If you haven't heard yet....

[PACdan]

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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I agree, it isn't.

 

But the greatest divide appears to come after school; from my meager understanding. So to sum it up, I think an "Assistant Physician" title for new unlicensed docs is a bad idea and I oppose it.

[Boatswain2PA]

Will you join and run for the BOD or try to get a delegate seat through a constituent organization? We need your common sense helping to move AAPA in the right direction. It can only represent the people that get off the couch and do something. It's like when people complain about an opposing political party but don't bother to go vote. Like it or not, AAPA is our national org and has the best capabilities to make change. Even those of us in PAFT realize that we should work with(and sometimes against) AAPA to make progress whether or not we support everything it does.

 

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I will not give my money, my membership, nor my voice to an organization that censors conservative speech.  Nor will I support an organization that is increasingly failing to do it's job of promoting our profession. 

 

 

[polarbebe]

wutthechris, on 23 May 2014 - 11:48 AM, said:

Will you join and run for the BOD or try to get a delegate seat through a constituent organization? We need your common sense helping to move AAPA in the right direction. It can only represent the people that get off the couch and do something. It's like when people complain about an opposing political party but don't bother to go vote. Like it or not, AAPA is our national org and has the best capabilities to make change. Even those of us in PAFT realize that we should work with(and sometimes against) AAPA to make progress whether or not we support everything it does."

 

Sent from my Nexus 5 using Tapatalk

 

I will not give my money, my membership, nor my voice to an organization that censors conservative speech. Nor will I support an organization that is increasingly failing to do it's job of promoting our profession.

 

I also did not renew my AAPA membership last year but joined PAFT instead for their failure to promote our profession.

 

Though now I disagree that AAPA is "increasingly failing" to do its job... PAFT has made some concrete steps in pushing them in the right direction. I also agree with wutthechris... If you disagree with their policies, join them and vote against their leadership for policies that align with you; they are really for better or worse needed to advance our professions. Divided we fall.

 

Will be rejoining AAPA this year (neither of my employers reimburse for professional memberships).

[andersenpa]

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.

I had a nice talk with a staff member of the DOH at the last meeting and he suggested that the barrier is the legislators- not for specific anti-PA reasons but rather "anti-getting anything done" reasons. A do-nothing legislative.

I'm a neophyte to that side of it so it's been an intersting learning process.

 

I have to get in touch with the PAs I know and see what they plan to introduce in the next session now that we have the recent HOD language. Hopefully we strike while the iron is hot. Change the statue, then the code....

[andersenpa]

I will not give my money, my membership, nor my voice to an organization that censors conservative speech.  Nor will I support an organization that is increasingly failing to do it's job of promoting our profession. 

 

 

As much as I disagree with much of what they've done, it's best to join and morph the organization into what you want it to be rather than inactively resent it.

[delco714]

June 12, 2014

 

During its 2014 annual meeting on June 7-11 in Chicago, the American Medical Association (AMA) House of Delegates considered and ultimately passed a resolution introduced by the Young Physicians Section to oppose the “use of unmatched medical students as ‘assistant physicians.’”

 

This new AMA policy will be very beneficial in opposing the “assistant physician” concept if it appears in other parts of the country.

 

Background on the resolution

The resolution was in direct response to legislation passed by the Missouri General Assembly in its 2014 session to create a new category of medical licensees. Senate Bills 716 and 754 contain language that will authorize the state Board of Healing Arts to license medical graduates who have passed steps 1 and 2 of the United States Medical Licensing Examination as “assistant physicians,” authorized to practice in primary care in rural and underserved areas.

 

The Missouri Academy of PAs and AAPA opposed the legislation and were joined in opposition by the Missouri Academy of Family Physicians. The Missouri State Medical Association supported the bill.

