Reality check needed

[EMEDPA]

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??

 

.

I have spoken with every member of the PAFT board at some point. they are not for independence but better autonomy and scope of practice with fewer legislative restrictions.

we may have to agree to disagree on this one my friend.

[Boatswain2PA]

We're not disagreeing E., I'm just trying to figure out what their actual position is. Some who are affiliated with PAFT say no to independence (you?), some say "maybe sometime in the future" (O'neal), and others say primary care PA's need to lead the way to independence (Paula). Meanwhile they have no firm language in their position statements to clarify the organization's goals on this matter.

[physasst]

I have spoken with every member of the PAFT board at some point. they are not for independence but better autonomy and scope of practice with fewer legislative restrictions.

we may have to agree to disagree on this one my friend.

 

Yeah, I'm on the board of advisors of PAFT, and I don't recall anyone pushing independence in practice. I support independence in the sense of PA professional self determination. Allowing physicians to dictate how our profession advances or changes indicates that we don't have a profession. A profession determines it's own course. A profession is not beholden to another one.

 

FWIW, I don't think of physicians as the end all be all of medicine. They are wrong too. I have my own spine panel. Guess what, EVERY SINGLE patient I have is referred, they have to be. You don't get to see me as a self referral. Maybe 10% of my patients are referred by PAs or NPs, the rest are all referred to me by physicians. Most of the time because they don't know what to do, or they want my advice.

 

My physician colleagues do not treat me as a subordinate.

 

Mike

[EMEDPA]

My physician colleagues do not treat me as a subordinate.

 

Mike

That is true at 2 out of 3 of my jobs. working on the third.

[Gordon, PA-C]

Yeah, I'm on the board of advisors of PAFT, and I don't recall anyone pushing independence in practice. I support independence in the sense of PA professional self determination. Allowing physicians to dictate how our profession advances or changes indicates that we don't have a profession. A profession determines it's own course. A profession is not beholden to another one.

 

FWIW, I don't think of physicians as the end all be all of medicine. They are wrong too. I have my own spine panel. Guess what, EVERY SINGLE patient I have is referred, they have to be. You don't get to see me as a self referral. Maybe 10% of my patients are referred by PAs or NPs, the rest are all referred to me by physicians. Most of the time because they don't know what to do, or they want my advice.

 

My physician colleagues do not treat me as a subordinate.

 

Mike

 

So why arent you going to them and complaining about making HALF of what they get? This is what doesnt make any sense.

[Guest Paula]

We're not disagreeing E., I'm just trying to figure out what their actual position is. Some who are affiliated with PAFT say no to independence (you?), some say "maybe sometime in the future" (O'neal), and others say primary care PA's need to lead the way to independence (Paula). Meanwhile they have no firm language in their position statements to clarify the organization's goals on this matter.

 

It's time for me to weigh in. PAs should be responsible for what we do. Many physicians don't want the responsibility of a PA and will hire an NP because they don't need "supervision". This is a reality and possibly wrong perception of the physicians regarding NPs. PAs need self-governance and not another profession telling us what we can and cannot do. The struggle of the PA profession is similar to the struggle of the optometrists. The ODs had to fight for every right they have including prescription privileges and the level charged at them was "If you want to be a doctor, go to med school, and become an ophthalmologist." BUt the OD realized they were a PROFESSION and did not succumb to the attempts of the medical boards to be under them. Hence they were successful in developing their own optometry boards, certifications, monitoring,etc. It has taken them 100 years and they are now recognized as their own profession.......as eye care professionals. They fought every level and became recognized within the government (VA system for example) and CMS. It was not without blood, sweat and tears.

 

The word independence is now the "black list" word and makes physicians quake. So, I (personally) am all for PAs being responsible for the care they provide, want my own PA board of medicine, want my job to be secure if my SP dies or leaves the practice, want PA jobs to be preserved and not have the NPs get preference over us. I want my DEA license to be my own, my PA license to be my own and not linked to another person or facility. And I want to work within my scope of practice (like the ODs who do not go outside their scope). This is about professionalism and medical ethics of how we conduct ourselves as PAs. Any rogue PAs who think they can do brain surgery will soon find themselves in trouble.....by their own board and will lose their license. Graduated supervised practices for five years......sure, why not....then complete responsibility.

 

To Boatswain: Last night at our PAFT board meeting one individual stated that at the last SEMPA meeting there was a discussion by physicians if PAs could practice "independently" in the ED. One of the leaders said that many PAs with experience were completely competent to run and manage an ED and were just as good as the ED physicians. Others (especially new grads..Pas and NPs) are not ready to be able to work without supervision. I worked in ED/UC for approximately five years as a locum and as an employee. I liked having the physicians nearby and realized this is one area of medicine where "total independence" is not feasible at the outset of a new PA/NP. I get your point.

