The benefits of major academic centers for PA's

[SocialMedicine]

Spent the morning catching up on healthcare reading. Many pieces discuss the changing developments in Primary Care. A number of nursing academics are quoted as experts, and the research they perform used to demonstrate NP capacity. This is just one of many examples

http://well.blogs.nytimes.com/2013/06/27/the-gulf-between-doctors-and-nurse-practitioners/?smid=fb-share . There are no similar PAs identified, because they do not exist. This is just another reason why we need to turn away from 200 smaller schools and create centers of excellence for PA education and research. I cannot say this enough.

[Guest Paula]

PAs are in the middle between physicians and nurses and not even in the middle. Another poster described us as odd puzzle pieces where no one knows where we belong. Your comment made me think that if medicine wants to keep us as medical practitioners they would think outside the box and offer the PA centers of educational excellence and research. They would completely graft us into the family of medicine so we are indistinguishable (is that a word, doesn't look right?) from physicians. They would place us in the 3 year medical schools or fast-track medical school for PAs in primary care, fold us into the flock, make us autonomous providers, juniors doctors? A new breed of PAs, a new concept of PAs? They would not fight against us with every state law that we work to change to improve our practice acts. I don't think it will happen.

 

Your idea has merit and PAs and PA organizations will need to be the ones to do something like that on our own.

[nhpilot]

PAs are in the middle between physicians and nurses and not even in the middle. Another poster described us as odd puzzle pieces where no one knows where we belong. Your comment made me think that if medicine wants to keep us as medical practitioners they would think outside the box and offer the PA centers of educational excellence and research. They would completely graft us into the family of medicine so we are indistinguishable (is that a word, doesn't look right?) from physicians. They would place us in the 3 year medical schools or fast-track medical school for PAs in primary care, fold us into the flock, make us autonomous providers, juniors doctors? A new breed of PAs, a new concept of PAs? They would not fight against us with every state law that we work to change to improve our practice acts. I don't think it will happen.

 

Your idea has merit and PAs and PA organizations will need to be the ones to do something like that on our own.

 

 

Admittedly, I am pre PA, but I still don't understand this thinking.

 

There IS a way for PAs to be indistiquishable from physicians....it's called med school.

 

I am sorry....but a 30+ year PA is STILL NOT A PHYSICIAN!

 

I know there is a battle between nursing and medicine...but that is 2 disparate communities fighting for turf. My opinion is nursing is trying to care out a place like DOs did and be accepted as equals to physicians. But they are doing this from outside the medical model. They are trying to establish a NEW healthcare provider that is not related to medicine. And by medicine I mean the medical model.

 

Personally, I'm not impressed by the NP efforts, and to me putting a pseudo clinical doctorate after their names still does not equate them to physicians.

 

By the same token, PAs are separated by NPs by the fact that we ARE bound by the medical model. We are not a separate community from physicians, but a part of THEIR community, albeit as "junior"members.

 

I know that "junior" part will insult many PAs but it is not my intent to do so....PAs are mid-level practitioners, and that won't change soon. Yes, I am for increased authority....yes, I am for professional acknowledgement....yes, I am for greater remuneration. But all this under the PA banner.

 

Yes I agree that the AMA must come down FIRMLY in the PA camp and embrace PAs as professionals, and support greater PA authority. In this way, I believe it is their only hope to control and limit greater scopes of practice for nurses.

 

Yet at the same time, if you want the privileges, titles, head aches, loan repayment, responsibilities, etc, of physicians, then GO TO MEDICAL SCHOOL. Honestly....if 3 years vs 4 years is the only thing holding you back from medical school, then you just don't want it badly enough.

 

I was in healthcare a long time. I DON'T want to be a physician....I want to be a PA...I know what I am getting into, and I am ecstatic with that.

 

There are 2 groups that I respect equally. Those PAs who love what they do and wouldn't change it, and those PAs that decided they wanted more, put their heads down, busted their tails and went to med school. They didn't say "I'm a PA....I deserve special consideration..."....they just sucked it up, worked hard and got their brass ring.

 

Just don't ask for equality when you haven't worked for it.

 

Just my 2 cents, and I apologize in advance if I offended anyone.

[Guest Paula]

No offense taken. What I was trying to say is that either physicians recognize us as competent autonomous providers and fold us into their world...to me that means we do not "need" (see my P.S.) supervision but they embrace the collaboration model and they support us in our efforts when we work for expansion of privileges. I have not yet seen a state medical society that has come alongside state PA organizations when they asked for increased prescriptive privileges, amending co-sig laws, etc. I have not seen AMA ever offer solutions as to how they can embrace us as a profession that is competent. We are competent.

 

PA profession (IMHO) has a problem defining ourselves. I agree with the argument of going to med school. I considered it. I started my PA career later in life as a second career and after careful consideration of med school, (I was looking at the LECOM 3 year track for PA-DO) decided it was financial suicide at my age. I've been practicing now for 9 years. Retirement in 10.

 

P.S. As far as "needing supervision" ......newly minted PA (and NP) grads need mentoring and "supervision" for a period of time.....or On the Job training. I'm all for that. I would like to see a point where after 3-5 years of mentoring, learning, growing in the career we can graduate to a collaborative model as autonomous providers working within a scope of practice within whatever specialty we are in. I actually think PA programs could expand the clinical year for primary care to have one year residencies offered or developed. PC is in my mind the hardest specialty to manage as one must know something about everything that walks in the door.

