NP soon to supervise PAs. Just a matter of time.

[andersenpa]

As an NP, I can tell you that I have no interest in supervising another provider. I have immense respect for PAs, and I consider them my peers. I think although are training is very different, the jobs that we do in many areas are very similar. Where I work, we all do the same thing, I just don't have to have a doctor sign my charts and I can get a DEA number. I think that they should be afforded the same autonomy as us. I do not think that NPs in general, or even nursing leadership for that matter, is trying to get on equal footing with physicians. They are just working to obtain respect and autonomy within the profession and I for one feel that is a wonderful thing. The stuff going on in Tennessee is ridiculous and as a provider just across the border (literally) I think it's terrible. I do not forsee that PAs will ever, ever, EVER be under the supervision of an NP. Sorry, but I feel like that's a little extreme. If you are really that worried, I would probably reconsider being a pre-pa student. PA organizations just need to fight as hard as organized nursing.

 

First off, I think most of us that read the NP propaganda would agree that NPs are most certainly looking for their own niche of nursing/medical practice which is equivalent to physicians in the eyes of patients and insurers. That's been out in the open for a while now. The rank and file NPs often cite the contrary- but you can be sure that if the nursing lobby enables such equal footing NPs won't turn away from it (nor would PAs if ever such a thing happened in PA Fantasyland).

 

Second I'm not sure what your understanding of chart review and prescribing is, but there are only a few states that don't allow scheduled drugs (from what you said I assume you are in KY). Chart review and cosignature for PAs is practice dependent and limited in most cases. While cosignature is a nuisance it's pretty low on the list of problems for PAs at this point.

 

Finally I agree that NP supervision of PAs is not going to happen, but I wouldn't tell someone who's worried about that to reconsider PA. Perhaps on the contrary they should be the PAs who have the desire to work at the lobby/legislative level.

[Hemoglobin]

fThis is the truest part of the issue.

 

The more PAs there are, the more density we will have, the more visible we'll be to ourselves, the more we'll feel like a unit, the more we will congregate, discuss and advocate. The more effective thing we could do in the long-term is to grow the number of PAs. Propagate the species. This would also probably be a relatively quick boon to advocacy with all of the fresh-faced, energetic PAs that would emerge in a short period of time.

 

 

Doesn't that mean too many PA's. Hence a possible saturation on the market? Don't Physician Assistant schools monitor the market? Physician Assistants don't have the unity of the Nurse sub group AND the Nurse Practitioner sub-group(both which there are a market for). There is only the unity of the Physician Assistants.

 

 

 

Your logic is flawed.

[Just Steve]

Don't Physician Assistant schools monitor the market?

I would assume PA schools monitor the market the same way fast food joints and coffee shops do....monitor the market via how much money they are making aka: student enrollment. PA school is a business plain and simple. If enough students want to sign up for the school, they will offer the course. It's up to the student to decide if there is a job market out there for them after graduation. Schools are not, and should not, be the gatekeeper to keep "population control" of PA's in check.

 

I am not hip to the number of job opportunities that are available for PA's in regions that are desirable to live in. Much like the cry of "nationwide nursing shortage" does not reflect the saturation of some key geographical areas like the Pacific Northwest and such. There is a possibility of over saturation of PA's but with the Baby Boomer generation growing in the country, I don't see a shortage of jobs any time soon as long as we're willing to move around a bit.

 

In the grand scheme of things, if my history memory is correct, nursing really got going around the time of the Civil War with Clara Barton and the formation of the American Red Cross. There was a huge need and it was met. That was around 1861, give or take. That gives nurses about a century of time head start to get established and organized. PA's just need to stay focused on getting organized and bring logical, sensible, yet forward thinking voices to the forefront of our profession. Get involved in your state's local scene and go from there, either running for elected position or voting for those you feel will best carry your notions forward to D.C.

[Hemoglobin]

I would assume PA schools monitor the market the same way fast food joints and coffee shops do....monitor the market via how much money they are making aka: student enrollment. PA school is a business plain and simple. If enough students want to sign up for the school, they will offer the course. It's up to the student to decide if there is a job market out there for them after graduation. Schools are not, and should not, be the gatekeeper to keep "population control" of PA's in check.

