azucardulce Posted November 12, 2014 Share Posted November 12, 2014 I am a clinical year student on the second day of my 3rd rotation in a Family Medicine practice which is linked to a group of around 40 other primary and specialty offices in a corporate structure. Apparently this group of practices, which has employed PAs in the past, has recently decided not to hire any more PAs because of the supervisory requirement. They delivered this news to a prospective new grad PA employee after interviewing them! This was a big let down for me because this group is rapidly exapnding in the area where I live, which means there should be multiple potential jobs come summer when I graduate. What is further concerning, however, is that this mindset could begin to inundate other practices in the area, as this group of practices is somewhat of a "model" for care within the region. In the past they have hired PAs and NPs to work essentially as locums, and rotate through various offices in the area until a doc permanently takes them on to work full-time at a specific office. Sometimes this is a year-long process or longer, whereas in other cases, it is only a few months. Of course, if there are 10 sites that need extra help over the course of a month, a PA would need to have a supervising physician (or multiple ones) at each of those sites, whereas an NP can be put wherever they are needed without having to go through the red tape. I personally think this current arrangement will hurt the profession in our area, and it flat out doesn't make any sense to me. I think they should hire directly to one office, but it doesn't look like that will be an option any time soon. Link to comment Share on other sites More sharing options...
SoCalPA Posted November 12, 2014 Share Posted November 12, 2014 Does your state require on site supervision? If they are large they should have more than enough docs to provide supervision. Are they trying to hire clinicians to work solo? If not then it's not an issue. All depends on the state law I think. Unless the docs are just lazy. In that case run. Link to comment Share on other sites More sharing options...
azucardulce Posted November 12, 2014 Author Share Posted November 12, 2014 The state does not require onsite supervision...and the organization is not trying to hire folks to work solo either. It's a multipractice corporation, and from what I can gather, when they do new "midlevel" hires, they may be in offce A in the morning, office B in the afternoon, office C, D, E, later on during the week, office Q two weeks later....So the issue is that it is easier to schedule an NP than to have docs from all 6 sites (which essentially operate as separate offices) fill out paperwork for each alternate supervising physician. As i mentioned, once the "midlevel" is working in the locum fashion, a doc may hire them on permanently to site D, if they like them. It is unfortunate because they have multiple offices in the area and are rapidly expanding, and also, they have great pay. I would think they could have a SP for all of the PAs in their "pool" but there is a limit on how many PAs can be supervised by one doc, so that becomes an issue. Link to comment Share on other sites More sharing options...
Moderator ventana Posted November 12, 2014 Moderator Share Posted November 12, 2014 welcome to the joys of being coupled to an MD/DO Yup NPs are less trained, possibly not as well educated, maybe not as good clinicians (I know some great NP's but on he hard sciences their education is very weak) YET they get hired over PAs due to regulations.... Link to comment Share on other sites More sharing options...
azucardulce Posted November 12, 2014 Author Share Posted November 12, 2014 Yes, I won't place NPs under the umbrella of having an inferior clinical/didactic education....but clearly from corporate's standpoint, it is easier to hire and place NPs...so that just freaking SUCKS! Link to comment Share on other sites More sharing options...
KMD16 Posted November 12, 2014 Share Posted November 12, 2014 welcome to the joys of being coupled to an MD/DO Yup NPs are less trained, possibly not as well educated, maybe not as good clinicians (I know some great NP's but on he hard sciences their education is very weak) YET they get hired over PAs due to regulations.... Yes. Link to comment Share on other sites More sharing options...
burnpac Posted November 12, 2014 Share Posted November 12, 2014 This is an issue, and a perceived advantage to some that hire NPs and PAs. However, the notion that no one is supervised in a corporate setting is not true, even the physicians. The idea that they can take a new hire, any new hire and just throw them out there and not look at their quality indicators and the practice of their medicine is not reality in corporate medicine. The supervisory issue is becoming much less of an issue and disadvantage in the era of EHR. At our community hospital, chart review and cosignature (which the NPs also have to follow the same medical staff rules as PAs) is but a simple couple of clicks in the physicians' inbox. Much different that it was in the "old days," and less and less of a barrier as EHRs improve and are more fully penetrated in all levels of health care delivery. Link to comment Share on other sites More sharing options...
burnpac Posted November 12, 2014 Share Posted November 12, 2014 I just had another thought on this. It is also an issue of supply and demand. If this corporation can find enough NPs trained in general medicine to fill all of its positions, all the more power to them. Many NPs, unlike PAs, are "niche" trained (women's health, geriatrics, etc.). I have learned that you really have to look into the training and credentials of an NP when you hire them. Not so a certified PA. In our community, the demand is so high for PAs and NPs that the job goes to the first candidate with a pulse, appropriate training / experience and a license to practice in that jurisdiction. PAs are winning the battle here in many (not all) parts of California because there are more of them available and you can count on their consistent generalist training. Link to comment Share on other sites More sharing options...
gbrothers98 Posted November 12, 2014 Share Posted November 12, 2014 While I understand the concern of the OP, using the supervisory requirement as an obstacle to hiring is really unfounded. It is a requirement I would like to see disappear or be modified for PAs with experience. The reality is that there usually is more to the etiology of dicontinuing the use of PAs or NPs in a practice. This could have to do with billing, with owner personal preference, with improved medicare reimbursement under HITECH, or a host of other reasons including bad experiences that are magnified and transferred onto the profession as a whole. Example, new PA 'misses' tonsillar abscess due to early in disease course, pt becomes toxic, encounters surgical complications due to progression of disease, poor outcome for patient, ENT surgeon sued, settled out of court. All events become due to new PA therefore dont hire any more PAs cause they will get you sued due to poor practice of medicine in general. But this is really a sample of one. For other practices and regions, PAs will be the solution to staffing. If this practice is rapidly expanding, taking on physician partners, those partners may look at PAs and NPs as competition within their own system for RVUs. There are and will be other opportunities plus it is not uncommon for decisions that are made within one timeframe to be reversed or reconsidered in another. I anecdotally worked in an ED where the PA picked up next chart. Only 2 PAs there, could never get time off. I stayed for 3 years, jumped to a better position in a better region of the state for me. Hired another PA after me. Other PA left and joined me. Other PAs hired after stayed for short period of time or did not work out. ED director called me up to brainstorm staffing and to make an offer to return. Discussed with him that staffing pattern had to change and more robust PA staff hired. He, the docs of the dept and HR did not agree. Decided to go with hiring more docs (a much more expensive option it turned out). Fast forward 5-7 years, new director is contacting PA staffing group I belong to about hiring for some coverage. Sometimes it all comes back to the beginning. G Brothers PA-C Link to comment Share on other sites More sharing options...
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