amyg Posted February 12, 2011 Share Posted February 12, 2011 PHYSIO is correct "An approved plan of collaboration with a physician licensed to practice in the State of Alaska" taken from the AK State Board Application to Practice (on the State Commerce website.) Even though I am Pre-PA I know this because I managed the Urgent Care for over a year and had to do the applications for the incoming locum PA's that the doc hired (they were all amazed that we did this for them, and he even paid for it) as he would only be in town half of every month he liked to hire PA's to fill in, he had about 4 of them that would rotate. He didn't like using the headhunter companies,said they cost too much, so he would place ads around the country. Sorry this is so long and so off subject....just wanted to let everyone know the wording does exist in Alaska. Link to comment Share on other sites More sharing options...
Contrarian Posted March 13, 2011 Share Posted March 13, 2011 ... [brevity edit]... No chart signing rules, no signing prescriptions for them, no forms filled out....... need I go on? ... [brevity edit]... Meanwhile, the NP's are taking our jobs. The VA center in Lexington now hires ONLY NP's. The Little Clinics, etc that you see popping up in the Wal-Marts, Krogers, etc are all staffed by NP's ONLY. The PA profession keeps harping about us being in Primary Care and serving rural areas, but I how can I do this if I cant untangle myself from these antiquated regulations? Had lunch with one of my old SPs this afternoon... This 15 Physician Specialty practice Now ONLY hires NPs and has been exclusively NP/Physician since 2006. He stated that his partners felt hiring PAs was a Burden and increased their Liability. According to him, it was the chart signing and "supervision" (no "collaboration" requirements for NPs here) issue that made them stop hiring PAs. He went on to say that the perception seems to be that the 5 NPs currently in the practice being considered "independent" providers... lowers ALL the Physician's in the practice Liability. He basically stated that if one of the NPs screwed up... while they may still all be sued... in court, the question of "who was watching the kids" has been diminished/subdued/removed... :wink: The other issue was that the partners no longer had to bicker about chipping in to cover the Mid-Level's salary & bennies. Since the NPs can bill independently, they can all be paid with a minimal salary/reasonable production scheme. A quick lesson in Specialty Physician reimbursement for the newbies: Due to our system of insurance and "Capitation"... most Specialty Physicians either get patients from being "On-Call" at the hospital(s) or PCP referrals. Then if they are in a group practice, their personal income is based upon production numbers/formulas. When I was at this practice, the 12 docs would get together once a month and bicker over the numbers, who stole who's patients, who hogged the cath lab, and why their numbers were off. One common point of contention was whether or not and who should get credit for the patients the PA-C (me) seen/tested/treated. So if you are a Cardiologist on call tonight, most of the patients you see in the ED this evening will become your long time patients. Or... due to your likable demeanor, and demonstrated clinical excellence, local Internal Med and Family Practice docs refer all of their patients with potentially complicated cardiac issues to you for eval & management. Above all... keep in mind that its a business, and one built on personal relationships, networking and reputation. As many of you know, in MOST specialty practices, ALL the patient's belong to the physicians (not the mid-level). Those PCP's referred those patients to a particular Specialty Physician to get that Specialty Physician's input on the management of a particular issue. These PCPs often get really *pissy* if their patient's care isn't substantially managed by the Physicians (NOT PA/NP) that they referred them to. Link to comment Share on other sites More sharing options...
COTA for now Posted March 14, 2011 Share Posted March 14, 2011 So what about the liability of hiring LPNs and CMAs instead of actual RNs. How about hiring medical billers who aren't even licensed and might not have more than vocational training? Link to comment Share on other sites More sharing options...
bobuddy Posted March 14, 2011 Share Posted March 14, 2011 So what about the liability of hiring LPNs and CMAs instead of actual RNs. How about hiring medical billers who aren't even licensed and might not have more than vocational training? This is irrelevant to the PA profession. The issue at hand is that if the PA profession does not act quickly to stay on level playing ground with the NP's, our jobs are gone. Contrarian - your conversation with your former SP is exactly what is happening in my state (KY). We are in trouble. Link to comment Share on other sites More sharing options...
Joelseff Posted March 14, 2011 Share Posted March 14, 2011 Soooo, should there be a PA to NP bridge??!? LOL *ducks for cover* Link to comment Share on other sites More sharing options...
COTA for now Posted March 14, 2011 Share Posted March 14, 2011 bobuddy, I am not trying to change the subject. I am trying to point out how it is a silly, pointless fear. Liability is unavoidable. Physicians, as do do all who work in healthcare, live in liability every day. Partly because of the nature of the work, and partly because Americans love to sue people. My point was, liability isn't going away. PAs need to challenge the idea that they are some sort of accident waiting to happen. Link to comment Share on other sites More sharing options...
andersenpa Posted March 15, 2011 Share Posted March 15, 2011 bobuddy, I am not trying to change the subject. I am trying to point out how it is a silly, pointless fear. Liability is unavoidable. Physicians, as do do all who work in healthcare, live in liability every day. Partly because of the nature of the work, and partly because Americans love to sue people. My point was, liability isn't going away. PAs need to challenge the idea that they are some sort of accident waiting to happen. We are ALL accidents waiting to happen. Being sued is not always due to a flaw in the provider. The argument is- why would a physician want to assume a liability that is not even of his/her own doing? (aside from the revenue generated by the PA) Link to comment Share on other sites More sharing options...
