Reality check needed

[UpRegulated]

I think we agree on this. They are not necessarily interchangeable and it really depends on the specialty, previous experience of the clinician, where they trained, etc. However, I don't think that necessarily precludes us from lobbying together, since there is often much overlap between the roles and we share many mutual goals.

 

You may have missed it, but what JMPA is really saying is to h*ll with NP's.  :)

[Lexapro]

You may have missed it, but what JMPA is really saying is to h*ll with NP's.  :)

Oh no, I read between the lines there. I agree with him actually, a psych np and a generalist trained PA are definitely not interchangeable and it would be misleading to argue that they have equivalent training. ;)

[Boatswain2PA]

If we could go back in time and convince the nursing mafia in the 60's to allow Dr. Stead to use nurses for his first PA programs, then the whole PA/NP conflict thing would be a moot point, and patient care would be improved (nursing experience + a great education).  It would be great if there were a way to merge the two professions, but I doubt there exists a way to do it, so we are stuck with the conflict.

 

The NPs have set course to independence.  This works for them because, since they supposedly practice "advanced nursing" vice "medicine", they have already established the precedence of their nursing board vice the board of medicine.  This has, historically, worked for PAs because #1) we had the support of physicians, and #2) physicians had significant political power.  Unfortunately for PAs, we may be loosing  the support of the physicians, and physicians are certainly loosing their political power.  This loss of physician political power, and the AAPA's mimicking of the AMA, has allowed the NPs to expand their "advanced nursing" into unsupervised medicine and other administrative advances described here (meaningful use, etc). 

 

So, the PA profession can continue with the politically correct AAPA flailing about and continue to lose administrative/legislative battles with the nursing mafia.  If this happens, I think our profession will eventually be pushed out as healthcare becomes more and more bureaucratic which limits physician authority. 

 

Or, the PA profession can follow Paula's roadmap toward independence.  Residencies will become common, and then mandatory as we become "Doctorates".  Of course, this path would put us in greater conflict with the physicians, and require the establishment of an entirely different "board" (ie: Board of Physician Assistants") like Paula advocates. 

 

Or the PA profession can throw in with the specialty physician groups which still have significant political power.  This seems to be happening in the EM field.  SEMPA is closely affiliated with ACEP, and those ties seem to be strengthening all the time.  As ACEP grows in political strength in the EM field, so does SEMPA.  Other PA specialties can follow this model. 

 

Of course, if some PAs take Paula's course and push for independence this would probably undermine the efforts of the specialty organizations like SEMPA.

 

If the general physician organizations, like the AMA, ever regain their political strength (which they could do by coming to the center politically and not alienating 80% of the physicians in the nation), then there could be another, much simpler fix to this.  If the physician groups worked to define exactly what the term "practicing medicine" means, then they could overnight turn the NPs back into a "dependent" practitioner like they should be.  If physician groups could successfully lobby state legislatures to define "practicing medicine" to include "the diagnosis of disease, interpretation of medical testing, and prescription of medications or therapies", this "advanced nursing" crap would end overnight. 

 

I don't know what is going to happen over the next 15 years, but it's going to be interesting to watch. 

[EMEDPA]

 

.  There are PA leaders on this board and I, for one, would love to see this board open up to NP's more.  That's a small thing, perhaps, but it's a start.  The two "camps" need to interact, form relationships, hold joint conferences, educate one another, and work together on legislative efforts.

www.clinician1.com is a board for both PAs and NPs.

[LT_Oneal_PAC]

If we could go back in time and convince the nursing mafia in the 60's to allow Dr. Stead to use nurses for his first PA programs, then the whole PA/NP conflict thing would be a moot point, and patient care would be improved (nursing experience + a great education). It would be great if there were a way to merge the two professions, but I doubt there exists a way to do it, so we are stuck with the conflict.

 

The NPs have set course to independence. This works for them because, since they supposedly practice "advanced nursing" vice "medicine", they have already established the precedence of their nursing board vice the board of medicine. This has, historically, worked for PAs because #1) we had the support of physicians, and #2) physicians had significant political power. Unfortunately for PAs, we may be loosing the support of the physicians, and physicians are certainly loosing their political power. This loss of physician political power, and the AAPA's mimicking of the AMA, has allowed the NPs to expand their "advanced nursing" into unsupervised medicine and other administrative advances described here (meaningful use, etc).

 

So, the PA profession can continue with the politically correct AAPA flailing about and continue to lose administrative/legislative battles with the nursing mafia. If this happens, I think our profession will eventually be pushed out as healthcare becomes more and more bureaucratic which limits physician authority.

 

Or, the PA profession can follow Paula's roadmap toward independence. Residencies will become common, and then mandatory as we become "Doctorates". Of course, this path would put us in greater conflict with the physicians, and require the establishment of an entirely different "board" (ie: Board of Physician Assistants") like Paula advocates.

