Assistant Physician law passed.

[whoRyou]

The latest from the UK ... NHS patient warn more doctor assistance may be 'health care on cheap' The National Health Service (NHS) is the publicly funded healthcare system for England. It is the largest and the oldest single-payer healthcare system in the world. Primarily funded through the general taxation system, the system provides healthcare to every legal resident in the United Kingdom, with most services free at the point of use.

 

"The physician associates will have two years of intensive training instead of the seven completed by doctors, and will provide support in the diagnosis and management of patients in hospitals." - Source: The Guardian (a weekly newspaper in the UK)

[Gordon, PA-C]

ABFM boards are quite strict about who is eligible to sit for them. I do not ever foresee an opportunity for a non-residency trained family physician to "challenge" these boards.

The list of requirements is long and arduous. Successful completion of residency from an accredited program. Passing step 3 USMLE or COMLEX. Meeting all the milestones established by ABFM/AAFP and recommendation for graduation by your residency program director. (these became much more detailed and specific just this year, yay class of 2017!!) Full unrestricted physician license. Adequate documented numbers of patient encounters for a broad range of diagnoses, in different settings, for all ages, including procedures. It's not a guarantee for anyone and some PGY3s do fail. I am confident that ABFM won't allow itself to be cheapened by permitting APs to challenge the exam. There are too many measures already in place to prevent that. I have no such guarantees about ACOFP but I'm not in an osteopathic FM program so I don't know their requirements as well.

 

It is irrelevant.  NPs have gotten around this by creating their own "boards" and I expect PAs and every other healthcare practitioner to do the same.

 

In 20 years, there will be 4 different "board" certifications for family medicine -- one for MDs, one for DOs, one for PAs, and one for NPs

 

It's going to be interesting seeing the websites and business cards of everyone claiming to be "board certified in family medicine" by these different organizations.

[whoRyou]

It is irrelevant.  NPs have gotten around this by creating their own "boards" and I expect PAs and every other healthcare practitioner to do the same.

 

In 20 years, there will be 4 different "board" certifications for family medicine -- one for MDs, one for DOs, one for PAs, and one for NPs

 

It's going to be interesting seeing the websites and business cards of everyone claiming to be "board certified in family medicine" by these different organizations.

To me it sounds like a mess ... Time will only tell

[archimedes]

Dear god I so much happier before I stumbled across this thread.

 

Here is the deal. I'm awaiting to hear if I will be interviewed (I have a pretty good shot of getting one, and getting in), and now I'm concerned that this might be a bad career move if these APs are going to spread. Can the currently working PAs give me some honest advice here? Should I be worried about my future in this career? Will PAs be going the way of the Dodo?

Prior to joining this forum, everything has looked bright for PAs.

[EMEDPA]

this is an isolated event in a backwards state. don't let this disuade you. every PA, doc, and NP will have a job for the next 30+ years...

[JohnnyM2]

Dear god I so much happier before I stumbled across this thread.

 

Here is the deal. I'm awaiting to hear if I will be interviewed (I have a pretty good shot of getting one, and getting in), and now I'm concerned that this might be a bad career move if these APs are going to spread. Can the currently working PAs give me some honest advice here? Should I be worried about my future in this career? Will PAs be going the way of the Dodo?

Prior to joining this forum, everything has looked bright for PAs.

Chicken Little syndrome is art work here.

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[db_pavnp]

People are vocal about issues that potentially impact their careers.

[GetMeOuttaThisMess]

I'm not so sure Johnny M2, especially in California.  The sky HAS fallen today, at least in the bay area.  Being serious for a moment, I don't doubt that positions will remain available in some capacity as EMEDPA has pointed out, but I'm not sure that how we see it today is how we will see it in 30 years.  My personal opinion is that in the long-term this will all come down to lobbying, who has the bigger pockets, and degree creep.  I could see it swinging as wide as our being merged (grandfathered) with any one of a number of professions in some capacity to our being relegated to an afterthought after being swallowed whole by another professional group.  I DO think that we are clearly the least stable bunch of the group made up of physicians, nurses (NP's), and PA's.  I won't be around to see it most likely in 30 years.

[Guest Paula]

^^^^ Me neither.  I'll be in Glory Land with the Great Physician. 