 

Passage in the AMA HOD

Reference Committee testimony was in strong support of the Young Physician’s Resolution, which read:

 

RESOLVED, That our American Medical Association oppose special licensing pathways for physicians who are not currently enrolled in an Accreditation Council for Graduate Medical Education or American Osteopathic Association training program, or have not completed at least one year of accredited post-graduate U.S. medical education.

 

The only testimony in support of the “assistant physician” concept came from the Missouri delegation.

 

The resolution again drew strong support when the entire House of Delegates considered it. The Pacific Rim Caucus; Council on Medical Education; Louisiana, Massachusetts and several specialty delegations testified in support of the Young Physicians. A delegate from the Medical Student Section stated that he certainly was not prepared to begin practicing in primary care in a rural area.

 

Delegates were sensitive to the plight of medical school graduates who do not match. But the testimony followed the sentiment of a delegate who said, “We should not replace a hardship with a danger.”

 

Although the Speaker cut off testimony as it was clear that the resolution would pass, the delegations from family medicine, psychiatry and several additional states supported the resolution to oppose the “assistant physician” concept.

 

The resolution passed by a resounding voice vote.

 

AAPA’s role in the resolution

Mary Ettari, MPH, PA, DFAAPA, AAPA’s liaison to the AMA, and Ann Davis, MS, PA-C, AAPA vice president for constituent organization outreach and advocacy, talked with numerous delegates prior to the vote in support of the idea that the “assistant physician” concept is bad for PAs, physicians and patients.

 

 

- See more at: http://www.aapa.org/twocolumn.aspx?id=2765&utm_content=06132014_story5_link1#sthash.VcZzi6pj.dpuf

 

[winterallsummer]

Copied from aapa newsletter.

 

American Medical Association House of Delegates rejects 'assistant physician' concept

AAPA

During its 2014 annual meeting on June 7-11 in Chicago, the American Medical Association House of Delegates considered and ultimately passed a resolution introduced by the Young Physicians Section to oppose the "use of unmatched medical students as 'assistant physicians.'"

 

The resolution was in direct response to legislation passed by the Missouri General Assembly in its 2014 session to create a new category of medical licensees. Senate Bills 716 and 754 contain language that will authorize the state Board of Healing Arts to license medical graduates who have passed steps 1 and 2 of the United States Medical Licensing Examination as "assistant physicians," authorized to practice in primary care in rural and underserved areas.

 

The Missouri Academy of PAs and AAPA opposed the legislation and were joined in opposition by the Missouri Academy of Family Physicians. The Missouri State Medical Association supported the bill.

 

Reference Committee testimony was in strong support of the Young Physician's Resolution, which read:

 

RESOLVED, That our American Medical Association oppose special licensing pathways for physicians who are not currently enrolled in an Accreditation Council for Graduate Medical Education or American Osteopathic Association training program, or have not completed at least one year of accredited post-graduate U.S. medical education.

 

 

The only testimony in support of the "assistant physician" concept came from the Missouri delegation.

[Guest Paula]

Darn.  I was so looking forward to PAs gaining the assistant physician title.  LOL!

[andersenpa]

Allies come from strange places sometimes.

[cinntsp]

Allies come from strange places sometimes.

 

The enemy of my enemy is my friend.

[DissentingVoice]

Hey all.  I was reading this post chain, and I found it very interesting.  Great read, but I felt the need to comment on a few things.

 

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).

I may be wrong, but isn't 800 the maximum score for PANCE?  A 98 on the USMLE typically corresponded to a sub-average score overall.  So...essentially you're saying you scored below average on the USMLE and the highest score possible on PANCE, so they are equivalent.  That does not make sense.

 

Fortunately, USMLE did away with the two digit scoring because too many people were confusing it with percentiles.  If you don't believe me, send me your three digit score, test average, and standard deviation, and I will calculate your percentile for you.  98 was typically in the 45-50th percentile range when those scores existed.

 

Awhile ago the DNPs created an exam with NBME which was essentially a watered down version of the already easy USMLE 3.  Even the easier version had a 50% fail rate among NPs.  Please don't be so cavalier about equating them.