 

I also agree with physst point of view. PAs need a profession that is recognized as a profession that can stand alone and on its own two feet. We can do it. There are creative ways for us to be our own profession.....not one that is dictated to by another profession.

[bobuddy]

It's time for me to weigh in. PAs should be responsible for what we do. Many physicians don't want the responsibility of a PA and will hire an NP because they don't need "supervision". This is a reality and possibly wrong perception of the physicians regarding NPs. PAs need self-governance and not another profession telling us what we can and cannot do. The struggle of the PA profession is similar to the struggle of the optometrists. The ODs had to fight for every right they have including prescription privileges and the level charged at them was "If you want to be a doctor, go to med school, and become an ophthalmologist." BUt the OD realized they were a PROFESSION and did not succumb to the attempts of the medical boards to be under them. Hence they were successful in developing their own optometry boards, certifications, monitoring,etc. It has taken them 100 years and they are now recognized as their own profession.......as eye care professionals. They fought every level and became recognized within the government (VA system for example) and CMS. It was not without blood, sweat and tears.

 

The word independence is now the "black list" word and makes physicians quake. So, I (personally) am all for PAs being responsible for the care they provide, want my own PA board of medicine, want my job to be secure if my SP dies or leaves the practice, want PA jobs to be preserved and not have the NPs get preference over us. I want my DEA license to be my own, my PA license to be my own and not linked to another person or facility. And I want to work within my scope of practice (like the ODs who do not go outside their scope). This is about professionalism and medical ethics of how we conduct ourselves as PAs. Any rogue PAs who think they can do brain surgery will soon find themselves in trouble.....by their own board and will lose their license. Graduated supervised practices for five years......sure, why not....then complete responsibility.

 

To Boatswain: Last night at our PAFT board meeting one individual stated that at the last SEMPA meeting there was a discussion by physicians if PAs could practice "independently" in the ED. One of the leaders said that many PAs with experience were completely competent to run and manage an ED and were just as good as the ED physicians. Others (especially new grads..Pas and NPs) are not ready to be able to work without supervision. I worked in ED/UC for approximately five years as a locum and as an employee. I liked having the physicians nearby and realized this is one area of medicine where "total independence" is not feasible at the outset of a new PA/NP. I get your point.

 

I also agree with physst point of view. PAs need a profession that is recognized as a profession that can stand alone and on its own two feet. We can do it. There are creative ways for us to be our own profession.....not one that is dictated to by another profession.

 

I stand with Paula's views on this. However, I am not sure that PA's have the luxury of time to make this happen. One advantage that the optometrists had - there was not a profession that was directly competing for their jobs already (besides the medical school trained Opthamologist) - that already had the scope of practice that they were fighting for. PA's do - they are the NP's.

 

 

For this reason, I think we still should seriously consider somehow joining forces with them. It is the whole - "keep your friends close and your enemies closer" thought. The way I see it - we have what they want - better education with medical training (my viewpoint only) instead of fluffy nursing theory classes. But they have what WE NEED - autonomy.

[Joelseff]

I stand with Paula's views on this. However, I am not sure that PA's have the luxury of time to make this happen. One advantage that the optometrists had - there was not a profession that was directly competing for their jobs already (besides the medical school trained Opthamologist) - that already had the scope of practice that they were fighting for. PA's do - they are the NP's.

 

 

For this reason, I think we still should seriously consider somehow joining forces with them. It is the whole - "keep your friends close and your enemies closer" thought. The way I see it - we have what they want - better education with medical training (my viewpoint only) instead of fluffy nursing theory classes. But they have what WE NEED - autonomy.

 

Problem is, I don't see the NPs reaching out to us and their leadership seems intent on wiping us out. If you look at it from their point of view, what benefit would there be for THEM, should we join forces...

 

Sent from my myTouch_4G_Slide using Tapatalk 2

[bobuddy]

Problem is, I don't see the NPs reaching out to us and their leadership seems intent on wiping us out. If you look at it from their point of view, what benefit would there be for THEM, should we join forces...

 

Sent from my myTouch_4G_Slide using Tapatalk 2

 

I do see your point. I think the only benefit would be for the NP's to say they are now being better trained - but only IF the NP/PA schools joined forces to produce an "Advanced Practice Provider". These students would be trained like a PA is now instead of the nursing theory fluff. However, the NP's have long used the excuse that they are not practicing medicine per se - they are practicing nursing. So maybe we as PA's have nothing they want or need.

