Reality check needed

[EMEDPA]

nope. PAFT is against PAs working under NP's or being supervised by them. read "collaboration" in this instance as "works with " or "refers to".

if, for example it is in a pts best interest to be seen by a podiatrist then the pa would refer the pt to a podiatrist.

[ventana]

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."

 

 

 

 

old news.......

 

 

ahhhheemmmmm AAPA is all over it and it will get changed sometime around 2020 - course all the money runs out in 2018 (or something like that) {VERY SARCASTIC FONT}

 

Seriously, this was a HUGE screw up for the AAPA. Yes I have heard NP getting hired over PA for the reason of the TENS OF THOUSANDS of dollars that an NP can get for EMR!!!

 

CRAZY stupid that AAPA let this get through - honestly I feel the entire management team should have been replaced due to this error - but ... well..... they work for themselves not us!

 

How about the ability to PA's to provide federal occ health, or to provide Hospice care (NP's have been doing this for years), or to order VNA services, or to bill directly, or even to be able to sign a script in some states......

 

 

AAPA is a joke, they have little tiny victories here and there and make themselves out to be the PA savior, but they are not. They are in fact becoming an enemy with errors and omissions like this.

 

Personally I have started my own practice, I have to attest to meaningful use to not get penalized so I am 100% sure that I would have gotten the incentive money - so the AAPA's oversight cost me almost $50,000!! way to go AAPA

[Guest Paula]

old news.......

 

 

ahhhheemmmmm AAPA is all over it and it will get changed sometime around 2020 - course all the money runs out in 2018 (or something like that) {VERY SARCASTIC FONT}

 

Seriously, this was a HUGE screw up for the AAPA. Yes I have heard NP getting hired over PA for the reason of the TENS OF THOUSANDS of dollars that an NP can get for EMR!!!

 

CRAZY stupid that AAPA let this get through - honestly I feel the entire management team should have been replaced due to this error - but ... well..... they work for themselves not us!

 

How about the ability to PA's to provide federal occ health, or to provide Hospice care (NP's have been doing this for years), or to order VNA services, or to bill directly, or even to be able to sign a script in some states......

 

 

AAPA is a joke, they have little tiny victories here and there and make themselves out to be the PA savior, but they are not. They are in fact becoming an enemy with errors and omissions like this.

 

Personally I have started my own practice, I have to attest to meaningful use to not get penalized so I am 100% sure that I would have gotten the incentive money - so the AAPA's oversight cost me almost $50,000!! way to go AAPA

 

This is the reason I wrote a letter to AAPA two years ago and am still waiting for a response. It was the straw that broke the camels back for me and why I did not renew my AAPA membership. This issue hits me too being in a FQHC and since I don't lead the center (we have a full-time physician on staff) I still don't qualify. But guess what? They want ME to be the meaningful use coordinator! Since my clinic is just getting on board with EHR we have not yet gotten any incentives yet. Why or why did the AAPA have their heads in the sand on this one? It was pure ineptness and incompetence. They tried to get it fixed and the fix is still unacceptable.

[Guest Paula]

Regarding independence: My personal belief is that PAs are capable of becoming "independent" providers that work within their scope of practice. We are capable to forming our own PA boards of medicine. I like to think of us as the same as the Optometrist profession who had to also fight medical boards and states to attain independent practices and gain recognition for being professional providers of eye care. Their history is interesting.

 

I also agree with removing the words supervision, dependent practitioners, dependence and the term assistant. ONe reason for wanting PAs to have an independent license is so that PAs who work in rural and underserved areas will not lose their jobs if the sole physician leaves the practice and their is no other physician to take the place. As in my case......I work with one MD...would immediately lose my ability to practice if he left, got fired...etc. 3,000 patients would then be out of access to medical care.

