Guest Paula Posted June 25, 2014 Share Posted June 25, 2014 The BIG question is: What is the answer? Link to comment Share on other sites More sharing options...
DissentingVoice Posted June 25, 2014 Share Posted June 25, 2014 There's rarely one answer. Sometimes it helps to recap the situation though. This threatens the PA profession by directly competing for jobs PAs/NPs threaten resident GME spots by offering a more cost effective employee than a resident This insults PAs by trying to say physicians are equal to PAs This insults physicians by saying they're not qualified to practice under supervision Years of practice benefit both physicians and PAs There's a vast difference in providers of all health professions with some much more qualified than others Supervision varies among attending physicians Legislature is based on populations and does not account for individuals Some wonder if physicians and PAs should take similar tests to prove ability but others feel this is insulting So I guess the issue is, how can we reconcile all of this into something that benefits physicians, physician extenders, and patients? Link to comment Share on other sites More sharing options...
Guest Paula Posted June 25, 2014 Share Posted June 25, 2014 Oh dear. Let's not use the term physician extender and use PA or NP. My proposal is both PA/NP be required to have 3-5 years of supervised practice, then enter in an independent license for each profession with collaborative agreements with physicians or hospitals or physician groups. It would give the PA/NP profession recognition yet provide the Collaboration needed for comprehensive care of the patient. Require insurance companies to reimburse for services provided by the PA/NP under our own NPI, and amend all CMS rules that cause delays in care because a physician cannot be found to sign an order. Unfortunately the ship has sailed and NP will not go backward in the 18 states of independent practice rights and PA won't be given the right because of our assistant status and title. Link to comment Share on other sites More sharing options...
DissentingVoice Posted June 25, 2014 Share Posted June 25, 2014 Oh dear. Let's not use the term physician extender and use PA or NP. My proposal is both PA/NP be required to have 3-5 years of supervised practice, then enter in an independent license for each profession with collaborative agreements with physicians or hospitals or physician groups. That sounds a lot like a residency. My questions is this: Why do we have four providers (MD, DO, PA, NP) providing the same service then? It just don't make much sense to me to have FOUR different providers each with a different level of education and experiences competing for the same thing. Maybe MD/DO should just decrease PCP spots and increase specialty? Maybe there should be a unified education system for all four? Maybe we should equalize the price of all of them and let the people who want extra training take it? Truth be told, our entire healthcare system is a bunch of people competing with government duct tape trying to hold it all together. Of course, socialized healthcare would be terrible. I mean, look how many other countries have tried a unified system and failed to offer our level of care. (Oh wait, we have a terrible life expectancy and our healthcare is six times more expensive than anyone else) Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted June 25, 2014 Moderator Share Posted June 25, 2014 If you want respect, then yeah, go for it. Otherwise, honestly, I don't think being an MD/DO gives you much more than a PA other than headaches. and 3x the salary for 2/3 the hours.... docs I work with make around 375k...I make around 125....I work 180+ hrs/mo, they work 120 or less. Link to comment Share on other sites More sharing options...
whoRyou Posted June 25, 2014 Share Posted June 25, 2014 The BIG question is: What is the answer? Wait ... Wait ... What was the question? Or better yet, was there ever one we haven't heard of before? Link to comment Share on other sites More sharing options...
Moderator LT_Oneal_PAC Posted June 25, 2014 Moderator Share Posted June 25, 2014 This thread has derailed into the perfect representation of an exercise in futility if I've ever seen one. Link to comment Share on other sites More sharing options...
whoRyou Posted June 25, 2014 Share Posted June 25, 2014 This thread has derailed into the perfect representation of an exercise in futility if I've ever seen one. ^^^ You think? I think Link to comment Share on other sites More sharing options...
delco714 Posted June 25, 2014 Share Posted June 25, 2014 The PA role in surgical subspec and family prac is way different. We need tight colab/supervision by necessity in surgical subspec. Steve PA-C, Maine, urologic surgery Link to comment Share on other sites More sharing options...
andersenpa Posted June 25, 2014 Share Posted June 25, 2014 So I guess the issue is, how can we reconcile all of this into something that benefits physicians, physician extenders, and patients? Step One stop using meaningless terms like "Physician Extender" Link to comment Share on other sites More sharing options...
andersenpa Posted June 25, 2014 Share Posted June 25, 2014 That sounds a lot like a residency. My questions is this: Why do we have four providers (MD, DO, PA, NP) providing the same service then? It just don't make much sense to me to have FOUR different providers each with a different level of education and experiences competing for the same thing Why do we have Crest and Colgate? Target and Walmart? Rite Aid, Duane Reade, and Walgreens? Link to comment Share on other sites More sharing options...