[Joelseff]

I do see your point. I think the only benefit would be for the NP's to say they are now being better trained - but only IF the NP/PA schools joined forces to produce an "Advanced Practice Provider". These students would be trained like a PA is now instead of the nursing theory fluff. However, the NP's have long used the excuse that they are not practicing medicine per se - they are practicing nursing. So maybe we as PA's have nothing they want or need.

 

If they wanted the claim of better training in medicine they would be subject to the medical body and that would be their downfall.

 

ETA: Frankly if we join forces with NPs we will alienate the Docs (some may argue this is not such a bad thing). I don't have the answer but PAs need to do something. If it starts becoming common practice to pass us up for jobs and give them to NPs because of perceived less liability and possibility of government subsidies (Meaningful Use etc.), we can be perceived as obsolete or worse, a perceived liability to a Doc.

 

Another problem with our dependent status. If a Doc dies, we are screwed. One of my classmates from PA school had this happen earlier this year. Her SP was killed in an accident. SHe was fortunately picked up by another surgeon in the practice but is #2 to the PA he already has. What if this happened to me with just one Doc? I would be out of work and I can't treat my panel or his patients. Thats a lose-lose.

 

Sent from my myTouch_4G_Slide using Tapatalk 2

[Guest Paula]

I stand with Paula's views on this. However, I am not sure that PA's have the luxury of time to make this happen. One advantage that the optometrists had - there was not a profession that was directly competing for their jobs already (besides the medical school trained Opthamologist) - that already had the scope of practice that they were fighting for. PA's do - they are the NP's.

 

 

For this reason, I think we still should seriously consider somehow joining forces with them. It is the whole - "keep your friends close and your enemies closer" thought. The way I see it - we have what they want - better education with medical training (my viewpoint only) instead of fluffy nursing theory classes. But they have what WE NEED - autonomy.

 

A point of trivia regarding optometrists: in 1915 the Pennsylvania State Supreme Court rules that optometry is a calling separate from medicine and can not be regulated by the State Board of Medicine as a "minor branch" of that profession. Albert Fitch had convinced the PA optometrists to pursue legal action. The optometrists have had opposition from ophthalmologists and medical boards throughout their history but have stood together with their professional organizations and credentialing orgs. They proved they are a profession.

 

The ideal for all PAs if for AAPA, PAFT, NCCPA, PAEA, State and constituent organizations to all come together and work for a PA profession recognition as a self-governing profession that is responsible for itself. Will it happen? I don't think so. So PAFT will continue on our chosen course. I hope we do not fail you and we realize we cannot please everyone.

[Boatswain2PA]

Paula - Thank you for your thoughts and clarifications. Have you read Dr. Stead's writings about his concerns about the PA profession being an eternally dependent profession? He said the profession would never last if there were not path for independence.

[PEGASUS]

I can’t believe I can read through this entire thread and aside from Paula no one just plain talks realities.

We are all clinicians and patients trapped within a megalithic economic quagmire of self-serving special interests – AMA trade unionism, the AHA, and the educational institutional interests, the PHARMS – that ALL profit enormously OBSCENELY , from keeping things just as they have structured them to preserve and perpetuate their own kingdoms.

I am sorry but please don’t ask me to believe a system that accepts and ABETS leaving 60 million disenfranchised– yeah I am including so-called illegals who ARE HERE and are human beings – and subjecting the rest to assembly line pop-in “consultations” really puts patient care as its top priority.

Let’s be real here people 75-90 % of medical care is routine EBM protocol certainly at the PC level …AND even within specialties these figures also hold true for their respective patient demographics. So where does this leave us …as sane rational thinkers ...in designing an efficient accessible available medical care system that , can you believe it, is actually structured to deliver the best competent care for the people it claims to exist to serve.

 

Forget old paradigms… PA …assistant/associate, NP , DNP, MD catch-all ,whatever…NONSENSE. For the majority of care these categories should fill the role/function of PRIMARY CLINICAL PROVIDERS. YES !..as autonomous and independent as is appropriate for their education experience AND DEFINED SCOPE OF PRACTICE permits. Yes anyone everyone must know when to consult , when to refer …PA NP or MD.

How is one prepared for this role…sorry to offend some but aside from the very real practical political advantage of independence from the medical monolith…the better model is the PA education. Nursing care is by definition ancillary and supportive. After basic PA education…THOUGH PLEASE BY ANOTHER NAME…the acolyte works in a journeyman/apprentice capacity IN ANY OF THE SPECIALTIES as an adjunct on their way to INDEPENDENT STATUS as a provider for the vast majority of those who seek care within that field....PCP of ******. Most likely appropriate boards will exist with requirements to be met before such autonomy is privileged. “PA-NP” clones would have to repeat this process if moving to another specialty and ONLY IF THEY SEEK A ROAD TO AUTONOMY within that field. If not they could begin/continue in the apprentice role indefinitely if they choose dependency for any senior independent practitioner in whatever specialty is willing to take them on in this more circumscribed role. They , and those still in apprenticeship training could be designated Associate/Assistant Clinical Provider of ******

To move to the status and function of SENIOR CLINICAL PRACTIONER in any specialty to deal with those atypical challenging presentations further fellowship concentration demonstration will be required.

