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  1. Let me provide a short background story for anyone who isn’t familiar with the recent happenings in Florida: There was legislation was pending, allowing independent practice in primary care for PAs and NPs in Florida under specific rules. To pass legislation, differences in the House and Senate bills have to be reconciled. The simplest thing to do would be to include PAs in the house bill and boom; there would be independent practice for both groups. The Senate bill made the provisions for PAs and NPs, yet when the companion bill was released in the house, it only mentioned NPs. Instead, the bills were reconciled by dropping PAs from the legislation. This happened despite a fantastic effort by FAPA (Florida Academy of PAs), its leadership, and PAs from all over the country.Why did this happen, and what should we do now? I believe we just saw, in its purest form, the political will of NPs. When there were discrepancies that needed to be reconciled in the two bills, they simply did what was best for them, and worked to have everyone but themselves removed from the legislation. Why would they put their agenda at risk to try to include another group? How would that benefit them? Simply put, it wouldn’t. So they did what was best for them. Many people will want to be angry about this and, while I am frustrated we weren’t able to make things go in our favor, we need not be angry with the NPs but, learn from them. They have, for over 20 years, demonstrated a dogged determination, general disregard for the opinions of other stakeholders, and a will to make their profession successful and that deserves respect. So let us stop carrying on about what they are doing and learn from it. What Do We Do Now? I believe there are a few big things we need to do to get our heads screwed on straight, face-forward, and get back to work. 1. We MUST purge our professional DNA of the urge to please and the fear of making any other group unhappy. It seems to be collectively hard-baked into us to worry about what the physicians think. Let me tell you what they think (at the organizational and political level). They believe we are inferior and undeserving of respect. They think we need to be controlled and closely monitored by physicians. They think if we slip our chains, it will cost them money, power, and control. They think they must keep us in our place. 2. Understand what the NPs are doing and how they are doing it. I don’t think they are our political enemies. I also don’t think they are our friends. They have been killing it legislatively for years. There is zero profit for them in adopting us to help with their causes. We are so far behind them; we would only be a liability if they decided to make us part of their efforts. They have left us in the dust, and they know it. Will there be chances to work together for our mutual benefit? Without a doubt. However, recent happenings in Florida should give all of us a clear view of what happens if we are perceived as dead weight. It is every man and woman for themselves. 3. We need to promote ourselves aggressively and unashamedly without the first care what any other group thinks about our self-promotion. My father used to say, “If you don’t blow your own horn, it doesn’t get blowed (sic),” and he was right. 4. We need to look people in the eye and tell them how amazing we are. We need to say, “we want to help…to do more…and you are stopping us. Why?” Then we don’t settle for pat answers. 5. We should demand to know why they want to keep us from being and doing our best. We need to demand data and proof when people say foolish things like “ people are going to die .” or “ you order too many tests because you don’t know what you are doing .” Physician groups, in particular, love bumper sticker answers that are not answers at all. The current favorite is “they don’t know what we know,” which makes me grind my teeth every single time I hear it. When this happens the speaker needs to be called out and this little bit of pithy sophistry needs to be exposed for what it is…nonsense. In short, we need to learn to look after OUR profession first and without excuse or apology. We have too much to offer and have too many amazing people in this profession to ever put our heads down or be so reluctant to trumpet our capabilities and accomplishments. We are amazing.
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