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Reasons for apathy in profession advocacy?? Please comment!


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I am doing part of a group presentation on PA professional memberships and advocacy groups. My portion of the presentation is talking about why PAs may be apathetic about being involved in advocacy. It seems many PAs want to have more autonomy and a larger scope of practice but the number of people actually involved doing so is low. What might be your reasoning in being NOT active in this process, whether at the state or federal level? Time? Hate politics? Busy? Think that the profession is fine as is? Any thoughts are appreciated!

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ohhh boy.

 

a quick thought:

 

despite what some others here may say, for decades the AAPA has been unresponsive to its membership, and seemingly tip-toed around the AMA and its own internal definitions of who were are/ were, and what we wanted.

 

enough so that, somewhere around the late 70s/ early 80s the member ships declined and PAs in large numbers looked at the national organization as a failure of leadership.

 

No so much the state organizations.. where the individual PA felt he vote and desires were much more closely regarded and his influence would more directly help his lot. The better / more favorable PAQ states consistently had proactive and strong PA organizations..

 

the less PA friendly states had less effective organizations.

 

The arguments are circular, I know.

 

what is boils down to, at least on the state level, is strong MD backing.

 

In states where the PAs truly influenced the SPs to the point the SPs were willing to advocate for them within the state medical boards and legislatures in getting practice restrictions lifted/ modified for positive change.

 

strong MD backing comes from personal relationships with the docs, particularly with the development of a bond of trust between the md the pa.

 

It does seem that, lately, the AAPA has turned a corner, and seems to be more actively listening to the trencher PAs... whether this is due to forces like the AAFPA or the PAFT, I do not know.. but it seems that THESE groups are in the forefront of both responding to, and effecting change.

 

Membership may be a simple feedback llop: the better and more effective the organization, the easier to justify the membership.

 

the more ineffective the organization, the less the desire to support it.

 

we are an organization 45 years old.. the memebership question for me is: does the group effect change, represent me, and reflect my professional values? Or does it continue to act as if the profession is a "start up" ?

 

just some thoughts

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I agree with rcdavis and would like to add that there seems to be a lot of different opinions amongst PA's as well. I am an ED PA and have been for about 10 years and have worked with a lot of mid-levels whose job descriptions vary. How do you bring together mid-levels who are comfortable at different levels? What I mean is: I work in an acute setting and even trauma sometimes( I have a lot of autonomy) and there are PA's who state they would never work in that environment and are comfortable discussing every active case with there attending.

We are all comfortable at different levels so PA's who do not want autonomy will not get involved as they are content.

Just my thoughts

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I've been active locally with PA advocacy in the past~ these days I find that my time is a major issue when it comes to adding one more thing on my "to do" list. Any requirement for a physical presence in an advocacy groups during time off work isn't of interest to me at this time in my life. I wouldn't say I'm apathetic rather just realize my own limitations when it comes to finding a work/life balance.

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If we compare ourselves to NPs, we are terrible at advocacy. They have a lobby that is backed by "dues" that they solicit even from CNA's to bring them on the team. LPNs, RNs, CRNAs, Midwives, and NPs all dump money into the same crew of washed up nurses that badger state legislatures and get the states to open up the blatant practice of medicine under the auspices of "nursing". "Hey, they are doctors and we are now doctors why can't we do what we want? There are xx,xxx number of nursing affiliated people in your state; wouldn't you like them and their families on your side?" We are in the process of watching the primary care physician being suffocated out of a job due to medical legal and now due to the cheaper ran practices of Nurses running FP clinics. Not all nurses are game for this and most nurses I know are awesome. That said, their lobby doesn't seem to share the easy going attitude of the nurses I've worked with.

