Grinder993 Posted February 6, 2011 Share Posted February 6, 2011 Why did Advance PA magazine merge with the Advance NP magazine? Why is the nursing lobby working so diligently behind the scenes to foster legislation that promotes them to the same pay tier as MD's but not PA's? Why are we standing idly by as the NP profession elevates themselves to the DNP? A wedge they will use to distort public perception that they are better trained than PAs because they have a doctoral title. Why do we continue to believe that if we are nicer and if we just love them more they will stop hitting us? I think we are in an abusive relationship and need a separation. The AAPA has failed us, they are terrified of the AMA. Why is the AAPA not shouting from the rooftops the DIFFERENCES between PA's and NP's. Why will they not understand that we are not collaberating with the nursing lobby we should be competing. In the near future NP's will all become DNP's, a title they will use to ensure them a more respected, secure seat at the medical table while we are still begging for scraps from the AMA. Ask yourself this...when the CMS wrote the legislation making NP's primary providers but PA's "optional" providers, did the nursing lobby step up to protect the interest of PA's or did they quietly pass that piece of legislation at the expense of PAs? You know that movie "Goodfellas"? You know the scene where Joe Pesci is taken by his "friends" to a house to be "made". He walks into an empty room and instantly realized he has been double crossed as he is shot in the back of the head. The nursing lobby is acting as our "friend" and they are telling us that we are going to be "made" if we just trust them. We are about to walk into an empty room. Link to comment Share on other sites More sharing options...
Joelseff Posted February 6, 2011 Share Posted February 6, 2011 I am a noob PA but I gotta say, what you have posted is intriguing. I have seen this "collaboration with NP's" in certain publications and websites but it seems kind of one-way. I often see PA's (or at least these publications) jump to defend midlevels in general (PA's and NP's lumped together) and I have yet seen NP support of PA's (like the thing in Tennessee, are NP's crying foul for their PA cousins?) in fact, the Degree Creep being imposed on us stems from their recent degree creep. I mean I understand the need to "play nice" but I think you bring up a good point and we should ask ourselves "WHY?" The NP agenda has no room for us PA's in my limited humble opinion. I must reiterate however that the NP agenda is probably NOT shared by our coworker NP's but the leadership, but doesnt that make it MORE dangerous? Link to comment Share on other sites More sharing options...
physasst Posted February 6, 2011 Share Posted February 6, 2011 Ummm, because it is probably in our best interests.... I am pretty good friends with the current president of the AANP, and she has reached out to the AAPA....She also believes that we can work together at times. If leadership from both sides still seem somewhat resistant to the idea, it's because of the scars left from previous battles between the two professions. Personally, I think the acrimony that some from either profession feel for the other is childish, and anachronistic. I work in a supervisory position, and when a position comes open, I list it as a PA OR an NP....I have hired NP's, and will continue to do so. For me, it is far more important to find the right person, than the initials after their name. This is also the entire premise behind Clinician One and the American College of Clinicians....We need to work together...United, we can accomplish much more, both at the federal and state levels. I mean, it's kind of simple. We know that there will ALWAYS be differences between the two professions, but in those areas where we can work together, we would be foolish not to. Also, the AAPA is hardly "terrified" of the AMA. The AMA has little real power left, as most real power resides in the specialty organizations now. The AAPA recognizes this, and over the past 5 years has been FAR more assertive towards the medical community than they had been previously. Out of curiosity, why would you be OPPOSED to working with NP's when and where we could? Link to comment Share on other sites More sharing options...
SocialMedicine Posted February 6, 2011 Share Posted February 6, 2011 Advance PA probably merged with Advance NP because neither were "advancing" solo. It is not really a journal ... I dont think it is searcheable in the medical literature and do not even think it is assigned an impact score. I read it ... I like reviewing some of the internal medicine articles. Probably hard for these issues seperate to get decent submissions and enough advertising to draw profit. Also, the AAPA is essentially all of us. I just completed a year ina leadership position. Will you do the same? Link to comment Share on other sites More sharing options...
