to affect their child, I tell anti-vaxxers they could cause harm to someone else. Outside of my practice, yes, I do think shaming is okay. Would you not shame a smoker who lights up on the ward?
  7. Vaccines are equally for the public good as well as the individual patient. So they can not make their decision in a vacuum. If they don’t have contraindications to the vaccines, like many people do with compromised immune systems or allergies, then their risk is determined to be lesser than the risk of them infecting a person who can’t be vaccinated. So one thing is for certain, if you don’t vaccinate and you medically can, you’re selfish or not medically literate. What do you tell people when explaining they shouldn’t vaccinate?
  8. I imagine they will still release the results of the report. Nobody there wants this things to sit for another year.
  9. So you are saying podiatric medical school is medical school? If we are going to use that logic, then all the PAs who get their DMS from LMU DCOM are able to use the title Doctor? PA students who go to Iowa COM go to medical school? I’m not saying they don’t, I just want to see if you apply the logic consistently. Just something always has been doesn’t mean it always needs to be. Physician assistant was original meant to be an assistant to the physician. Now it doesn’t. A barber use to be a surgeon. “This is the way we have always done it,” if you allow it, can also be used against improving our scope, so I would be hesitant to use it. it would be very wrong and probably illegal depending on the state to say you are Dr. x and not clarify your title. Never seen this. I’ve been working with APCs for 13 years in multiple states, specialties, and settings. Not once. What is acceptable in my opinion is “I’m Dr. x, the family nurse practitioner” or “Dr. x, the EM PA.” I won’t introduce myself as a doctor because I was raised by parent-physicians who said it’s pretentious for anyone to use it, but I’m not going to go down the slippery slope of regulating things like this on other people. I have never seen a nurse say their education is equivalent to a physician either, not one that wasn’t a nut job and there are those in every profession. I have seen them say their outcomes are the same, which the evidence does agree with this. i don’t mean to suggest you hate them. I use the colloquial term “hating on” meaning to deride.
  10. Money. Power. NCCPA has been backhanded in the past. They have even have been against PA improving legislation because it didn’t include mandatory certification. Stopped one state from moving forward on progress I agree that I would rather it be in the hands of SEMPA or a new board (since Sempa is an advocacy organization like the difference between ACEP and ABEM) that would be created by SEMPA. Though we saw the cluster that happened when a physician tried to make the PA derm board.
  11. We’ll have to disagree on this. what language are they playing with? They are a doctor, but not a physician. I’m defending not NPs, but everyone to have their education recognized. Why do physicians get to put a restriction on an educational title they did not create, but not have to change anything about what they do? Why can’t they just say “everyone, including us, must introduce themselves by their license.” Should all FM docs state their residency training in the ED or doing OB? Should podiatrists not use doctor in the OR or clinic? What about psychologists? Optometrists? The point is it would be a lot simpler and clearer to patients if we all were mandated to use our professional title and apply that across the board. That “kid” is a pre-PA and needs an update on the realities of PA “supervision”. He is neither correct, nor doing us favors telling people we are all supervised, which implies we need hand holding to the lay person. He can advocate once he is in and has an actual understanding of the reality that goes on in healthcare. As a pre-Pa, who rarely know their elbow from their ass, they should refrain from commenting in a place of ignorance, especially about other professions which comes off as “holier than thou.” It smacks of the same arrogance Med students and pre-meds have when that crap on PAs. Is that okay? You can hate on NPs all you want, but I do not find that putting down others has ever elevated me. Not that I’m perfect and never done it. Sometimes passion for PA progression can become overzealous.
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