Is anyone ready to listen yet?

[Grinder993]

I haven't been on this forum in a few years. I have been known in the past to rant about what I perceive to be the looming threat to our profession. The threat that our "fearless" PA leaders say is not real. What threat? DNP's! I just finished my most recent issue of NP's & PA's, which I am still pissed off about the merging of, but I digress. When I was last here years ago, I warned that the DNP was going hurt us if we did not respond in kind and offer a DScPA degree, as an option. Nevada has just become the 17th state to give DNP's full autonomy to practice medicine. New York and New Jersey are soon to follow. Now that they have the title of "doctor" they will soon be fully autonomous nationwide. Why does that matter to us?

Well sports fans let me spell it out to you. With the looming budget cuts in insurance reimbursement, physicians are going to be looking to protect their salaries. How do you do that? Limit the number of providers that can do what they do. They have NO control over the ANA and the lobby of the ANA crushes the AMA everyday. So what they can do is limit the scope of and put pressure on PA's. Yes we are the red headed bastard children of medicine asking for another scoop of gruel from our headmaster. In my state of TN, they have already shut down PA's from doing any kind of pain management including joint injections. They are now trying to pass a bill to prevent any PA/NP from "altering the skin". That is pretty vague and can mean that we would not even be able to suture. So now that the MD's protect themselves by putting us in the corner, how does the DNP hurt us you ask? Here's how...

DNP's will be getting 100% Medicare reimbursement and the acknowledgement by the government that they are "doctors". DNP's will push for legislation as well that limits the scope of the PA. Even going so far as to be approved to "supervise" PA's. You think it's impossible? Think again.

The only way to save our profession is to match degree for degree with NP's, otherwise we are at a gross market disadvantage in the arena of legislative opinion......that is the only one that matters. For all of you who are going to say "the degree will not make better PA's", you have entirely missed my point and are oblivious to the danger in front of you. It does not matter....what matters is public perception. A "doctor NP" sounds better qualified than a "physician ASSISTANT". We are going to lose this war if we do not move immediately to for a residency option that awards a DSc-PA (Doctorate of Science-PA). We then have to follow the trail paved by the NPs and push for autonomous practice. I now that is heresy to the old timer PAs but it's time has come and the alternative is extinction.

We are in trouble....that light at the end of the tunnel is a freight train coming our way.

[Proballr32]

In my state of TN, they have already shut down PA's from doing any kind of pain management including joint injections.

 

Not true. I practice in TN as well, and am familiar with the legislation. I currently run an orthopedic clinic solo for a primary care doc, with no physician onsite. There has been a movement spearheaded by some MD's that don't want us to have as much autonomy. As a result, recent legislation was passed that only required an MD to be present in the building for us to perform invasive spine procedures. Joint injections are NOT included in that legislation, and can be performed by a PA in any setting.

[PM2PA]

I think the DNP is going to ultimately bite them hard in the end. At least that's what my professors tell me.

[cinntsp]

I think the DNP is going to ultimately bite them hard in the end. At least that's what my professors tell me.

 

That's what they say...as NPs continue to get a bigger piece of the pie and there's nothing the docs can do about it.

[Grinder993]

As I understand the legislation, midlevels cannot do joint injections for pain management under the new legislation.

[Grinder993]

The MD's cannot touch the power of the nursing lobby. There is nothing they can do as the DNP's grow in power. They have the title "doctor" and they will now push for 100% insurance reimbursement. So in essence, they will have all of the benefits of being "doctors" (the title and the money) without ever setting foot in medical school. I am not hating on DNP's for this move, personally I think it is brilliant. I am extremely pissed off at the PA establishment who are more interested in begging for scraps from the AMA and saying "Thank you sir may I have another" than looking down the long road of our professional future and making moves to protect it. It is time for us to move toward cutting the umbilical cord with the MD's. The MD's will throw the PA's under the bus to protect themselves and most importantly their money. If you think the nursing lobby is not going to push to limit the scope of the lowly "masters degree" PA you are in denial. They will and they will get it. We are at a great disadvantage both professionally and market wise by allowing them to move to DNP and us not match that move. You realize we are now the only allied health profession without a doctorate option. Change with the times or go extinct!

