If you haven't heard yet....

[eddoc]

Fortunately or unfortunately as the case may be, a person is a "doctor" when a doctorate is conferred. Therefore, these assistant physicians, having received an MD, are doctors and unless this legislation indicates otherwise, can call themselves doctors. On the other hand, practice rights are derived from state law and hospital bylaws and do not necessarily require board certification for either licensing or privileges. It remains to be seen what Missouri and its hospitals will do to operationalize this disaster but perhaps the State Board will drag its heels writing regulation giving sufficient time for an injunction.

[andersenpa]

Hmmm...here's a novel concept....  Did any of you who are bashing the situation, AAPA, MOAPA leadership, and lobbyist ever take just one moment to consider that perhaps there is more to the story (as there always is!), rather than go crazy with nothing but negativity???  I suspect the answer is an overwhelming "NO."  Hateful, emotional comments are nonproductive.  A better way to approach this news and situation would be to say, "wow, this is terrible for PAs in Missouri and potentially everywhere else.  What can we do to help?"  Perhaps MOAPA has a better idea of what would be helpful within their own state legislative issues and what kind of support they need, if any of you just reached out and asked.  It is much easier to sit back and point fingers and point out faults than to channel a bad situation into positive, proactive energy, and that is what most of you are doing. 

 

In addressing the idea that there may be "more to the story," Mr. PAFT President--are you oppossed to increasing Medicaid prenatal funding and funding for hospitalized seniors' influenza vaccines?  I certainly hope not.  If you have Gov. Nixon completely veto this bill, you are saying you and all of the PAFT members do not support these causes, thus you do not support preventative patient care. 

 

To pglaser01--while I commend you for being a member of your state chapter, my comments to you are:  1. if you are so passionate about PA legislation in your state, at least get your organization's name right--it's the Missouri Academy of Physician Assistants, not the Missouri PA Society.  2. are you an active member, meaning have you ever actually attended a meeting?  Better yet, before you decided to take it upon yourself to be the one to publish the letter sent out by MOAPA's president, did you take the time to try to contact him or any other BOD members to get more information?  If the answer to either of these questions is "no," it would probably be helpful for you to take a moment to reflect on how "heroic" your actions are.  

 

While I am, by no means, defending even the idea of an assistant physician, seeing all of these hot-headed, ignorant comments are even more upsetting to me than the original issue at hand.

You're conflating. PAFT's opposition to an item in the bill does not mean they oppose preventive care. Please. It means they oppose this aggression on MO PAs. The bill can be rewritten, without this Asssitant Physician buisiness, and then move it through. I'm guessing (hoping) you know a bit about legislative process to see that as an endpoint.

 

I see this is your first post, so welcome to the forum. This is a place where PAs can (and should) feel free to share their impressions and opinions. As you can assuredly understand, a lot of "water cooler talk" is inevitable with a hot button issue like this. I would not advocate stifling that conversation just because some parties feel that it is too reactive.

 

Regarding the OP, it is always nice to see a pre-PA this aware of political issues. I would not favor criticizing any involvement of young, passionate PAs, Students, or PrePAs.  

 

Are you a MO PA? In leadership?

 

If you have information that would better inform opionions here, please feel free to share.

[pglaser01]

Who was trying to be heroic? It's a big issue that others should know about. For someone harping on people with emotional responses you really forgot to take your own advice

[primadonna22274]

This statement is inaccurate. They are in fact doctors. They are qualified to act as doctors. They are not board certified. If they have completed USMLE-2 (which is harder than PANRE) then certainly they are more qualified than a Freshly graduated PA

 

 

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Having taken both PANCE/PANRE and USMLE/COMLEX 1/2, I can unequivocally state that step 2 is very, very similar to PANCE/PANRE. In fact I took step 2 cold without any special study and scored 98. Not difficult. It was almost an equivalent score to my PANRE in 2012 (99/800).

