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What do you want PAFT to focus on in the next 3 years?


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I too have been a charter member of PAFT and am  a big proponent in the name change.  However,  I think a more pressing issue is reimbursement at 100%.  Hell, I did 100% of the work.  Maybe a name change would help us to get that done.  Assistant  GRRRRR  vs Associate ; ).

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Hi all-

I'm the new President-Elect of PAFT. Over the next few years I will be working with the board of PAFT to pursue an agenda important to our members and potential members.

What would you like to see PAFT accomplish in the next 3 years and what long-term goals should we start working on?

Thanks

Eliminate all the artificial barriers that have been thrown up such as counter-signature requirements for...well anything (DME, Home Health, Hospice).

Increase reimbursement that, besides suggesting we somehow provide inferior care, is also a barrier to employment and increased salaries.

Get rid of any restrictions on practice ownership where such restrictions exist.

Develop a public education program that defines us as different from NPs.

Stop Medicare from foisting restrictions and requirements that exceed state laws.

 

I think that will keep you busy for several years. :-)

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Hi all-

I'm the new President-Elect of PAFT. Over the next few years I will be working with the board of PAFT to pursue an agenda important to our members and potential members.

What would you like to see PAFT accomplish in the next 3 years and what long-term goals should we start working on?

Thanks

 

unions for PAs

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  • 1 month later...

I had a shower thought about this the other day: we need to get better consistency and understanding about PA as a professional designation. Why don't we start by emphasizing the idea of standardizing the academic degree?

 

An MD (or a DO) is a professional title, as well as the degree it feeds. DNP, same thing. BSN or MSN, not exactly, but within the paradigm of RN they have an understood place. Meanwhile, I feel that the wide range of degrees awarded by PA schools makes us look more fragmented and inconsistent than we are.

 

This isn't even a Bachelors vs Masters thing. I have an MS in Physician Assistant Practice (...as though that's a different kind of practice than medical practice? Whatever). That's better than having an MS in PA Studies, in my opinion. That's a vague, unhelpful degree title. You can get an MS in Chemistry, and everybody understands what that means. You studied Chemistry. You got a Masters in that field. You didn't get a Masters in "Chemistry Studies," because that's redundant, and honestly kind of weird.

 

So I was thinking, how much better would it be for everybody if we made sure everyone graduated with a "Masters in Medical Science" (although that one is tricky, because the Ohio State University has that program for MD-track students looking to do research) or "Masters in Medical Practice"? It's obviously not an MD, but it would be descriptive, and the consistency would help a lot, I think.

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Easy. 

Get rid of supervision.

Independent license.

Let all scope determinations be made at the level of the practice.

 

I'm of two minds about this. On the one hand, the NPs (in my state anyhow) already have this, and it's not like they're killing people left and right. I think we could handle things, clinically, and outcomes would be fine. Plus in the real world, it's true that a lot of us really are *functionally* pretty independent already. So let's get that acknowledged.

 

But on the other hand, the "dependence" thing has some significant up-sides for PAs like me who, depending on how you look at things, are maybe a little lazy -- or else simply prefer not to take on 100% of the responsibility of being an MD without getting a bigger proportion of the rewards that come with it.

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I'm of two minds about this. On the one hand, the NPs (in my state anyhow) already have this, and it's not like they're killing people left and right. I think we could handle things, clinically, and outcomes would be fine. Plus in the real world, it's true that a lot of us really are *functionally* pretty independent already. So let's get that acknowledged.

 

But on the other hand, the "dependence" thing has some significant up-sides for PAs like me who, depending on how you look at things, are maybe a little lazy -- or else simply prefer not to take on 100% of the responsibility of being an MD without getting a bigger proportion of the rewards that come with it.

What responsibilities do MDs have that PAs don't?

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It depends a lot on practice setting, of course. And specialty, at least to an extent. But for me and in my urgent care, I realize that my patients are "my" patients because there is no one else around who's practicing evenings and weekends, but I'm not primary care. I'm not following them over time. I'm not really responsible for long-term outcomes. I provide a service, I try to do it well, and sure, it shouldn't matter if they came in for me on a Monday or Dr. X on Wednesday, the care should be the same.

 

Even so, I see a lot of discussion on the boards about how we don't need to be "supervised" and while I agree with that much, there's still a difference between autonomy and independence. My SP and I meet in person twice a year. I send emails about this and that, but over the years those have become less frequent. Nonetheless, what I do is technically co-signed by that MD. Someone else is responsible along with me. I always have the option, really whenever I see fit, to kick something up the chain, say "this is not something I want to deal with," and walk away. It's my impression that most MDs do not really have that option.