 

Do I think PAs can practice independently immediately out of school? NO. We (and NPs) need mentors and physicians to come alongside us and collaborate with us for a few years. Why not have graduated autonomy/independence as far as licensing goes? Those that attain a residency for primary care and pass an autonomous/independent licensing exam can then practice in rural areas without an MD..... Maybe the surgical PAs want to be dependent and that's ok. They are different than those of us who work in PC and medical/IM specialties.

 

I am not saying that anyone should work in a silo. We all as medical practitioners have an obligation to our patients to practice in collaboration with other health care professionals including physicians. I would call this idea a medical ethic and is something that should be in our practice laws. We all need feedback and accountability for our practices.

[Guest JMPA]

Regarding independence: My personal belief is that PAs are capable of becoming "independent" providers that work within their scope of practice. We are capable to forming our own PA boards of medicine. I like to think of us as the same as the Optometrist profession who had to also fight medical boards and states to attain independent practices and gain recognition for being professional providers of eye care. Their history is interesting.

 

I also agree with removing the words supervision, dependent practitioners, dependence and the term assistant. ONe reason for wanting PAs to have an independent license is so that PAs who work in rural and underserved areas will not lose their jobs if the sole physician leaves the practice and their is no other physician to take the place. As in my case......I work with one MD...would immediately lose my ability to practice if he left, got fired...etc. 3,000 patients would then be out of access to medical care.

 

Do I think PAs can practice independently immediately out of school? NO. We (and NPs) need mentors and physicians to come alongside us and collaborate with us for a few years. Why not have graduated autonomy/independence as far as licensing goes? Those that attain a residency for primary care and pass an autonomous/independent licensing exam can then practice in rural areas without an MD..... Maybe the surgical PAs want to be dependent and that's ok. They are different than those of us who work in PC and medical/IM specialties.

I am not saying that anyone should work in a silo. We all as medical practitioners have an obligation to our patients to practice in collaboration with other health care professionals including physicians. I would call this idea a medical ethic and is something that should be in our practice laws. We all need feedback and accountability for our practices.

 

mds dont practice immediately out of school, they have to finish their residency. and yes i totally agree with you, why cant we use our on the job work experience to open doors for independence, not for fresh out of school but with several years practicing in the field of choice, but no instead we get a caq that does nothing for independence and increases un necessary testing/expense/ wasted time ect...

[pct2010]

So where does the solution lie from here? Naturally the goals of PAFT are admirable but how exactly does the profession move forward when it's 100% under the thumb of the physicians? It's apparent that physicians don't advocate for the common interest of the supposed MD/PA team or the name change issue wouldn't have ruffled so many feathers. Is it possible that the new patient load with the affordable care act will force changes in loosening depenence and/or allow PAs to correctly market the name/role of the profession? My cocern as a future PA lies in the fact that all of the training/certs/clinical opportunites will be meaningless if the public still percieves PAs as uanble to do anything without an MD peeking over their shoulder and insurance companies see PAs as a billing afterthought. I'm applying this cycle and once I'm in school I'd really like to make sure that, in my class at least, my fellow students are aware of the devil in the details nonsense that's creeped up over the past few years.

[EMEDPA]

sam2010- join PAFT now as a student at a much lower rate. we need every member. we are already starting to make waves and influence the direction the PA discussion is headed on the national stage.

[ventana]

sam2010- join paft now as a student at a much lower rate. We need every member. We are already starting to make waves and influence the direction the pa discussion is headed on the national stage.

 

 

 

 

yes yes yes!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

 

Join!!!!!!!!!!!!!!!!!!!!!!!!!!

[Boatswain2PA]

Paula do you have an official position with PAFT?

 

E - I've read the PAFT positions. Nowhere does it explicitly say that we work "for" docs. PAFT is using the same language as NPs (ie: "collaboration"), and that term is leading to independent practice. If PAFT would clearly state that board certified physicians are the pinnacle position in medicine and should be ultimately responsible for patient care, then I will get on board with them.