[SocialMedicine]

nhpilot ... disagree with your opinions and in a 10 years when you gain some experience as a PA in our current medical system I hope you find yourself in a position to disagree as well. If not, then you will likely be a PA who has gone down a career which will lead to dissatisfaction. I am not a big opponent of the MD in 3 year for PA's. In fact some MD programs are already moving to a 3 year program without the PA degree (NYU). I want PAs to stay as PAs and do what we were designed to do , create a cost effective and quality healthcare system. I want to see PA schools become decent academic centers and not just degree mills with 3 overworked core faculty struggling to find anyone to precept or give a lecture.

[chickitabanana]

if 3 years vs 4 years is the only thing holding you back from medical school, then you just don't want it badly enough.

 

 

Medical school length is usually not the reason those of us who are PAs didn't become MDs. By the time I finished all of my pre-reqs and HCE I graduated from PA school 4 years after undergrad. So, in essence, had I gone to med school like most people do directly from undergrad I would've finished at the same time.

 

The reason I, and many others, chose PA was mostly due to the flexibility the career provides, both in your personal life and professional life. I knew I wanted to work in cardiothoracic surgery, but did not want to be a cardiac surgeon. I wouldn't have minded 4 years of med school, but I would've minded 10 years of residency/fellowship and not starting a career until I was in my late 30s. As a woman I had to consider what else I wanted out of life in regard to family and children. Also, the flexibility of being able to change specialties is wonderful. I have a lot of friends in medical school and listening to them trying to choose only one area of medicine to practice for the rest of their life is stressful -- and I'm not the one making the decision! Could I have gotten into medical school? Definitely. Are the majority of people who graduate from PA school smart enough to have become doctors? Yes.

 

Also, while a PA with "30 years experience" will never, officially, be a physician it doesn't mean they aren't just as capable. I would rather be treated by a PA with 30 years experience than a newly minted doctor who just started residency.

[nhpilot]

I think I have to agree with a lot of the points you all make, especially after rereading the posts last night and realizing I may have come off as a snarky and dismissive outsider.

 

I went to nursing school, but withdrew in my Junior year, mostly because the nursing model just wasn't my cup of tea....as a Surg Tech I was (and am) more of a medical model type of guy. But another reason I withdrew is because it seemed like 9.9 outta 10 of the nurses I met on my rotations where absolutely miserable and told every student they met, "Get out while you can!"...lol

 

So it just doesn't make sense to me that the AMA doesn't embrace PAs more than than they do. Heck, to me it just makes sense to me as a weapon against the NP encroachment on their turf, by being able to say, "We already have medically trained practitioners...there is no need for nurses with less training to attempt to do what we do."

 

I do agree with more autonomy with less oversight for PAs. I also believe there should be one national PA board, resulting in the same privileges nationwide for all qualifying PAs, such as physicians enjoy now, and it is in the power of the AMA to see that that happens, if they would just wise up and realize that that would be in their best interests.

 

So I think I was much too hasty in my last post...I have to agree that perhaps the centers of excellence for PAs would be a good start. And I know I will be crucified for this by some, but perhaps a mandatory 1 year residency would also be such a step.

[SocialMedicine]

hearing your surgical background makes some sense .... working in general and ID medicine I can obtain a high level of skill and autonomy. If I worked in surgery or something very specialized that would not be so easy.

[Houstonian]

The best weapon MD's have against independent NP practice is to simply quit hiring them.

 

Most NP's are not in true independent practice, nor do they want to be. Most NP's are employed by MD's or MD groups.

[physasst]

I think I have to agree with a lot of the points you all make, especially after rereading the posts last night and realizing I may have come off as a snarky and dismissive outsider.

 

I went to nursing school, but withdrew in my Junior year, mostly because the nursing model just wasn't my cup of tea....as a Surg Tech I was (and am) more of a medical model type of guy. But another reason I withdrew is because it seemed like 9.9 outta 10 of the nurses I met on my rotations where absolutely miserable and told every student they met, "Get out while you can!"...lol

 

So it just doesn't make sense to me that the AMA doesn't embrace PAs more than than they do. Heck, to me it just makes sense to me as a weapon against the NP encroachment on their turf, by being able to say, "We already have medically trained practitioners...there is no need for nurses with less training to attempt to do what we do."

 

I do agree with more autonomy with less oversight for PAs. I also believe there should be one national PA board, resulting in the same privileges nationwide for all qualifying PAs, such as physicians enjoy now, and it is in the power of the AMA to see that that happens, if they would just wise up and realize that that would be in their best interests.

 

So I think I was much too hasty in my last post...I have to agree that perhaps the centers of excellence for PAs would be a good start. And I know I will be crucified for this by some, but perhaps a mandatory 1 year residency would also be such a step.

 

 

Sure it does, the AMA does not want PAs to be around. Heck, ACEP has a position statement that EVERY ER in the country should be staffed with board certified EM physicians, and that others are not trained appropriately.

 

Why would the AMA embrace us? That will never happen. They don't want PAs or NPs doing anything besides taking H&Ps..

 

Also, physicians do not have "one national board". They have national board certification in their specialty (as do we, it's called the PANCE/PANRE), and then they need to get licensure in EACH state. Each state's medical board determines what the physicians can and can't do, to some degree. They have the FSMB (Federation of States Medical Boards) which attempts to help with uniformity, but unless we wanted to create separate PA boards of medicine, it won't help us.

 

SocialMedicine, I agree. There is some discussion going on that I can't really delve into the particulars on, but it revolves around the creation of 1-2 senior research fellow positions for PAs.....where it will go right now, I don't know.