End of the PA Profession in Tennessee??

[Hemegroup]

Exactly right. I thought that was a little naive when I read Heme's comment, but didn't want to start an argument.

 

My point is that MD/DO knowledge isn't to be disregarded so lightly, as the NP lobbies are doing by striving for complete autonomy.

[bradtPA]

If we want our voice as PAs heard, be sure to contact your representatives on this and any other matters you deem important. I have sent letters to my senators and representative on both the issue of PAs not qualifying for the EMR bonus, and on the issue of allowing PAs to prescribe suboxone. I will be asking them to modify the Medicare law for this change, and for allowing PAs to authorize home health and hospice care. Finally, I just sent the AAPA Political Action Committee a donation. Nothing can get done without funding, and they need help. If 88,000 practicing PAs give up sodas for a month and send the $20 in the PAc, that's almost two million dollars to advance our agenda.....

[darryl]

I'm starting PA School this Fall and have longed to be work as a PA for many years now (I have 13 years experience in Ophthalmology). It hurts to hear what is going on and it scares me. I've always seen the PA profession as a field that is growing and has a great future. Am I now incorrect in my thoughts...and going to PA School?

[eddoc]

The designation as optional vs. Mandatory provider is embedded in the federal Medicare/Medicaid legislation and therefore must be changed by Congress. Apparently the AAPA has offered language for PA's every year but fear of adding costs to the programs has stayed the legislators hands. If you want this changed, contact your Congressional representative and your Senators - and add some $$ to the cause. If not the AAPA PAC, then some other fund that will advance the PA agenda.

[okccj]

I'm starting PA School this Fall and have longed to be work as a PA for many years now (I have 13 years experience in Ophthalmology). It hurts to hear what is going on and it scares me. I've always seen the PA profession as a field that is growing and has a great future. Am I now incorrect in my thoughts...and going to PA School?

 

I'm in a similar boat. Is this actually something that people considering PA school should worry about? It seems far fetched to believe that a profession could disintegrate, but is it possible? Thanks

[SocialMedicine]

I wonder if a PA caucus or committee could be formed which collects PAs interested in policy. Individuals could donate directly to this group. These polcy group members could be used to advance our cause and further their interests. I have a few friends in the LGBT PA caucus .... talk a bout a group of motivated and involved people. They are involved in many medical organizations and policy decisions and represent their cause with fervor. Too bad we do not have a group in the policy sector similarly.

[Rob77]

It seems that Tenncare is trying to get this changed and just limit pt. visits to 8/year. Approximately 45% of my practice is Tenncare and Im the only office in my city and the neighboring city that accepts Tenncare. This is what the Tenncare site is saying now:

 

 

Amendment #12 has been posted to allow the General Assembly and the public a 30-day review and comment period. We welcome comments on the Amendment. We continue to believe that all outpatient professional services, regardless of provider type, should fall under the 8-visit benefit limit originally envisioned. The original Amendment #12 that was posted on the TennCare website at the end of January 2011 was written to comply with the directions we received from CMS last year. Our proposal included a limit on outpatient visits to physicians and nurse practitioners and an elimination of physician assistant and podiatrists’ services. We have decided, after receiving many comments on this proposal, to return to our original proposal of an 8-visit benefit limit on health care practitioners’ office visits. We agree with the commenters that proposing a separation of mandatory and optional provider types could negatively affect access to cost-effective care for enrollees, and we will attempt to re-open discussions with CMS on this point.

[bobuddy]

The original Amendment #12 that was posted on the TennCare website at the end of January 2011 was written to comply with the directions we received from CMS last year. Our proposal included a limit on outpatient visits to physicians and nurse practitioners and an elimination of physician assistant and podiatrists’ services. We have decided, after receiving many comments on this proposal, to return to our original proposal of an 8-visit benefit limit on health care practitioners’ office visits. We agree with the commenters that proposing a separation of mandatory and optional provider types could negatively affect access to cost-effective care for enrollees, and we will attempt to re-open discussions with CMS on this point.

 

Interesting. Glad it is changed for the sake of PA's but I would rather see them change PA's to be included in the "mandatory providers" category. I hope the AAPA is still working on this issue and does not let it slide (again), because it will come up again next year.

[starlitez7]

Should I be worried about this if I want to practice in nyc?

[xxbowiexx]

Any profession is vulnerable to failure if it doesn't show its utility. That's why we must share what we do to the policy maker so that they are aware of our role in the medical model. While we are facing uncertainty in our role as a PA, i think we should play our part by advocating and promoting aggressively towards the law-maker, who does have a say in what we can and can't do. As a student, i try to play my part by joining AAPA in visiting State's law-makers in DC. We talked about expanding the role of PA in prescribing Xuboxone, changing the HITECH act, and allow PA to continuing patient care in the hospice setting. I plan to visit our Senators and other law-makers in my state in the future to build relationships with them. My point is, we should work together to help transform our role. If each of us advocate our profession actively, i foresee the role of PA will be here to stay.

[rcdavis]

Any profession is vulnerable to failure if it doesn't show its utility. That's why we must share what we do to the policy maker so that they are aware of our role in the medical model. While we are facing uncertainty in our role as a PA, i think we should play our part by advocating and promoting aggressively towards the law-maker, who does have a say in what we can and can't do. As a student, i try to play my part by joining AAPA in visiting State's law-makers in DC. We talked about expanding the role of PA in prescribing Xuboxone, changing the HITECH act, and allow PA to continuing patient care in the hospice setting. I plan to visit our Senators and other law-makers in my state in the future to build relationships with them. My point is, we should work together to help transform our role. If each of us advocate our profession actively, i foresee the role of PA will be here to stay.