[gleannfia]

Regarding independence: My personal belief is that PAs are capable of becoming "independent" providers that work within their scope of practice. We are capable to forming our own PA boards of medicine. I like to think of us as the same as the Optometrist profession who had to also fight medical boards and states to attain independent practices and gain recognition for being professional providers of eye care. Their history is interesting.

 

I also agree with removing the words supervision, dependent practitioners, dependence and the term assistant. ONe reason for wanting PAs to have an independent license is so that PAs who work in rural and underserved areas will not lose their jobs if the sole physician leaves the practice and their is no other physician to take the place. As in my case......I work with one MD...would immediately lose my ability to practice if he left, got fired...etc. 3,000 patients would then be out of access to medical care.

 

Do I think PAs can practice independently immediately out of school? NO. We (and NPs) need mentors and physicians to come alongside us and collaborate with us for a few years. Why not have graduated autonomy/independence as far as licensing goes? Those that attain a residency for primary care and pass an autonomous/independent licensing exam can then practice in rural areas without an MD..... Maybe the surgical PAs want to be dependent and that's ok. They are different than those of us who work in PC and medical/IM specialties.

 

I am not saying that anyone should work in a silo. We all as medical practitioners have an obligation to our patients to practice in collaboration with other health care professionals including physicians. I would call this idea a medical ethic and is something that should be in our practice laws. We all need feedback and accountability for our practices.

 

 

No offense to surgical PAs. But we really don't want them to lead the way on this sort of thing. SAs were the original pioneers here in Ohio in the 70s and 80s, and we are STILL paying for it in 2013 in terms of horrible practice/RX laws.

[dhageremtp]

I feel for you. It has been said that many docs love PAs and prefer PA to NPs. Here in North Dakota NPs are free to set up shop. Without the regulatory oversight of an MD like a PA needs to have. We in ND have an advanced PA practice and have worked hard to have many "old" rules updated to our practices., however with that being said, there are many facilities that will hire an NP over a PA just because they do not require MD oversight. In these small facilities that are having a harder time recruiting MDs adding the supervision of a PA is thought to add more to the workload of the Doc so if they hire an NP there is no "burden" to them. I had applied to a larger hospital a few miles down the road for a job and got back an email saying their policy is to hire NPs only. The squeeze is out there in many places.

[Guest Paula]

Paula do you have an official position with PAFT?

 

E - I've read the PAFT positions. Nowhere does it explicitly say that we work "for" docs. PAFT is using the same language as NPs (ie: "collaboration"), and that term is leading to independent practice. If PAFT would clearly state that board certified physicians are the pinnacle position in medicine and should be ultimately responsible for patient care, then I will get on board with them.

 

Yes, I have an official position with PAFT as a director at large. I do not see PAFT stating that board certified physicians are the pinnacle position in medicine and should be ultimately responsible for patient care. You need to join AAPA, not PAFT.

[Guest Paula]

As far as the surgical PAs: If they want to remain dependent they can and stay as Physician Assistants and the rest of us can become Physician Associates (or some other terminology like Licensed Medical Practitioner). PAs in primary care need to lead the way for collaboration/autonomy/independence.

[Guest Paula]

I feel for you. It has been said that many docs love PAs and prefer PA to NPs. Here in North Dakota NPs are free to set up shop. Without the regulatory oversight of an MD like a PA needs to have. We in ND have an advanced PA practice and have worked hard to have many "old" rules updated to our practices., however with that being said, there are many facilities that will hire an NP over a PA just because they do not require MD oversight. In these small facilities that are having a harder time recruiting MDs adding the supervision of a PA is thought to add more to the workload of the Doc so if they hire an NP there is no "burden" to them. I had applied to a larger hospital a few miles down the road for a job and got back an email saying their policy is to hire NPs only. The squeeze is out there in many places.