 

Examples... ACP Urology... PCP Urology... SCP Urology....

 

The same can be ascribed for any speciality ...INCLUDING THOSE IN PRIMARY CARE AREAS...family, peds, ob/gyn

 

The point being independence is perfectly reasonable when competency within scope of practice is demonstrated. Again IN ANY FIELD those who go beyond their abilities or refuse to consult are fools BUT THIS CAN HAPPEN AT ANY LEVEL , in any profession and is not a justification to keep any category permanently indentured. It is stark insanity to talk about Master of PA…Doctorate of PA or NP…as opposed to moving on to MD equivalency in scope of practice.

What sane reason exist for denying professional career mobility for practitioners of demonstrated qualifications and requiring the absurdity of having to BEGIN ANEW and discount years of experience. Really ??? PA’s with years of experience seriously considering going back to school to become RN’s on the route to achieving a NP degree....an MD diploma. And exactly whose purpose does that serve ? ALL THAT WASTED TIME AND MONEY..AND LIFE ! Yes it preserves MD fiefdoms, keeps educational mills churning with cash, and man’s hospitals with subservient profit generating personnel…but what does it do for the sincerely motivated practitioner and the millions w.o. access to respectful healthcare due to restrictions fossilized to keep existing outdated power policy institutions able to block the way to a more rational…civilized model.

 

We don’t need PA’s NP’s masters doctorates blah blah. We need the sensible core of their originating idea, a clinician to see the overwhelming common garden variety of ailments in a cost effective manner and allocate as needed by the medical reality, not the economic fee for profit/service model, access to advanced practice modalities.

We need to combine and redefine who we are and what we are about, why and how we are needed and how we need to be recognized as professionals. We are not challenging MD’s. We are simply plainly putting forth that training and experience are the road to move forward professionally. 5 10 20 years down the road, especially with the pace of medicine accelerating changing continuously, those extra hours in medical school are just not an rational justification for …lets be real about this…keeping others of clear clinical competence equivalency…IN THEIR PLACES…for a lifetime...PERMANENTLY.

What are the costs and consequences? Perhaps incomes for all across the board will fall – good – lets have people enter who are fully in this for the right reasons...they love the science, the service. Yes there will be dislocations whole institutions, power brokers and categories will become obsolete fall disappear …fine – authority and respect presence need to be earned not automatically aristocratically assumed and inherited.

Healthcare will become affordable available and recognized like air and water as a human necessity and delivered as efficiently as possible. Pharms and hospitals will need to get on-board most likely by single payer model to get their priorities straight.

 

We who love this opportunity to serve others will be able to do so as our training skills and heart dictate with respect for those who come to us…AND FOR OURSELVES.

[Guest JMPA]

I can’t believe I can read through this entire thread and aside from Paula no one just plain talks realities.

We are all clinicians and patients trapped within a megalithic economic quagmire of self-serving special interests – AMA trade unionism, the AHA, and the educational institutional interests, the PHARMS – that ALL profit enormously OBSCENELY , from keeping things just as they have structured them to preserve and perpetuate their own kingdoms.

I am sorry but please don’t ask me to believe a system that accepts and ABETS leaving 60 million disenfranchised– yeah I am including so-called illegals who ARE HERE and are human beings – and subjecting the rest to assembly line pop-in “consultations” really puts patient care as its top priority.

Let’s be real here people 75-90 % of medical care is routine EBM protocol certainly at the PC level …AND even within specialties these figures also hold true for their respective patient demographics. So where does this leave us …as sane rational thinkers ...in designing an efficient accessible available medical care system that , can you believe it, is actually structured to deliver the best competent care for the people it claims to exist to serve.

 

Forget old paradigms… PA …assistant/associate, NP , DNP, MD catch-all ,whatever…NONSENSE. For the majority of care these categories should fill the role/function of PRIMARY CLINICAL PROVIDERS. YES !..as autonomous and independent as is appropriate for their education experience AND DEFINED SCOPE OF PRACTICE permits. Yes anyone everyone must know when to consult , when to refer …PA NP or MD.