 

In the realm of advocacy, I first have to ask myself, do I want the Physician-PA relationship dissolved? The answer to that question is "no". I didn't go to PA school to shortcut my way to being equivalent to a doctor. I wanted to spend less time in school, be in no debt, practice medicine within my comfort zone, and when necessary staff patients with doctors or even other PAs who have more experience and training in what's going down to make it happen for the patient. I'm all about learning more, putting in my time off work to study and expand my skill set to be able to do more for my patients and need to consult with others less, that's the beauty of our profession. You can't go to Grad school for 2 years and be twin to a doctor. You can't go to 2 years of grad school and be twin to a 20 year Emergency Medicine PA with a Bachelor's degree just because you went through a program who added a couple non-clinical classes and a thesis paper.

 

Advanced Practice nurses want a NP or a DNP to have scope dictated by degree and they have the legislative and lobbying involvement to make that happen. This is deadly. We don't want or need that as PAs. I think the beauty of what we do is that in most cases, it is physicians and state medical boards that advocate for us. Our scope being dictated by our supervising physicians makes excellent sense. I have been an Army PA for 4 years and an Army medic for 8 years prior to that. I can run through a trauma management scenario, evaluate and manage musculoskeletal trauma/injury, perform injections, biopsies, and minor procedures like military medicine is it's own specialty. If I go into an ER and that ER physician says, "you can rock out in your lane but after your perform your History and Physical run your geriatric and pediatric patients by me" he is keeping him, me, and most importantly our patients safe. I don't want to be treated like "Scottpac" because he and I have the same degree because we don't have the same experience. I'd like to get there once out of the military but that takes time. I have worked up child and elderly trauma but I haven't seen a lethargic newborn or a 68 year old with a blood glucose of 900mg/dL since school. I don't want to be asked to "sink or swim" on day one. That's stupid. No level of degree will get you there. It takes experience and study.

 

All that is to say this; "We are apathetic because we are more diverse than nurses and doctors are", "We need to advocate for the physician-PA relationship to be dictated at the physician level based on the physician and the PAs level of comfort with specific patients" and "To limit PAs at the state level does a disservice to PAs who have spent a career in a particular field." The absence of a Physician/PA relationship will restrict PAs scope to the furthest deviation to the dumb side of the mean at each level of education weather it be Bachelors, Master's, Doctorate/Specialty Certification. The Doc/PA relationship is what got us here, why advocate to cut ties?

 

Side note, the AAPA sucks and I refuse to send them a dime until they are working at state levels to pull of prescription limitations and to put more control into the supervising physician's hands when it comes to PA scope. They are busy lobbying for social issues such as when they wanted to make it mandatory for all medical providers to Rx Plan B and assist in abortions etc... I'm not arguing the validity of the argument (and I refuse to here) but I think we can all say that there are many divisions among us with social issues and we are of one voice with opening prescriptive capabilities and removing state medical board restricted scopes. They suck. Register one time only as a student-graduate so you get included in on emails and the PA magazine etc. Then never give them another dime. IMHO :D

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Emedpa,

 

good to see you are back.

 

With the recent AMA flare-up, I was expecting to see PAFT out in front. They were no where to be found. I have since spoken with several of the board members as I think this is critical that if they wish to be an alternate voice, it needs to be out there. AAPA is reactionary. PAFT MUST be pro-active. I hope you see the concerns to which I am alluding and consider them accordingly.

 

G

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If we compare ourselves to NPs, we are terrible at advocacy. They have a lobby that is backed by "dues" that they solicit even from CNA's to bring them on the team. LPNs, RNs, CRNAs, Midwives, and NPs all dump money into the same crew of washed up nurses that badger state legislatures and get the states to open up the blatant practice of medicine under the auspices of "nursing".

 

Just wanted to make a note that this is not true. CNA has no advocacy group that I know of, and CRNA has their own advocacy group, AANA, that is separate in every way possible from ANA because they want nothing the to do with main stream nursing as they originally denied anesthesia as a nursing specialty. So they created their own group. Good thing they did because CRNAs are now the most independent APCs ever, without a dime from mainstream nursing and a fraction of the numbers.

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Emedpa,

 

good to see you are back.

 

With the recent AMA flare-up, I was expecting to see PAFT out in front. They were no where to be found. I have since spoken with several of the board members as I think this is critical that if they wish to be an alternate voice, it needs to be out there. AAPA is reactionary. PAFT MUST be pro-active. I hope you see the concerns to which I am alluding and consider them accordingly.