physasst Posted February 6, 2011 Share Posted February 6, 2011 Advance PA probably merged with Advance NP because neither were "advancing" solo. It is not really a journal ... I dont think it is searachable in the medical literature and do not even think it is assigned an impact score. I read it ... I like reviewing some of the internal medicine articles. Probably hard for these issues seperate to get decent submissions and enough advertising to draw profit. Also, the AAPA is essentially all of us. I just completed a year ina leadership position. Will you do the same? Yep, I am in a leadership position with them now too. As far as pub med indexed....which is a big deal if you are in academia, the ONLY PA journal that is pub med indexed is JAAPA. I just received my "Assistant Professor" academic ranking..and was disappointed that several of my publications were in Clinician Reviews and others, that ARE NOT pub med indexed. Therefore they do not qualify for academic ranking. I need roughly 10 more pub med indexed articles for the "Associate Professor" ranking...and then of course....FULL "Professor" which is pretty hard to get to..... But yeah, Advance is not pub med indexed. Link to comment Share on other sites More sharing options...
Hemegroup Posted February 7, 2011 Share Posted February 7, 2011 Hoping someone can help clear this up for me, as I just don't know ... do all NPs have experience as nurses first? Link to comment Share on other sites More sharing options...
physio Posted February 7, 2011 Share Posted February 7, 2011 Not necessarily. They have several direct-entry programs for non-nurses Link to comment Share on other sites More sharing options...
Grinder993 Posted February 7, 2011 Author Share Posted February 7, 2011 TO physasst: Congratulations on being an assoc. professor and in a leadership role, you sound very proud of it. Your opening line being "Ummm, because it is probably in our best interests...." leads me to believe you recognize that the PA profession is at a disadvantage next to our NP cousins. What is in our best interest is to promote the PA profession, not allow ourselves to become the afterthought of the ANA when they are at the table crafting legislation. All of you who believe the DNP is an innocuous event are going to be surprised one day when legislation is passed allowing "independent" "Doctor"ate-NP's to hire and supervise "dependent" PA's. Making us essentially N-PA's. Our profession is approaching a crossroad, if we cannot define why we are different from NP's then why do we exist? At a legislative level PA billing could be phased out since we are so similar to NP's you could trim some fat by doing away with what appears to be a redundant provider. I predict we will either be folded into the NP camp, form some fast track MD/DO route or end up in medical/billing limbo. The other option is to fire back with a Doctorate PA degree and really begin championing our profession above our NP cousins. I mean we are different, we are trained differently, we are fundamentally trained differently!! Medical model vs Nursing model. Those of you who support the play nice attitude please refer to my opening statement and my example from the movie "Goodfellas". The pseudo-intellectuals who continue to say "we have to work together" are not showing me any examples of where, when and what legislation has the ANA stepped up to protect or promote the PA profession. When the President of the US gave a speech about healthcare a few years ago and mentioned only Doctors and Nurse Practicioners, I don't recall the ANA being the one to remind him of the noble PA profession. You guys are being suckered. I hope the PA leaders wake up and smell the cordite, as for me, I do and my plan is to make as much money as possible for my family and get out before its too late because no one is listening. Link to comment Share on other sites More sharing options...
Guest cabkrun Posted February 7, 2011 Share Posted February 7, 2011 Hoping someone can help clear this up for me, as I just don't know ... do all NPs have experience as nurses first? There are direct entry programs... The ones I am most familiar with require a year to do all of the basic nursing stuff, clinical rotations/work as a staff nurse, etc. Get your license. The two years after are often part-time for the Master's, where you work while taking classes. An ACNP specialty I looked at required you take a "step out" year to work before finishing the Master's / NP stuff.... They felt it was way too intense not to have the basic nursing experience foundation before becoming an NP. So, technically in those programs you do not have to have years of experience working as an RN, but they do get you some level of nursing experience before becoming an NP. Link to comment Share on other sites More sharing options...