[LIPPER]

Having taken both PANCE/PANRE and USMLE/COMLEX 1/2, I can unequivocally state that step 2 is very, very similar to PANCE/PANRE. In fact I took step 2 cold without any special study and scored 98. Not difficult. It was almost an equivalent score to my PANRE in 2012 (99/800).

very well done and respectable on your part but I'm not sure statistically of sample size of one ;)

 

 

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[Cardsfan66]

• You're conflating. PAFT's opposition to an item in the bill does not mean they oppose preventive care. Please. It means they oppose this aggression on MO PAs. The bill can be rewritten, without this Asssitant Physician buisiness, and then move it through. I'm guessing (hoping) you know a bit about legislative process to see that as an endpoint.

   

  Missouri Legislative session ended last Friday so no, the bill cannot be rewritten without the PA language. There is also no line item veto in MO so that is not an option either. So the protest/rewrite option is off the table. You would have to introduce new legislation next Jan to have this "profession"/language removed from the MO statute which is not as easy as you think.

[andersenpa]

 

• Missouri Legislative session ended last Friday so no, the bill cannot be rewritten without the PA language. There is also no line item veto in MO so that is not an option either. So the protest/rewrite option is off the table. You would have to introduce new legislation next Jan to have this "profession"/language removed from the MO statute which is not as easy as you think.

 

Veto the whole bill and rewrite/reintroduce, not line item

[Guest Paula]

News flash! AAPA HOD passed collaboration resolution on first round without opposition and now waits final discussion and vote.

[ventana]

News flash! AAPA HOD passed collaboration resolution on first round without opposition and now waits final discussion and vote.

 

 

maybe just maybe there is hope for the AAPA

 

Also, Dave Mittman (runs Clinician 1) and is a progressive thinker for both PA and NPs! was voted onto the AAPA advisory committee

http://clinician1.com/posts/article/dave_mittman_named_to_aapa_advocacy_committee1/

[cinntsp]

News flash! AAPA HOD passed collaboration resolution on first round without opposition and now waits final discussion and vote.

We haven't voted on it yet. It was only pulled for testimony but sounded pretty positive.

 

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[ventana]

We haven't voted on it yet. It was only pulled for testimony but sounded pretty positive.

 

Sent from my Nexus 5 using Tapatalk

 

honestly, if they vote this down, I wound consider never again joining AAPA - there is NO reason to not move forward with this and there is no cost, barriers or other reasons to not move forward......   

 

If the AAPA is so disconnected from the entire medical community that they think this is not important I don't think i would want to be a part of their organization any more....

 

 

Just this week in MASS - the NPs have successfully  added an amendment to a bill currently in the legislature that would give them independent practice after two years......   Meanwhile PAs have not done anything to move forward...... 

 

PAs are being left behind

[mashlee]

News flash! AAPA HOD passed collaboration resolution on first round without opposition and now waits final discussion and vote.

 

I'm kind of a newbie to the political side of the career, but what exactly would this "collaboration resolution" entail? I'm assuming from the wording it would make PAs collaborators with physicians rather than being supervised. if that is the case what does that mean exactly? that PAs would no longer be supervised but rather collaborate or would it merely mean that the language we use in describing our relationship to docs changes from "working under" to "in collaboration with"? Thanks!

[Guest Paula]

It would be a starting point for all PAs to get out from under the onus of supervision and allow state chapters to start amending laws. It will help us to be seen as professionals who are responsible for our own cate of our patients. It will help us with cms issues and for government and credentialed to see us in a more positive light. It will still take a few years to get our title corrected. It means AAPA is behind us in moving the profession forward. They are starting to listen to the PAs in the trenches. A few states such as Alaska already use collaboration language in their laws and Washington uses sponsoring physician. It gives us hope for a better tomorrow.....you know.....The sun will come up tomorrow....oh gosh I hate that song.

[PACdan]

This statement is inaccurate. They are in fact doctors. They are qualified to act as doctors. They are not board certified. If they have completed USMLE-2 (which is harder than PANRE) then certainly they are more qualified than a Freshly graduated PA

Green is green. I don't think that your intimating a wet behind the ears MD is a preferential practitioner, over a new PA, is correct in this scenario.

 

Most here have echoed that the 3+ years of intensive residency is what really builds the divide between an MD's base and a PA's... which these "Assistant Physicians" won't have. Other than that, MDs/DOs have another year of core sciences/pathophys that PAs lack from school.