 

http://www.nccpa.net/Scoring

http://www.usmle.org/announcements/?ContentId=111

http://www.amednews.com/article/20090608/profession/306089978/1/

 

That said, the 99th percentile is very impressive and something to be proud of.  There's a big difference between a good score and ace-ing the test (given the ceiling effect).

 

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.

 

Um...that depends on the school.  50 weeks M3 year and 28 weeks+ M4 year is common.  That's 78 weeks of clinicals.  At (a very conservative) 50 hours per week, that's 3,900 hours of pure clinical time (studying not included).  Some PA-C programs have as little as 2,000 hours.  M4 year also includes sub-internships which are generally where medical students progress to an intern level of functioning, and those are far more important than anything in M3 year.  I wouldn't diss the physician's clinical hours.  They put in a lot of work.

 

The enemy of my enemy is my friend.

 

The us-vs-them mindset probably isn't so helpful for patients.

 

 

Also, I don't remember who said it, but the idea of unlicensed physicians having to take PANCE before acting as the "assistant physician" is probably a great idea.  Also, the name "assistant physician" does suck.  It's confusing at best.  

[Woody85]

:O  ^^^Let the showdown begin^^^

[andersenpa]

Also, I don't remember who said it, but the idea of unlicensed physicians having to take PANCE before acting as the "assistant physician" is probably a great idea.

Actually it's a bad idea, since they didn't attend PA school or meet any other proven metrics to sit for PANCE.

[EMEDPA]

Hey all.  I was reading this post chain, and I found it very interesting.  Great read, but I felt the need to comment on a few things.

 

I may be wrong, but isn't 800 the maximum score for PANCE?  A 98 on the USMLE typically corresponded to a sub-average score overall.  So...essentially you're saying you scored below average on the USMLE and the highest score possible on PANCE, so they are equivalent.  That does not make sense.

 

Fortunately, USMLE did away with the two digit scoring because too many people were confusing it with percentiles.  If you don't believe me, send me your three digit score, test average, and standard deviation, and I will calculate your percentile for you.  98 was typically in the 45-50th percentile range when those scores existed.

 

Awhile ago the DNPs created an exam with NBME which was essentially a watered down version of the already easy USMLE 3.  Even the easier version had a 50% fail rate among NPs.  Please don't be so cavalier about equating them.

 

http://www.nccpa.net/Scoring

http://www.usmle.org/announcements/?ContentId=111

http://www.amednews.com/article/20090608/profession/306089978/1/

 

That said, the 99th percentile is very impressive and something to be proud of.  There's a big difference between a good score and ace-ing the test (given the ceiling effect).

 

 

Um...that depends on the school.  50 weeks M3 year and 28 weeks+ M4 year is common.  That's 78 weeks of clinicals.  At (a very conservative) 50 hours per week, that's 3,900 hours of pure clinical time (studying not included).  Some PA-C programs have as little as 2,000 hours.  M4 year also includes sub-internships which are generally where medical students progress to an intern level of functioning, and those are far more important than anything in M3 year.  I wouldn't diss the physician's clinical hours.  They put in a lot of work.

 

 

The us-vs-them mindset probably isn't so helpful for patients.

 

 

Also, I don't remember who said it, but the idea of unlicensed physicians having to take PANCE before acting as the "assistant physician" is probably a great idea.  Also, the name "assistant physician" does suck.  It's confusing at best.  

primmas score on the usmle wasn't 98 it was 98th percentile. she ( and most of the PA to DO students in her class) scored significantly better than the normal track DO students and most matched to their first choice residency.

[PACdan]

I wouldn't diss the physician's clinical hours.  They put in a lot of work.

 

In no way dissing the student physician's clinical hours, they do have more. Merely demonstrating that the gap in clinical hours between PA programs of increasing length and medical schools is not astronomical.