 

Or the PA profession can throw in with the specialty physician groups which still have significant political power. This seems to be happening in the EM field. SEMPA is closely affiliated with ACEP, and those ties seem to be strengthening all the time. As ACEP grows in political strength in the EM field, so does SEMPA. Other PA specialties can follow this model.

 

Of course, if some PAs take Paula's course and push for independence this would probably undermine the efforts of the specialty organizations like SEMPA.

 

If the general physician organizations, like the AMA, ever regain their political strength (which they could do by coming to the center politically and not alienating 80% of the physicians in the nation), then there could be another, much simpler fix to this. If the physician groups worked to define exactly what the term "practicing medicine" means, then they could overnight turn the NPs back into a "dependent" practitioner like they should be. If physician groups could successfully lobby state legislatures to define "practicing medicine" to include "the diagnosis of disease, interpretation of medical testing, and prescription of medications or therapies", this "advanced nursing" crap would end overnight.

 

I don't know what is going to happen over the next 15 years, but it's going to be interesting to watch.

Excellent thoughts. I agree with all here, especially Paula's POV, except the last part. Even if they do "define medicine," which there already is a federal definition, it would not change nursing. The AMA would have to define the definition of nursing as NOT being able to diagnose and treat disease. Perhaps they could try to establish that ONLY medicine can do this, but anti-compete and restraint of trade laws would not allow one profession to define another. This points to CRNAs who have multiple case laws where it was established that anesthesia is the practice of nursing AND medicine. So I think that would have a bit tougher fight on their hands.

[Boatswain2PA]

Excellent thoughts. I agree with all here, especially Paula's POV, except the last part. Even if they do "define medicine," which there already is a federal definition, it would not change nursing. The AMA would have to define the definition of nursing as NOT being able to diagnose and treat disease. Perhaps they could try to establish that ONLY medicine can do this, but anti-compete and restraint of trade laws would not allow one profession to define another. This points to CRNAs who have multiple case laws where it was established that anesthesia is the practice of nursing AND medicine. So I think that would have a bit tougher fight on their hands.

You completed my thought there with the premise that the AMA (or alternately, the specialty physician organizations like ACEP) could push for legislative changes that clearly delinated what exactly consisted of practicing medicine, and then put all such activities under the purview of the board of medicine.  Anti-compete and restraint of trade laws could similarly be avoided by legislative action. 

[LT_Oneal_PAC]

I'm just stating fact. This was already tried in Alabama, and the FTC wrote a cease and desist letter to the Alabama BOM and AMA threatening action over restraint of trade. I never say never, but history has shown that it is really improbable.

[Boatswain2PA]

I agree, it's unlikely to happen for many reasons, including the one you bring up.

[UpRegulated]

.

[UpRegulated]

If the general physician organizations, like the AMA, ever regain their political strength (which they could do by coming to the center politically and not alienating 80% of the physicians in the nation), then there could be another, much simpler fix to this.  If the physician groups worked to define exactly what the term "practicing medicine" means, then they could overnight turn the NPs back into a "dependent" practitioner like they should be.  If physician groups could successfully lobby state legislatures to define "practicing medicine" to include "the diagnosis of disease, interpretation of medical testing, and prescription of medications or therapies", this "advanced nursing" crap would end overnight. 

. 

 

I don't think it is that simple at all. That nursing encompasses the diagnosis and treatment of illness is codified into the laws and regulations of all 50 states and the federal government.  No medical board, even all 50 of them put together, can waive a wand and make that go away. One profession cannot define what another profession is or isn't.  It would not only require new legislation, but the repeal of laws in all 50 states.  Even if there were success at the state level, the federal government already allows NP's to practice via their hiring in federal agencies (e.g. the VA), and via reimbursment from CMS, and whatever other federal regulations and legislation that recognizes NP's.  It would be a massive web to untangle (50 states + the federal government), and it ain't gonna happen.  No way will medical boards ever gain that kind of control over nursing.

 

Which raises the issue of PA's establishing their own boards.  The legal and philisophical precedent for NP's is that nursing is an independent profession and what NP's do falls within the realm of nursing practice. PA's practice medicine.  On what legal or philosophical grounds would PA's convince state legislatures to create a board just for them?  If PA's practice medicine, do PA's want to create a second medical board in every state?

[UpRegulated]

www.clinician1.com is a board for both PAs and NPs.

 

Yes, mentioned it in my earlier post.

[UpRegulated]

If we could go back in time and convince the nursing mafia in the 60's to allow Dr. Stead to use nurses for his first PA programs, then the whole PA/NP conflict thing would be a moot point, and patient care would be improved (nursing experience + a great education).  It would be great if there were a way to merge the two professions, but I doubt there exists a way to do it, so we are stuck with the conflict.

 

It is rather ironic that the NLN is responsible for creation of the PA.  It's also ironic that Stead's first choice was to advance the skills of nurses.

