Reality check needed

[UGoLong]

There is one part of this that I think I'm missing. The whole thing started because you are being paid $700 less than you deserve, right? That's certainly not fair, but, otherwise, you still have a job you like and will let you help patients one at a time? You think you are too late in life to go to med school and make up for all that lost time and money, and you are close enough to the end of your working life (and your husband's) so that big changes are not in the cards, at least for now.

 

If I've interpreted that right, then why not come to terms with the $700 and just try to be happy where you are? You can get involved in whatever you can to change things.

 

When I was young, I was sure that the world would have solved all of its problems by the time I was ready to retire. Not so, unfortunately. We have an obligation to help out as best we can to make the situation better for those that follow us. We also have to live in the now, and the closer you come to retirement, the more limited that "now" is. The evolutionary forces within health care have their own timetables and they may be way longer than what is left in our careers.

 

So, if you like where you live, if you like what you do, and if you need to stay where you are, then why not try to terms with that? If you can change something, then change it.

 

Or, if you're like me, you can write bitter letters to the AAPA...

[bobuddy]

UGOLong -

 

When all of the changes came about to our clinic as we joined up with the medical center, I was told what PA's make. The HR rep told me very clearly that the salary given to PA's is based on specialty and years of experience and I verified the salary with other PA's that hold the same position with years of experience. However, the docs had to say "okay" to bringing me up to that salary - and they have not agreed to it. It seems to be a very convoluted merging of our clinic with the medical center. It took 6 months for them to agree to give me productivity (which other PA's also have in this medical center).

 

$700 per month to me IS significant - and when all of this transpired I did try to not take it all personally (but I did) and focus on the good parts of the job. However, it is also the principal of it. I felt no longer like a colleague or a valued employee that generates a significant part of the clinic income. In the four days I work, I am there 12 hour days - just like the docs.

 

That is when I started looking to see what other opportunities were out there. I have kept my head down and my mouth shut for 6 months and quietly looked and applied for other jobs. It has been over that 6 months that I have come to the reality of our PA jobs going to the NP's.

 

Hence the question of - do I go back to school myself and become more marketable? That is my struggle.

 

I do like the part about writing bitter letters to the AAPA :)

[UGoLong]

I guess only you can decide if you can live with the injustice and you have the wherewithal to take a different path. Life is too short to be miserable in your job, assuming your situation gives you a way out.

 

I wouldn't expect the situations between PA and NP jobs to clear up overnight. There are laws to change and, probably more importantly, perceptions changed, especially within hospitals where senior nurses have always had a strong leadership role. If you can't move and have the time, then a new path might be a good idea for you.

 

Good luck! (And I sent another bitter email to AAPA today!)

[EMEDPA]

I didn't read the whole thread but have you considered options like this:

http://www.passllc.com

work long shifts out of state elsewhere and be home the majority of the time. do 3-14 days/row/mo at a high rate of pay and spend the rest of the time at home.

you can do 2 weeks on/2 weeks off in alaska and easily make 125k/yr and be home half the time.

there are alaksa jobs on several schedules; 2 weeks on /2 weeks off. 1 month on, 1 month off. 2 weeks occasional at 7k/2 weeks, etc

[bobuddy]

EMEDPA - that link looks really interesting. I just sent my contact information to them. Thanks!

[EMEDPA]

sure- some of their sites have the option of 24 OR 48 hr shifts at low volume sites. these are all federal contracts like indian reservations, etc so any state license works.

a buddy of mine worked for them a few years ago for just 1 summer when he was between jobs and made serious bank. no benefits except malpractice but good money/hr and doing a 48 hr shift you can make almost 3k/shift.

[Boatswain2PA]

This is another example of the failure of AAPA to fight against the NP profession. It is these continual failures (real or perceived) that has led to a disillusionment for many PAs of the AAPA...and to the creation of PAFT which seems to be pushing for a new model of the PA profession (ie: independence).

 

I'm not sure what the future holds for our profession. We were created by physicians, to work WITH and FOR physicians. Physicians groups were active in our early milestones (ie: the National Board of Medical Examiners created and administered the PANCE for a long time). However, as we maintained our subservient positions to the physicians (and enjoyed protection, of a sort, from the physicians), the NP profession has successfully pushed for independent practice.

 

Now we are at a crossroads. Do we keep the current model of physician led teams? Where we work FOR them? That model works, and it works well, if the physician is in charge of healthcare. Unfortunately it sounds like many places, like Kentucky, physicians have been superceeded by bureaucrats.

 

I think it is possible that we can keep going with this very successful model, however it would require the "awakening" of the physician groups. Dr. Ben Carson may be the type of person who could lead this. His speech where he spanked President Obama highlighted the influence of physicians in the political processes in our nation's early years. One way that Doc's could do this is by pushing a new definition of what practicing medicine is, and then requiring a medical license (MD/DO/PA) to practice medicine. This could then subjugate the NP profession to the medical profession, and effectively making NPs into PAs (the way it should be).