 

I am not hip to the number of job opportunities that are available for PA's in regions that are desirable to live in. Much like the cry of "nationwide nursing shortage" does not reflect the saturation of some key geographical areas like the Pacific Northwest and such. There is a possibility of over saturation of PA's but with the Baby Boomer generation growing in the country, I don't see a shortage of jobs any time soon as long as we're willing to move around a bit.

 

In the grand scheme of things, if my history memory is correct, nursing really got going around the time of the Civil War with Clara Barton and the formation of the American Red Cross. There was a huge need and it was met. That was around 1861, give or take. That gives nurses about a century of time head start to get established and organized. PA's just need to stay focused on getting organized and bring logical, sensible, yet forward thinking voices to the forefront of our profession. Get involved in your state's local scene and go from there, either running for elected position or voting for those you feel will best carry your notions forward to D.C.

 

 

Except for each passing year, the nursing population will have 100 years more of establishment relative the PA population............

[kyboynp]

First off, I think most of us that read the NP propaganda would agree that NPs are most certainly looking for their own niche of nursing/medical practice which is equivalent to physicians in the eyes of patients and insurers. That's been out in the open for a while now. The rank and file NPs often cite the contrary- but you can be sure that if the nursing lobby enables such equal footing NPs won't turn away from it (nor would PAs if ever such a thing happened in PA Fantasyland).

 

Second I'm not sure what your understanding of chart review and prescribing is, but there are only a few states that don't allow scheduled drugs (from what you said I assume you are in KY). Chart review and cosignature for PAs is practice dependent and limited in most cases. While cosignature is a nuisance it's pretty low on the list of problems for PAs at this point.

 

Finally I agree that NP supervision of PAs is not going to happen, but I wouldn't tell someone who's worried about that to reconsider PA. Perhaps on the contrary they should be the PAs who have the desire to work at the lobby/legislative level.

 

 

Good points. I guess I was just going by what I know about my state. I'm glad that my state is the exception and not the rule. Like I said, I feel that PAs should have as much autonomy if not more in some cases than nurse practitioners. I'm also not advising against anyone going to PA school. I almost went myself but after some research, I found out that the NP route made better sense, and in the case of the location where I work, it seems that the NPs on average make more. I was just saying that if I really thought that as a PA I was going to be under the supervision of an NP, I would be HORRIFIED. It is wrong on so many levels. It will never happen for so many reasons. I also agree cosignature is low on the list of problems, I just said that's the only difference between me and the PAs I work with WHERE I work. Still, as an NP, no matter what some nursing organizations/groups are trying to convey, I do not think there is any room for us to think we are or ever will be equivalent in the eyes of the patient as a doctor. I don't have a problem with believing that an NP, or PA for that matter should be reimbursed the same amount for the same procedure/treatment as a physician. I do not think we should make as much in general, because their education is much longer, more thorough, requires an internship/residency, etc. The PAs I work with, as I've said other times on this forum, are wonderful clinicians. I personally am an advocate for both NPs and PAs, as we are all integral parts of healthcare. Thanks for the information though. I get no personal or other type of satisfaction from having any advantage over a PA. I think that if practicing in the same environment, we should be on equal footing, equal pay, etc. with the same rights, privileges, and respect from physicians/patients. Some of my best friends are PAs and I have nothing but respect for them. I even feel like that in many ways the PA education is superior to the NP programs, but we as "mid level providers" need to support each other IMO

[Just Steve]

Except for each passing year, the nursing population will have 100 years more of establishment relative the PA population............

And the rotary phone had decades of a jump over cell phones, horses over cars, switchboard operators over computers...My point is some things take time to get a foot hold but once they do, they take off. You just have to make the new thing more convenient over the established product.

 

I don't pretend to know my backside from my ear when it comes to the world of health care politics. But what I do know is that the PA establishment is relatively young in it's inception and things will continue to develop. My personal belief is that by reducing the amount of HCE needed to get into PA school does the profession no favors but the powers at be are trying to remedy that pendulum swing by making programs move to a Masters program. It'll take a bit more time before we know how it all washes out.

[orangutanna]

Attending national hill lobby day early this month showed just how few PAs participate in lobbying with the AAPA. Sadder still was when I attended state Lobby day last month, only about a dozen or so practicing PAs attended. Point blank, the nurses move in mass numbers. If the NPs want something done they have the entire nursing lobby which by sheer numbers the PA profession will never compete with.