 

Is there a prohibition against PAs in NC against prescribing suboxone. ( beyond the BME statements that it should be tx'd by pain management and addiction treatment centers).???

[bradtPA]

Is there a prohibition against PAs in NC against prescribing suboxone. ( beyond the BME statements that it should be tx'd by pain management and addiction treatment centers).???

 

The preclusion is written in the US laws. Only physicians who are certified may use suboxone for addiction therapy. That said, there was an interesting article in JAAPA a month or so ago that stated you can prescribe it off-label for pain, as long as you are licensed to prescribe schedule III. The trick was to put "for treatment of pain" on the script.

 

http://www.jaapa.com/pa-prescribing-of-buprenorphine-swapping-out-aminoglycosides/article/197451/

[heme-onc]

Based on my personal observations over the years, Vanderbilt University's massive nurse practitioner program led to a overabundance of underpaid nurse practitioners throughout the state. Salaries were extremely low for many years (until maybe 2007-2008?), with a good number of NPs earning less than RNs in other states. This factor DRAMATICALLY reduced the demand for PAs in Tennessee. This is one factor of many, and so I don't believe you can pin the entire PA issue in Tennessee on the AAPA.

 

In fact, as a recruiter I currently have two oncology PA openings in Texas. And these employers prefer PAs to NPs due to licensing laws in Texas.

 

So the full picture likely varies on a state-by-state basis.

 

By the way, I think the suggestion to call PAs "physician associates" is a much better alternative. Physician assistant sounds like it's on the same professional level as a medical assistant, whereas nurse practitioner has a completely different connotation.

[marilynpac]

Your last paragraph says it all...that's why we NEED a professional name change. The AAPA hasn't endorsed this and thus making it more difficult to achieve. When the org that represents you starts working against you, very little gets done in the name of progress.

[heme-onc]

Hi, Marilyn--

 

After thinking it over, I actually disagree with the idea to rename "physician assistants" as "physician associates." It still gives a somewhat similar connotation, whereas the title "nurse practitioner" connotes (to me) something a little more professional.

 

In fact, I'd personally rename PAs as "medical practitioners" and then call PAs and NPs together "health care practitioners" or "patient practitioners"--or something similar.

 

Whether PAs should practice independently (and in which specialties) is a whole other issue--but I feel PAs would be happier seeking a more professional name along the lines of NPs.

 

Also, there's been widespread dissatisfaction with what to call PAs and NPs as a whole: physician extenders has a similar feel as physician assistants. Mid-level providers seems to connote that PAs and NPs only provide "half" the quality of care as physicians. The name advanced practice nurses doesn't apply to PAs but can be changed as I mentioned to encompass both.

 

I do agree that pretty much anything is better than "physician assistant" for the reasons discussed, and hope this happens in the near future.

 

Any thoughts on other appropriate names, especially for the pairing of PAs and NPs?

[marilynpac]

If our name is to change at all, in some places it already has, it will be to Physician Associate.

[Vulgatus]

Question about the name change. If current laws are written specifically for "Physician Assistants" and the AAPA states that changing the name to Physician Associates would be too costly then how do graduates from Yale, who are considered Physician Associates, operate under the current wording of the law? If one can graduate from a Physician Associate program and call them a Physician Associate in practice but still effectively practice under the law for Physician Assistants, then why does the AAPA need to bother changing the wording of the laws in the first place? Just focus on changing the program/degree names.

 

Anyone familiar with this able to lend some insight?

[mshells90]

Maybe a professional name change will keep mistakes like this from happening: http://seeker.allhealthcarejobs.com/jobsearch/servlet/JobSearch?op=101&dockey=xml/0/3/036408327192a30ebda4103fb27e5cc5@endecaindex&c=1&source=20&utm_source=Indeed&utm_medium=organic&utm_campaign=Indeed

[Joelseff]

Hi Heme-Onc, The term "Medical Practitioner" (My FIRST-CHOICE TOO BTW!!!) has been brought up on this forum before but was immediately shot down as another "Oh the AMA will never go for that..." kind of thing...From what I have been told, a professional name change for PA's is astronomically and logistically more difficult than the move that RT's and Med techs etc have made with the names of their professions. I am still unclear on WHY!!! The most common cited reason is that it is a state by state issue and each state would have to adopt changes to that effect...

 

I actually think that the name change issue has not really gone much further than discussion and discourse among PA's and the current leadership has no real interest in pursuing it. Most often during these discussions and discourses, it gets ultimately shot down and forgotten for about another 10 years or so then gets brought up again...Kinda like a chronic disease that flares-up from time-to-time. I think enough PA's (I speculate) WANT a name change but those of us who do can't seem to organize a united front strong enough to get it past making a statement that we want it. If i am wrong on this please somebody show me proof of the contrary... I am not criticizing the efforts of the most recent movement but I think it is on its way to fizzling out.

[Vulgatus]

I'm still curious how graduates of Yale (Physician Associates) can practice under the current wording of the law if it's intended for Physician Assistants without any controversy?

[Joelseff]

I graduated from a Primary Care Associate program but on my diploma it states "Physician Assistant." Does Yale's program actually grant them the title Physician Associate on their diplomas? I think the title of the school is not important because we take a "Physician Assistant National Certification Exam."

[Vulgatus]

Good point. Thanks for the clarification!

[deborah212]

I graduated from a Primary Care Associate program but on my diploma it states "Physician Assistant." Does Yale's program actually grant them the title Physician Associate on their diplomas? I think the title of the school is not important because we take a "Physician Assistant National Certification Exam."

The diploma is in Latin. Honestly, I'm not quite sure what it says.

[Joelseff]

"Physician Socius" perhaps???

[free2speed]

this sucks to read. I'm about to start PA school and to even think my degree won't stand for much once im done...