If you haven't heard yet....

[KMD16]

This is bad for physicians too. FMGs and unmatched physicians across the country and world will flock to Missouri in droves. It will push primary care physicians out of jobs. Cheaper = better in a lot of employers minds. t.

True. Words on the street. Here they comes.

 

It was a tough year for offshore MD grad to match. And, the future does not look promising. Given newly MD/DO program, school expanding class size with residency program spot fixed.

 

OK. We've got a new PCP in town. Them instead of NP/DNP. Was this their thought?

[physasst]

Well, a few things here.

 

1. The AAPA and the MOAPA were involved and working on this. But, just because your Academy works or lobbies on the behalf of the profession DOES NOT mean that they can always succeed in changing legislation or exerting influence to do so.

 

2. I was wondering when this might happen, and I think you might see this happen elsewhere too. What this is, is a reflection of the expansion of medical school enrollment. Part of the AAMC's answer to the physician workforce shortage, was to call for an increase in medical school enrollment by 30% by 2017, which they are well on their way to accomplishing. The issue is, that since CMS monies are being cut, there has been NO increase in residency positions. In fact, there may even be a reduction in the future. While this is thought to primarily displace FMG's from completing US residencies, it will undoubtedly affect the lower tier of US graduates as well.

 

3. What this leads to, with pending workforce shortages, is the question of what to do with educated, medical school graduates, who are heavily in debt, and do not match into US residencies. I can see many politicians, in many states, seeing this as possibly solution.

 

4. This does NOT mean that it is the right solution, as infringing on another profession is not really acceptable. That being said, I think you can look for a LOT more of this in state legislatures over the coming years as medical school enrollment increases and postgraduate positions remain stagnant or slightly decreased.

 

My thoughts at least.

 

Michael Halasy

[Guest Paula]

^^^^^^ Plus it must be illegal for a legislature to decide in one fell swoop who can be deemed an "assistant physician" or a "physician assistant for CMS purposes".  I see a lawsuit coming if it passes. 

[hlj25950]

Well, a few things here.

 

1. The AAPA and the MOAPA were involved and working on this. But, just because your Academy works or lobbies on the behalf of the profession DOES NOT mean that they can always succeed in changing legislation or exerting influence to do so.

 

2. I was wondering when this might happen, and I think you might see this happen elsewhere too. What this is, is a reflection of the expansion of medical school enrollment. Part of the AAMC's answer to the physician workforce shortage, was to call for an increase in medical school enrollment by 30% by 2017, which they are well on their way to accomplishing. The issue is, that since CMS monies are being cut, there has been NO increase in residency positions. In fact, there may even be a reduction in the future. While this is thought to primarily displace FMG's from completing US residencies, it will undoubtedly affect the lower tier of US graduates as well.

 

3. What this leads to, with pending workforce shortages, is the question of what to do with educated, medical school graduates, who are heavily in debt, and do not match into US residencies. I can see many politicians, in many states, seeing this as possibly solution.

 

4. This does NOT mean that it is the right solution, as infringing on another profession is not really acceptable. That being said, I think you can look for a LOT more of this in state legislatures over the coming years as medical school enrollment increases and postgraduate positions remain stagnant or slightly decreased.

 

My thoughts at least.

 

Michael Halasy

I agree with all of this.

[pglaser01]

Then why in the hell would they, on one hand try to increase enrollment in medical schools, yet not match residency placement increases?  Even if the money is not coming from the same place there really should have been a solution in place before this got anywhere

[Guest Paula]

Plus there was the Florida and NY experiments in the 80s (I think) where FMGs challenged the PA boards and most failed the test.  

 

So why doesn't the AAMC think proactively to alleviate the problem and look to PAs as the go to provider to fill the gaps in primary care?

[hlj25950]

Then why in the hell would they, on one hand try to increase enrollment in medical schools, yet not match residency placement increases? Even if the money is not coming from the same place there really should have been a solution in place before this got anywhere

Like things are supposed to make sense?

 

 

[delco714]

And they don't have to pass our boards? What's next FMGs?

 

Steve PA-C, Maine, urologic surgery

 

 

[physasst]

And they don't have to pass our boards? What's next FMGs?