Contrarian Posted March 15, 2011 Share Posted March 15, 2011 The argument is- why would a physician want to assume a liability that is not even of his/her own doing? (aside from the revenue generated by the PA) YEP..!!! He assured me that they would accept ALL of the revenue those 5 NPs produced but would have NO hesitation in tossing any one or all of them under the bus if it comes to that. Key here is that if one of those NPs commits a error of commission or ommission... there is NO state law here that says they were to be "SUPERVISED"... there is NO form in a file cabinet somewhere that has a Physician's signature on it stating that the physician is responsible for the actions or inaction of those NPs. The practice pays their Malpractice insurance, but last I checked... the premium for all 5 of them probably equals that of one policy for a PA-C (~$700/yr/NP versus ~$4600/yr/PA-C) Link to comment Share on other sites More sharing options...
maebashi Posted March 15, 2011 Share Posted March 15, 2011 Contrarian, May I ask what state this is? Link to comment Share on other sites More sharing options...
discogenic Posted March 15, 2011 Share Posted March 15, 2011 YEP..!!! He assured me that they would accept ALL of the revenue those 5 NPs produced but would have NO hesitation in tossing any one or all of them under the bus if it comes to that. Key here is that if one of those NPs commits a error of commission or ommission... there is NO state law here that says they were to be "SUPERVISED"... there is NO form in a file cabinet somewhere that has a Physician's signature on it stating that the physician is responsible for the actions or inaction of those NPs. The practice pays their Malpractice insurance, but last I checked... the premium for all 5 of them probably equals that of one policy for a PA-C (~$700/yr/NP versus ~$4600/yr/PA-C) Malpractice for a PA is 6x that for a NP? How does that compute? Link to comment Share on other sites More sharing options...
bobuddy Posted March 15, 2011 Share Posted March 15, 2011 Soooo, should there be a PA to NP bridge??!? LOL *ducks for cover* Sadly, I would consider doing this. If I could sit for NP boards, I would do it in a heartbeat. Here in KY, NP's have no supervision issues, no board re-cert every 6 years, no prescribing issues, no forms to sign for supervising physicians , no co-signing charts, no insurances that do not recognize NP's, etc...... It is easy for others to say "move to the jobs". However, I have responsibilities/commitments to other family members that will keep me here for awhile. Link to comment Share on other sites More sharing options...
Contrarian Posted March 15, 2011 Share Posted March 15, 2011 Malpractice for a PA is 6x that for a NP? How does that compute? Acturarial Science... NPs practice "advanced nursing" and is therefore lumped in a pool with ALL nurses . The more people in the pool... the lower each has to pay... There are 10-30x as many nurses as there are PAs...:wink: The NP sitting next to me as I type this says that she pays $722/yr for Malpractice insurance. When I renewed mine in Dec. I paid $4,638. Link to comment Share on other sites More sharing options...
Houstonian Posted March 16, 2011 Share Posted March 16, 2011 In states where the "independent" status of nurse practitioners seems to be tilting the job market in favor of NP's and away from PA's, then there are two possible strategies that I can think of. One, which almost everyone is focused on, is leveling the playing field by liberalizing the laws regulating PA's and moving toward independence ourselves. The other strategy might be to carefully examine "scope of practice" laws for the NP's and be sure that the state is effectively enforcing them--if a "specialty" medical practice is employing "independent" NP's, are those NP's fully functioning within their scope of training and education? Is a "family nurse practitioner" practicing acute care medicine for a CT surgery practice? Did her education include rotations in CT surgery? Is there an Adult Nurse Practitioner functioning as an ER nurse practitioner? Has the ER nurse practitioner ever examined a pediatric patient? Do the laws in the state actually authorize the NP's to perform their duties? If not, both the NP's and MD's should be prosecuted, and see how quickly the MD's drop the NP's from their payrolls. Have you seen an NP performing acts not specifically within her hospital privileges? One of the great advantages of being a PA is the very, very broad scope of practice that we are capable of having; we can do everything from surgery to pediatrics to psychiatry to ER medicine, and the scope of practice is indeed determined by the physician, and based on the skill and experience of the PA. Link to comment Share on other sites More sharing options...
browndog Posted March 16, 2011 Share Posted March 16, 2011 Acturarial Science... The NP sitting next to me as I type this says that she pays $722/yr for Malpractice insurance. When I renewed mine in Dec. I paid $4,638. Your correct. I think that my 6m insurance was about $1k/yr. Link to comment Share on other sites More sharing options...