How is one prepared for this role…sorry to offend some but aside from the very real practical political advantage of independence from the medical monolith…the better model is the PA education. Nursing care is by definition ancillary and supportive. After basic PA education…THOUGH PLEASE BY ANOTHER NAME…the acolyte works in a journeyman/apprentice capacity IN ANY OF THE SPECIALTIES as an adjunct on their way to INDEPENDENT STATUS as a provider for the vast majority of those who seek care within that field....PCP of ******. Most likely appropriate boards will exist with requirements to be met before such autonomy is privileged. “PA-NP” clones would have to repeat this process if moving to another specialty and ONLY IF THEY SEEK A ROAD TO AUTONOMY within that field. If not they could begin/continue in the apprentice role indefinitely if they choose dependency for any senior independent practitioner in whatever specialty is willing to take them on in this more circumscribed role. They , and those still in apprenticeship training could be designated Associate/Assistant Clinical Provider of ******

To move to the status and function of SENIOR CLINICAL PRACTIONER in any specialty to deal with those atypical challenging presentations further fellowship concentration demonstration will be required.

 

Examples... ACP Urology... PCP Urology... SCP Urology....

 

The same can be ascribed for any speciality ...INCLUDING THOSE IN PRIMARY CARE AREAS...family, peds, ob/gyn

 

The point being independence is perfectly reasonable when competency within scope of practice is demonstrated. Again IN ANY FIELD those who go beyond their abilities or refuse to consult are fools BUT THIS CAN HAPPEN AT ANY LEVEL , in any profession and is not a justification to keep any category permanently indentured. It is stark insanity to talk about Master of PA…Doctorate of PA or NP…as opposed to moving on to MD equivalency in scope of practice.

What sane reason exist for denying professional career mobility for practitioners of demonstrated qualifications and requiring the absurdity of having to BEGIN ANEW and discount years of experience. Really ??? PA’s with years of experience seriously considering going back to school to become RN’s on the route to achieving a NP degree....an MD diploma. And exactly whose purpose does that serve ? ALL THAT WASTED TIME AND MONEY..AND LIFE ! Yes it preserves MD fiefdoms, keeps educational mills churning with cash, and man’s hospitals with subservient profit generating personnel…but what does it do for the sincerely motivated practitioner and the millions w.o. access to respectful healthcare due to restrictions fossilized to keep existing outdated power policy institutions able to block the way to a more rational…civilized model.

 

We don’t need PA’s NP’s masters doctorates blah blah. We need the sensible core of their originating idea, a clinician to see the overwhelming common garden variety of ailments in a cost effective manner and allocate as needed by the medical reality, not the economic fee for profit/service model, access to advanced practice modalities.

We need to combine and redefine who we are and what we are about, why and how we are needed and how we need to be recognized as professionals. We are not challenging MD’s. We are simply plainly putting forth that training and experience are the road to move forward professionally. 5 10 20 years down the road, especially with the pace of medicine accelerating changing continuously, those extra hours in medical school are just not an rational justification for …lets be real about this…keeping others of clear clinical competence equivalency…IN THEIR PLACES…for a lifetime...PERMANENTLY.

What are the costs and consequences? Perhaps incomes for all across the board will fall – good – lets have people enter who are fully in this for the right reasons...they love the science, the service. Yes there will be dislocations whole institutions, power brokers and categories will become obsolete fall disappear …fine – authority and respect presence need to be earned not automatically aristocratically assumed and inherited.

Healthcare will become affordable available and recognized like air and water as a human necessity and delivered as efficiently as possible. Pharms and hospitals will need to get on-board most likely by single payer model to get their priorities straight.

 

We who love this opportunity to serve others will be able to do so as our training skills and heart dictate with respect for those who come to us…AND FOR OURSELVES.

 

well said!!

[Houstonian]

Agreed. Five years experience in any given specialty leading to autonomous certification; we would have our own specialty certification exams as a requirement for this.

 

We should not be relying on another profession to define ours.

 

New grad = supervision required.

[bobuddy]

Agreed. Five years experience in any given specialty leading to autonomous certification; we would have our own specialty certification exams as a requirement for this.

 

We should not be relying on another profession to define ours.

 

New grad = supervision required.

 

I am all in favor of this - Especially the statement that we should not rely on another profession to define ours. Just to play devil's advocate - this would still make us behind the 8 ball when it comes to the NP's who come out independent from the get go (in many states). So, instead of labeling it "supervision required" (which makes me feel like a burden rather than a colleague) - it could be labeled as a "residency" instead.

 

Which begs the next question. PA's are not only in primary care - we are migrating more and more to the specialty clinics. What about those that are in surgery/ interventional cardiology/urology/ob/gyne? Do they also get independence after 5 (or however long ) years? What would that "residency" entail? THAT will really make the MD's hair stand on end and they will surely fight this.