 

Steve PA-C, Maine, urologic surgery

Florida did this for years.

 

Mike

[physasst]

Plus there was the Florida and NY experiments in the 80s (I think) where FMGs challenged the PA boards and most failed the test.  

 

So why doesn't the AAMC think proactively to alleviate the problem and look to PAs as the go to provider to fill the gaps in primary care?

 

They do Paula, but even doing so, there is evidence that substituting PAs or NPs for rural primary care providers results in reduced service.

 

http://journals.lww.com/lww-medicalcare/Abstract/2014/06000/The_Contribution_of_Physicians,_Physician.12.aspx

 

Background:

 

Estimates of the relative contributions of physicians, physician assistants (PAs), and nurse practitioners (NPs) toward rural primary care are needed to inform workforce planning activities aimed at reducing rural primary shortages.

 

Objectives:

 

For each provider group, this study quantifies the average weekly number of outpatient primary care visits and the types of services provided within and beyond the outpatient setting.

 

Methods:

 

A randomly drawn sample of 788 physicians, 601 PAs, and 918 NPs with rural addresses in 13 US states responded to a mailed questionnaire that measured reported weekly outpatient visits and scope of services provided within and beyond the outpatient setting. Analysis of variance and χ2 testing were used to test for bivariate associations. Multivariate regression was used to model average weekly outpatient volume adjusting for provider sociodemographics and geographical location.

 

Results:

 

Compared with physicians, average weekly outpatient visit quantity was 8% lower for PAs and 25% lower for NPs (P<0.001). After multivariate adjustment, this gap became negligible for PAs (P=0.56) and decreased to 10% for NPs (P<0.001). Compared with PAs and NPs, primary care physicians were more likely to provide services beyond the outpatient setting, including hospital care, emergency care, childbirth attending deliveries, and after-hours call coverage (all P<0.001).

 

Conclusions:

 

Although our findings suggest that a greater reliance on PAs and NPs in rural primary settings would have a minor impact on outpatient practice volume, this shift might reduce the availability of services that have more often been traditionally provided by rural primary care physicians beyond the outpatient clinic setting.

 

Plus, we don't make anywhere CLOSE to enough PAs to be "the only" solution.

[physasst]

Then why in the hell would they, on one hand try to increase enrollment in medical schools, yet not match residency placement increases?  Even if the money is not coming from the same place there really should have been a solution in place before this got anywhere

 

Different funding. There was some hope that CMS would increase funding to help with the residency issue. Unfortunately, the current environment in DC makes this untenable. In fact, the "fiscal cliff" called for some reduction in GME funding. So far, residency positions haven't been affected. AAMC I think operated with the assumption that lawmakers understood that there is a pending physician shortage. By increasing enrollment, it was thought that Congress would come to their senses and increase GME funding to help alleviate this crisis. I know that there has been SIGNIFICANT lobbying efforts to increase GME slots. Unfortunately, Congress is not in the mood, or mental state to even entertain slight increases in federal spending.

 

IIRC the numbers correctly, it was thought that the increase in medical school enrollment would primarily displace FMGs applying for residency. There were roughly 7,000 FMGs completing US residencies annually. This increase will total roughly 6800 students. Obviously though, some US medical students will be affected. Law of unintended consequences.

[MedicinePower]

Any way to work it out so that PAs will now be considered "Assistant Physicians"? It might require just another sentence or two in the bill and it would slightly elevate the status of PAs, as well as clarifying the confusing title that is Physician Assistant.

[rcdavis]

Hmmm.

 

Couple thoughts:

 

1. These "assistant physicians" are graduates of us medical schools, right?

 

2. Am I to assume that, because they failed a match, they are unable to complete an intern year.. Hence the need to limit their MD degree?

 

3. If so, it would seem that, in the least, we should be able to offer unmatched intern year opportunity to these graduates so that in the least they can get a full, unrestricted license a la the old general practitioner... As far as I know the states only require completion of an intern (pgy1) year, not a full residency for licensure... The marketplace has dictated the need for residency in hospitals...

 

 

4. So, it would seem that "de-coupling" internship from residency might be an answer to this problem.

 

5. I feel that these kids have been unjustifiably screwed by the system ( unintended consequences as stated above)

 

6. If each of these students graduated from a US Medical school, and since all us medical schools are associated with a hospital or training program, it would seem that the medical schools would have the easiest path to creating an intern year for any failed to match students.