[PACdan]

Just a thought, but there are about double (192,000 according to AANP fact sheet) the total number of NPs than PAs. And of course, many more nurses in general.

 

I know many lament the rapid growth of PA programs (nearly 100 new ones in the works), but in theory, as the number of PAs increase, so does the potential for influence, power in lobbying, etc. Bigger group usually correlates to stronger lobby.

 

Just a thought on the positive side, that the explosion of PAs could do some good via shear numbers.

 

[GetMeOuttaThisMess]

^^^ Gives new meaning to the term "universal health care".  ;-)  PACdan, remember the basic rule of economics, increase the supply and demand drops off, thus income drops.  Speaking solely for myself, there is no way I'd do this job full-time for $60-70K/year with the inherent stresses and demands.

 

On a side note, whenever I got out of school in the "stone-age", the profession was still quite new and demand wasn't anywhere near what it is today.  I'd like to be able to compare what my initial starting salary then would equate to today using the time value of money.  I do recall that most primary care positions were starting/paying <$20K per year.  My specialty setting reported income (found at SS Admin site) was $26,200 for that year and I felt rich in comparison to many others.

[PACdan]

^^^ Gives new meaning to the term "universal health care". ;-) PACdan, remember the basic rule of economics, increase the supply and demand drops off, thus income drops. Speaking solely for myself, there is no way I'd do this job full-time for $60-70K/year with the inherent stresses and demands.

Has the number of NPs (which is always going up) driven down salary?

 

I don't know if we can satiate the demand in health care. From lifespan to ACA, every source says that demand far outweighs supply. Several month waitlist to see a specialist or even a PCP.

 

I do agree that PAs taking those low ball offers aren't doing themselves or the profession any favors. But that's personal naivety.

 

[PACdan]

Oh wow, haha. Bit of a change in PC salaries for PAs.

[GetMeOuttaThisMess]

There IS a saturation point.  It may not have been met yet, but eventually it will I believe.  You also have to take into consideration that many available positions are in areas that either demographically or professionally, are not highly desirable.  I see it as the bell curve.  When I got out there was only one opportunity that I was aware of in the N. Texas area (which I accepted).  There were offers extended for a Fam. Medicine residency clinic which was part of UT-Houston in a suburban setting, and then the Tx. Dept. of Corrections (they started at a whopping $28K!).

[GetMeOuttaThisMess]

Here's the answer with regard to salary comparison, thanks to the Bureau of Labor website.  $26,200 in '84 is the equivalent of $60,078 today.

[EMEDPA]

few issues here:

demand continues to go up, mostly due to ACA and an increasing(aging) population coupled with many docs retiring and few entering primary care.

almost 1/2 of Nps actually work as RNs so the # in actual practice isn't much larger than the # of PAs in practice as the vast majority of PAs work as PAs

[LT_Oneal_PAC]

Just a thought, but there are about double (192,000 according to AANP fact sheet) the total number of NPs than PAs. And of course, many more nurses in general.I know many lament the rapid growth of PA programs (nearly 100 new ones in the works), but in theory, as the number of PAs increase, so does the potential for influence, power in lobbying, etc. Bigger group usually correlates to stronger lobby.Just a thought on the positive side, that the explosion of PAs could do some good via shear numbers.

Been saying this forever. Furthermore, if we DON'T put out more providers to fill jobs, guess who will? The NPs. Then when they have all the jobs and admin positions, who will be the provider of choice?

[GetMeOuttaThisMess]

If this is the case then what has happened to the overall effectiveness of the AMA over the past decade or so? Overall numbers don't always translate into a more vocal/involved body.

[JohnnyM2]

If this is the case then what has happened to the overall effectiveness of the AMA over the past decade or so? Overall numbers don't always translate into a more vocal/involved body.

I seem to remember reading, somewhere, that only around 20% of physicians belong to the AMA and the vast majority of these members are FP, PEDs and other non-specialized physicians. Obviously, specialists feel better represented by their own organizations. This came up during the ACA debates when the AMA supported the ACA, though the vast majority of mds opposed it.

 

The point is that if a national organization does not represent the views of the vast majority of potential members, then the number of potential members is irrelevant because they won't join. While I agree that the growing number of PAs could increase the influence of the profession, that will only happen if PAs feel represented by AAPA, PAFT, their state chapters, or whatever, and join those organizations in large numbers.