[EMEDPA]

We have a doctorate option. in fact, several. DHSc, PhD, EdD, DrPH, etc.

That being said, the DNP is one reason I went back for my doctorate 2 yrs ago. 1/2 way done now.

Emedpa

DHSc Student

[Guest Paula]

I agree with you Grinder993. I have concerns that DNPs will eventually supervise PAs. They will for sure when they are the hospital administrators and may also restrict the hiring of PAs if they are in charge. PAs can get doctorates.....i.e....the military EM and Ortho doctorates.....but those are only for the few in the military. We can get a doctorate in health sciences....it is just not recognized by the AAPA or endorsed by them. The key to all of this is to amend the dependence and supervisory language in all of our laws, allow PAs to have full autonomy as far as licensing, and then follow the scope of practice we are educated in for the specialty or area of medicine we work. The CAQ requirements should allow a doctorate once the test is passed. I will always advocate for our profession to be a stand alone profession, just like OD, DPMs, Chiropractors, NPs. Our profession is so steeply embedded with physicians that the AAPA will not budge on their physician-led team concept and seem to be escalating the rhetoric on that concept.

[Guest Paula]

P.S. I just finished my masters completion program. I compared the course work to a few DNP programs and guess what? The courses were very similar. Health care policy, epidemiology, statistics, bio-ethics, evidence -based medicine, writing the research paper, and a clinical focused study. I think I have more academic credits than a DNP. I have no desire right now to undergo a doctorate....maybe if I was younger.....?

[Guest Paula]

We have a doctorate option. in fact, several. DHSc, PhD, EdD, DrPH, etc.

That being said, the DNP is one reason I went back for my doctorate 2 yrs ago. 1/2 way done now.

Emedpa

DHSc Student

 

Do you think the doctorate for PAs (who are still dependent and supervised) will make a difference in your autonomy and the ability of PAs to be hired over DNPs in full-practice authority states? I'm all for PAs getting doctorates. I know yours is for a possible future in overseas work in public health and medicine.

[True Anomaly]

From a personal standpoint, the only doctorate I'll go back to school for now will be a JD and turn a "PA/JD" combo into something unique for myself.

[bcstout]

I am also a little concerned about what Grinder has discussed here.

 

However, IMHO there is NO WAY a new grad/green PA should have complete autonomy- even if they do a 12 month post grad residency right after school. I truly believe an auto minus provider needs a lot of training and experience before you're there on an island.

 

My proposal would be a min. 3 years as a PA before applying for a 'doctorate residency' of some length which should confer a modified title of some sort and autonomy.

 

 

Pp

[Grinder993]

I am also a little concerned about what Grinder has discussed here.

 

However, IMHO there is NO WAY a new grad/green PA should have complete autonomy- even if they do a 12 month post grad residency right after school. I truly believe an auto minus provider needs a lot of training and experience before you're there on an island.

 

My proposal would be a min. 3 years as a PA before applying for a 'doctorate residency' of some length which should confer a modified title of some sort and autonomy.

 

 

Pp

I think that is a good and reasonable idea. I agree a new grad PA being autonomous is as frightening as a new grad MD being unleashed without 4 years of residency guidance. There is room here for discussion. A pathway needs to be found to confer a doctorate to our professional title, the autonomy will follow. Most importantly this allows us to become more the masters of our destiny as opposed to being at the mercy of the physician groups.

[Grinder993]

From a personal standpoint, the only doctorate I'll go back to school for now will be a JD and turn a "PA/JD" combo into something unique for myself.

PA/JD would be unique and awesome. Go for it!

[Grinder993]

We have a doctorate option. in fact, several. DHSc, PhD, EdD, DrPH, etc.