 

I know I'm just a pre-PA but knowing several PAs, it seems to me that this is the least of their worries. Most PAs just want to be a PA and work as a PA and treat patients and practice medicine. They don't seem to care where they stand against NPs, who seems to me are more concerned with a title and so-called-power; they are a proud bunch, most nurses are, not just NPs. There are many nurses who believe nursing is superior to PA, but in all honesty it's all about individual preference. In my experience, PAs are more concerned with the medicine rather than the glory of a 'title' and 'power' as they should be. I mean, in the global scheme of things, what's more important? a title with power? or the ability to serve people with proper medical care?

[orangutanna]

Doesn't that mean too many PA's. Hence a possible saturation on the market? Don't Physician Assistant schools monitor the market? Physician Assistants don't have the unity of the Nurse sub group AND the Nurse Practitioner sub-group(both which there are a market for). There is only the unity of the Physician Assistants.

 

 

 

Your logic is flawed.

 

 

 

I would assume PA schools monitor the market the same way fast food joints and coffee shops do....monitor the market via how much money they are making aka: student enrollment. PA school is a business plain and simple. If enough students want to sign up for the school, they will offer the course. It's up to the student to decide if there is a job market out there for them after graduation. Schools are not, and should not, be the gatekeeper to keep "population control" of PA's in check.

 

It is to my understanding that PAs are a very proud bunch of their profession, as they should be. They screen applicants heavily because they believe it is an honorable profession, and it is. They do not want to impart their knowledge of medicine and experience to students who will become PAs for all the wrong reasons. There are tons of nurses that should not be nurses, and PAs want to eliminate that possibility in the PA world. PA program directors and colleagues all look for the same thing: individuals that represent the physician assistant role and oath.

[orangutanna]

My personal belief is that by reducing the amount of HCE needed to get into PA school does the profession no favors but the powers at be are trying to remedy that pendulum swing by making programs move to a Masters program. It'll take a bit more time before we know how it all washes out.

 

The problem with making programs move into a masters program is that it eliminates the opportunity for several people that do not have bachelor's degrees but have TONS of experience in the health care field, giving them a much more difficult experience when they decide to go the next level and pursue their medical career as a PA. There are several PAs out there now that only have certificates (having no bachelor's or master's of any kind) and are great PAs. Moving into a master's program will inhibit great health care providers becoming future PAs.

 

If you ask me, I'd rather take someone with a vast amount of HCE than someone with a bachelor's and/or master's. At least you know for sure that the individual with more experience would be more prepared as a physician assistant AND they are absolutely sure that they want to be a PA.

[Rob77]

I don't believe we'll end up being supervised by NP's but I'm also not very optimistic about our future. The only press we seem to get is negative and after almost 50 years if existence the general public and many in the medical community have no idea as to who we are and what we do. The blame for this lies squarely on our leadership. This nonsense of educating the public one encounter at a time is a cop-out and it doesn't work. It's time fir a new strategy. The current situation in my state of TN is a prime example of our leadership being asleep at the wheel and now we may suffer for it. I fear that if changes don't occur soon our profession will be marginalized without hope of recovery. Rob

[EMEDPA]

There are tons of nurses that should not be nurses.

and tons((ok, not tons but many) of pa's who should not be pa's.

[deborah212]

and tons((ok, not tons but many) of pa's who should not be pa's.

 

Ouch. How so? I realize there are, of course, bad apples in every bunch... I know you have a strong opinion on those without medical experience becoming PAs, but do you still feel the same way about these people once they've been practicing for years (ie. can never catch up to the former medics, nurses, etc)?

[andersenpa]

The problem with making programs move into a masters program is that it eliminates the opportunity for several people that do not have bachelor's degrees but have TONS of experience in the health care field, giving them a much more difficult experience when they decide to go the next level and pursue their medical career as a PA. There are several PAs out there now that only have certificates (having no bachelor's or master's of any kind) and are great PAs. Moving into a master's program will inhibit great health care providers becoming future PAs.

 

If you ask me, I'd rather take someone with a vast amount of HCE than someone with a bachelor's and/or master's. At least you know for sure that the individual with more experience would be more prepared as a physician assistant AND they are absolutely sure that they want to be a PA.

 

So...we take people who have bachelor degrees and no HCE and ask them to take the time to get jobs (EMT, medic, HHA, CNA, RT, RN, etc) in order to gain HCE hrs to become PA school applicants....

