Fairmeadow Posted February 5, 2011 Share Posted February 5, 2011 My guess, this does not hold up. Especially where healthcare "reform" is wanting to go and the need for primary providers. The AAPA and its members and patients will flood this state's office with faxes and emails, he will reconsider the elimination of PA under the cuts. Once again, this is not a state problem. The CMS is driving it. The state cannot change. AAPA, where were you when NP's were being classified as mandatory providers and PA's as optional providers. I would like to know. Like one of the above posters mentioned, if I was younger and needed to, I would go to NP school to continue to practice. Link to comment Share on other sites More sharing options...
BigDuke06 Posted February 5, 2011 Share Posted February 5, 2011 From Clinician 1 Thanks, AAPA.It turns out that Tenncare wants PA’s to be providers. It is CMS that makes the distinction between NP’s and PA’s, with NP’s being “mandatory” providers and PA’s being “optional” providers. Tenncare has protested this arrangement, but CMS refuses to put optional and mandatory providers on the same list. In order to be able to limit annual visits of Tenncare patients, and meet budget cuts, Tenncare has to play along for now, and try to negotiate changes. This came up a year ago. The state of Tennessee passed a one year tax on hospitals that brought in enough revenue to avoid cuts. This tax expires in July 20011. Hopefully, it will be renewed by the state legislature and this will put off this mess, at least temporarily. TAPA (Tennesee Academy of Physician Assistants) is a super organization. They rock! Very few PA’s in Tennessee know, and few seem to care, how much their state organization has done for them.Unfortunately, this problem is on a federal level. While the NP’s were diligently working to further their profession, the AAPA was asleep at the wheel. They were not working with CMS to get us classified as mandatory providers. They were hiding under their rock, afraid that the big bad AMA was going to come and get them.TAPA is working diligently with the state to get a work around solution. Tennessee is a terrific state, and our legislators are very sympathetic and appreciative of PA’s for the most part. Please don’t sit around and feel sorry for us in Tennessee, because this is your problem, too, if you are a PA. When your cash strapped state has to cut its’ Medicaid program, you will also be thrown out. After all, you are optional. I belonged to the AAPA for many years. About 8 years ago, I realized that, not only were they not helping my profession, they were hurting it. I would read from them where they were “in dialogue” about a problem or where they “sent a memo” protesting something. I never read about any real action. I dropped out, not wanting to help my enemies.I will not be a member again until I am shown proof that they are furthering the PA profession.This will spell disaster for PA’s in Tennessee who see large amounts of adult Tenncare patients. I am close enough to retirement that the AAPA’s incompetence and inaction will not hurt me financially. But it breaks my heart to see the profession that I love so dearly go down the drain because of the timidity of its’ national organization. Hey no disagreement , but you sound like my now banned from PAF buddy CAdamsPAC! Link to comment Share on other sites More sharing options...
BigDuke06 Posted February 5, 2011 Share Posted February 5, 2011 I am actually considering applying to an NP bridge program. If I do that I won't even have to retake my boards every six years. Once you are an NP it is for life and all you have to do maintain it is your CMEs. As far as the AAPA I never renewed my membership after graduated from school. They seem to be an ideological dictatorship and the only way people make it into leadership positions is to think just like those who came before them. The only thing I have seen AAPA lobby hard for in Washington was Obama care, which is opposed by 60% of the country! Way to get out there and chose your battles AAPA! Meanwhile back at the ranch NPs are knocking our socks off when it comes to professional turf, but at least Obama and the AMA will like us. Speaking of the AMA, why does the AAPA want so desperately to be liked by them? Does the AAPA know that less than 20% of U.S. physicians are members? Even physicians don't like the AMA, but the AAPA thinks it is important to kiss up to the AMA. We have no national leadership for this profession and if we don't get one soon we won't have a profession!! The entire AAPA and far too many PAs for a very long time , have been big old lap dogs rolling over to have their bellies rubbed and trying to please their physician masters! They should have been watch dogs ready to take a bite out of those or whatever threatens them....but no let's all play nice so everybody likes us. Guess what who are the suckers now? Link to comment Share on other sites More sharing options...