 

I don't invoke it often at all, but that sense of "this is above my pay grade, goodbye" is something I value. If I'm going to be truly independent, whatever I gain I'll be losing that. And all I'm saying is, if that's the case then I want more compensation.

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It depends a lot on practice setting, of course. And specialty, at least to an extent. But for me and in my urgent care, I realize that my patients are "my" patients because there is no one else around who's practicing evenings and weekends, but I'm not primary care. I'm not following them over time. I'm not really responsible for long-term outcomes. I provide a service, I try to do it well, and sure, it shouldn't matter if they came in for me on a Monday or Dr. X on Wednesday, the care should be the same.

 

Even so, I see a lot of discussion on the boards about how we don't need to be "supervised" and while I agree with that much, there's still a difference between autonomy and independence. My SP and I meet in person twice a year. I send emails about this and that, but over the years those have become less frequent. Nonetheless, what I do is technically co-signed by that MD. Someone else is responsible along with me. I always have the option, really whenever I see fit, to kick something up the chain, say "this is not something I want to deal with," and walk away. It's my impression that most MDs do not really have that option.

 

I don't invoke it often at all, but that sense of "this is above my pay grade, goodbye" is something I value. If I'm going to be truly independent, whatever I gain I'll be losing that. And all I'm saying is, if that's the case then I want more compensation.

I have a panel of 1500 patients that are mine. I'm solely responsible for managing their care. Point being, not having responsibility is a practice dependent thing. Urgent care docs practice the same as urgent care PAs and same thing with family practice. The only place there is true distinction between the scope and responsibility level is surgery.

 

MDs kick things off all the time and walk away through referrals. I certainly can't kick off my patient to another family practice doc. I can ask them questions, just like they can ask me questions, or more often I ask another PA in the office their thoughts on a tricky patient.

 

If your state requires co-sig, it makes you no less responsible. Technically it gives the MD more responsibility, but this is entirely the choice of the MD to take on. It's not inherent in having an MD. I personally have no co-sig and honestly do not know who my supervising physician is.

 

The point of all this is: what you have is practice dependent and no reason for it to change whether you are labeled independent or dependent on the eyes of the law. Many of us don't have this option despite still having "dependent practitioner" status. If an MD is willing to take on patients you don't want, that doesn't have to change with being able to practice with a license unattached to another person. But it will help those of us who want our own practice, bill under our own name, and not find new work when an MD moves/passes away/gets pissy.

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I'm of two minds about this. On the one hand, the NPs (in my state anyhow) already have this, and it's not like they're killing people left and right. I think we could handle things, clinically, and outcomes would be fine. Plus in the real world, it's true that a lot of us really are *functionally* pretty independent already. So let's get that acknowledged.

 

But on the other hand, the "dependence" thing has some significant up-sides for PAs like me who, depending on how you look at things, are maybe a little lazy -- or else simply prefer not to take on 100% of the responsibility of being an MD without getting a bigger proportion of the rewards that come with it.

PAs do not need the tether of a state-endorsed supervisory relationship. It is a top-down mandate that has no evidence basis and is not being clamored for the any group other than the state medical commissions/physician groups. Oh, and OK plenty of backward-thinking PAs.

 

If you as a PA aren't willing to accept professional responsibility for your malpractice-covered actions, then maybe you shouldn't be in medicine.

 

I wouldn't link the need for professional stewardship with financial reward. I understand your point but it is easy to accuse that argument of being ONLY financially based, which invalidates ANY of the principle PAs are endorsing with a goal of striking out "supervision"

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"II had the chance to come back in read this whole thread as I awaken at 3:30 this morning and came into the office. I have some questions.  I will start by saying that I'm in the dark these days about PAFT and I take responsibility for that. I am so busy as the owner of a growing practice that I go through cycles where I don't come to this forum for weeks. I have piles of e-mails every morning that I don't read because I don't have time."

 

Next question: Avaya24 . . . who are you?  I don't know who the sitting president is.  I know Eric and he is a great guy.

 

jmj11 - as I was pilfering through some old notifications on PAForum, I came across your post with a directed inquiry that I missed.  I, too, am a clinically practicing PA, the President of PAFT, two small boys and blah, blah blah.  It is hard to keep up with the plethora of communication from all directions - at least that's my excuse for missing  your directed post to me.