Guest Paula Posted June 25, 2014 Share Posted June 25, 2014 Around and around and around we go. Link to comment Share on other sites More sharing options...
whoRyou Posted June 25, 2014 Share Posted June 25, 2014 Around and around and around we go. Where and when do we stop no one knows Here we go round the mulberry bush, The mulberry bush, The mulberry bush. Here we go round the mulberry bush On a cold and frosty morning. Here we go round the mulberry bush, The mulberry bush, The mulberry bush. Here we go round the mulberry bush So early in the morning. Link to comment Share on other sites More sharing options...
delco714 Posted June 25, 2014 Share Posted June 25, 2014 You know what needs a mass exodus? The use of mid level. God do i hate it. Steve PA-C, Maine, urologic surgery Link to comment Share on other sites More sharing options...
primadonna22274 Posted June 25, 2014 Share Posted June 25, 2014 Interesting sidenote on the dreaded term "midlevel".... Learned from our staff PharmD recently that the term was originated by the DEA who needed some way to designate PAs and NPs controlled substance rx authority as different from MD/DO. They came up with "mid-level provider" and designated the M preceding our DEA numbers...hence my DEA ML..... (Second initial as you've realized is first initial of your last name at time of registration). Link to comment Share on other sites More sharing options...
Guest Paula Posted June 26, 2014 Share Posted June 26, 2014 Interesting sidenote on the dreaded term "midlevel".... Learned from our staff PharmD recently that the term was originated by the DEA who needed some way to designate PAs and NPs controlled substance rx authority as different from MD/DO. They came up with "mid-level provider" and designated the M preceding our DEA numbers...hence my DEA ML..... (Second initial as you've realized is first initial of your last name at time of registration). A bunch of us (can't remember if it was PAFT or Clinician 1 effort) wrote a letter to the DEA to ask to dispense with the mid-level terminology and a form letter came back stating it couldn't be done. I bet they didn't even try. Government Bureaucracy. Link to comment Share on other sites More sharing options...
andersenpa Posted June 26, 2014 Share Posted June 26, 2014 You know what needs a mass exodus? The use of mid level. God do i hate it. Steve PA-C, Maine, urologic surgery I have been doing work at my institution of revising our privileging documents and have been using every opportunity I can get to axe terms like Midlevel, Allied Health, Extender, etc. Here is a segment from the US Code which clearly defines Allied Health as NOT including PAs: TITLE 42--THE PUBLIC HEALTH AND WELFARE CHAPTER 6A--PUBLIC HEALTH SERVICE SUBCHAPTER V--HEALTH PROFESSIONS EDUCATION Part F--General Provisions Sec. 295p. Definitions •(5) The term ``allied health professionals'' means a health professional (other than a registered nurse or physician assistant)—[Emphasis added] (A) who has received a certificate, an associate's degree, a bachelor's degree, a master's degree, a doctoral degree, or post-baccalaureate training, in a science relating to health care; (B) who shares in the responsibility for the delivery of health care services or related services, including— (i) services relating to the identification, evaluation, and prevention of disease and disorders; (ii) dietary and nutrition services; (iii) health promotion services; (iv) rehabilitation services; or (v) health systems management services; and (C) who has not received a degree of doctor of medicine, a degree of doctor of osteopathy, a degree of doctor of dentistry or an equivalent degree, a degree of doctor of veterinary medicine or an equivalent degree, a degree of doctor of optometry or an equivalent degree, a degree of doctor of podiatric medicine or an equivalent degree, a degree of bachelor of science in pharmacy or an equivalent degree, a degree of doctor of pharmacy or an equivalent degree, a graduate degree in public health or an equivalent degree, a degree of doctor of chiropractic or an equivalent degree, a graduate degree in health administration or an equivalent degree, a doctoral degree in clinical psychology or an equivalent degree, or a degree in social work or an equivalent degree or a degree in counseling or an equivalent degree. Link to comment Share on other sites More sharing options...