Moderator ventana Posted February 5, 2011 Moderator Share Posted February 5, 2011 What is the NP bridge program? Don't laugh but I would really entertain a bridge program to NP (heck I already have an AS, BS, MS, MBA what is one more degree..) get your own practice and and bill on your own #'s all the time and never have to fight the insur co's - heck in MA I can not be someone's PCP - they have to select an MD - stupid found this but not sure if they do a PA-->NP bridge http://www.ucdmc.ucdavis.edu/fnppa/contactus/ Link to comment Share on other sites More sharing options...
Greg Cain PA-C Posted February 5, 2011 Author Share Posted February 5, 2011 Hey no disagreement , but you sound like my now banned from PAF buddy CAdamsPAC! I will take that as a compliment. I really like CAdamsPAC and consider him a friend. He spent 20 years in the military defending our right to say what we want here and of course he ends up getting banned for it. I too have been banned from the forum for something I didn't even say. I had to contact Banuchi (the forum owner) to get reinstated. Anyway I think we should be able to say whatever we think as long as we aren't using foul language. We are all adults so we should be able to take it. I wonder if I'll get banned for say that I like CAdamsPAC. I guess we'll see in a day or two. Link to comment Share on other sites More sharing options...
Greg Cain PA-C Posted February 5, 2011 Author Share Posted February 5, 2011 What is the NP bridge program? UT Knoxville has an NP bridge program where anyone with a B.S. and undergrad science prereqs. can apply to the NP program. They just have to take an extra nursing class or two. I had a job lined up with my kids' pediatrician when I graduated from school. We had all of the details worked out and even had made plans to open additional clinics in underserved rural areas and staff them with mid-levels. In other words we had spent a lot of time figuring all of the details out. We had agreed upon a starting salary of $100k for me. High for a new grad, but I also have lots of business experience that would help in developing the other clinics. Well, after I graduated and took my boards I went by his office to start working on the employment paperwork I was shocked to see that he had hired not one but two NPs who had graduated after I did and hadn’t even taken their boards yet. One had been an R.N. and the other had been a civil engineer. She had zero health care experience. These two NPs were working for $70k and $65k respectively. He had hired 2 NPs for only $35k more than what one PA was going to cost!!! Hard to blame the doc, but it's just another sign of things to come if the NPs keep working for peanuts. I have a cousin who is a charge nurse in an ER and I asked her if she had ever thought about PA or NP school. Turns out she had looked into it, but she makes $85k now and thought that NP school would mean a pay cut!!! Link to comment Share on other sites More sharing options...
Davidson25 Posted February 5, 2011 Share Posted February 5, 2011 I e-mailed the AAPA two days ago, but have yet to hear anything back. I'm not sure that they will pay much attention to what a PA-S has to say anyways but I am also very concerned. Maybe if all the PAs would get on them we might start seeing some action. I don't graduate until May but I am wondering if I will even be able to find a job when I get out. Anybody have any suggestions as to what we can all do to lobby for PAs?? think many people probably have the same idea as I did when I first started school. I thought well I am not into politics, so I will just pay my TAPA and AAPA dues and let someone else look out for the profession. Apparently this is not working.... Link to comment Share on other sites More sharing options...
archerry Posted February 5, 2011 Share Posted February 5, 2011 Having followed many of these threads, I am of the opinion that: 1. Name change to "Physician Associate" makes a lot of sense. 2. PA independence within a group setting with a MD or DO (a "coupled" independence, with rule sets set by the group as to limits and intragroup scope of practice of the PA) or separately in underserved areas, particularity for primary care, could serve our profession well. Personally, I think it is an overstep that NPs can practice completely uncoupled from MD and DOs in some States. Link to comment Share on other sites More sharing options...
jmj11 Posted February 5, 2011 Share Posted February 5, 2011 Having followed many of these threads, I am of the opinion that: 1. Name change to "Physician Associate" makes a lot of sense. 2. PA independence within a group setting with a MD or DO (a "coupled" independence, with rule sets set by the group as to limits and intragroup scope of practice of the PA) or separately in underserved areas, particularity for primary care, could serve our profession well. Personally, I think it is an overstep that NPs can practice completely uncoupled from MD and DOs in some States. I think if we could build a legal firewall between the PA and the SP (regarding malpractice liability) it would really help PAs who really want to have an association with an MD or MD group but yet set up shop in an independent manner in undeserved areas. I think I approached about 6 MDs to be my SP for my new clinic in the past 5 years and the liability issue scared them to death. I too do not believe that independence is a good option for NPs nor PAs, especially during their first 10 years of practice. I will be the first to say that an NP and a PA do NOT come out of PA school at the same level of competence as an MD who has just finished their residency. I caulk up the first decade that a PA (and NPs) work as their residency. Link to comment Share on other sites More sharing options...