 

My name is Nichole Bateman, I practice in northeast Oklahoma.  I've been in clinical practice 22+ years, primarily in OB/GYN and FP/UC.  Am back in specialty practice - opportunity in my small community that sought me out though I really am a primary care animal at heart.  UC was sucking the life out of me with hours and volume that were unrelenting - had to make a change.  This came my way, I took it and haven't looked back yet. 

 

Now - on to PAFT.  We have been busy on the advocacy front.  One of the most difficult things for me in the communication - it's hard to keep up with all the methods of communication available to us and I'm not a marketing expert, that's for sure.  It has been a focus I think about each day and have tapped our student board member and another member at large of the PAFT organization to help develop a more comprehensive method of membership communication. 

 

In fact, in very short order, there will be a press release soon about our most important project to date that will be a collaborative project with another national PA organization.  Once the initial roll-out framework is complete - by mid November - the announcements will come forward.  I really do hope that you will consider rejoining PAFT.  We will need key people who are progressive and interested in giving their time to move this project forward state by state.   I really believe that once we're announced and the word gets out, we'll do great things with or without the AAPA's involvement.  I personally hope with as there are many changes happening at the AAPA board and administrative leadership level (HOD, I think, still needs a tremendous overahaul and impedes the progress of what the AAPA could and should really be doing).  It's something I've never seen AAPA do - or any other national organization for that matter - on the PA advocacy and progress front.   This project will ultimately require the skill sets of a great many professionals and will certainly not be limited to PAFT membership once the basic framework is in place. 

 

My apologies for being 6 mos late in a response....a symptom of communication overload.  Still, I'm glad you inquired and indicate interest - I hope you still have an interest despite the time that has passed!

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  • 2 months later...

PAFT should focus on the following:

The rate of new PA school openings is important to gear up for the ACA's projected 40M-plus newly insured.  I would however strongly encourage all PA programs to recalibrate their admissions philosophy to align with the ACA's current and future healthcare service access demands. Specifically, I have read on this forum, YouTube and other platforms that the typical profile of a successful PA student is a single, white female, aged 25, GPA 3.6, and 2 years clinical experience. 

 

The United States has historically been challenged by clinical and public health care disparities (2x-3x preventable acute and chronic ailments) faced by several ethnic & racial groups.  As of 2010, 48% of all newborns were Black, Hispanic and Asian. The US Census clearly indicates that by 2040 America will be a majority ethnic diverse country. 

 

 

With clear data as such how can the rapidly growing PA profession continue to undervalue or ignore the critical importance of an ethnic diverse PA student and practitioner workforce? We have already seen the results of this skewed philosophy across allopathic medicine. Much also can be said for PA admissions that emphasize a more mature (age and clinically experienced) student profile.  Most patients prefer to relate their embarrassing and confidential health concerns to a practitioner that looks far more mature than their grandchild. More importantly, many ethnic diverse patients feel a strong resentment having limited to no options in seeing a primary care or subspecialist of the same ethnicity.

 

 

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  • 3 weeks later...

- Increase recognition of the profession

- Name change that more appropriately reflects the profession

- Advocate for increased scope (IE: independent practice, even if only in primary care or collaborative agreements instead of supervising agreements

- Encourage schools to get back to basics and require adequate clinical experience

- Longer term goal: work with international aid organizations to recognize PAs (Doctors Without Borders - I'm talking about you!)  Increase awareness / use of PAs in foreign countries

 

*I just applied to be a member of PAFT and am very excited to finally hear about this organization!

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- Increase recognition of the profession

- Name change that more appropriately reflects the profession

- Advocate for increased scope (IE: independent practice, even if only in primary care or collaborative agreements instead of supervising agreements

- Encourage schools to get back to basics and require adequate clinical experience

- Longer term goal: work with international aid organizations to recognize PAs (Doctors Without Borders - I'm talking about you!)  Increase awareness / use of PAs in foreign countries

 

*I just applied to be a member of PAFT and am very excited to finally hear about this organization!

PAFT already approached DWB/MSF about their no PA stance and their board sent back a letter clarifying their use of NPs. when they use NPs they only use them as RNs, they are not using them as practicing clinicians. They are willing to use PAs who possess an MPH in a logistical support role doing planning, epidemiology, etc. They get enough applications from residency trained/boarded docs that they reject most of those apps so have no need for PAs/NPs to work as clinicians.