 

G

I was in Haiti for 2 weeks working on a school project.

PAFT did have an email writing campaign on the ama issue. we sent an email blast to the membership with links to send comments.

are you a member yet?

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Very good. I was hoping to see a letter from the president of PAFT to the AMA as well. But any advocacy is a good place to start.

 

You know my thoughts on this... just passing them along out loud,

G

 

hey, I checked out your empa guru site again. good stuff on there!

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Emedpa,

 

good to see you are back.

 

With the recent AMA flare-up, I was expecting to see PAFT out in front. They were no where to be found. I have since spoken with several of the board members as I think this is critical that if they wish to be an alternate voice, it needs to be out there. AAPA is reactionary. PAFT MUST be pro-active. I hope you see the concerns to which I am alluding and consider them accordingly.

 

G

 

PAFT worked with AFPPA on the AMA issue. We posted the AMA resolution on paforum, C1, PAs for Physician Associate FB page, and sent out email blasts for the petition, which by the way got over 7,000 signatures. PAFT has sent a letter to the President elect of the AAFP who dissed us. We are being pro-active and need many more to join. We are working on other issues as well.

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Side note, the AAPA sucks and I refuse to send them a dime until they are working at state levels to pull of prescription limitations and to put more control into the supervising physician's hands when it comes to PA scope. They are busy lobbying for social issues such as when they wanted to make it mandatory for all medical providers to Rx Plan B and assist in abortions etc... I'm not arguing the validity of the argument (and I refuse to here) but I think we can all say that there are many divisions among us with social issues and we are of one voice with opening prescriptive capabilities and removing state medical board restricted scopes. They suck. Register one time only as a student-graduate so you get included in on emails and the PA magazine etc. Then never give them another dime. IMHO :D

 

Geronimo, I can only assume that you haven't been a PA very long, and practice in the environment that the AAPA worked hard over 4 decades to create, with the assistance of state chapters and specialty groups, which are constituent components of the AAPA. I have been in leadership on the state, national and specialty PA organizations since 1991, and we have made incredible progress on prescribing, and the barriers to physician PA practice. You need to go back to the practice environment in California and every state in 1981 to understand the road traveled and the progress made. You would be appalled at the conditions that PAs practiced under in the '70s and '80s. Professional PA practice is the most important agenda of the AAPA, and their support of trench level legislative activities has been continuous and strong since the inception of the the AAPA. There is a whole group on AAPA staff, led by PA Ann Davis, who focus on nothing but state PA legislation in support of state chapter legislative affairs.

 

The AAPA HOD has set policy on reproductive rights, from an access to care perspective, but has no specific policy on abortion rights or Plan B. Our general and broad policies on access to care, and opposition to interference in the provider - patient relationship, provides the opportunity for the AAPA to weight in on debates on this subject at the national level. However, aside from signing in on one amicus brief with the AMA, AAFP, ACP, ANA, and others, the AAPA is expending no time, money or effort lobbying for the issues you describe. I'm not sure where you got the impression that the AAPA has taken this stand, but it is not accurate.

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Geronimo, I can only assume that you haven't been a PA very long, and practice in the environment that the AAPA worked hard over 4 decades to create, with the assistance of state chapters and specialty groups, which are constituent components of the AAPA. I have been in leadership on the state, national and specialty PA organizations since 1991, and we have made incredible progress on prescribing, and the barriers to physician PA practice. You need to go back to the practice environment in California and every state in 1981 to understand the road traveled and the progress made. You would be appalled at the conditions that PAs practiced under in the '70s and '80s. Professional PA practice is the most important agenda of the AAPA, and their support of trench level legislative activities has been continuous and strong since the inception of the the AAPA. There is a whole group on AAPA staff, led by PA Ann Davis, who focus on nothing but state PA legislation in support of state chapter legislative affairs.