That being said, the DNP is one reason I went back for my doctorate 2 yrs ago. 1/2 way done now.

Emedpa

DHSc Student

Understood EMEDPA, but you're PA degree is still a Master's. Those other degrees do not confer higher level of medical training. No different than if I had a PhD in biochemistry and was also a PA. I am still just a Master's degree PA-C. You are comparing apples and oranges.

[marktheshark89]

Understood EMEDPA, but you're PA degree is still a Master's. Those other degrees do not confer higher level of medical training. No different than if I had a PhD in biochemistry and was also a PA. I am still just a Master's degree PA-C. You are comparing apples and oranges.

 

For currently praciticing APRNs, the DNP does not confer a higher level of medical training either (i.e. make them better providers), so I'm not sure this is really comparing apples to oranges at all. If you look at DNP curricula for those who are already APRNs, most courses are biostatistics, epidemiology, health policy, public health, or other health care related topics, but do not improve practitioner skills in any way. The DNP programs that are transitioning from Master's to Doctoral level, largely offer the same master's training, and then throw these courses on top of that to make it a doctorate. Again, this does not improve clinical skills and there is not generally substantial additional clinical training provided. This may not be true for all schools, but for those that friends of mine are in, and others that I have researched, it is. The DNP can be helpful for nurses hoping to pursue leadership positions, faculty appointments, or research, much like the DHSc, PhD, EdD can for PAs.

[chickitabanana]

Will DNPs really be able to supervise PAs? I thought we had to have a "supervising physician" not a "supervising doctorate degree holding clinician"? I understand they may hold leadership positions in hospital settings which may impact PA practice, but I don't think they'll ever be in a position the way our SPs are now...

 

Also, they won't get the "benefits" of being called a doctor and the money. I highly doubt that a DNP in cardiology is going to make the same 400K salary that a cardiologist makes. Does anyone remember that NY Times article about DNPs introducing themselves as "Doctor Smith" to the patient and how many felt it was misleading? Yes, technically they're doctors, but so are JDs and no one calls them doctors. The day a DNP starts referring to him/herself as "Doctor" is the day I start introducing myself as "Master." (What? I have a Master's degree. I'm allowed to use the title!)

[Grinder993]

Will DNPs really be able to supervise PAs? I thought we had to have a "supervising physician" not a "supervising doctorate degree holding clinician"? I understand they may hold leadership positions in hospital settings which may impact PA practice, but I don't think they'll ever be in a position the way our SPs are now...

 

Also, they won't get the "benefits" of being called a doctor and the money. I highly doubt that a DNP in cardiology is going to make the same 400K salary that a cardiologist makes. Does anyone remember that NY Times article about DNPs introducing themselves as "Doctor Smith" to the patient and how many felt it was misleading? Yes, technically they're doctors, but so are JDs and no one calls them doctors. The day a DNP starts referring to him/herself as "Doctor" is the day I start introducing myself as "Master." (What? I have a Master's degree. I'm allowed to use the title!)

I can tell you that is already happening. I worked in a local ER where the nurse manager who was a DNP routinely introduced herself as "doctor".

[True Anomaly]

If you're very very concerned about a DNP one day supervising a PA, then I highly suggest you get involved with your state PA society and, through that, start developing relationships with state legislators. ONce they get to know you, they will be more likely to listen to what you have to say when it comes to bills pertaining to medicine that come through the state house. Think of it as "prophylactic politics".

[Grinder993]

For currently praciticing APRNs, the DNP does not confer a higher level of medical training either (i.e. make them better providers), so I'm not sure this is really comparing apples to oranges at all. If you look at DNP curricula for those who are already APRNs, most courses are biostatistics, epidemiology, health policy, public health, or other health care related topics, but do not improve practitioner skills in any way. The DNP programs that are transitioning from Master's to Doctoral level, largely offer the same master's training, and then throw these courses on top of that to make it a doctorate. Again, this does not improve clinical skills and there is not generally substantial additional clinical training provided. This may not be true for all schools, but for those that friends of mine are in, and others that I have researched, it is. The DNP can be helpful for nurses hoping to pursue leadership positions, faculty appointments, or research, much like the DHSc, PhD, EdD can for PAs.