physasst Posted February 7, 2011 Share Posted February 7, 2011 . Our profession is approaching a crossroad, if we cannot define why we are different from NP's then why do we exist? At a legislative level PA billing could be phased out since we are so similar to NP's you could trim some fat by doing away with what appears to be a redundant provider. Well, I love fear mongering as much as anyone...but let me ask you this. Do you have ANY proof that PA's are somehow better than, or superior to NP's? I read this data all the time, and every single study I have seen suggest similar outcomes...and ONE, showed that NP's were superior to physicians and PA's in the care of one diagnosis (DM). Do you honestly think that we will be "phased" out? That's not born out in the empiric data. There will be enough work for every provider for the next forty years at least. Now, if you want to argue that as the population, particularly the elderly population contracts in about 35-40 years, if you want to say that this "may" create an oversupply of healthcare providers...I might say maybe....but for the conceivable future, the PA profession is well positioned. The problem is, you are looking at this, and arguing from an emotional position. When you think about it logically, there is not much difference between a PA and an NP. I supervise both...and I hire both. I think of it as akin to the MD/DO argument...both physicians, but trained differently with different philosophies underpinning the allopathic v osteopathic curriculums. At the end of the day, they are similar. Same with PA's and NP's....My experience tells me that in Emergency Medicine...PA's are slightly better as new graduates, but that after a year or so, they are completely the same in practice. I've hired 3 NP's, and 4 PA's over the years....That trend will likely continue....The PERSON is what matters....the degree, not so much. They are for the most part, completely interchangeable. At our institution, we list every position (save for one department) as an NP OR PA position. Doctor of PA degree is not going to happen. And it shouldn't. I would be completely opposed to such a move. YMMV. Link to comment Share on other sites More sharing options...
Moderator ventana Posted February 7, 2011 Moderator Share Posted February 7, 2011 I think we should try to ride their coat tails a bit at this point - They are active and fighting to be PCP's and we should have the same right's as them in the world of insurance regulations and like it or not the Nursing lobby is far better then the PA lobby - they are bigger, have deeper pockets, are older and more established. Heck climb in bed with them a little bit and try to get some things through I for one enjoy working with GOOD PA's or NP's and hate the bad one's (*of which I have only meet a few) but the PA and NP are pretty much the same thing in the 'real world' pisses me off when NP's can open a practice i.e. in NY - but NY has specifically barred a PA from opening a practice....... Link to comment Share on other sites More sharing options...
Grinder993 Posted February 7, 2011 Author Share Posted February 7, 2011 My concerns cannot be diminished to "fear mongering", they are legitimate and you should pay attention. You are grossly missing part of my point. I agree that NP's and PA's serve in a similar function but yes in certain areas PA's are better trained. I am a residency trained ER PA, I am the only PA that works in my ER all of the rest are NP's. Yes, I am better than they are. They even agree. They cannot do the procedures I do, and most frankly don't want to. They do not pick up the main ER charts as often, they prefer to stay in the shallow waters of fast track. That's fine. They freely admit that NP school is more nursing theory than medicine and that they are not really equipped to "hit the ground running" out of school. I am friends with them, we enjoy working together and I enjoy teaching them the finer points of emergency medicine whenever they ask. My main stay point is not the individual NP that is the problem for PAs. It is the collective ANA that is going to crush us. The ANA is prepared and currently doing battle with the AMA and they are winning. The ANA and NP's are in direct competition with MDs. If they are brazen enough to challenge MDs on their own turf and come out on top with (Doctorate, Independent practice and 100% billing) why do you think they are going to allow competition from the PAs? They will either partake in the crafting of legislation that will make hiring a PA so difficult that MDs won't, or they will subjugate us by slipping legislation in that will make an independent doctoral NP a qualified supervising provider of PAs. The Doctoral degree for PA's will happen. You are showing how little you know of history to make such a brash statement. It will happen because their is a demand for it, I want it and many other PA's recognize that we have to match the DNP. Many like you said that PAs didn't need a Bachelors degree, then it was nay sayers like you who didn't want it to be a Master's degree. Your kind lost every step of the way. I will see the Doctorate level PA in my career. The schools will begin to offer it in time because the free market has indicated the demand for it. While I agree that a Masters for PA graduation is fine, I want to see a clinical doctorate awarded for completion of specialty residency/fellowship. But, just like with the Masters degree, the AAPA will be out of the loop and left behind. Link to comment Share on other sites More sharing options...