 

They owe their students that much.

[PACdan]

If the NCCPA is a national credentialing body and graduation from an ARC-PA accredited PA program is necessary to take the PANCE, the only legal way to be considered a certified Physician Assistant.... how can a state legally declare, or have someone considered for paperwork or billing purposes, that which they are not and are ineligible to be?

 

This is fraud, IMO. It would be the same as the state passing a law that says all medical assistants, collaborating with a physician, can now be considered doctors for billing purposes. What's to stop that in this context?

 

This seems quite absurd.

 

 

Sent from the Satellite of Love using Tapatalk

 

[hlj25950]

Hmmm.

 

Couple thoughts:

 

1. These "assistant physicians" are graduates of us medical schools, right?

 

2. Am I to assume that, because they failed a match, they are unable to complete an intern year.. Hence the need to limit their MD degree?

 

3. If so, it would seem that, in the least, we should be able to offer unmatched intern year opportunity to these graduates so that in the least they can get a full, unrestricted license a la the old general practitioner... As far as I know the states only require completion of an intern (pgy1) year, not a full residency for licensure... The marketplace has dictated the need for residency in hospitals...

 

 

4. So, it would seem that "de-coupling" internship from residency might be an answer to this problem.

 

5. I feel that these kids have been unjustifiably screwed by the system ( unintended consequences as stated above)

 

6. If each of these students graduated from a US Medical school, and since all us medical schools are associated with a hospital or training program, it would seem that the medical schools would have the easiest path to creating an intern year for any failed to match students.

 

They owe their students that much.

Nope. Not true. In some cases, in many states, in fact, a physician needs at least 2-3 years of residency. They also need to pass all three USMLE steps.

 

Applicants to become a licensed Medical Doctor must meet either the requirements for Licensure by Endorsement or Licensure by Examination to proceed with the application process.

 

LICENSURE BY ENDORSEMENT

 

For Licensure by Endorsement, the requirements are as follows and can be found in Chapter 458.313 F.S.:

 

Be a graduate of an Allopathic US Medical School of a school recognized and approved by the US Office of Education (AMG) and completed at least one year of approved residency training

OR

 

Be a graduate of an allopathic international medical school (IMG) and have a valid Educational Commission for Foreign Medical Graduates (ECFMG) certificate and completed an approved residency of at least 2 years in one specialty area

OR

 

Be a graduate who has completed the formal requirements of an international medical school except the internship or social service requirement, passed parts I and II of the NBME or ECFMG equivalent examination, and completed an academic year of supervised clinical training (5th pathway) and completed an approved residency of at least 2 years in one specialty area

And both of the following:

 

Passed all parts of a national examination (NBME, FLEX, or USMLE) and

Licensed in another jurisdiction and actively practiced medicine in another jurisdiction for at least two of the immediately preceding four years; or passed a board-approved clinical competency examination within the year preceding filing of the application or; successfully completed a board approved postgraduate training program within two years preceding filing of the application.

LICENSURE BY EXAMINATION

 

For Licensure by Examination, applicants who do not hold a state license or who have not passed a national examination, the requirements are as follows and can be found in Chapter 458.311 F.S.:

 

Be a graduate of an Allopathic US Medical School of a school recognized and approved by the US Office of Education (AMG) and completed at least one year of approved residency training

OR

 

Be a graduate of an Allopathic international medical school (IMG) and have a valid Educational Commission for Foreign Medical Graduates (ECFMG) certificate and completed an approved residency of at least 2 years in one specialty area

OR

 

Be a graduate who has completed the formal requirements of an international medical school except the internship or social service requirement, passed parts I and II of the NBME or ECFMG equivalent examination, and completed an academic year of supervised clinical training (5th pathway) and completed an approved residency of at least 2 years in one specialty area

And one of the following:

 

Passed all parts of a national examination (NBME, FLEX, or USMLE) or currently licensed in the U.S. or Canada, and has actively practiced pursuant to such licensure for at least 10 years, has passed a state board or LMCC examination, and passed the SPEX examination

 

I know an MD right now who was a PGY-2 pathology resident and didn't finish his second year of residency. He was unable to match or SOAP in any specialty. He cannot get a license. I know another resident who was a PGY-2 ortho resident who cannot get a license in his new state and cannot join the program he rematched in.