 

The AAPA HOD has set policy on reproductive rights, from an access to care perspective, but has no specific policy on abortion rights or Plan B. Our general and broad policies on access to care, and opposition to interference in the provider - patient relationship, provides the opportunity for the AAPA to weight in on debates on this subject at the national level. However, aside from signing in on one amicus brief with the AMA, AAFP, ACP, ANA, and others, the AAPA is expending no time, money or effort lobbying for the issues you describe. I'm not sure where you got the impression that the AAPA has taken this stand, but it is not accurate.

 

And the party line goes. Surely for anyone to not like the AAPA they must be new??? That sounds like, "No one as smart as I and as experienced as I can reasonably disagree with me". To be fair, I misspoke to a degree as it was 2008 I read this- "A [physician assistant] has an ethical duty to offer each patient the full range of information on relevant options for their health care. If personal moral, religious, or ethical beliefs prevent a PA from offering the full range of treatments available or care the patient desires, the PA has an ethical duty to refer an established patient to another qualified provider. PAs are obligated to care for patients in emergency situations and to responsibly transfer established patients if they cannot care for them." —American Academy of Physician Assistants, Guidelines for Ethical Conduct for the Physician Assistant Profession Which came out right around the time the big push at the national level to force that providers provide or refer people to those who provide abortion related services. According to the AAPA I should be sending my 14 week pregnant female patients downtown to our local shady Alaska abortion clinic to get their abortions since the Army doesn't provide that service. Again, I refuse to argue the merits for or against this on a forum because it inevitably gets stupid.

 

As far as advocacy on the state level: read this http://www.physicianassistantforum.com/forums/showthread.php/30749-Expose-on-AAPA

 

In over 4 decades how much money has been poured into AAPA and we still don't have full prescriptive privileges in all 50 states?

 

Does the AAPA publish it's income and expenditures? I'd be interested in how much goes into "advocacy" and how much of it goes to salaries and the development of "Ethical Guidelines" which is totally stupid because I look to the medical model of my specialty and my conscience for my ethical guidelines. Moreover, if the AAPA was even capable of writing ethical guidelines that weren't a duplication of another organization's perspective on something and were somehow different, would I as a provider under supervision be protected by the AAPA for holding onto their positions? I wonder how much time and money is spent pontificating on verbiage of guidelines produced by this organization that plays no direct role in certification or educational standards at schools vs. engagement of state and federal legislatures. Maybe providing legal protection for PAs that get caught in a sling for working "outside of their scope" when it was actually grey area or something that is widely accepted in other facilities within a state or in most other states is a good place to pick up. When PAs get bullied by companies like Kaiser Permaentae when they openly paid NPs more because they were previously RNs, though they saw no more patients than PAs, did no actual "nursing", they did not make exceptions for PAs who were previously RNs, and put harsher physician-PA rules in place where was the AAPA? The VA, the largest employer of PAs makes no distinction between NPs and PAs as an organization and as a general rule (with a few exceptions) they hire PAs under "Mid-level provider Hires" which opens it up for NPs as well. However in states with significant nursing lobbies the MLP positions are written for Nurse Practitioners. I wrote directly to a hiring official in Oregon to see if they would be open to changing it to a MLP position (it was for the ER) and I was sent the job description back and a small note said, "the requirements for the position you are inquiring about are listed below". Has the AAPA fought to level the hiring playing field? If so when? Why aren't PAs being presented to the American people as an answer for healthcare shortages and instead PAs are still having to explain what PAs are to people?

 

I'm just tired of AAPA advertising to PAs but not to the civilian population. I'm tired of ethical papers being written yet schedules II-V prescriptive authority isn't nation-wide. I will say, the Modern PA Practice Act is something I am impressed with, but is it even possible to get a federal law that forces state medical boards to expand PA privileges passed? If it gets pushed at the state level without the appropriate lobbying aren't we going to end up right where we started? I'm not sold on the AAPA and I'm no 40 year PA but I am well aware of the highs and lows of AAPA membership and the quest for relevance the AAPA has had to undergo. You can't slap "American Association of" in front of my job title and win my money. If the organization is willing to be 100% open with it's finances and pursue issues that I want addressed then I'd be interested. We have a similar thing going on in the Army currently. We have a bunch of our senior people making decisions that will pull PAs out of clinical medicine and into administration for the purposes of career (rank) advancement. They never asked the lowly types that became PAs to take care of patients (God forbid) what they wanted. Now we have a mass exodus of PAs from the Army because they don't want to do Healthcare Administration for 3+ years. Membership and relevance must go hand in hand and I just haven't seen where AAPA has been very effective at more than website building. The PA profession has come a long way but is that related more to the individual state medical boards advocating for PAs or is that all the AAPA's success? I'm interested in your thoughts.