Grinder993 Posted February 7, 2011 Author Share Posted February 7, 2011 Ventana, That is my point exactly. Do you hear anything at all from the NY Nursing Lobby fighting for PA's to be able to open a practice? They are only looking out for themselves. We have been in bed with them, yes they are MUCH more powerful than we are. That is why I believe unless we match the DNP, they will crush/subjugate us in the end. They are going to become PCP's and yet you still have the old guard "leadership" PAs who scream blasphemy if you even mention PA's moving to the same model. We are redundant providers and I am in full support a bridge MD/DO-PA program. Link to comment Share on other sites More sharing options...
physasst Posted February 7, 2011 Share Posted February 7, 2011 Well, opinions vary... We had a clinical doctorate summit. This issue was put to rest for now. You're correct, I don't agree with a mandatory Master's degree...Our profession was never intended to compete with physicians, but rather to complement them. You seem to be missing that understanding. The ANA is fighting their own battles. It's not about "matching" the DNP....I think that would be a grave mistake for our profession, and I will fight it tooth and nail at the legislative and national policy level. I graduated with an Associate's degree and began practicing as a PA, I have serious concerns about this degree creep that is occuring. So don't worry, go ahead an advocate for what you believe in, and I will be there to speak out against it (A doctoral degree that is) at every turn. Link to comment Share on other sites More sharing options...
Grinder993 Posted February 7, 2011 Author Share Posted February 7, 2011 My suspicion is that the old PA's that are still practicing with Associates degrees are the ones most vocal against a Doctorate. They don't want to have to go back to school and obtain the degree. In other words, you are looking out for yourselves and not in the best long term interest of the profession. The term "degree creep" is overused. All other Allied Health Professions have moved to it as we will sooner or later. As far as the "clinical degree summit" goes, you are not the final word Sir! How arrogant of you. The free market is the final word and where there is an interest in the Doctorate PA, a college somewhere will someday offer it and the AAPA will not be able to do a thing about it. A handful of old guard Associate degree PA's will not dictate our direction in the end. The younger PA's will frankly wait you out. Link to comment Share on other sites More sharing options...
andersenpa Posted February 7, 2011 Share Posted February 7, 2011 The remnant thinking is that the masters locks out applicants who lack the bachelors.....probably a good portion of applicants who are medics, nurse aids, etc. The NP model is showing that they can train direct entry applicants. PA programs are essentially doing the same with fully integrated programs (admit as a HS grad->BS/MS->PA-C). Once the market becomes more saturated with these graduates, and shows that they can be trained as competent PAs while lacking the HCE that the above mentioned medics and nurse aides have, there will be less concern that we are excluding the +HCE crowd. Whatever any particular group wants or doesn't want, believes in or not, is irrelevant to the forces that push low/non-HCE applicants into PA programs and make them into PANCE-passing, state licensed PA-Cs with jobs. THOSE numbers will get accreditation and $$$ to those PA programs and reinforce the model. Also to the OP- I am sure that PA and NP advance journals merged not out of need for a philosophical alliance but rather to save money. Most journals are folding (remember Surgical PA journal?!?!!) to streamline expenses. Those journals survive by ad revenue and the internet is killing them. Link to comment Share on other sites More sharing options...
Contrarian Posted February 8, 2011 Share Posted February 8, 2011 My suspicion is that the old PA's that are still practicing with Associates degrees are the ones most vocal against a Doctorate. They don't want to have to go back to school and obtain the degree. In other words, you are looking out for yourselves and not in the best long term interest of the profession. Pure silliness and fantasy when one considers that "the old PA's that are still practicing with Associates degrees" don't need to do anything but CMEs and pay fees to continue practicing. It has been my experience that even states that require a Bachelors or Masters for a PA-C to practice "grandfathers"... "the old PA's that are still practicing with Associates degrees" as long as that PA was certified & licensed before the degree requirement was enacted. So those "old PA's that are still practicing with Associates degrees" can pretty much practice ANYWHERE they please because they will likely be "grandfathered," They don't hold the student debt that requires them to practice in urban settings in lucrative specialties and... They have the experience that will trump degrees any day of the week. Also... had you considered that the folks opposed to the "degree creep" may be looking out for the best long term interest of patient's access to competent providers and concerned about the construction of unimportant, artificial barriers to practice...? Just a few thoughts... Contrarian, PA-C P.s... yes I have a Masters degree... :heheh: Link to comment Share on other sites More sharing options...