 

I do think we need to come together as a group to cut the cord and be our own governing body.

[bobuddy]

Paula - Thank you for your thoughts and clarifications. Have you read Dr. Stead's writings about his concerns about the PA profession being an eternally dependent profession? He said the profession would never last if there were not path for independence.

 

Boatswain - do you have a link for this? I would love to read it. Thanks!

[Boatswain2PA]

Boatswain - do you have a link for this? I would love to read it. Thanks!

 

A shout-out to these authors: "The perceptions of US physician assistants regarding physician assistant-to-physician bridge programs." Richard Muma; Brandon Phipps; Shawn Vredenburg.

The journal of physician assistant education : the official journal of the Physician Assistant Education Association 2012;23(3):7-11.The perceptions of US physician assistants regarding physician assistant-to-physician bridge programs.

 

Or, in the words of the father of the PA profession himself:

 

"Medical Education and Practice." Eugene Stead. Annals of Internal Medicine. 1970; 72 (2): 273.

[gleannfia]

I can’t believe I can read through this entire thread and aside from Paula no one just plain talks realities.

We are all clinicians and patients trapped within a megalithic economic quagmire of self-serving special interests – AMA trade unionism, the AHA, and the educational institutional interests, the PHARMS – that ALL profit enormously OBSCENELY , from keeping things just as they have structured them to preserve and perpetuate their own kingdoms.

I am sorry but please don’t ask me to believe a system that accepts and ABETS leaving 60 million disenfranchised– yeah I am including so-called illegals who ARE HERE and are human beings – and subjecting the rest to assembly line pop-in “consultations” really puts patient care as its top priority.

Let’s be real here people 75-90 % of medical care is routine EBM protocol certainly at the PC level …AND even within specialties these figures also hold true for their respective patient demographics. So where does this leave us …as sane rational thinkers ...in designing an efficient accessible available medical care system that , can you believe it, is actually structured to deliver the best competent care for the people it claims to exist to serve.

 

Forget old paradigms… PA …assistant/associate, NP , DNP, MD catch-all ,whatever…NONSENSE. For the majority of care these categories should fill the role/function of PRIMARY CLINICAL PROVIDERS. YES !..as autonomous and independent as is appropriate for their education experience AND DEFINED SCOPE OF PRACTICE permits. Yes anyone everyone must know when to consult , when to refer …PA NP or MD.

How is one prepared for this role…sorry to offend some but aside from the very real practical political advantage of independence from the medical monolith…the better model is the PA education. Nursing care is by definition ancillary and supportive. After basic PA education…THOUGH PLEASE BY ANOTHER NAME…the acolyte works in a journeyman/apprentice capacity IN ANY OF THE SPECIALTIES as an adjunct on their way to INDEPENDENT STATUS as a provider for the vast majority of those who seek care within that field....PCP of ******. Most likely appropriate boards will exist with requirements to be met before such autonomy is privileged. “PA-NP” clones would have to repeat this process if moving to another specialty and ONLY IF THEY SEEK A ROAD TO AUTONOMY within that field. If not they could begin/continue in the apprentice role indefinitely if they choose dependency for any senior independent practitioner in whatever specialty is willing to take them on in this more circumscribed role. They , and those still in apprenticeship training could be designated Associate/Assistant Clinical Provider of ******

To move to the status and function of SENIOR CLINICAL PRACTIONER in any specialty to deal with those atypical challenging presentations further fellowship concentration demonstration will be required.

 

Examples... ACP Urology... PCP Urology... SCP Urology....

 

The same can be ascribed for any speciality ...INCLUDING THOSE IN PRIMARY CARE AREAS...family, peds, ob/gyn

 

The point being independence is perfectly reasonable when competency within scope of practice is demonstrated. Again IN ANY FIELD those who go beyond their abilities or refuse to consult are fools BUT THIS CAN HAPPEN AT ANY LEVEL , in any profession and is not a justification to keep any category permanently indentured. It is stark insanity to talk about Master of PA…Doctorate of PA or NP…as opposed to moving on to MD equivalency in scope of practice.

What sane reason exist for denying professional career mobility for practitioners of demonstrated qualifications and requiring the absurdity of having to BEGIN ANEW and discount years of experience. Really ??? PA’s with years of experience seriously considering going back to school to become RN’s on the route to achieving a NP degree....an MD diploma. And exactly whose purpose does that serve ? ALL THAT WASTED TIME AND MONEY..AND LIFE ! Yes it preserves MD fiefdoms, keeps educational mills churning with cash, and man’s hospitals with subservient profit generating personnel…but what does it do for the sincerely motivated practitioner and the millions w.o. access to respectful healthcare due to restrictions fossilized to keep existing outdated power policy institutions able to block the way to a more rational…civilized model.