 

Pt. encounters are virtually the same through schooling (as I understand it). And you're greatly discounting that many (not all) PAs have had previous healthcare careers and pt. interactions. While this may be changing...many MD students have never touched a pt. before school; their first experience coming during rotation. I've worked with them and new grads at a large teaching hospital...their fear is palpable.

 

We're talking about the delivery of rural, primary care to (more often than not) lower income individuals and families with less access to healthcare at their disposal. Lots of social issues, poverty, substance and physical abuse... hard, difficult issues.

 

I don't know if the 24 yo new MD without residency "is certainly more qualified" than a possibly older, more life experienced new PA in that role...because the usmle step 2 is "harder". Which Prima kinda shot you down about.

 

Not a sermon, just a thought. While looking at this role and the providers to fill it...

 

 

Afterthought: Many PA programs take an active role in training primary care practitioners. They make it a focus of the program. They have extra rotations and courses for it. While traditionally (most) med schools have the expectation that students will do an internship and residency afterwards to specialize. One could argue that a new PA grad who trained specifically in a primary care focus is MORE qualified in primary care delivery than the new med school grad without that focus and without residency. Interesting thought.

 

[andersenpa]

It would be a starting point for all PAs to get out from under the onus of supervision and allow state chapters to start amending laws. It will help us to be seen as professionals who are responsible for our own cate of our patients. It will help us with cms issues and for government and credentialed to see us in a more positive light. It will still take a few years to get our title corrected. It means AAPA is behind us in moving the profession forward. They are starting to listen to the PAs in the trenches. A few states such as Alaska already use collaboration language in their laws and Washington uses sponsoring physician. It gives us hope for a better tomorrow.....you know.....The sun will come up tomorrow....oh gosh I hate that song.

Paula

I was at the WA DOH meeting a few weeks ago

The are rewriting the language which originally had "sponsoring physician" (certified PAs) and "supervising physician" (noncert)

 

They will now call it "sponsoring supervising physician"

 

I asked why the emphasis and the code (dictated by DOH) has to reflect statute

 

New statute being planned. Hard to push through state leg. AAPA endorsement of collaboration may help that.

[LIPPER]

Dan as a student I'm not clear you're qualified to define who or what "makes" an adequate practitioner. I was as confident , arrogant and cocky as you could get when I was fresh out. That's said, looking back it was a few years at least before was comparing myself to the residents I encountered thinking I was better then them.  Make no mistake, if my previous posts have left any doubt I'll clear it up here. I don't believe for a minute that a PA or an MD with a fresh degree should be left alone. I'm not overly concerned with how much pre-schooling experience, or how confident one is. That's my opinion. Can some succeed that way? of course.  

 

LOL I hardly think Prima "shot me down"... A sample size of one doesn't qualify. That said her move into the doctoring world is admirable. I couldn't/wouldn't do it.  However in her previous post on another forum she clearly stated "you don't know what you don't know" when you're a PA. So defending PA's as just, if not more qualified to start off alone in the field doesn't really fair well.

 

Again, blanket statements about PA's, and now using pre-PA work experience as some sort of post-grad qualification is laughable. You virtually eliminate and categorize med students as not having any med-field experience while at the same time playing up the PA student as some underutilized, overqualified person making PA school as simple stepping stone into primary care, saving the world. For every med student wet behind the ear you come up with, I can certainly relate both a naïve PA doing rotations, and a well qualified med student.

 

PA students do 1 year of rotations. Med student do 2 years. Again, no comparison so try not to discount that again.

 

Im certain there are loan repayment programs and incentives for MD's to go into primary care, not just PA's....PA students are not so altruistic as you make them out to be. Med students want to save the world too and consider primary care. However just like PA's they'll chase down the $. Want proof PA's chase the $?--> there is a decent percentage of PA's in specialty practice.  .

 

We can extrapolate hypothetical scenarios if you'd like. Med school is harder to get in to than PA school.

 

I'd much rather see PA's be critical of NPs, rather than trying in vain to try and one-up doctors. Though I'm not even interested in that either. I see some have a "sponsoring supervising physician"... I just shake my head.

[swooshie1]

"....PA students are not so altruistic as you make them out to be. They'll chase down the $ just like med students. want proof?--> there is a decent percentage of PA's in specialty practice."

 

Yep. I will soon be graduating from one of those "primary care focus" programs; in my class of 26 there are 3 of us who will be going into primary care.  Sad.