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And the party line goes. Surely for anyone to not like the AAPA they must be new??? That sounds like, "No one as smart as I and as experienced as I can reasonably disagree with me". To be fair, I misspoke to a degree as it was 2008 I read this- "A [physician assistant] has an ethical duty to offer each patient the full range of information on relevant options for their health care. If personal moral, religious, or ethical beliefs prevent a PA from offering the full range of treatments available or care the patient desires, the PA has an ethical duty to refer an established patient to another qualified provider. PAs are obligated to care for patients in emergency situations and to responsibly transfer established patients if they cannot care for them." —American Academy of Physician Assistants, Guidelines for Ethical Conduct for the Physician Assistant Profession Which came out right around the time the big push at the national level to force that providers provide or refer people to those who provide abortion related services. According to the AAPA I should be sending my 14 week pregnant female patients downtown to our local shady Alaska abortion clinic to get their abortions since the Army doesn't provide that service. Again, I refuse to argue the merits for or against this on a forum because it inevitably gets stupid.

 

I'm sorry if I offended you, but your original line asserted that the AAPA has done nothing on prescribing and PA scope of practice since its inception. Nothing could be further from the truth, and my assumption, erroneously is that you just haven't practice for very long. As a matter of record, I was the lead author on the Guidelines for Ethical Conduct for the PA Profession. I was a volunteer, along with fellow members of the Professional Practice Council, and we were supported by staff. We worked on this document for three years, and it was presented to the 2000 HOD, where more than 230 of your peer delegates, elected by state and specialty organizations, debated and passed this document, making it AAPA policy. It is a living document and has been continuously reviewed and amended since. One of the hallmarks of a true profession is a statement of ethical standards. The line from the ethical guidelines you cite above is a standard that reflects the ethical beliefs of the all the major medical associations. You do have this duty. There is nothing that forces you do do anything. But if you deny care to a women, or a man, based on your own beliefs, or morals, are you not deny the patient the right to make their own decision based on their beliefs and values? If you don't want to be put in that situation, don't practice in specialties in which you confront these ethical dilemmas.

 

 

I have no knowledge of this, but there is always two sides to every story. In California, we have had more than our share of loose cannons who want to push personal legislative agendas, which threaten the hard work we have done developing relationships with all the stakeholders in the legislative process. Again, having no knowledge of what really happened in WV aside from the thread posted here, I will reserve judgement. The best way to accomplish legislative change is everyone working together.

 

In over 4 decades how much money has been poured into AAPA and we still don't have full prescriptive privileges in all 50 states?

 

So, if we don't have full prescriptive privileges in every state, the AAPA and state chapters have been a complete failure? If 100% success is the bar, then yes, we have failed. You need to talk with Ohio to understand how hard this is in some states. The prescriptive map of the United States looks one hell of a lot better than it did when I started practice in 1982. I call that significant progress and success. You call that failure. We will have to agree to disagree. How much money have you contributed to your state's PAC to advance your local legislative agenda?