 

We don’t need PA’s NP’s masters doctorates blah blah. We need the sensible core of their originating idea, a clinician to see the overwhelming common garden variety of ailments in a cost effective manner and allocate as needed by the medical reality, not the economic fee for profit/service model, access to advanced practice modalities.

We need to combine and redefine who we are and what we are about, why and how we are needed and how we need to be recognized as professionals. We are not challenging MD’s. We are simply plainly putting forth that training and experience are the road to move forward professionally. 5 10 20 years down the road, especially with the pace of medicine accelerating changing continuously, those extra hours in medical school are just not an rational justification for …lets be real about this…keeping others of clear clinical competence equivalency…IN THEIR PLACES…for a lifetime...PERMANENTLY.

What are the costs and consequences? Perhaps incomes for all across the board will fall – good – lets have people enter who are fully in this for the right reasons...they love the science, the service. Yes there will be dislocations whole institutions, power brokers and categories will become obsolete fall disappear …fine – authority and respect presence need to be earned not automatically aristocratically assumed and inherited.

Healthcare will become affordable available and recognized like air and water as a human necessity and delivered as efficiently as possible. Pharms and hospitals will need to get on-board most likely by single payer model to get their priorities straight.

 

We who love this opportunity to serve others will be able to do so as our training skills and heart dictate with respect for those who come to us…AND FOR OURSELVES.

Very well said! When will the US join the rest of the industrialized nations and go Single Payer? Big In$urance must go---it is an unnecessary Middle Man that operates with a 20% overhead in many instances. Flawed as it is, Obamacare allows for individual states to implement their own programs which include a single system. Those states that wish to continue to bend over and take it in the as* from Aetna, et al, can continue to do so as well. I am all about choice.

[PEGASUS]

NECESSITY'S SOBERING REALITIES

 

These links demonstrate just how far and flexible a healthcare education/delivery system can be designed that reflects real world outcomes rather than fear mongering nightmare scenarios to preserve profit/turf. We have seen this over and over again... when clear thinking is given a chance to demonstrate that old restrictions are institutionalized legacy strangleholds that actually do great harm as they morph to become primarily self-serving and hide behind a public relations smokescreen.

 

I suggest that the frustration most of us feel can be understood and relieved when we finally recognize that we are trying to talk reason, make sense, with and within a health delivery system that is fundamentally outdated flawed in design and motivated primarily by economics. A system further...worse... that knows of its failings to meet its mandate...the reasons the causes the solutions... but which nevertheless seeks to survive to continue because its serves the established players/policy makers narrow interests exceedingly $$$ well.

 

You cannot reason with those who know the merits of your position but despite lip service agreements with your "goals in general" in reality in specifics in implementation have a quite different agenda. You must work for fundamental structural revamping of educational and training pathways, professional categories and designations. and models of care delivery. Trying to work within accommodate placate supplicate subordinate to existing power centers is futile as we have seen in our brief PA professional history. We are actually going retrograde ...possibly extinct.

 

Civil Rights... MLK 50...any greater parallels lessons to be derived ?

 

Anyway back to the links. Yes EVEN SURGERY has a strong (primary) PCP-Surgery scope of practice...and for those w.o. healthcare we are a 3rd world country

 

http://www.ncbi.nlm.nih.gov/pubmed/17570847?dopt=Abstract&holding=f1000,f1000m,isrctn

 

http://opinionator.blogs.nytimes.com/2012/08/08/repairing-the-surgery-deficit/?_r=0

 

http://www.uniteforsight.org/global-health-surgery/module5

 

http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1000078

[Guest Paula]

download document From PAEA, the article referenced about PA-MD programs.

[Boatswain2PA]

Very well said! When will the US join the rest of the industrialized nations and go Single Payer? Big In$urance must go---it is an unnecessary Middle Man that operates with a 20% overhead in many instances. Flawed as it is, Obamacare allows for individual states to implement their own programs which include a single system. Those states that wish to continue to bend over and take it in the as* from Aetna, et al, can continue to do so as well. I am all about choice.

 

I do not see how anyone can be "all about choice" and at the same time be for a single payer system. Single payer systems, by definition, give the patient a single choice for healthcare "insurance".

 

Furthermore, single payer systems never turn out to be single payer systems....because the wealthy see the poor quality of health care delivered in them so they pursue better healthcare in the capital market.

 

And lastly - yes, Big Insurance makes money. Let's go with your "20% overhead". How much "overhead" do you think the government will skim off of the top in your utopian single payer system? I've worked for uncle sam for 20 years, I guarantee it will be a lot more than 20%, and the quality controls will be a bureaucratic nightmare resulting in poor patient care for EVERYONE.