You're missing the point. This isn't about whether or not it makes you a "better" clinician. This about public perception. You can have all of the advanced degrees you want, but your professional degree, your PA degree is still a Masters. Our professional degree must be brought up to the doctorate title.

[D.C.]

Speaking as someone doing the pre-reqs for P.A. school right now, I have to say that I sometimes think about going into nursing instead. Think about this progression:

 

CNA-->RN-->BSN-->NP-->and now DNP (which they're lobbying to make as close to MD as possible? or so I gather)

 

It's a logical progression, you can continue schooling until you reach the level of responsibility you're comfortable with. That's appealing. Now consider this progression (I'm a CNA so I used CNA as the starting point):

 

CNA-->PA-->???

 

Nothing wrong with that, but compare it to this:

 

CNA-->PA-->MD or DO

 

That's much more appealing. My understanding is that there are bridge programs already out there, why not encourage those rather than a DPA. Think about the endgame. DPA vs. DNP... you're looking at very similar outcomes. But MD or DO vs. DNP? Come on! DNP is going to get trumped every time!

[physasst]

If you're very very concerned about a DNP one day supervising a PA, then I highly suggest you get involved with your state PA society and, through that, start developing relationships with state legislators. ONce they get to know you, they will be more likely to listen to what you have to say when it comes to bills pertaining to medicine that come through the state house. Think of it as "prophylactic politics".

 

And I would suggest that if you are very concerned about a DNP someday supervising a PA, that I have some land to sell you. Beautiful, beachfront property....really cheap too.

 

As long as NPs reside under the umbrella of the board of nursing, they cannot supervise a PA who is under the board of medicine. Unless the DNP candidate was willing to come under the auspices of the BOM (which they will NEVER, EVER do for very obvious reasons) its completely ludicrous line of thought.

 

I have a doctorate. So what? There is a clinical doctoral process for PAs...it's called medical school. We should ask primadonna about it.....(although I think she won't be posting for awhile)....

 

I'm not even happy about PAs being mandatory Master's......(as an old AAS graduate) I think moving to a clinical doctorate is moving away from what PA is or should be.

 

I'd rather focus on streamlining our process at the state BOM level. Make it easier for practices and institutions to hire PAs, eliminate some of the hassle factor. Eliminate barriers to autonomy. Those are all far more important....and believe me, wouldn't be solved with some mythical "doctor" title.

[Grinder993]

Speaking as someone doing the pre-reqs for P.A. school right now, I have to say that I sometimes think about going into nursing instead. Think about this progression:

 

CNA-->RN-->BSN-->NP-->and now DNP (which they're lobbying to make as close to MD as possible? or so I gather)

 

It's a logical progression, you can continue schooling until you reach the level of responsibility you're comfortable with. That's appealing. Now consider this progression (I'm a CNA so I used CNA as the starting point):

 

CNA-->PA-->???

 

Nothing wrong with that, but compare it to this:

 

CNA-->PA-->MD or DO

 

That's much more appealing. My understanding is that there are bridge programs already out there, why not encourage those rather than a DPA. Think about the endgame. DPA vs. DNP... you're looking at very similar outcomes. But MD or DO vs. DNP? Come on! DNP is going to get trumped every time!

True. But this road leads to the extinction of the PA profession. It becomes nothing more than a weigh station on road to being a Physician. I am interested in preserving our profession. Otherwise, since we are all trained in the medical model like Physicians, then we all abandon the PA profession and go to med school, leaving only Physicians and Doctor Nurses.

[Grinder993]

And I would suggest that if you are very concerned about a DNP someday supervising a PA, that I have some land to sell you. Beautiful, beachfront property....really cheap too.