Greg Cain PA-C Posted February 5, 2011 Author Share Posted February 5, 2011 Having followed many of these threads, I am of the opinion that: 1. Name change to "Physician Associate" makes a lot of sense. 2. PA independence within a group setting with a MD or DO (a "coupled" independence, with rule sets set by the group as to limits and intragroup scope of practice of the PA) or separately in underserved areas, particularity for primary care, could serve our profession well. Personally, I think it is an overstep that NPs can practice completely uncoupled from MD and DOs in some States. I think independent practice, particularly in primary care, makes complete sense. It is no different than what we do now - you run into something over your head or out of your scope of practice and you refer it out. No different than what we do now if the doc is physically in the building with you - you run the case by him. Lots of PAs work in different physical locations from their SP from time to time or in some cases every day. Nothing changes for those guys. If they run across a case that they can't handle they call the doc, send the patient to see the doc or refer the patient out. Under any of these circumstances (independent practice, rural practice where the doc isn't physically present, or when the doc is just down the hall in the next exam room) the bottom line is knowing your limits and not straying beyond them. It’s funny to me how civilians hit the panic button when we talk about PA independent practice. I wonder how many people know that the Navy has been sending Independent Duty Corpsmen out to sea on submarines, frigates destroyers and with Special Forces since at least WWII. These guys receive 1 year of training and no clinicals. They are the only medical personnel or medical services available to the crews on these ships. They are much less qualified than a PA or NP and they are the guy. They are often thousands of miles away from an MD or medical facility and they have all of the medical responsibility for the entire crew! Suddenly a PA practicing independently two blocks down the street from a hospital or an MD doesn’t seem like such a terrible proposition. Link to comment Share on other sites More sharing options...
marilynpac Posted February 5, 2011 Share Posted February 5, 2011 It all has to do with the politics of it all. Who has the stronger lobby(?!), and who has the weaker/impotent one. Link to comment Share on other sites More sharing options...
Greg Cain PA-C Posted February 5, 2011 Author Share Posted February 5, 2011 It all has to do with the politics of it all. Who has the stronger lobby(?!), and who has the weaker/impotent one. Exactly right!! And our lobby (AAPA) is like a one-legged man at an a** kicking contest. :) LOL Link to comment Share on other sites More sharing options...
GREATMDPA Posted February 5, 2011 Share Posted February 5, 2011 Don't laugh but I would really entertain a bridge program to NP (heck I already have an AS, BS, MS, MBA what is one more degree..) get your own practice and and bill on your own #'s all the time and never have to fight the insur co's - heck in MA I can not be someone's PCP - they have to select an MD - stupid found this but not sure if they do a PA-->NP bridge http://www.ucdmc.ucdavis.edu/fnppa/contactus/ This program requires that you have a BSN to do the FNP, so I guess being a PA-C won't meet the requirement for FNP. You would still need to have a BSN. It just makes no sense to go back and do BSN after having a MPAS. That takes a long time. Link to comment Share on other sites More sharing options...
Hemegroup Posted February 5, 2011 Share Posted February 5, 2011 I will take that as a compliment. I really like CAdamsPAC and consider him a friend. He spent 20 years in the military defending our right to say what we want here and of course he ends up getting banned for it. I too have been banned from the forum for something I didn't even say. I had to contact Banuchi (the forum owner) to get reinstated. Anyway I think we should be able to say whatever we think as long as we aren't using foul language. We are all adults so we should be able to take it. I wonder if I'll get banned for say that I like CAdamsPAC. I guess we'll see in a day or two. I miss CAdams as well. We didn't agree on much politically, but I could usually count on him for good debate. I never noticed that he went too far over the line, I guess I missed it. Link to comment Share on other sites More sharing options...
Hemegroup Posted February 5, 2011 Share Posted February 5, 2011 I too do not believe that independence is a good option for NPs nor PAs, especially during their first 10 years of practice. I will be the first to say that an NP and a PA do NOT come out of PA school at the same level of competence as an MD who has just finished their residency. I caulk up the first decade that a PA (and NPs) work as their residency. When NPs and PAs can know and deliver all of the information presented in Grand Rounds, then they'll be ready for 'autonomy', in my opinion. Link to comment Share on other sites More sharing options...