 

If you want a view of what a totally government/bureaucratically controlled healthcare system looks like then go talk to a retired veteran and ask him/her about their care at the VA.

[Guest Paula]

About skimming off the top: There will be lots of it and case in point is the many grants I've written in my former life before PA for Indian tribal agencies. First, a grant announcement comes out from the gov and it can be millions of dollars. It will be divided among the grantees. Some grants go directly to states, who take their 20-30% and then the grant is offered to organizations within the state. One is allowed to write for a certain amount total....out of that the organization gets a 30% cut for their expenses and the rest is for running the grant. It trickles down to a much smaller amount of $ to work with. Some goes directly into the pocket of the tribal leader, who gets jailed for three years, and then voted back into office once he is out. (Sounds like our FEDS). So, in a single payer system....I agree with Boatswain2PA...there will be much taken off the top. My relatives in Denmark visited recently. They have a socialized medicine system and pay about 70% of their income for taxes and government services.

[Boatswain2PA]

NECESSITY'S SOBERING REALITIES

 

These links demonstrate just how far and flexible a healthcare education/delivery system can be designed that reflects real world outcomes rather than fear mongering nightmare scenarios to preserve profit/turf. We have seen this over and over again... when clear thinking is given a chance to demonstrate that old restrictions are institutionalized legacy strangleholds that actually do great harm as they morph to become primarily self-serving and hide behind a public relations smokescreen.

 

I suggest that the frustration most of us feel can be understood and relieved when we finally recognize that we are trying to talk reason, make sense, with and within a health delivery system that is fundamentally outdated flawed in design and motivated primarily by economics. A system further...worse... that knows of its failings to meet its mandate...the reasons the causes the solutions... but which nevertheless seeks to survive to continue because its serves the established players/policy makers narrow interests exceedingly $$$ well.

 

You cannot reason with those who know the merits of your position but despite lip service agreements with your "goals in general" in reality in specifics in implementation have a quite different agenda. You must work for fundamental structural revamping of educational and training pathways, professional categories and designations. and models of care delivery. Trying to work within accommodate placate supplicate subordinate to existing power centers is futile as we have seen in our brief PA professional history. We are actually going retrograde ...possibly extinct.

 

Civil Rights... MLK 50...any greater parallels lessons to be derived ?

 

Anyway back to the links. Yes EVEN SURGERY has a strong (primary) PCP-Surgery scope of practice...and for those w.o. healthcare we are a 3rd world country

 

http://www.ncbi.nlm.nih.gov/pubmed/17570847?dopt=Abstract&holding=f1000,f1000m,isrctn

 

http://opinionator.blogs.nytimes.com/2012/08/08/repairing-the-surgery-deficit/?_r=0

 

http://www.uniteforsight.org/global-health-surgery/module5

 

http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1000078

 

So anyone who disagrees with your "clear thinking", or when you "try to talk sense, make sense" talking about a "fundamentally outdated flawed in design and motivated primarily by economics", etc, etc....is just a chump who wants to keep the money to themselves?

 

Perhaps those who disagree with you do so because they have a different, and maybe even better, understanding of how to best care for our patients.

 

You say "You cannot reason with those who know the merits of your position but despite lip service agreements with your 'goals in general' in reality in specifics in implementation have a quite different agenda." Well, I'm sure those who disagree with you may feel the same way. They probably have the same'goals in general' as you (ie; improve patient care at lesser cost), but they may not see your way as the best way.

 

Furthermore, your post seems full of fearmongering itself. "We are actually going retrograde...possibly extinct!" Really?

 

As to your links: I'm not sure if the success of Malawi clinical officers performing C-sections is generalizable to the U.S. Did you forget about the legal environment we operate in? Very few family physicians do obstetrics anymore because of the damn lawyers. Is Malawi in the same position?? I don't think so, so it's not generalizable. The same thing with your Unite for Sight link.

 

It may indeed be a great idea to put lesser trained people into rural Zambia to do trauma surgery. In the United States we have a system of Level 1 Trauma Center's with catchment areas and a vigorous transportation system. I work in a rural emergency room and I have never had a patient who needed surgery NOW who didn't get it.

 

The bottom line is you have some great ideas, but implementing them HERE may not be the best idea because they are not GENERALIZABLE ideas. And just because someone doesn't completely agree with you doesn't mean we are these horrible greedy people who want to keep all of the money for ourselves, it may just be because we see the picture from a different angle than you.

[physasst]

They have a socialized medicine system and pay about 70% of their income for taxes and government services.

 

And, by coincidence....our economic growth here in the US was greatest when marginal income rates were at about 65%.

 

Completely different discussion though.