[Boatswain2PA]

 

I don't think it is that simple at all. That nursing encompasses the diagnosis and treatment of illness is codified into the laws and regulations of all 50 states and the federal government.  No medical board, even all 50 of them put together, can waive a wand and make that go away. One profession cannot define what another profession is or isn't.  It would not only require new legislation, but the repeal of laws in all 50 states.  Even if there were success at the state level, the federal government already allows NP's to practice via their hiring in federal agencies (e.g. the VA), and via reimbursment from CMS, and whatever other federal regulations and legislation that recognizes NP's.  It would be a massive web to untangle (50 states + the federal government), and it ain't gonna happen.  No way will medical boards ever gain that kind of control over nursing.

 

Which raises the issue of PA's establishing their own boards.  The legal and philisophical precedent for NP's is that nursing is an independent profession and what NP's do falls within the realm of nursing practice. PA's practice medicine.  On what legal or philosophical grounds would PA's convince state legislatures to create a board just for them?  If PA's practice medicine, do PA's want to create a second medical board in every state?

 

Never said it would be simple, but it is an option for the medical profession.  The various medical associations would have to work with the medical boards to lobby the state and federal legislature's to change the laws.  This is, effectively, how the nurses have expanded nursing into medicine.  I agree that it probably won't happen, especially in today's society which castigates those who have worked their way to the top.

 

And yes, one profession can "define" what the definition of that profession is, even to the exclusion of other professions.  This is typically done via lobbying legislatures.

 

I think Paula's argument (correct me if I'm wrong here Paula) is we should start a PA board because we are inherently our own profession.  While I personally agree with you UpReg, that we are NOT our own profession but are rather an extender of the physician, I think those who think like Paula could get some legislative traction by focusing first on the need for primary care providers....just like the nurses did. 

[Boatswain2PA]

It is rather ironic that the NLN is responsible for creation of the PA.  It's also ironic that Stead's first choice was to advance the skills of nurses.

The NLN bears absolutely no responsibility for the creation of the PA profession.  Stead went to them first to solicit the use of experienced nurses in his "mid-level" experiement, but they adamantly refused because "nurses practice nursing" and not medicine - like diagnosing medical conditions and prescribing medical or other therapies for such conditions. 

 

It was only after Stead went back to Duke to get approval for using military medics for his "mid-level" experiment did the NLN and Colorado University realize they might have missed the boat and started NP profession. 

[UpRegulated]

The NLN bears absolutely no responsibility for the creation of the PA profession.  Stead went to them first to solicit the use of experienced nurses in his "mid-level" experiement, but they adamantly refused because "nurses practice nursing" and not medicine - like diagnosing medical conditions and prescribing medical or other therapies for such conditions. 

 

It was only after Stead went back to Duke to get approval for using military medics for his "mid-level" experiment did the NLN and Colorado University realize they might have missed the boat and started NP profession. 

 

Poorly worded on my part.  What I was trying to say was that the's NLN rejection of accreditation for Duke's program led Stead to create the PA, hence the NLN's action resulted in the PA being created.  That's what I meant when I said "...the NLN is responsible for creation of the PA."

 

I think it is also interesting, historically speaking, how over the years, nurses have done more and more things once considered only the domain of medicine, but now considered to be part of nursing.  If I understand correctly, Stead wanted his nurse to start taking histories and performing physicals, which at the time was considered a practice of medicine - now that is done at the RN level.  At one time, even taking a blood pressure was considered the practice of medicine. Imagine a nurse telling a doc that he/she won't take a blood pressure 'cause that's a physicians responsibility. :)

[EMEDPA]

Now nurses just refuse to take manual BPs because they only use dinamaps....:)

[Guest Paula]

PAs should develop their own boards of (PA) medicine and be a completely separate profession.  Full practice autonomy is a goal for PA practice that I advocate for.  I believe in the profession enough to know we do not need supervision, delegation, or dependence.

 

We can manage, educate, develop our own scope of practice, discipline our own.  A full scale effort in just one state is needed to start the domino effect for other states.  Michigan has taken a step in that direction by putting forth a senate bill to develop  PA, NP, MD, DO boards that operate under the Michigan Public Health Code.  I does not however allow for independence of either PA/NP profession, and has in the language that PA/NP must work within a patient care team, with a physician as part of the team.

[UpRegulated]

Now nurses just refuse to take manual BPs because they only use dinamaps....:)

 

Ha ha, true!  I bet many nurses don't even remember how to take a manual BP.

[EMEDPA]

Ha ha, true!  I bet many nurses don't even remember how to take a manual BP.

yup, it is not uncommon for them to tell me pt has a bp of (ridiculously high or low) and I say recheck it manually and they can't even find a manual cuff. I keep my own, recheck it myself and find it completely normal.

dinamaps are worthless in my opinion and encourage laziness.