 

If they don't do this, then perhaps it is time for the PAFT to push for independence.

 

But, unfortunately, this is not in the best interest of our patients. They are the one's who will suffer.

[Guest Paula]

UGoLong: What do you say in your bitter emails? Do you ever get a response? I'm still waiting for a response from an email I sent two year ago.

[EMEDPA]

PAFT is not pushing for independence per se but for increased autonomy and doing away with terms which harm us in the eyes of our colleagues and our patients.

wouldn't it be nice if instead of articles in the major media saying

"physician assistants require continuous supervision by a physician"(untrue, but believed by 99.9% of docs and patients)

they said "physician associates work in all fields of medicine and do so by law in collaboration with physicians".

which is closer to the truth? which sounds better?

why can't we just say what we do? we practice medicine with physician partners. they are not there 24/7 looking over our shoulders but are available when and if we need them.

do away with these terms and replace them with better ones:

supervision becomes collaboration

midlevel becomes advanced practice clinician

assistant becomes associate.

 

it's all about appearances. words matter. "assistants" require constant oversight and work for someone. "associates" are trusted partners.

I'm not looking for independence, I'm looking for respect. we are the only "assistants" out there who write prescriptions and have such a broad scope of practice. it's time we had a name which reflects what we really do. I would even be ok with "clinical associates". get rid of the word "physician" entirely at the same time we get rid of "assistant". that is what south africa did. their "PAs" are "clinical associates". much better term and less likely to piss anyone off.

http://southafrica.usembassy.gov/pepfar_success_graduates-ar.html

[Boatswain2PA]

E - if the PAFT came out with a position statement that clearly and concisely stated that they were NOT pushing for independence...that clearly stated that PAs must always have some level of physician oversight and supervision, then I would believe it. As the current position statements read I think the PAFT founders are using the name change as a spring board to independent practice which I completely disagree with.

 

Maybe I'm wrong. Paula, what do you say? Should PAs ever be completely independent providers??

 

I would personally rather the AAPA and PAFT join forces with the physician organizations to fight back against the encroachment of the NPs. Again, all they have to do is clearly define what medicine is. If they chose a definition such as "The diagnosing of physical and psychiatric ailments, and the prescribing of medications or performing of procedures to ameliorate these ailments", and then pushed this definition into the 50 state legislators, then the NPs would be dead in the water. They would have to work FOR a doctor to practice.

[bobuddy]

I saw this link to a youtube video posted on the AAPA FB page.

 

I was mortified to say the least.

 

And then there is this link that I posted earlier:

 

In the land of unicorns and puppy dogs, I would say YES to implementing all of the wording changes that define us as PA's that EMED stated above. But then you see a youtube video like the one above and you realize that the docs that we are supposed to be in a partnership/team with - don't even want us........ Yes, I know - one video does not make it so - but geez...... So maybe independence really is the way to go?

[gleannfia]

This is another example of the failure of AAPA to fight against the NP profession. It is these continual failures (real or perceived) that has led to a disillusionment for many PAs of the AAPA...and to the creation of PAFT which seems to be pushing for a new model of the PA profession (ie: independence).

 

I'm not sure what the future holds for our profession. We were created by physicians, to work WITH and FOR physicians. Physicians groups were active in our early milestones (ie: the National Board of Medical Examiners created and administered the PANCE for a long time). However, as we maintained our subservient positions to the physicians (and enjoyed protection, of a sort, from the physicians), the NP profession has successfully pushed for independent practice.

 

Now we are at a crossroads. Do we keep the current model of physician led teams? Where we work FOR them? That model works, and it works well, if the physician is in charge of healthcare. Unfortunately it sounds like many places, like Kentucky, physicians have been superceeded by bureaucrats.

 

I think it is possible that we can keep going with this very successful model, however it would require the "awakening" of the physician groups. Dr. Ben Carson may be the type of person who could lead this. His speech where he spanked President Obama highlighted the influence of physicians in the political processes in our nation's early years. One way that Doc's could do this is by pushing a new definition of what practicing medicine is, and then requiring a medical license (MD/DO/PA) to practice medicine. This could then subjugate the NP profession to the medical profession, and effectively making NPs into PAs (the way it should be).

 

If they don't do this, then perhaps it is time for the PAFT to push for independence.

 

But, unfortunately, this is not in the best interest of our patients. They are the one's who will suffer.

Your ideas are great, but as a conservative, Dr. Ben Carson may not be an advocate for PAs. But I could be dead wrong.

[rev ronin]

Your ideas are great, but as a conservative, Dr. Ben Carson may not be an advocate for the AAPA. But I could be dead wrong.