 

It's not as easy as that.

[andersenpa]

Notice the part where it basically says, "Why haven't you heard of this before? Well weren't going to say anything because it probably wouldn't pass"  Oh come on! Plus, the Association and the lobbyist "monitored" the legislation?  Isn't the lobbyist supposed to, say, LOBBY!?!?!

 

And of course the state legislature only got active on the subject in the last week....when does a legislative body ever not do anything at the last minute???  Just change the name from Congress to Procrastinate

This is the biggest sin, if the story is represented accurately here.

INFORM your consituents. MO PAs could have been writing emails/letters and making phone calls the whole time this was brewing.

 

Either MOAPA sat idle on this thinking (gambling) that it wouldn't pass (bad...) or they are rewriting hx (worse....).

[andersenpa]

Wow.  A resident who couldn't match now can be an assistant physician.  That is unsafe and PAs have more educational hours with our 2000 hours of clinical training.  How on earth did this pass?  Where was NCCPA?  How can one state have the power to let CMS declare "assistant physicians" to be considered physician assistants?

 

This reminds me of the missteps of the HITECH act that AAPA screwed up on.  The thought of assuming gets us nowhere. 

 

I am stunned.  

 

But then....if it truly passes all physician assistants in Missouri who work in primary care and rural and underserved areas need to declare themselves as assistant physicians and start looking for residencies, as I'm sure the "newly minted assistant physicians" will continue to do.  Why not challenge  the Missouri Medical societies in this manner and the Missouri PAs need to stand up and rebel.  Oh, boy PAs are in for a huge mess.

Well I bet that they will say that all APs are PAs  but PAs are not APs!

 

Has PAFT formally taken a position yet? Contacted AAPA? 

[andersenpa]

Nope...no consolation here.  It's a slam on the PA profession that a state legislature could possibly think an unmatched resident is equivalent to a PA.   Now, if they stated that real PAs could be the collaborating physician for the newly minted assistant physician and it gave Missouri PAs an automatic promotion to Physician, with an MD license and complete CMS privileges...then.......ok. 

I just don't see how this can fly. It should be in statute that a PA is defined as someone who has passed an ARC PA program, passed PANCE etc.

How can one group co-opt our title without the established criteria for holding that title?

[pglaser01]

Nope. Not true. In some cases, in many states, in fact, a physician needs at least 2-3 years of residency. They also need to pass all three USMLE steps.

 

Applicants to become a licensed Medical Doctor must meet either the requirements for Licensure by Endorsement or Licensure by Examination to proceed with the application process.

 

LICENSURE BY ENDORSEMENT

 

For Licensure by Endorsement, the requirements are as follows and can be found in Chapter 458.313 F.S.:

 

Be a graduate of an Allopathic US Medical School of a school recognized and approved by the US Office of Education (AMG) and completed at least one year of approved residency training

OR

 

Be a graduate of an allopathic international medical school (IMG) and have a valid Educational Commission for Foreign Medical Graduates (ECFMG) certificate and completed an approved residency of at least 2 years in one specialty area

OR

 

Be a graduate who has completed the formal requirements of an international medical school except the internship or social service requirement, passed parts I and II of the NBME or ECFMG equivalent examination, and completed an academic year of supervised clinical training (5th pathway) and completed an approved residency of at least 2 years in one specialty area

And both of the following:

 

Passed all parts of a national examination (NBME, FLEX, or USMLE) and

Licensed in another jurisdiction and actively practiced medicine in another jurisdiction for at least two of the immediately preceding four years; or passed a board-approved clinical competency examination within the year preceding filing of the application or; successfully completed a board approved postgraduate training program within two years preceding filing of the application.