Oh, the 60-hour clinical week (studying not included) is the norm for PA students too; at least at my school.

 

 

 

wutthechris, on 16 Jun 2014 - 4:20 PM, said:

The enemy of my enemy is my friend.

 

The us-vs-them mindset probably isn't so helpful for patients.

 

Neither are insurance companies, rogue admins, or jelly doughnuts. Once you go eliminate all of those, come back here and I'll help you destroy all the levity on this internet forum that is harming patients.

[EMEDPA]

In no way dissing the student physician's clinical hours, they do have more. Merely demonstrating that the gap in clinical hours between PA programs of increasing length and medical schools is not astronomical.

 

yup, I had >3000 hrs of clinicals in 54 weeks. my trauma surgery rotation was > 100 hrs/week(alternating 24 and 12 hr days, 1 day off on entire rotation). EM rotations (peds em, general em, em elective) were all 60 hrs/week. ob also had call, OR time, nights in the hospital for L+D, etc. FP, Hospitalist IM, Inpatient psych were more reasonable hours.

[DissentingVoice]

Actually it's a bad idea, since they didn't attend PA school or meet any other proven metrics to sit for PANCE.

I don't disagree with this either.  I think the whole matter is worth a debate.  Missouri is attempting to launch this thing without consulting any of the medical societies.  In response, the PAs and physicians start screaming the sky is falling without even fully evaluating the issue.  I feel like actual providers should have been brought into these discussions and medical societies at least warned to allow discussions a year out or so.

 

primmas score on the usmle wasn't 98 it was 98th percentile. she ( and most of the PA to DO students in her class) scored significantly better than the normal track DO students and most matched to their first choice residency.

I would actually ask her that.  In her post, she never said percentile.  That's the reason I feel it is misleading.  If a DO scored a 98th percentile on an MD test without studying, that's, quite frankly, incredibly impressive.  (I would not expect MDs to score well on the COMLEX without studying either)  Kudos to her either way.  What she's done is still, no doubt, impressive.

 

In no way dissing the student physician's clinical hours, they do have more. Merely demonstrating that the gap in clinical hours between PA programs of increasing length and medical schools is not astronomical.

Oh, the 60-hour clinical week (studying not included) is the norm for PA students too; at least at my school.

 

Neither are insurance companies, rogue admins, or jelly doughnuts. Once you go eliminate all of those, come back here and I'll help you destroy all the levity on this internet forum that is harming patients.

I know.  I've worked with PA students.  They essentially function as M3s at a lot of programs.  You're right, that's not an astronomical difference.  Why does everyone keep screaming physicians are not qualified to act under another physician out of medical school without really sitting down and discussing the issue?  Seems silly to me, but I must be missing something.  

 

I could not agree with you more on the problems in medicine.  Hard to eliminate those problems when you have 10 minutes with each patient twice a year to manage their current conditions.  Appropriate smoking cessation and obesity counselling would take all of that.  The business of medicine was not created entirely for patient oriented purposes.

[SocialMedicine]

Why are we screaming that MD w/o resident and foreign physicians cannot become licensed PAs in the United States ? Same reason MDs scream that NP and PA w 20+ years cannot function as an attending physician in primary care medicine. It is all about promoting ones profession and ensuring that the huge amount of time and stress and money invested in a career in medicine is not wasted and well reimbursed.  

[andersenpa]

I don't disagree with this either.  I think the whole matter is worth a debate.  Missouri is attempting to launch this thing without consulting any of the medical societies.  In response, the PAs and physicians start screaming the sky is falling without even fully evaluating the issue.  I feel like actual providers should have been brought into these discussions and medical societies at least warned to allow discussions a year out or so.

 

The reaction is approriate BECAUSE it wasn't rolled out correctly.

 

If the initiating parties want to try this, then pilot it. Don't christen an entire new profession (with an eerily familiar title) and say they function like PAs but without supervision.

 

And don't take those who who couldn't make the cut in their own process and impose them on ours.