 

Does the AAPA publish it's income and expenditures? I'd be interested in how much goes into "advocacy" and how much of it goes to salaries and the development of "Ethical Guidelines" which is totally stupid because I look to the medical model of my specialty and my conscience for my ethical guidelines. Moreover, if the AAPA was even capable of writing ethical guidelines that weren't a duplication of another organization's perspective on something and were somehow different, would I as a provider under supervision be protected by the AAPA for holding onto their positions? I wonder how much time and money is spent pontificating on verbiage of guidelines produced by this organization that plays no direct role in certification or educational standards at schools vs. engagement of state and federal legislatures. Maybe providing legal protection for PAs that get caught in a sling for working "outside of their scope" when it was actually grey area or something that is widely accepted in other facilities within a state or in most other states is a good place to pick up. When PAs get bullied by companies like Kaiser Permaentae when they openly paid NPs more because they were previously RNs, though they saw no more patients than PAs, did no actual "nursing", they did not make exceptions for PAs who were previously RNs, and put harsher physician-PA rules in place where was the AAPA? The VA, the largest employer of PAs makes no distinction between NPs and PAs as an organization and as a general rule (with a few exceptions) they hire PAs under "Mid-level provider Hires" which opens it up for NPs as well. However in states with significant nursing lobbies the MLP positions are written for Nurse Practitioners. I wrote directly to a hiring official in Oregon to see if they would be open to changing it to a MLP position (it was for the ER) and I was sent the job description back and a small note said, "the requirements for the position you are inquiring about are listed below". Has the AAPA fought to level the hiring playing field? If so when? Why aren't PAs being presented to the American people as an answer for healthcare shortages and instead PAs are still having to explain what PAs are to people?

 

As I have not been on the BOD for a number of years, I'm not privy to the budget of the AAPA. However, as a non-profit, this information is probably readily available from the 990 they are required to file, and by just picking up the phone and calling them. Message me privately, and I would be happy to hook you up with President Herman.

 

The playing field will alway be rocky due to geographic differences. There are more than 2 million nurses and 100,000 PAs. We have been touting PAs as a solution since I have been in leadership. You have to understand that we are not the big dog on the porch, and have to work smarter and more efficiently. The acceptance of PAs universally, and their expansion into every specialty, is an example of the success of the profession. We will never have equal footing with nursing and physicians, so we have to address the problem differently. If KP pays PAs less, don't work there. We have a strong nursing lobby in our state in the Bay Area, and PAs have a difficult time getting jobs and pay equity. When folks complain about it, I tell them to relocate the the Central Valley, were all the PAs I know are making 6 figures. When institutions can't fill the jobs, this will change in our favor. Nursing is in a mode now to make NP education much more expensive and harder to obtain, while PA programs are expanding rapidly. In my community, the jobs go to the warm body that presents with the credentials to do the job.

 

I'm just tired of AAPA advertising to PAs but not to the civilian population. I'm tired of ethical papers being written yet schedules II-V prescriptive authority isn't nation-wide. I will say, the Modern PA Practice Act is something I am impressed with, but is it even possible to get a federal law that forces state medical boards to expand PA privileges passed? If it gets pushed at the state level without the appropriate lobbying aren't we going to end up right where we started? I'm not sold on the AAPA and I'm no 40 year PA but I am well aware of the highs and lows of AAPA membership and the quest for relevance the AAPA has had to undergo. You can't slap "American Association of" in front of my job title and win my money. If the organization is willing to be 100% open with it's finances and pursue issues that I want addressed then I'd be interested. We have a similar thing going on in the Army currently. We have a bunch of our senior people making decisions that will pull PAs out of clinical medicine and into administration for the purposes of career (rank) advancement. They never asked the lowly types that became PAs to take care of patients (God forbid) what they wanted. Now we have a mass exodus of PAs from the Army because they don't want to do Healthcare Administration for 3+ years. Membership and relevance must go hand in hand and I just haven't seen where AAPA has been very effective at more than website building. The PA profession has come a long way but is that related more to the individual state medical boards advocating for PAs or is that all the AAPA's success? I'm interested in your thoughts.

 

Just FYI, there is no way that the Federal government can mandate scope of practice to a state medical board. Regulating the practice of medicine is totally under the control of the state. I'm tired of people saying that the AAPA just advertises to PAs. Look at my numerous other posts on this subject. You have to ask the Ann Landers question. Are you better off with the AAPA, or better off on your own? if you can improve on your profession situation as an army of one, go for it. For me, it make sense to support my state, specialty and national PA organization.

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