 

Send a copy of that email to AAPA. They don't believe us when we say NPs are preferred over PAs because of our poor practice laws and dependent nature of our profession. Ask them how to correct the problem and ask them for a differential diagnoses on why hospitals put policies in place that favor NPs. Let us know what they say. (and how many years it takes for them to respond):;;D:

[gleannfia]

As far as the surgical PAs: If they want to remain dependent they can and stay as Physician Assistants and the rest of us can become Physician Associates (or some other terminology like Licensed Medical Practitioner). PAs in primary care need to lead the way for collaboration/autonomy/independence.

 

Agreed, Paula, and thank you for all of your work! How do I join PAFT?

[Boatswain2PA]

As far as the surgical PAs: If they want to remain dependent they can and stay as Physician Assistants and the rest of us can become Physician Associates (or some other terminology like Licensed Medical Practitioner). PAs in primary care need to lead the way for collaboration/autonomy/independence.

 

E- Are you sure PAFT isn't pushing for independence?

 

Paula - Neither the AAPA nor the PAFT represent my interests. One is too busy being politically correct (being nice to the nursing mafia and castigating anyone with a conservative opinion) to represent me, the other is trying to not only change the name of the profession (no big deal, and I actually kind of support it), but also to fundamentally change the profession in a way that will be detrimental to our patients.

 

The organization that represents me, and supports my efforts, is SEMPA. They are teaming WITH physician organizations to make emergency medicine better for us and, more importantly, for our patients.

[LT_Oneal_PAC]

Yes, I have an official position with PAFT as a director at large. I do not see PAFT stating that board certified physicians are the pinnacle position in medicine and should be ultimately responsible for patient care. You need to join AAPA, not PAFT.

 

As far as the surgical PAs: If they want to remain dependent they can and stay as Physician Assistants and the rest of us can become Physician Associates (or some other terminology like Licensed Medical Practitioner). PAs in primary care need to lead the way for collaboration/autonomy/independence.

 

Excellent posts as always, Paula.

 

Agreed, Paula, and thank you for all of your work! How do I join PAFT?

 

Go to http://www.pasfortomorrow.com. PAFT is doing a lot of exciting things.

 

E- Are you sure PAFT isn't pushing for independence?

 

Paula - Neither the AAPA nor the PAFT represent my interests. One is too busy being politically correct (being nice to the nursing mafia and castigating anyone with a conservative opinion) to represent me, the other is trying to not only change the name of the profession (no big deal, and I actually kind of support it), but also to fundamentally change the profession in a way that will be detrimental to our patients.

 

They aren't pushing for independence.

Aren't (or weren't depending on your definition) you a new grad in solo ER? Some may say that is detrimental to patients. I'm not saying that as it seems you are handling it well and I'm sure you are collaborating with those of higher experience.

[bobuddy]

As far as the surgical PAs: If they want to remain dependent they can and stay as Physician Assistants and the rest of us can become Physician Associates (or some other terminology like Licensed Medical Practitioner). PAs in primary care need to lead the way for collaboration/autonomy/independence.

 

I see autonomy/independence as the only way to go. The NP squeeze seems to be a growing concern in many states. One of the standard comments/answers to the NP squeeze is to leave the state and go where PA's are valued. Now, here lies the next issue. New PA schools are opening left and right. KY is pumping out approximately 150 (best guess) new PA's every year - with no where to go. Now we are coming to your state to compete for your jobs. Now the job market in your area gets tight and the salaries start dropping.

 

In my area hospitals, they are firing their ADN's and replacing them with only BSN's. The older seasoned ADN's now have no where to go - but back to school to get their degree and compete for the same jobs as the newly graduated BSN's. Of course, the new BSN's are cheaper to employ. If we don't fight for and win our independence, I am afraid the PA profession will go the way of the ADN with NP's replacing us. Seems to be happening already in many areas.

[Boatswain2PA]

They aren't pushing for independence.

Aren't (or weren't depending on your definition) you a new grad in solo ER? Some may say that is detrimental to patients. I'm not saying that as it seems you are handling it well and I'm sure you are collaborating with those of higher experience.