 

As long as NPs reside under the umbrella of the board of nursing, they cannot supervise a PA who is under the board of medicine. Unless the DNP candidate was willing to come under the auspices of the BOM (which they will NEVER, EVER do for very obvious reasons) its completely ludicrous line of thought.

 

I have a doctorate. So what? There is a clinical doctoral process for PAs...it's called medical school. We should ask primadonna about it.....(although I think she won't be posting for awhile)....

 

I'm not even happy about PAs being mandatory Master's......(as an old AAS graduate) I think moving to a clinical doctorate is moving away from what PA is or should be.

 

I'd rather focus on streamlining our process at the state BOM level. Make it easier for practices and institutions to hire PAs, eliminate some of the hassle factor. Eliminate barriers to autonomy. Those are all far more important....and believe me, wouldn't be solved with some mythical "doctor" title.

Enter the old timer denial. If you are angry about the Master's being the entry level, I don't know what to say to you. We function in a free market, one based on titles. You can shout from the rooftops all day long that "doctorate" doesn't matter. But to the uneducated masses (politicians and general public) it does matter. We are getting our collective rear-ends kicked in the marketing arena. The purists who want to insist that titles don't matter have hobbled us long enough. I am not requesting doctorate as entry level degree. I think it should remain as a Masters with the option of a DSc residency. The DSc-PA will have more autonomy than Master's PA. But know this, eventually the Master's PA will fade away. Same as the old Associate RN and BSN. They are almost entirely BSN now.

[physasst]

Enter the old timer denial. If you are angry about the Master's being the entry level, I don't know what to say to you. We function in a free market, one based on titles. You can shout from the rooftops all day long that "doctorate" doesn't matter. But to the uneducated masses (politicians and general public) it does matter. We are getting our collective rear-ends kicked in the marketing arena. The purists who want to insist that titles don't matter have hobbled us long enough. I am not requesting doctorate as entry level degree. I think it should remain as a Masters with the option of a DSc residency. The DSc-PA will have more autonomy than Master's PA. But know this, eventually the Master's PA will fade away. Same as the old Associate RN and BSN. They are almost entirely BSN now.

 

Okay, well, for starters it's not denial or anger. I rarely get angry about anything. It's a tempered realism. Here's a few questions to foster further debate:

 

1. DSc is NOT a clinical degree. It is a research degree and typically awarded in science domains such as engineering, epidemiology, biostatistics, etc. How does that help the practicing PA? Does being well versed in research methods or stats change how you practice?

 

2. How is this funded? I know that Baylor has one, but that is for the Army and is funded by the federal government. Setting up and getting funding for a residency for PAs is hard enough (I know, we are trying to do one now) how is the educational component funded? The awarding school will expect compensation or reimbursement for this, no? Funding for PA residencies is already tightening up and this would be considered a non-essential requirement, how would it be paid for?

 

3. You haven't addressed how having a non-clinical doctorate changes public perception or changes perception in the "marketing arena"? Does merely having the title confer some magical process by which you instantly have more respect? I can tell you, it does not. It has changed my career path in leadership and research tracks, but clinically? No one cares. It doesn't change the fact that I am a PA, and I am not a physician. Doctor or not.

 

4. You mention increased autonomy. How is that determined? Who determines that? Does it change pay? Does it change supervisory requirements at the state level? Graduation from current residency programs does not change your restrictions regarding autonomy and practice at the state level, how would adding a non-clinical doctorate change that? Would the FSMB suddenly change, and say..."OH, you mean you have a non-clinical doctorate?, well, we'll change the wording for that group of PAs" Would there be a different PANCE for those with the DSc? Would you be eligible to take physician specialty board exams? How would that work?

 

5. How many residencies would there be? Would this apply to every specialty? How is this accredited? Managed? Do you now create the need for DSc PA program directors? Where do they come from?

 

Not to be difficult, but this idea has so many questions, that it is difficult to take seriously......