 

To put a positive spin on this, my hope is that PAs will join these organizations, in large numbers, and force them to represent their needs. Then, and only then, will these organizations have the backing and the incentive to lobby for positive changes that benefit their membership, including scope of practice and a name change.

 

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[LT_Oneal_PAC]

If this is the case then what has happened to the overall effectiveness of the AMA over the past decade or so? Overall numbers don't always translate into a more vocal/involved body.

AMA stopped listening to its members and certainly stopped listening to those who made the majority (primary care) instead making the mistake of going for the few with deeper pockets (specialist). And the specialist don't want to pay dues to them and their specialty org. Bad planning.

 

And the AMA is still extremely effective, just not against the nursing lobby because they don't have evidence on their side.

[LT_Oneal_PAC]

I seem to remember reading, somewhere, that only around 20% of physicians belong to the AMA and the vast majority of these members are FP, PEDs and other non-specialized physicians. Obviously, specialists feel better represented by their own organizations. This came up during the ACA debates when the AMA supported the ACA, though the vast majority of mds opposed it.

 

The point is that if a national organization does not represent the views of the vast majority of potential members, then the number of potential members is irrelevant because they won't join. While I agree that the growing number of PAs could increase the influence of the profession, that will only happen if PAs feel represented by AAPA, PAFT, their state chapters, or whatever, and join those organizations in large numbers.

 

To put a positive spin on this, my hope is that PAs will join these organizations, in large numbers, and force them to represent their needs. Then, and only then, will these organizations have the backing and the incentive to lobby for positive changes that benefit their membership, including scope of practice and a name change.

 

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While that would be great, I have no hope for the AAPA which is structured fundamentally different than nursing advocate organizations (completely different than the most successful lobby of CRNAs) with a power structure involving CEOs and what not that are not PAs and really have little incentive to help PAs other than getting to their next big paying gig. Seriously, how many CEOs of organizations as big as ours can you say run the company properly? They've made improvements with a kick from PAFT, but I fear it's lip service and realization that their piggy bank was on the verge of collapse.

[andersenpa]

few issues here:

demand continues to go up, mostly due to ACA and an increasing(aging) population coupled with many docs retiring and few entering primary care.

almost 1/2 of Nps actually work as RNs so the # in actual practice isn't much larger than the # of PAs in practice as the vast majority of PAs work as PAs

E- where did you get the data about the percentage of NPs working as NPs?

[EMEDPA]

E- where did you get the data about the percentage of NPs working as NPs?

that's a stat from David carpenter a few years ago. anecdotally, I know many ER nurses who are licensed as NPs but make more working as nurses so they do that instead of using their np license.

[EMEDPA]

interesting fp resident take on this issue (highlighting and underlining mine):

 

Competition for residency slots is intense, and many qualified graduates are left without a match. Legislation recently enacted in Missouri allows medical school graduates who have not matched into a residency program to work as "assistant physicians" in the state's medically underserved areas with a physician's supervision.

Although the legislation is intended to increase access to primary care, residents at the meeting were concerned that graduating medical students are not prepared for patient care and adopted a resolution that calls for the Academy to develop a policy statement opposing special licensing pathways that are not associated with accredited U.S. postgraduate medical training programs.

"Medical school graduates are not prepared to practice medicine," resolution co-author Jennifer Allen, M.D., of Mercy Family Medicine Residency-St Johns in St. Louis, Mo., told AAFP News. "They are trained to be residents."

The problem of inadequate numbers of primary care residency positions should be addressed head-on, Allen contended, "We need to create more residency slots," she said. "We don't need to create a new licensing pathway."

 

source:http://www.aafp.org/news/education-professional-development/20140813rescong.html

[Guest Paula]

It makes me wonder then why PAs are prepared to practice medicine?  Are we the forever residents, never able to truly practice medicine?  Would a resolution that AAFP passes cause  detrimental unintended consequences for PAs?  i.e.  we NEVER get beyond the dependent status? 

 

How the heck have the NPs gotten their independence?  (that's a rhetorical question). I have seen the NP's language change in some of their writings that is now saying they practice medicine.  It's their new mantra (I'm not against NPs, BTW).