"Researchers Call for Increasing NP Scope"

[discogenic]

From Medscape today, referring to a study in Health Affairs:

http://www.medscape.com/viewarticle/814430?nlid=38823_1981&src=wnl_edit_medn_fmed&uac=19406EZ&spon=34

 

"Eliminating restrictions on NPs’ scope of practice could have a large impact on the cost savings that can be achieved by retail clinics."

 

This focuses on retail clinics.  What's the consensus among practicing PAs regarding working in retail clinics?  I would think working in that environment isn't a 'dream job' kind of position.

 

A recent post mentioned some new legislation proposed in Michigan which will, among other things, provide for the creation of an independent Board for PAs.  Perhaps that's what's needed before 'researchers' call for increasing PA scope.

[ventana]

funny

 

I emailed my state rep on some legal issues which they need to address

 

his health care specialist called me back and wanted to know if I supported the bill for NP independent practice..... ugh politely declined to get overly involved, but did state that after a 3-5 year time of supervision I believe that PA or NP should be able to be a highly effective part of the health care team and that no one truly practices independently.....    the NP lobby is HIGHLY effective and active - just last year they put a single line in a bill that said NPs can sign anything a doc can sign.....  amazing......

[EMEDPA]

retail medicine is on my nightmare list of jobs right up there with pain clinic, occupational med, and wt loss clinic.

I know folks who have worked those jobs. it's all about "the pt is always right" and never about good medical care. z-pak for your runny nose?, sure. oxycodone for your pinky sprain? why not? 10 days off work for a bee sting? definitely!

[Epangerl]

I shadowed at an occ med / urgent care and was impressed by the quality of care the one evening I was there so far. There were several quick DOT physicals, a bladder infection, back pain, as well as a patient whose work just wanted clearance for him to travel home and the PA found crescendo angina and got him transferred (which he initially resisted but she and the SP convinced him). I certainly thought I wouldn't mind working there someday, there was some variety and a real sense of helping people. Maybe I was there on a good day. It beats my old dream job as a forensic scientist.

[generalfluff]

Before they call for more NP coverage, they should make it a point that they get more clinical education to actually have a better idea of what the hell it is they're doing. Granted, it's low acuity urgent care, but that's no reason to rely on what is largely an algorithmic approach to medicine, rather than the proper clinical science. It just seems wrong that these NPs with one-half to one-quarter the formal clinical training are given a larger scope of practice, due largely to these so-called gaps that only NPs can supposedly fill. 

 

It's obviously their clinical skill and not their lobbyists that qualifies them for expanded practice.

[discogenic]

Before they call for more NP coverage, they should make it a point that they get more clinical education to actually have a better idea of what the hell it is they're doing. Granted, it's low acuity urgent care, but that's no reason to rely on what is largely an algorithmic approach to medicine, rather than the proper clinical science. It just seems wrong that these NPs with one-half to one-quarter the formal clinical training are given a larger scope of practice, due largely to these so-called gaps that only NPs can supposedly fill. 

 

It's obviously their clinical skill and not their lobbyists that qualifies them for expanded practice.

 

But you have to hand it to them.  They get researchers, as the title of the article notes, to research them and come up with data with which they can make claims.  It seems that's what works in the world of policy making, not necessarily quality/rigor of training.

[Guest Paula]

Plus NPs have autonomous practices in 17 states so it will make sense to legislative bodies to give them more freedom and to remove restrictions.

 

PAs have no one who advocates for us on a national basis in the same way NPs do and we have no money or lobbying power anywhere. 

 

If we did wouldn't AAPA be at the table to advocate for us to amend ALL restrictions...including the home health issue and co-signing orders by physicians and the HITECH act and the...etc.....

[generalfluff]

I'm well aware of these things, and how painfully ineffective AAPA is. However, this is medicine. 

 

I don't care how good the lobby is. Ineffective care cannot be amended by that. To be honest, we don't really see NPs taking that much advantage of their so-called "independence" either. New Mexico gave full independence to NPs in the 90s, but it's not like they flooded the state with NP-owned practices.  The terms "collaboration" and "supervision" are just that misleading. I don't see MDs looking over the PA's shoulder everytime a script is written and after every visit. Neither are NPs free from having periodic chart review and in some states, requiring a physician when they write for controlled substances. For all the talk of autonomy, both PAs and NPs are within their capabilities and training.

 

It's asking for more than what you're trained to do that puts patients in jeopardy. If these researchers are really looking into the issue deeply, they would see how well the training prepares for the expanded role, or at least recommend exactly what should be added to have a prepared clinician.

 

They wouldn't just draw poorly based claims in the name of furthering a political issue, which may or may not be due to "support" their sponsors.

 

Oh wait . . .

[Iain1028]

The AAPA is as effective as Obama's new Ebola Czar (LOL) !

 

If you like your Ebola, you can keep your Ebola.  Period!