[Guest JMPA]

Can we introduce a law that allows graduate PAs whom have not passed the pance to practice as NPs?

[EMEDPA]

 

PA students do 1 year of rotations. Med student do 2 years. Again, no comparison so try not to discount that again.

 

I'm sure you realize 4th yr is not a full year of rotations. calling it 6 months is generous at some places....lots of built in time for interviewing for residency, big vacation blocks, etc. I give the docs a lot of credit for more education, but on the didactic, not the clinical side. MS1is a much harder year than PA1. Clinically, I don't know that any med student I rotated with, 3rd or 4th yr, was any better clinically than I was. I taught the intern on my medicine rotation (in july...) how to dictate, draw blood, and start IVs for example...my differentials were just as good as his on rounds. granted, his internship year started the same day as my rotation, but still you would think he would be ahead of a pa student across the board. he wasn't. and this was at a respectable residency program and he went to a respectable school.

[GetMeOuttaThisMess]

Second half of my IM rotation none of the MS4s could read an EKG, unlike the second yr PA student. Res found it funny.

[True Anomaly]

Can we introduce a law that allows graduate PAs whom have not passed the pance to practice as NPs?

 

I literally LOL'ed.  Well done

[EMEDPA]

Second half of my IM rotation none of the MS4s could read an EKG, unlike the second yr PA student. Res found it funny.

on my hospitalist rotation none of the med students knew what Virchow's traid was or how it related to the development of dvt/pe. then none of them knew what a greenfield filter was....it was funny, the whole conversation was me and the attending with a bunch of confused med student looking on. he even called on them.....crickets.....I think he was embarassed for them...

[PACdan]

Dan as a student I'm not clear you're qualified to define who or what "makes" an adequate practitioner. I was as confident , arrogant and cocky as you could get when I was fresh out. That's said, looking back it was a few years at least before was comparing myself to the residents I encountered thinking I was better then them.  Make no mistake, if my previous posts have left any doubt I'll clear it up here. I don't believe for a minute that a PA or an MD with a fresh degree should be left alone. I'm not overly concerned with how much pre-schooling experience, or how confident one is. That's my opinion. Can some succeed that way? of course.  

 

LOL I hardly think Prima "shot me down"... A sample size of one doesn't qualify. That said her move into the doctoring world is admirable. I couldn't/wouldn't do it.  However in her previous post on another forum she clearly stated "you don't know what you don't know" when you're a PA. So defending PA's as just, if not more qualified to start off alone in the field doesn't really fair well.

 

Again, blanket statements about PA's, and now using pre-PA work experience as some sort of post-grad qualification is laughable. You virtually eliminate and categorize med students as not having any med-field experience while at the same time playing up the PA student as some underutilized, overqualified person making PA school as simple stepping stone into primary care, saving the world. For every med student wet behind the ear you come up with, I can certainly relate both a naïve PA doing rotations, and a well qualified med student.

 

PA students do 1 year of rotations. Med student do 2 years. Again, no comparison so try not to discount that again.

 

Im certain there are loan repayment programs and incentives for MD's to go into primary care, not just PA's....PA students are not so altruistic as you make them out to be. Med students want to save the world too and consider primary care. However just like PA's they'll chase down the $. Want proof PA's chase the $?--> there is a decent percentage of PA's in specialty practice.  .

 

We can extrapolate hypothetical scenarios if you'd like. Med school is harder to get in to than PA school.

 

I'd much rather see PA's be critical of NPs, rather than trying in vain to try and one-up doctors. Though I'm not even interested in that either. I see some have a "sponsoring supervising physician"... I just shake my head.

 

A few points, Brian:

 

1. I agree completely that no new grad, be it an MD or PA, should be without supervision and guidance. Big mistake, no good, they are still very much the learners. But we aren't comparing a new PA to residents in terms of skills & knowledge, we're comparing that PA to a med school grad with NO RESIDENCY, just school. Different animal. The "AP" would start this proposed job and not recieve any different OTJT than a new PA would in that same position.

 

2. I don't see a fresh MD, without internship and labeled an "AP" as a vastly superior qualified candidate for this new proposed position, over a fresh PA. In terms of the practicality of treating patients, it appears to be a toss up. (sorry, I used a sample from the respondents here).