[andersenpa]

Why are we screaming that MD w/o resident and foreign physicians cannot become licensed PAs in the United States ? Same reason MDs scream that NP and PA w 20+ years cannot function as an attending physician in primary care medicine. It is all about promoting ones profession and ensuring that the huge amount of time and stress and money invested in a career in medicine is not wasted and well reimbursed.  

Licensed PAs, NPs and docs have gone through the vetting of their respective professions and represent a finalized product. Striclty for PAs and docs that is the practice of medicine- independent w/ ACGME, and dependent w/ NCCPA PAs.

 

Unmatched docs or IMGs haven't met those criteria.

 

PAs are US trained to license and practice medicine (physician level of care) and can meet the competency level of a doc. IMGs and unmatched MDs don't meet any of the above measures.

[68W2PA]

Actually it's a bad idea, since they didn't attend PA school or meet any other proven metrics to sit for PANCE.

 

Could a Med School graduate who is unmatched just take the PANCE?

If  they did and passed, what would be the objection to having them work as PAs?

[DissentingVoice]

I think it's important to consider who those unmatched doctors are.  Some are FMGs, and that's an entirely different ballgame as their programs aren't regulated like the US ones.

 

I do know of a few, I'll let you all be the judge.

 

I know of one medical student who missed a month of 4th year rotations due to personal reasons.  She graduated in July.  She was only unable to match because residencies start July 1st.  I've seen other medical students in the clinics.  They get pregnant, sick, etc just like everyone else.

 

I also know of one who was going into orthopaedics - currently one of the most competitive specialties.  He did not interview at enough programs and did not match.  His proficiency and board scores are leagues above most PCP docs, but his goal was higher and he refused to accept less.

 

Another was going into dermatology - again, a very competitive specialty.  He successfully matched derm, BUT he neglected to interview for enough preliminary year programs and didn't match.  Interviewing is a VERY expensive process for medical students.  If you drop $10,000 interviewing for dermatology, it's hard to drop another $5,000 on preliminary year programs.  Not everyone has college educated parents who have $15,000 lying around to help out.

 

I don't personally know anyone who failed to match for academic reasons, but maybe others do?  Every specialty has bad apples.  I've seen many people I would never allow to be my physician, but you can't just assume people are inept because they failed to match.

[Steve]

Could a Med School graduate who is unmatched just take the PANCE?

If  they did and passed, what would be the objection to having them work as PAs?

 

My objection would be that they haven't gone through the PA training, so why exactly do they deserve the right to even sit for PANCE? Why should they impose on an entirely different profession that they have no relationship with b/c they failed to succeed in the one they were in? It's like running for president, losing the race, and then saying "I'm still qualified to be the governor, when do I start?".

[68W2PA]

My objection would be that they haven't gone through the PA training, so why exactly do they deserve the right to even sit for PANCE? Why should they impose on an entirely different profession that they have no relationship with b/c they failed to succeed in the one they were in? It's like running for president, losing the race, and then saying "I'm still qualified to be the governor, when do I start?".

 

What part of the PA curriculum do you feel is missing from med school curricula?

We always hear how PA school is modeled after medical school - only compressed and trimmed for time. If a person is capable of passing the non-compressed medical curriculum (while spending more money and time to do so) and can demonstrate enough competency to pass the exact same certifying exam PAs have to pass, I say let them be PAs.

 

Conversely, I wouldn't mind if PAs (ideally with significant experience) were able to sit for the USMLEs.

[andersenpa]

Could a Med School graduate who is unmatched just take the PANCE?

If  they did and passed, what would be the objection to having them work as PAs?

This is the scenario we're talking about - unmatched MD.

 

If by "work as PAs" means "practice medicine", then they would need a license, no?

 

If that is the case then they should go through the process to get a license.

 

There is no logic in the idea that someone who couldn't make the grade to practice medicine as an MD should be allowed to practice medicine as a PA.