GREATMDPA Posted February 5, 2011 Share Posted February 5, 2011 I've read somewhere that the DNPs will be eligible to take USMLE in the near future, hence become independent as MD. Perhaps that might be an option for PAs who feel they should be independent may be eligible to sit for the USMLEs. Just a thought. Link to comment Share on other sites More sharing options...
Hemegroup Posted February 5, 2011 Share Posted February 5, 2011 I've read somewhere that the DNPs will be eligible to take USMLE in the near future, hence become independent as MD. I'd love to see them try ;) Incidentally, can you provide a link to your reference? Link to comment Share on other sites More sharing options...
GREATMDPA Posted February 5, 2011 Share Posted February 5, 2011 I'd love to see them try ;) Incidentally, can you provide a link to your reference? http://www.fiercehealthcare.com/story/medical-testing-board-to-offer-doctor-of-nursing-certification/2008-06-11 Link to comment Share on other sites More sharing options...
discogenic Posted February 6, 2011 Share Posted February 6, 2011 http://www.fiercehealthcare.com/story/medical-testing-board-to-offer-doctor-of-nursing-certification/2008-06-11 That article is dated June 2008, and it says "in the fall", meaning Fall of 2008. So has that exam been administered for 2+ years now? Link to comment Share on other sites More sharing options...
GREATMDPA Posted February 6, 2011 Share Posted February 6, 2011 That article is dated June 2008, and it says "in the fall", meaning Fall of 2008. So has that exam been administered for 2+ years now? I believe so :( Link to comment Share on other sites More sharing options...
marilynpac Posted February 6, 2011 Share Posted February 6, 2011 Clark Adams is fine in fact I met him while I was in Key West. He's going to do the panre one more time and then retire. Link to comment Share on other sites More sharing options...
andersenpa Posted February 6, 2011 Share Posted February 6, 2011 When NPs and PAs can know and deliver all of the information presented in Grand Rounds, then they'll be ready for 'autonomy', in my opinion. By this logic ALL physicians should meet the grand rounds litmus test. They don't. Link to comment Share on other sites More sharing options...
bradtPA Posted February 6, 2011 Share Posted February 6, 2011 I've read somewhere that the DNPs will be eligible to take USMLE in the near future, hence become independent as MD. Perhaps that might be an option for PAs who feel they should be independent may be eligible to sit for the USMLEs. Just a thought. That test is not the USMLE. And from other postings I read, I believe their pass rate was not the greatest at 50%. http://nurse-practitioners-and-physician-assistants.advanceweb.com/News/Doctorate-of-Nursing-Practice-News/Results-for-DNP-Exam-Announced.aspx Link to comment Share on other sites More sharing options...
Administrator rev ronin Posted February 6, 2011 Administrator Share Posted February 6, 2011 http://www.fiercehealthcare.com/story/medical-testing-board-to-offer-doctor-of-nursing-certification/2008-06-11 That says nothing about USMLE; it appears to be a proposal for a separate licensing exam... But then, DO's don't take USMLE, they take COMLEX... Link to comment Share on other sites More sharing options...
GREATMDPA Posted February 6, 2011 Share Posted February 6, 2011 That test is not the USMLE. And from other postings I read, I believe their pass rate was not the greatest at 50%. http://nurse-practitioners-and-physician-assistants.advanceweb.com/News/Doctorate-of-Nursing-Practice-News/Results-for-DNP-Exam-Announced.aspx It's not exactly USMLE step 3, but supposedly "comparable". The questions were taken from the pool of "no longer used" questions from previous USMLE step 3 exams. Step 3 is usually taken by first or second year MD residents, or people who are not in residency but have passed step 1 and step 2. Although the pass rate is low, but I assume they can retake it, and those who had passed can claim they are equivalent to MD? So I guess they're called "Dr. Nurse"? Medicine has, unfortunately, become more of a political battle for power than helping the need. I'm saying PAs should be given a chance to do something similar to this, since the nursing side is doing it. Hell, I'm preparing for my USMLE step 3 right now and will be taking in a few months. Link to comment Share on other sites More sharing options...
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