Moderator True Anomaly Posted June 26, 2014 Moderator Share Posted June 26, 2014 Interesting sidenote on the dreaded term "midlevel".... Learned from our staff PharmD recently that the term was originated by the DEA who needed some way to designate PAs and NPs controlled substance rx authority as different from MD/DO. They came up with "mid-level provider" and designated the M preceding our DEA numbers...hence my DEA ML..... (Second initial as you've realized is first initial of your last name at time of registration). Very interesting- I had thought the two letters were for both first and last initials, just because my DEA is my exact initials Link to comment Share on other sites More sharing options...
68W2PA Posted June 26, 2014 Share Posted June 26, 2014 I agree, PA and MD students most likely learn at a comparable rate. The way the data is packaged differs. The PA students are missing about 33% of that data pie, not including the residency afterwards. Big divide, hence doctor > PA. Excluding the obvious benefits and education that comes with a residency, I often wonder what it is that I am missing in terms of instruction. What part of that data pie are we not getting? In my PA program, in the didactic phase (4 terms over 16 months) we earn 101 graduate semester hours. I looked up UNMC's med school curricula and it is only 84 semester hours in the first two years. Link to comment Share on other sites More sharing options...
andersenpa Posted June 26, 2014 Share Posted June 26, 2014 Very interesting- I had thought the two letters were for both first and last initials, just because my DEA is my exact initials Me too Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted June 26, 2014 Moderator Share Posted June 26, 2014 Excluding the obvious benefits and education that comes with a residency, I often wonder what it is that I am missing in terms of instruction. What part of that data pie are we not getting? In my PA program, in the didactic phase (4 terms over 16 months) we earn 101 graduate semester hours. I looked up UNMC's med school curricula and it is only 84 semester hours in the first two years. a lot of basic medical sciences year 1. Prima can probably chime in having done both pa and med school now. Link to comment Share on other sites More sharing options...
PACdan Posted June 26, 2014 Share Posted June 26, 2014 Excluding the obvious benefits and education that comes with a residency, I often wonder what it is that I am missing in terms of instruction. What part of that data pie are we not getting? In my PA program, in the didactic phase (4 terms over 16 months) we earn 101 graduate semester hours. I looked up UNMC's med school curricula and it is only 84 semester hours in the first two years. A year of core sciences and more in-depth pathophysiology. This is what I've been told and read. Med school students also get more time in rotations. Whereas PA students usually rotate 4-weeks in each area, med school students can spend 4, 6, 8 (and I've seen 12) weeks in a clinical concentration. Are you sure 101 isn't your program credit total? I admit, it is a lot. The NP programs are no where near PA credit totals. I cannot think of another graduate school program that requires this many credits (100+) and does not award a doctorate. If anything, this should be a big point of "hey, don't dismiss my education" in a "you're just a PA" scenario. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted June 26, 2014 Moderator Share Posted June 26, 2014 my program did six 5 week rotations and two 12 week preceptorships. I know a lot of programs now do 10-12 one month rotations. since the advent of the research program requirement, many programs have decreased clinical training hours a bit. Link to comment Share on other sites More sharing options...
PACdan Posted June 26, 2014 Share Posted June 26, 2014 my program did six 5 week rotations and two 12 week preceptorships. I know a lot of programs now do 10-12 one month rotations. since the advent of the research program requirement, many programs have decreased clinical training hours a bit.Yeah, that is how mine is. Luckily we have 2 elective slots (and possibly a 3rd) to focus in an area for up to 4 months. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted June 26, 2014 Moderator Share Posted June 26, 2014 Yeah, that is how mine is. Luckily we have 2 elective slots (and possibly a 3rd) to focus in an area for up to 4 months. we didn't have any electives but had several selectives. peds em for peds, trauma surgery for surgery, etc. our preceptorships required 1 block of 12 weeks of fp. 2nd block could be fp or em. guess which I did.....:) Link to comment Share on other sites More sharing options...
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