 

They may not be overtly pushing for independence, but I see nothing in their statements about maintaining a physician led medical team. They are using the "collaboration" term which the NPs are leveraging into independent practice, and then we have the Director at Large saying that (primary care) PAs need to "lead the way in collaboration/autonomy/independence". All of those things make me think that PAFT is out for independent practice.

 

Yes, I am a new grad in a solo ER. And yes, some say that can be detrimental to patients. Yes, I collaborate with my physicians/PAs/nurses/techs/janitors/bureaucrats. However I have an attending who I work FOR. That attending has some level of responsibility for the care that I give. That level of responsibility ensures that attending stays involved in what I do.

 

This is one of the foundational constructs of our profession when it was started almost 50 years ago. Do we, with our 6-7 years of education, really want to hold ourselves as equal to physicians with 11-15 years of education, which includes that all-important 3-5 year residency? I understand it is frustrating to have our political a$$es handed to us by the nursing mafia every time you read the legislative changes, but that doesn't mean we should push for independence.

[EMEDPA]

E- Are you sure PAFT isn't pushing for independence?

 

yup. there is a difference between independence and stopping the practice of kissing docs' backsides at every opportunity and telling them how cool they are.

I'm ok with working with docs. I'm not ok with being micromanaged.

[gleannfia]

yup. there is a difference between independence and stopping the practice of kissing docs' backsides at every opportunity and telling them how cool they are.

I'm ok with working with docs. I'm not ok with being micromanaged.

After 26 years as a PA, neither am I!

[LT_Oneal_PAC]

They may not be overtly pushing for independence, but I see nothing in their statements about maintaining a physician led medical team. They are using the "collaboration" term which the NPs are leveraging into independent practice, and then we have the Director at Large saying that (primary care) PAs need to "lead the way in collaboration/autonomy/independence". All of those things make me think that PAFT is out for independent practice.

 

Yes, I am a new grad in a solo ER. And yes, some say that can be detrimental to patients. Yes, I collaborate with my physicians/PAs/nurses/techs/janitors/bureaucrats. However I have an attending who I work FOR. That attending has some level of responsibility for the care that I give. That level of responsibility ensures that attending stays involved in what I do.

 

This is one of the foundational constructs of our profession when it was started almost 50 years ago. Do we, with our 6-7 years of education, really want to hold ourselves as equal to physicians with 11-15 years of education, which includes that all-important 3-5 year residency? I understand it is frustrating to have our political a$$es handed to us by the nursing mafia every time you read the legislative changes, but that doesn't mean we should push for independence.

 

Well that is your opinion and isn't the opinion of PAFT or its many members. We are obviously at an impasse, so just continue on supporting your thing. The rest of us shall march on.

[Boatswain2PA]

yup. there is a difference between independence and stopping the practice of kissing docs' backsides at every opportunity and telling them how cool they are.

I'm ok with working with docs. I'm not ok with being micromanaged.

 

How do you align your belief that PAFT isn't pushing for independent practice with the Director at Large's statement that (at least Primary Care) PAs should lead the way in things such as independence??

 

Micromanagement is now a way of life in the American workforce due to the data-collecting/collating ability of the modern computer. You will never get away from it again. If you work for a hospital system, as your supervising physician if they feel micromanaged.

 

And the only a$$es I kiss are the one's who have proven to me they deserve it.

[Boatswain2PA]

Well that is your opinion and isn't the opinion of PAFT or its many members. We are obviously at an impasse, so just continue on supporting your thing. The rest of us shall march on.

 

Are you sure it's not the opinion of PAFT? We have the Director at Large here who seems to say otherwise.

[LT_Oneal_PAC]

Are you sure it's not the opinion of PAFT? We have the Director at Large here who seems to say otherwise.

 

As I'm close with several on the board, I know it's not currently on the agenda. Maybe one day, but it will be with stipulations such as residencies, testing, ect. No one is advocating for new grads to be independent.