Fixed that for you.

[Boatswain2PA]

Your ideas are great, but as a conservative, Dr. Ben Carson may not be an advocate for PAs. But I could be dead wrong.

 

Why in the WORLD would you think that being conservative would preclude someone from advocating for PAs?

[UGoLong]

Paula,

 

I sent a note to Ann Davis at AAPA and she wrote back. I met with her briefly in DC in May. Got more to do though and I wrote back to her over the weekend.

[gleannfia]

Why in the WORLD would you think that being conservative would preclude someone from advocating for PAs?

 

I dunno. Maybe because many conservative like the status quo, and even like to harken back to the 1950's. Maybe because most physicians who are conservative politically are NOT big PA advocates. Just my experience. But I remain open to the possibility that I am wrong. I am all for finding our advocates where we may. Contact Dr. Carson and let us know his position. IF I am wrong, I will be the first to acknowledge it.

[Boatswain2PA]

I dunno. Maybe because many conservative like the status quo, and even like to harken back to the 1950's. Maybe because most physicians who are conservative politically are NOT big PA advocates. Just my experience. But I remain open to the possibility that I am wrong. I am all for finding our advocates where we may. Contact Dr. Carson and let us know his position. IF I am wrong, I will be the first to acknowledge it.

 

I am not going to bother the good Doctor to ask his opinion. However, you may want to look at who received the PARAGON award from the AAPA. Yup, you guessed, it...Dr. Ben Carson AND HIS PA!!

 

Of course, the AAPA totally whimped out and asked him not to come and personally receive the award because HE was conservative.

 

Perhaps you should reconsider which comes first....conservative Doc's not liking the AAPA, or the AAPA not liking conservative Doc's.

[Guest KRJames]

I saw this link to a youtube video posted on the AAPA FB page.

 

I was mortified to say the least.

 

And then there is this link that I posted earlier:

 

In the land of unicorns and puppy dogs, I would say YES to implementing all of the wording changes that define us as PA's that EMED stated above. But then you see a youtube video like the one above and you realize that the docs that we are supposed to be in a partnership/team with - don't even want us........ Yes, I know - one video does not make it so - but geez...... So maybe independence really is the way to go?

 

How exactly was that video demoralizing? He said both were respected professions. He only said that typically NPs have had more years of clinical experience working their way up the ranks as a nurse. PA schools are now putting emphasis, and sometimes requirements, on direct patient care experience. I would feel confident in getting a position with "this one" doctor you are basing your feelings on.

[lmccary31]

My friend that does the credentialing is the one that tells me about the reimbursement rates. Her job is to set up the new providers and negotiate with the insurance companies to set the contract rates/reimbursements. She told me in last 6 months, she has been getting NP's equal contract rates from the insurance companies. She would have no reason to tell me otherwise. This tibit of information came up with my recent conversation with her regarding me going back to school.

 

The problem with me leaving the state is my elderly parents/grandmother - and the fact that my husband is 51 and has been at his job for 30 years. If he lost his job tomorrow I could see leaving - but to ask him to leave a good paying job in this economy where there are many 50+ year old people that were "downsized" out of their jobs now working at the local walmart - well, I just cant do it.

 

Paula - If I were even 10 years younger I would go to medical school. I have been going through the MCAT prep information (keeping options open) and re-learning everything that I knew 20 years ago in undergrad ( geez - the thought of organic chemistry makes me sweat even 20 years later) seems overwhelming. And, yes, I took the first year of med school for the PhD - but I would not want credit for it now - since I would need to re-learn it again anyways for the USMLE step 1 exams. It is the small details that you dont use everyday that have long left my brain. :)

 

As far as the bickering between the MD's and the NP's - they can bicker all they want -but the reality in KY (and obviously other states as well) the NP's are winning the fight. But the bigger issue I am seeing locally is the independent docs that say they would hire us instead of NP's - well they have already sold out to the hospitals and mega medical centers. They now are just an employee like the rest of us - with no say so in what happens or who they hire. The independent practices are falling like dominoes - with a few left in Louisville, and a few left in Lexington. I don't know about the Cinci area but I would assume it would be similar? What does everyone else see? Is this happening in your state too?

 

I am active in the KAPA organization - along with the two PA friends that lost their jobs this year (that are now pharmaceutical reps). They were both HEAVILY involved in KAPA - and worked very hard this past year to get a bill passed that took away our 18 month onsite supervision (after 10 years of fighting this). I hope they will continue to help KAPA even though they are not currently working as PA's. Guess who was our biggest opponent to our bill to remove the supervision? Yep - our lovely KMA and KBML. Instead of standing with us and supporting us - they took every opportunity, and then some, to keep us in our place. I got a first hand backstage view of the kind of kindergarten playground politics that are being played out in Frankfort and it was sickening. If the KMA had put as much energy into the concept of a MD/PA team as they did to fight us - we might be in a different spot. Meanwhile, while they were fighting us - the NP bill danced right behind them.