 

But...we feel it is innappropriate to ask people with plenty of HCE to take the time to attend classes and complete a bachelors degree in order to become PA school applicants?

 

How are you so sure who is the "better" PA school applicant?

[orangutanna]

Ouch. How so? I realize there are, of course, bad apples in every bunch... I know you have a strong opinion on those without medical experience becoming PAs, but do you still feel the same way about these people once they've been practicing for years (ie. can never catch up to the former medics, nurses, etc)?

 

I wouldn't say that they will never catch up. It all depends on the experience they will obtain after PA school.

 

Former health care professionals do have a leg up during and after PA school, but depending on job placement and now the opportunity of residencies, PAs without HCE previously can somewhat catch up.

 

 

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[orangutanna]

So...we take people who have bachelor degrees and no HCE and ask them to take the time to get jobs (EMT, medic, HHA, CNA, RT, RN, etc) in order to gain HCE hrs to become PA school applicants....

 

But...we feel it is innappropriate to ask people with plenty of HCE to take the time to attend classes and complete a bachelors degree in order to become PA school applicants?

 

How are you so sure who is the "better" PA school applicant?

 

I wouldn't say I'm SURE who is "better." But I don't think it's fair to completely remove the opportunity for those health care professionals that do not have a bachelors.

 

I like the way things are right now, having several options for several types of applicants. The program directors have their ways of figuring out the "better" applicants and I completely respect that. There's a method to all the madness, whether you have a bachelors or not or previous HCE.

 

I'm not saying my views are right and superior. It is merely my opinion. Frankly, I'm not the only one with this view point.

 

I'm not trying to piss anyone off. I just stated an opinion which is open to being accepted or rejected.

 

Sent from my iPhone using Tapatalk

[andersenpa]

I wouldn't say I'm SURE who is "better." But I don't think it's fair to completely remove the opportunity for those health care professionals that do not have a bachelors.

 

I like the way things are right now, having several options for several types of applicants. The program directors have their ways of figuring out the "better" applicants and I completely respect that. There's a method to all the madness, whether you have a bachelors or not or previous HCE.

 

I'm not saying my views are right and superior. It is merely my opinion. Frankly, I'm not the only one with this view point.

 

I'm not trying to piss anyone off. I just stated an opinion which is open to being accepted or rejected.

 

Sent from my iPhone using Tapatalk

 

All applicants have options. if I wanted to apply to medical or dental school I have options as well. Learn the prerequisites and fulfill them....

 

Standardization is a very real force in our world today.

 

You can argue the merit of a masters for clinical practice. The fact that there are skilled cert/AS PAs out there is a case for that.

There are also merits to having a masters entry level degree (credentialling, NP competition, compensation, legislative issues, preparing more PAs for education and leadership roles).

 

What we need to address is 1) the idea that there are swathes of non-BS holding applicants with >10,000 hrs HCE who would be unable to meet the baccalaureate requirement and be placed out of qualification for application, and 2) that those applicants are more deserving/better performing than applicants who hold the BS degree.

 

The true problem (and perhaps LESH may comment on this) is if the areas where PA services are really needed- underserved/underallocated communities- could not be staffed because they can't train PAs to work there. I'm not sure that creating a masters requirement would limit the number of PAs trained by programs with that sort of mission statement.

 

I think it's hard to measure how the heterogeneity in degrees and background helps or hurts PAs. I've said it before, perception is everything. When we deal with one of these news pieces or commentaries which rips PAs, it sounds awful (to me) to say "We're almost all master's trained...well, most of us...some of us have a bachelors degree when we start PA school....and some states require the masters, some don't."

 

Patient reception is based on understanding and perception. How nice would it be to make a strong, universal statment about ALL PAs in terms of education? Patients look up their physicians all the time- where did they go to school, where did they train, etc. While we all understand that great clinicians come from all sorts of backgrounds, it would be foolish to disgregard this critical part of our PA-patient relationships.

[orangutanna]

I think it's hard to measure how the heterogeneity in degrees and background helps or hurts PAs. I've said it before, perception is everything.

 

Patient reception is based on understanding and perception. How nice would it be to make a strong, universal statment about ALL PAs in terms of education? Patients look up their physicians all the time- where did they go to school, where did they train, etc. While we all understand that great clinicians come from all sorts of backgrounds, it would be foolish to disgregard this critical part of our PA-patient relationships.