 

3. My student status has no bearing on my ability to process this information. You have no insight into my prior experiences.

 

4. You are factually incorrect in your med school vs. PA school times on rotation. M3 at most schools is 48 weeks of rotations, varying between 4 to 12 weeks per speciality. M4, as EMED stated, is mostly electives and preparing to match, breaks, etc. My PA school will have OVER a calendar year worth of rotations, for 56 weeks total time on rotation. With electives allowing the student to spend up to 12 weeks in one speciality total. So try not to make non-factual statements so flippantly.

 

4.5. Okay, US med school IS harder to get into than PA school. What's your point exactly? PA school isn't a cake walk to get into though, they don't exactly scrape the bottom of the barrel.

 

5. No one here is trying to "one up the doctor". Maybe you're projecting a bit of your past in that statement. I don't want to be a doctor, I want to be a really good PA. BUT, I will not let myself, my work, or my future profession be marginalized so easily. I don't understand why any PA would acquiesce to this "AP" concept without a fight. ...Is it because you didn't finish that novel you've been working on? (just a little Family Guy humor)

[Guest Paula]

Paula

I was at the WA DOH meeting a few weeks ago

The are rewriting the language which originally had "sponsoring physician" (certified PAs) and "supervising physician" (noncert)

 

They will now call it "sponsoring supervising physician"

 

I asked why the emphasis and the code (dictated by DOH) has to reflect statute

 

New statute being planned. Hard to push through state leg. AAPA endorsement of collaboration may help that.

I sure hope it helps.  Does the state of WA have any PA friendly legislators? Is this the state that has the rabid lawyer that is trying to shut down PA owned practices? It frustrates me to see PAs take a step forward only to have some new idiotic rules put into place.  In Wisconsin the state PA chapter did a great job of enhancing the practice rights and at the end we had to acquiesce to a stupid rule that every PA has to document in their note who the SP is that they can link the note to.  WI does not require co-signature for charts or scripts and that is determined at practice level.  I see it as a step backwards for us.  I am not sure if any other WI PAs feel the same but it seems burdensome to me.  Fortunately for me I practice in MI and keep my WI license active.  If I ever start working in WI again I will have to figure it out.  It's an odd rule.

 

Let's hope the HOD approves the collaboration language and you can take it to your DOH and lobby for collaboration.  Maybe AAPA will help the state of WA.

[LIPPER]

A few points, Brian:

 

1. I agree completely that no new grad, be it an MD or PA, should be without supervision and guidance. Big mistake, no good, they are still very much the learners. But we aren't comparing a new PA to Residents, we're comparing that PA to a med school grad with NO RESIDENCY. Different animal. That "AP" will start this proposed job and not recieve any OTJT different than a new PA.

 

2. I don't see a fresh MD, without internship and labeled an "AP" as a vastly superior qualified candidate for this new proposed position, over a fresh PA. They're sitting in very similar waters at that stage.

 

3. How does my student status have any bearing on my ability to process this information? You have no insight into my prior experiences, and are simply using a tired fallacy as a cop-out in an attempt to bolster your argument.

 

4. You are factually incorrect in your med school vs. PA school times on rotation. M3 at most schools is 48 weeks of rotations, varying between 4 to 12 weeks per speciality. M4, as EMED stated, is mostly electives and preparing to match, breaks, etc. My PA school will have OVER a calendar year worth of rotations, for 56 weeks total time on rotation. With electives allowing the student to spend up to 12 weeks in one speciality total. So try not to make non-factual statements so flippantly.

 

4.5. Okay, US med school IS harder to get into than PA school. What's your point exactly? PA school isn't a cake walk to get into though, they don't exactly scrape the bottom of the barrel.

 

5. No one here is trying to "one up the doctor". Maybe you're projecting a bit of your past in that statement. I don't want to be a doctor, I want to be a really good PA. BUT, I will not let myself, my work, or my future profession be marginalized so easily. When did you lose that drive? Is it because you didn't finish that novel you're working on? (a little Family Guy humor)

Your/our PA education isn't equivalent to MD. It just isn't. Again it's not about you. If you feel that's a flippant attitude, well then ok. I'm flippant.

 

 

 

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