 

You live on the wrong side of the state. I live in Paducah and PAs flourish here. If you look at the orthopaedic institute if western kentucky you will see that every MD has 1 or 2 PAs. Matter of fact they are hiring 2 more. The urgent care center downstairs is run by a PA exclusively. The hospital in Mayfield is hiring an ER PA and Baptist Health and Lourdes have plenty of providers that need PAs. Your situation sucks and its up to you to do what you want with it. You could easily move across state and find a higher paying job immediately or get in debt and go be a NP.

[FSUnoles]

I think this highlights one of weaknesses of our job. If your market is saturated or overrun by NPs if you want a quality paying job you have to relocate. I think if you have the ability to move you can find a good paying job. Its being tied down geographically that hurts. But this is the same for specializing docs out of their residency they can't just set up shop in a major metropolitan area without competition

 

Sent from my Nexus 4 using Tapatalk 4

[gleannfia]

I am not going to bother the good Doctor to ask his opinion. However, you may want to look at who received the PARAGON award from the AAPA. Yup, you guessed, it...Dr. Ben Carson AND HIS PA!!

 

Of course, the AAPA totally whimped out and asked him not to come and personally receive the award because HE was conservative.

 

Perhaps you should reconsider which comes first....conservative Doc's not liking the AAPA, or the AAPA not liking conservative Doc's.

 

 

Wow, I am impressed. Since I have very little use for the AAPA, and consider the dues a waste of money, I was totally unaware of this. Politics aside, I will say it again: I am happy to find our advocates where we may.:=D:

[FSUnoles]

this strikes a cord as one of my classmates just lost a job because according to the office their EMR incentive program only allows Drs and NPs to qualify. Has anyone heard of anyone losing a opportunity due to this requirement?

 

http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/index.html?redirect=/ehrincentiveprograms/

 

"Physician assistant who furnishes services in a Federally Qualified Health Center of Rural Health Clinic that is led by a physician assistant."

 

[Joelseff]

this strikes a cord as one of my classmates just lost a job because according to the office their EMR incentive program only allows Drs and NPs to qualify. Has anyone heard of anyone losing a opportunity due to this requirement?

 

http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/index.html?redirect=/ehrincentiveprograms/

 

"Physician assistant who furnishes services in a Federally Qualified Health Center of Rural Health Clinic that is led by a physician assistant."

 

 

Yah the facility can't get the EMR incentives off of a PA so they will go with a NP who does not have theses restrictions. It's 50k that they can lose.

 

Sent from my myTouch_4G_Slide using Tapatalk 2

[EMEDPA]

E - if the PAFT came out with a position statement that clearly and concisely stated that they were NOT pushing for independence...that clearly stated that PAs must always have some level of physician oversight and supervision, then I would believe it. As the current position statements read I think the PAFT founders are using the name change as a spring board to independent practice which I completely disagree with.

 

Maybe I'm wrong. Paula, what do you say? Should PAs ever be completely independent providers??

 

I would personally rather the AAPA and PAFT join forces with the physician organizations to fight back against the encroachment of the NPs. Again, all they have to do is clearly define what medicine is. If they chose a definition such as "The diagnosing of physical and psychiatric ailments, and the prescribing of medications or performing of procedures to ameliorate these ailments", and then pushed this definition into the 50 state legislators, then the NPs would be dead in the water. They would have to work FOR a doctor to practice.

 

I just spoke with several PAFT board members and they confirmed that independence is not part of their agenda.

they want to do away with terms which miscategorize us and allow us to work to our fullest potential with physician collaboration.

see here:

http://www.pasfortomorrow.org/Default.aspx?pageId=1577685

specifically #2:

2. The PA is an autonomous medical care provider that is both a team member and team player. The PA collaborates with physicians and also other healthcare professionals whenever appropriate and the PA is responsible for the medical care the PA provides.

[bobuddy]

I just spoke with several PAFT board members and they confirmed that independence is not part of their agenda.

they want to do away with terms which miscategorize us and allow us to work to our fullest potential with physician collaboration.

see here:

http://www.pasfortomorrow.org/Default.aspx?pageId=1577685

specifically #2:

2. The PA is an autonomous medical care provider that is both a team member and team player. The PA collaborates with physicians and also other healthcare professionals whenever appropriate and the PA is responsible for the medical care the PA provides.

 

EMEDPA -

 

The bolding is mine - that portion of the sentence bothers me. Would this ever possibly include collaboration with the NP's - since they are (currently in most states) independent providers? I see a potential slippery slope. But may be over reacting to it also.