discogenic Posted March 16, 2011 Share Posted March 16, 2011 Acturarial Science... NPs practice "advanced nursing" and is therefore lumped in a pool with ALL nurses . The more people in the pool... the lower each has to pay... There are 10-30x as many nurses as there are PAs...:wink: The NP sitting next to me as I type this says that she pays $722/yr for Malpractice insurance. When I renewed mine in Dec. I paid $4,638. Wow. That just seems crazy. That there can be 2 people, one a PA and one a NP, in the same office, doing the same things, having the same responsibilities (and if anything, the NP being even more independent in some states), yet one pays more than 600% more for malpractice insurance, sounds insane. But I guess it does come down to actuarial calculations. I would just think that the actuaries would be separating the independently practicing (i.e., higher risk) NPs from a much lower risk RN, but perhaps not. Link to comment Share on other sites More sharing options...
marilynpac Posted March 16, 2011 Share Posted March 16, 2011 If there was a PA to NP bridge...I would do it in a heart beat. Think about it. One test, you're done for life. Lower malpractice ins premiums, nursing lobby is awesome. I would like to be represented by an awesome lobby. Drs falling all over each other to hire you....in a heartbeat... Link to comment Share on other sites More sharing options...
discogenic Posted March 17, 2011 Share Posted March 17, 2011 If there was a PA to NP bridge...I would do it in a heart beat. Think about it. One test, you're done for life. Lower malpractice ins premiums, nursing lobby is awesome. I would like to be represented by an awesome lobby. Drs falling all over each other to hire you....in a heartbeat... Anyone else share Marilyn's feelings? And are there states where the 'NP advantage', if there is such a thing, does not exist? Link to comment Share on other sites More sharing options...
Joelseff Posted March 17, 2011 Share Posted March 17, 2011 Anyone else share Marilyn's feelings? And are there states where the 'NP advantage', if there is such a thing, does not exist? I was talking to a youngster this weekend who asked me how I liked being a PA. He is graduating with a BS in biosci from UCD. I told him to go to Med School. He asks about PA vs NP. I told him about the differences in training which favors PA education. He says "So I should go for PA?" I say "No, are you crazy? Go NP!!!" LOL The confused look in this kids face was priceless hahaha... (I explained my reasons why, you know progression of profession, less restrictions in general etc.) Link to comment Share on other sites More sharing options...
bobuddy Posted March 17, 2011 Share Posted March 17, 2011 I would be in line right behind Marilyn - I am in KY. Link to comment Share on other sites More sharing options...
Contrarian Posted March 17, 2011 Share Posted March 17, 2011 For those of you stating that you would do a bridge... Why not simply apply to a DE MSN program... Surely you have ALL the prereqs and then some... and we read on here all the time about how much "fluff" its supposed to be... 1st yr full-time will get you the RN (maybe work part-time or weekends as a PA-C)... then the next 2 yrs part-time will get you the MSN (can work full-time as a PA-C and do the last 2 yrs online). Hell... as a PA-C with a Masters... a DE MSN should be a "part-time" CAKEWALK... That's IF we believe all the reports on here (from NON-Nurses) about how "fluffy" it is. Or... As masters degree holders.... If student loan debt loads is an issue... Why not simply apply to a Local CC ASN program. Complete it in ~ 15 months... then apply to a online part-time RN-->MSN program. The most difficult part about this would be keeping ones ego and knowledge on the "down-low" during the RN portion and writing 30-40 "fluffy-a$$ed" papers during the MSN portion. The FNP part should be "easy as pie" for a PA-C... :wink: YAHOO... (You Always Have Other Options) Just a few thoughts... Contrarian Link to comment Share on other sites More sharing options...
marilynpac Posted March 17, 2011 Share Posted March 17, 2011 If I was younger I would consider it...schooling for me is done. Learning continues and always will but the didactic and everything that goes with that....not an option... Link to comment Share on other sites More sharing options...
cbrsmurf Posted March 17, 2011 Share Posted March 17, 2011 OK, here's a crazy idea, why don't we pay dues to the nursing association instead of AAPA. They have the bigger and better organization that has better lobbying powers. OK, it's a silly idea, but wouldn't the resources they have be nice... Link to comment Share on other sites More sharing options...
marilynpac Posted March 17, 2011 Share Posted March 17, 2011 I think I can speak for a few other forum members too that are disgusted by our slower than molasses progress. I see our profession being squeezed out. As programs go to all masters, I do believe the programs will get smaller. I'm sure if anyone wants to give money to the ANA, they will gladly accept it accomp with a good belly gut laugh.... Link to comment Share on other sites More sharing options...
Contrarian Posted March 17, 2011 Share Posted March 17, 2011 If I was younger I would consider it... You are gonna be 3 yrs older regardless of whether or not you "act" or "re-act"... the 3 yrs are gonna come and go either way. Hmmm... Maybe there should be a 12 month Masters PA--> MSN/FNP program.... That would be a serious coup d'état by the Nursing Lobby... and together... WE could outpace/out practice Physicians. :;;D: Link to comment Share on other sites More sharing options...
ankylosaurus Posted March 17, 2011 Share Posted March 17, 2011 Wow this thread is depressing. I'm thinking of going RN --> NP now instead of going into PA. I probably would except new RNs can't get hired these days... Link to comment Share on other sites More sharing options...
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