 

I see your point and it makes perfect sense. Most people may not see it that way until it is brought up to their attention.

 

Thank you for the clarification of your view on the matter.

 

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[EMEDPA]

sure they may catch up someday( 5 yrs maybe) but how many folks did they adversely effect in those 5 yrs that a better pa wouldn't have?

the first person you see your first day out of school is entitled to good care too.

there are folks I work with who are > 10 yrs out of school who still don't have some basic em procedural skills that every paramedic has. sure, not everyone wants to work solo in a rural dept but it's not even an option for someone who can't intubate, start lines, run a code with some degree of competence, etc

[David the Nome]

Luckily, there is more to medicine than doing procedures. Further, not every PA wants to work in EM, much less "solo" in a "rural" department.

 

I am a PA-s who will graduate in 2 months and worked for one year as an EMT before PA school, and the students who have done the best clinically in my program are the ones who are most motivated and assertive in their training. Additionally, I often find that EMTs and Paramedics think they know much much more than they actually do, which in itself can be dangerous. Lastly, PAs work under the supervision of a physician. Obviously, a new grad PA with little or no prior HCE should not be seeing patients alone with no input from an attending. They should take a job where they will be adequately supervised and trained until the point when it is safe for them to practice with additional autonomy.

 

There is more than one way to become a good PA. Similarly, knowing how to put in an IV, give a breathing treatment, and perform subpar CPR prior to PA school doesn't mean one will be a competent PA capable of solo, rural practice.

[EMEDPA]

"subpar cpr".

what's up with that?

I know not everyone wants to work in em or solo primary care but wouldn't it be nice if everyone was able to?

pa's who require major handholding at their first job make docs want to hire np's the next time around.

[Joelseff]

The Paramedics in my class were great with EKG's and ACLS stuff but when it came to titrating chronic meds and pharmacology of IM and the idea of HCM, they had a harder time than the IM MA's. But we all still learned it. I think it was more about comfort level and familiarity.

 

Thing is in PA school, everyone had a niche and we ALL had an opportunity to shine. Our class and our program though is more geared for HCE. Our average HCE for our class was like 6-7 years from MANY different fields, RT, EMT, RN, MA, PT, RD, FMG's, L.Ac's, DC's and a few corpsmen.

[EMEDPA]

Thing is in PA school, everyone had a niche and we ALL had an opportunity to shine. Our class and our program though is more geared for HCE. Our average HCE for our class was like 6-7 years from MANY different fields, RT, EMT, RN, MA, PT, RD, FMG's, L.Ac's, DC's and a few corpsmen.

 

sounds like an ideal situation....

[Joelseff]

Yes emed, yes it was!!! :0)

[med218]

This is my opinion only: there are definitely positions for acquiring HCE prior to PA school that are better than others, but I do not think there is any "ideal" or "perfect" position. Everyone brings their own unique experience with them to the educational experience. I learned a lot in my positions as a CNA in an ICU setting, an EMT-I working 911 and non-emergent transfers, and finally for a hospital based critical care transport service. I was fortunate to see and learn a lot and it has helped me through the first part of PA school, but there are definitely areas that I am not as familiar with. I have known/worked with paramedics and nurses who are incredibly intelligent and capable providers, but I have also encountered Paramedics (a few I've worked with) who do not provide what many would consider the standard of care. Some didn't know the difference between miller and mac laryngoscope blades and others having difficulty with pharmacology and EKG recognition (that others would consider the most basic of concepts). Not all people have the same experience and not all will receive the same educational experience during PA school (based on either didactic or clinical variability). The only way the profession can guarantee having "standardized" providers out of school would be to require the same HCE to get into school and for programs to adapt identical curriculums, but even then you're still going to have variability. Again, just my .02 cents.

[Contrarian]

... pa's who require major handholding at their first job make docs want to hire np's the next time around.

 

YEP...!!!

Seen this a few times.

 

Even if the NP that they hire the "next time around" requires some "hand-holding".... the docs perception is at-least they are generally cheaper to hire (salary and employee burden) and there is no document sitting in a file cabinet somewhere that clearly states that the doc(s) are fully responsible for the NP's commissions and/or ommissions... :wink: