Future of PAs, NPs (and Assistant Physicians??)

[andersenpa]

Well said, andersenpa!

 

These type of arguments are advocated by countless PAs, and make our profession look utterly foolish. There is a difference between PAs and MDs (though not as large as the public thinks) that is useless to deny. It's a sign of insecurity more than anything else.

The gap is most prominent in specialties.

Primary care as it relates to PAs and docs should be treated differently. You can argue that an expereinced PA/NP can manage PC just as well (many are doing it), but it's hard to say that specialty fellowships for docs are a waste of time.

[andersenpa]

With the exception of the joint PA-NP program in CA, I haven't seen an NP masters program come close to the clinical hours and classroom time that is standard for PA programs. NP programs are usually 1/2 the credit hours and 1/4 or less rotation time. Although they are both called the "M-word", I don't see how training that dramatically different can routinely produce the same providers, regardless of "individual qualifications".

Some perspective is needed on this.

Compare this to a PC doc saying " I haven't seen an PA program come close to the clinical hours and classroom time that is standard for MD/DO programs."

Yet we claim a good deal of equivalency in primary care (and rightly so IMO).

 

So we can't in good word claim superiority to NPs with that same argument.

 

What matters is the practice outcomes, because with what is available in 2014 medical practice, we really don't know how much medical education is needed to train a primary care provider, we only know what has been done for many many years!

[andersenpa]

I am so tired of having AAPA and NCCPA say that PAs are trained for primary care so there is no need for additional training.  By this logic then brand new med school grads should be able to full fledged medicine docs....

They are....in Missouri!

[PACdan]

Some perspective is needed on this.

Compare this to a PC doc saying " I haven't seen an PA program come close to the clinical hours and classroom time that is standard for MD/DO programs."

Yet we claim a good deal of equivalency in primary care (and rightly so IMO).

 

So we can't in good word claim superiority to NPs with that same argument.

 

What matters is the practice outcomes, because with what is available in 2014 medical practice, we really don't know how much medical education is needed to train a primary care provider, we only know what has been done for many many years!

That's a interesting perspective, but in regards to the comparison, PAs are much closer to Docs in regards to training than NPs.

 

You say don't use the argument that we have more training than a NP, because a doctor can say the same about us? I don't have a problem with that. We're trying to compete with NPs for the same jobs, not physicians. The NPs have already leapfrogged us, and claim equivalency with primary care physicians, why hold back?

 

***

 

At this point I see no harm in saying PAs have more training time, it's just a fact. PA school costs more, has 50-60 more credits, you can't work (usually) during the intensive training, and your clinical exposure is 4 times greater...yet we accept the same pay/jobs/descriptors as NPs?

 

Why does PA even exist if one cannot be allowed to make a distinction?

[andersenpa]

That's a interesting perspective, but in regards to the comparison, PAs are much closer to Docs in regards to training than NPs.

 

You say don't use the argument that we have more training than a NP, because a doctor can say the same about us? I don't have a problem with that. We're trying to compete with NPs for the same jobs, not physicians. The NPs have already leapfrogged us, and claim equivalency with primary care physicians, why hold back?

 

***

 

At this point I see no harm in saying PAs have more training time, it's just a fact. PA school costs more, has 50-60 more credits, you can't work (usually) during the intensive training, and your clinical exposure is 4 times greater...yet we accept the same pay/jobs/descriptors as NPs?

 

Why does PA even exist if one cannot be allowed to make a distinction?

Cost, credits, duration- I'm not sure how all these really matter in the end. Anyone can make all the distinctions they want. Yes, PA school has more clinical hours; cost comparison I don't know. But what does that mean for the results patients are getting? Look at it from the patient's side and not the provider.

 

We live in an outcomes/evidence based world now. The data must grow on how well patients do being taken care of by these different providers. If primary care can be done just as effectively by NPs vs PAs then the length/cost/intensity of our training doesn't reach a significance. Patient outcome is the metric. 

[PACdan]

Cost, credits, duration- I'm not sure how all these really matter in the end. Anyone can make all the distinctions they want. Yes, PA school has more clinical hours; cost comparison I don't know. But what does that mean for the results patients are getting? Look at it from the patient's side and not the provider.

 

We live in an outcomes/evidence based world now. The data must grow on how well patients do being taken care of by these different providers. If primary care can be done just as effectively by NPs vs PAs then the length/cost/intensity of our training doesn't reach a significance. Patient outcome is the metric.

So, the same outcomes based evidence can be used against MDs/DOs? Because a common argument I see is "PAs don't know what they don't know, they don't have year 1 of med school/residency, which equals more knowledgeable providers". I'm inclined to believe this as a general rule, but IF the difference in outcomes of patients (let's say in primary care) are not statistically significantly between PAs and Docs... PAs can/should claim outright parity?

 

[andersenpa]

So, the same outcomes based evidence can be used against MDs/DOs? Because a common argument I see is "PAs don't know what they don't know, they don't have year 1 of med school/residency, which equals more knowledgeable providers". I'm inclined to believe this as a general rule, but IF the difference in outcomes of patients (let's say in primary care) are not statistically significantly between PAs and Docs... PAs can/should claim outright parity?

There isnt close to enough data yet. A few have come out for specific metrics like HgbA1C but not near enough to say anything concrete.

I'm talking about the comparison you asked about, PA vs NP. That's an easier tline to draw b/c of the closer similarity of PA to NP than PA to MD. Yes PA/MD are medical model but docs have residency +/- fellowship vs PA/NP which don't.

 

ONLY in regard to primary care should PAs make a call for parity and it depends on too many variables- the duration of the PA's experience, what practice relationship they were in (high autonomy vs short apron strings), etc.

 

The claim of "they don't know what they don't know" is horses#!t because a PC doc doesn't know neurosurgery, an EM docs doesn't know nephrology. They know their BC scope and refer out when they reach the edge of their sphere of knowledge. PAs do the same. Docs who claim PAs don't know their own sphere are pulling the same ivory tower BS that "holistic" practitioners pull on us lowly allopathic PAs!

[JohnnyM2]

At this point I see no harm in saying PAs have more training time, it's just a fact. PA school costs more, has 50-60 more credits, you can't work (usually) during the intensive training, and your clinical exposure is 4 times greater...yet we accept the same pay/jobs/descriptors as NPs?

This, IMO, is a primary reason why PAs should object to the "mid level" and other similar monikers. It Isn't just that PAs don't offer a lower level of care than MDs, but these names bundle PAs together with NPs and create a forced equality in terms of job responsibility and pay in a competitive job market.

 

I can't address the issue of how hard it is to be in primary care but I do agree that, just because schools profess to graduate people ready for primary care doesn't mean PC PAs don't need (or shouldn't have available) residencies or CAQs that would allow them to work more independently. Unfortunately, two things need to happen.. First a CAQ or residency needs to be available and, secondly, state boards and employers need to offer opportunities for a higher level of independence for those who have acquired the additional skills and knowledge.

 

One problem is that the lack of additional formal training shouldn't put at a disadvantage, PAs who have developed the same skills by working in a specialty for many years.

 

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