Moonwalk Posted February 8, 2011 Share Posted February 8, 2011 In my opinion there are a few fundamental issues in the PA/NP/MD drama currently going on: 1) Nurse practitioners are backed by the organizational strength of the very large nursing profession, which outnumbers physicians by at least 3 or 4 to 1. Physicians and politicians know that--nurses have way more votes in the US democratic process than do physicians. 2) The issue of dependence vs. independence. If you need someone (are in a dependent position), that person has power over you. However, dependence isn't just a one-way street. Physicians need nurses to care for their hospitalized patients. A physician may need his PA to perform high-quality clinical assessments, so he can focus on higher paying procedures. Physician organizations promote and support the concept of a physician-led team; they do not support the concept of independent nurse practitioners--and this just may have more to do with their concerns about the four-month wonders that come out of NP school than about political domination. 3) PA's cannot survive politically without the support of the physicians, and we cannot survive politically without the support and/or at the bare minimum the tolerance of nurses. 4) The nurse practitioner profession and their leadership is fundamentally prevaricating in their insistence that they practice nursing. Baloney--they diagnose and treat disease; therefore they practice medicine. 5) The nurse practitioner profession seems to be focusing on primary care as their target/sphere of influence and potential market niche. However, in my opinion hospital nursing is poor preparation for a career in primary care. 6) Physicians can solve their whole dilemma if they just stop hiring nurse practitioners. There just isn't a huge demand in the market for independent NP's by the medical consumer. Link to comment Share on other sites More sharing options...
marilynpac Posted February 8, 2011 Share Posted February 8, 2011 I agree with a lot of what moonwalk posted except for 5 and 6. As a RN b/f PA, the patients that we use to treat on a medical floor are now showing up in the office/clinic and therefore being treated on an outpatient basis. If you had pneumonia you automatically went into the hospital as a patient, not so anymore due to the advance of better meds. I remember when patients use to come into the hospital as a patient for lab and/or XRs. Now even a lot of that is done at clinics. If you have a patient in the hospital now, that patient needs to be there. In IL, the NP profession is exploding. The University of Illinois, that is very strong politically, has specialized their NP program as most NP programs are doing. Their focus is no longer on just primary care. In IL many NPs are rapidly b/c physician replacements. I assure you as the economy continues to suffer in many states and malpractice ins prem are sky high, so high MDs/DOs leave, they are being replaced with a cheaper NP by the hospital. Link to comment Share on other sites More sharing options...
bobuddy Posted February 8, 2011 Share Posted February 8, 2011 I agree with Marilyn - here in KY, NP's have the ability to practice independently and have their DEA. I overhear docs talking on a regular basis about "why hire a PA because we are a PITA to supervise when they can hire a NP and not have to worry about the supervisory regulations". More and more job listings are for NP's ONLY. Even at UK where we have a PA program - lots of NP listings for jobs and nothing for PA's. Face it, NP's are just as good as us - salary is the same, but less "work" for the docs. Why even hire a PA then? I will repeat what I said in a different thread - PA's as dependent practitioners need to be a thing of the past. Sure, the PA's were initially supposed to compliment the MD's but isn't that what the nurses were supposed to do also? Come on, times are changing and we need to either get with the program and be part of the future or hang it up and kiss our jobs goodbye. Link to comment Share on other sites More sharing options...