LICENSURE BY EXAMINATION

 

For Licensure by Examination, applicants who do not hold a state license or who have not passed a national examination, the requirements are as follows and can be found in Chapter 458.311 F.S.:

 

Be a graduate of an Allopathic US Medical School of a school recognized and approved by the US Office of Education (AMG) and completed at least one year of approved residency training

OR

 

Be a graduate of an Allopathic international medical school (IMG) and have a valid Educational Commission for Foreign Medical Graduates (ECFMG) certificate and completed an approved residency of at least 2 years in one specialty area

OR

 

Be a graduate who has completed the formal requirements of an international medical school except the internship or social service requirement, passed parts I and II of the NBME or ECFMG equivalent examination, and completed an academic year of supervised clinical training (5th pathway) and completed an approved residency of at least 2 years in one specialty area

And one of the following:

 

Passed all parts of a national examination (NBME, FLEX, or USMLE) or currently licensed in the U.S. or Canada, and has actively practiced pursuant to such licensure for at least 10 years, has passed a state board or LMCC examination, and passed the SPEX examination

 

I know an MD right now who was a PGY-2 pathology resident and didn't finish his second year of residency. He was unable to match or SOAP in any specialty. He cannot get a license. I know another resident who was a PGY-2 ortho resident who cannot get a license in his new state and cannot join the program he rematched in.

 

It's not as easy as that.

 

Next question though...Would MDs and DOs who own practices or even hospitals who would be on the hook, choose unlicensed med graduates and FMGs who couldn't match residency (forgive me for not knowing enough about matching, I'm assuming this means they  weren't a strong enough candidate?) over trained, board certified PAs/NPs??  What would the excuse be? "Oh they took med school classes so they must be better at it" ?

[andersenpa]

Exactly what I've been saying. Everyone talks about how complicated it is, but it has a simple, single line to establish the scope of a "assistant physician" is the same as ours.

It's not though- PAs are supervied and APs "collaborate". They're NPs!

 

Unless the MO statute says differently about PAs.

[pglaser01]

This is the biggest sin, if the story is represented accurately here.

INFORM your consituents. MO PAs could have been writing emails/letters and making phone calls the whole time this was brewing.

 

Either MOAPA sat idle on this thinking (gambling) that it wouldn't pass (bad...) or they are rewriting hx (worse....).

 

 

I usually get emails every few weeks...never once did I hear anything about this. 

 

But earlier in the year I was getting weekly updates from MOAPA about the progress of legislative language to allow PAs to bill MCS as a provider....

[polarbebe]

What is the likelihood of this passing?

 

If this passes and other states jump on the bandwagon and every foreign medical grad becomes an "assistant physician" that collaborates with a physician...

 

Ridiculous.

 

http://www.senate.mo.gov/14info/BTS_Web/Bill.aspx?SessionType=R&BillID=28296866

[pglaser01]

It already passed the Senate...it's in the house now I believe

 

 

Interesting choice of language though.  They have offered this giant golden egg with the collaboration agreement.  Yet they choose words such as "certain graduates"  and "temporary assistant physician license".  What limits are these going to be?  Could this be saying that in the case of a one-year long "temporary" license, a practice could hire a new graduate that doesn't place each and every year and pay rock bottom compensation??

 

Edit: If you read a few paragraphs down you see the brief sentence about PAs being Healthnet providers.  For APs it's "Collaborative agreement", but for a PA it's "under supervision"...

[polarbebe]

It looks like it has already passed the house and senate?

 

http://legiscan.com/MO/bill/SB716/2014

 

History

Date Chamber Action

2014-05-16 Senate Truly Agreed To and Finally Passed

2014-05-16 Senate CCS#2 H Third Read and Passed

2014-05-16 Senate CCR#2 H adopted

2014-05-13 House CCS#2 S Third Read and Passed

2014-05-13 House CCR#2 S offered & adopted (5335S09.1SR)

2014-05-13 House H submits CCR#2 (5335S09.1SR)

2014-05-12 House H submits CCR (5335S07.1SR)

2014-05-06 House H conferees appointed: Scharnhorst, Frederick, Kelly-45

2014-05-06 House S conferees appointed: Brown, Schmitt, Sater, Sifton, Walsh

2014-05-06 House H refuses to recede and grants conference

2014-05-01 House S requests H recede or grant conference

2014-05-01 House S refuses to concur in HCS, as amended

2014-04-30 House H Third Read and Passed

[EMEDPA]

wow...forwarded to president of PAFT...