physasst Posted February 8, 2011 Share Posted February 8, 2011 My suspicion is that the old PA's that are still practicing with Associates degrees are the ones most vocal against a Doctorate. They don't want to have to go back to school and obtain the degree. In other words, you are looking out for yourselves and not in the best long term interest of the profession. The term "degree creep" is overused. All other Allied Health Professions have moved to it as we will sooner or later. As far as the "clinical degree summit" goes, you are not the final word Sir! How arrogant of you. The free market is the final word and where there is an interest in the Doctorate PA, a college somewhere will someday offer it and the AAPA will not be able to do a thing about it. A handful of old guard Associate degree PA's will not dictate our direction in the end. The younger PA's will frankly wait you out. Umm, I went back to school. I now have two Master's, a baccalaureate, and will finish my doctoral in June 2012. The point is, there are other considerations.... For example....with nurses moving to a DNP, there will already be a greater financial burden laid upon them at graduation....Will this mean that fewer will pursue low paying jobs in CHC, inner city clinics, and HIV clinics....(where by the way, NP's have been a very valuable workforce commodity)? Will fewer of them enter primary care? What will the effect be on the applicant pool? Salaries? Will they migrate to higher paying specialties in suburban areas? Historically, the most likely RN's to practice in rural and underserved areas as NP's upon matriculation, have BEEN FROM those areas....the education will now be more expensive and longer....what will the affect be on this pool? Will fewer choose to be NP's? What effect will the DNP have on collaboration? (HINT, it might not be positive, and collaboration is still required by a majority of states last I looked [Although I could be mistaken, as I haven't looked in about 8 months or so.].) From my own calculations, there will already be a decrease in primary care presence secondary to the creation of the DNP.....despite Polly and Mary's inclinations. Our profession was founded on the concept of working WITH our physician colleagues....a compliment, not a competitor....Pursuing independent practice and/or doctoral education is NOT what our profession is about. I don't care how good you are as a PA...YOU ARE NOT A PHYSICIAN.....I've been told numerous times by some of the top EM academics in the country that I can practice equivalent to an EM attending....SO what? It's a nice compliment, sure....but, at the end of the day, I am still a PA, and not a physician. That's our job...that's the profession you chose. Now, if you have proof, showing that doctoral level PA education will not affect salaries, applicant matrixes, specialty selection etc.etc.etc....I'd be happy to look at it. But in the absence of data, it is nothing but conjecture. Which is fine, but saber rattling doesn't really interest me. Good luck with your pursuits. Link to comment Share on other sites More sharing options...
Contrarian Posted February 8, 2011 Share Posted February 8, 2011 ... I overhear docs talking on a regular basis about "why hire a PA because we are a PITA to supervise when they can hire a NP and not have to worry about the supervisory regulations". More and more job listings are for NP's ONLY... I have heard this expressed and noticed this as a hiring trend locally also... Link to comment Share on other sites More sharing options...
klb48 Posted February 8, 2011 Share Posted February 8, 2011 I have heard this expressed and noticed this as a hiring trend locally also... Yeah I saw this a LOT in Pennsylvania. 10 NP jobs for every 1 PA job. Link to comment Share on other sites More sharing options...
bcstout Posted February 8, 2011 Share Posted February 8, 2011 Come on, times are changing and we need to either get with the program and be part of the future or hang it up and kiss our jobs goodbye. I believe this is a valid concern that many of us share. We should not be at war with the NPs, however we need to keep apace with them or our profession may become less then what it is now, or at worse, completely obsolete. I interviewed at a major teaching hospital for a hospitalist position that I very much wanted. The physician staff were impressed by me and expressed a desire to hire me. The medical director was familiar with PAs from a previous job she held. There were other midlevel hospitalists on staff but they were all NPs. These NPs were great and seemed like it would be nice to work with them. The problem: in my state PA's have no prescriptive authority until at least 1 year experience post PA school is achieved (I was a new grad at the time). Also PAs in my state can not prescribe schedule II. Well the NPs have no such restrictions. They can prescribe schedule II right after graduation. Well hospitalists give orders all the time for schedule II medications so who will they hire? I had to find a job in a different state due to my home state's legislation. We have to fight to get good state legislation and we need as many allies as we can get to get it done. Link to comment Share on other sites More sharing options...
bobuddy Posted February 8, 2011 Share Posted February 8, 2011 "Our profession was founded on the concept of working WITH our physician colleagues....a compliment, not a competitor....Pursuing independent practice and/or doctoral education is NOT what our profession is about. I don't care how good you are as a PA...YOU ARE NOT A PHYSICIAN.....I've been told numerous times by some of the top EM academics in the country that I can practice equivalent to an EM attending....SO what? It's a nice compliment, sure....but, at the end of the day, I am still a PA, and not a physician. That's our job...that's the profession you chose. Now, if you have proof, showing that doctoral level PA education will not affect salaries, applicant matrixes, specialty selection etc.etc.etc....I'd be happy to look at it. But in the absence of data, it is nothing but conjecture. Which is fine, but saber rattling doesn't really interest me." Who says we want to be physicians and be called doctor? I dont think anyone is saying that. I think as PA's we can still be a compliment to MD's - just as NP's are now. But, we can still compliment MD's and have more independent functions. What I am saying is that when an MD thinks of hiring someone next week, next month or next year, I want to be in the running for that job - not "a PITA to supervise because of all the regulations and rules" that a current PA brings. Link to comment Share on other sites More sharing options...
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