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Facilitating ARC's and NCCPA's approval of online PA education (didactic year only). Across our country in the past 15 years we have come to approve online RN programs, MBA programs, Post Bacc programs, DHSc programs, MOOC's, etc.  Even at the secondary school level we are now accepting online or computer-based SATs/ACTs. We all take online CME/CE courses for medical licensure recertification/maintenance.  So why the pushback on Online PA program model?

 

What are we talking about?  Online video instruction (Q&A), critical thinking, discussion posts across physiology, pharmacology, microbiology, histology, pathology, and other basic sciences classes. How hard can that be....its already being done across other graduate level academia....

The ACA is expected to flood the US healthcare system with 40M newly insured. Not to mention the current 100M with limited-poor access. The US is already 50,000 short of primary care MD/DOs and 2x (100,000) short of community nurses.  The brick n mortar medical school education model of 100-150 medical students per class per year or 30-50 PA students per class per year is wholly insufficient to meet the current and/or future demands of the ACA.  The traditional PA education model is already proving insufficient in increasing the number of URMs PAs who could return to their ethnic-diverse and HPSA communities to practice healthcare. The brick n mortar college and graduate school model/bubble across all careers is forecast to burst in the next 3-5 years owing to a host of US economic constraints.

The Online PA Program model is smart economics, academics, and workforce development philosophy. With an online Year-1 curriculum a typical brick n mortar PA program can increase its class size 3-fold to 150 students per year.  The Online PA model also has the benefit of admitting the thousands of PA candidates who should or could make great PAs if it were not for a physical seat (brick-n-mortar) classroom and available PA faculty constraint.

 

Lastly, structuring the year-2 clinical rotations would be a typical task already performed successfully by US IMGs/FMGs who attend classes in the Caribbean and seek clinical rotations across a myriad of states hospitals and community practices.

 

###
 

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I, for one, NEVER want to see an online PA program - ever. We are interpersonal practitioners who NEED face to face contact and education to be worthy of our profession.

 

Also, we have TOO many PA programs churning out new grads and saturating a market with fewer and fewer docs.

 

We have the cart in front of the horse - as long as we are tethered to docs - we have to have them.

 

If we keep churning out new grads who need jobs - we are defeating our current limitations and PAs will continue to take crummy jobs as glorified scribes for arrogant doctors.

 

So, let's figure out HOW PAs are going to work in the future and THEN figure out how many PAs to graduate and how to educate them.

 

My very old 2 cents......

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Never say Never!
Healthcare is 20% of our national GDP. This horse has been way outta the barn long before you and I were postgrads.  

 

You don't need a face-to-face lecture neccessarily to read and interpret histopathology slides and understand the physiology of the RAAS.  The online version permits greater immersion and repeat study to become expert.  So there are clear benefits to an online and/or hybrid PA education model in additional to brick n mortar.

 

I eat dinner 3x monthly with 45 year old MDs. They are seriously contemplating or actively retiring from practice.  These are the young ones....who are still young enough to pivot to another profession before they get too old. They are totally dismayed and burnt out from the never-break even educational debt, long-hours without seeing family, negative payscale, malpractice, etc... That's just the tip of the iceberg.

 

Who is going to fill the clinical void between those physicians 60+ retiring and those 40+ retiring.  Plus remember it takes 12 years to churn out 1 board-certified pediatrician or family medicine physican versus 3 years for a IM/FP physician assistant or specialist. So the workforce-development economics do not support entrenched brick n mortar allopathic/osteopathic/mid-level practitioner education. 

 

We can all stand on ceremony about the good ol days of MD/PA classroom-based academia.  But the WORLD IS FLAT and nearly 9 billion humans will need healthcare services over the next century.  Who's gonna meet that demand....how are we going to rapidly meet that demand....

 

All it takes is for 1 or 2 simultaneous natural disasters, infectious disease outbreaks or terrorists attacks on "any soil" to Code Black an already fractured domestic or international healthcare system. 

 

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I still will not stand for copious numbers of grads with no supporting docs in our current structure.

 

The structure has to change to meet the needs. We just can't keep churning out grads and opening new schools. We don't have enough rotation sites or mentors or proctors as it is.

 

I am also very old in this business and can tell you that producing an online PA opens the door for an IDIOT provider to be produced - one who has no interpersonal skills or can't function with other humans but can do fine online. 

 

I have taught for a long time at PA programs. I can weed out the bad ones in a few lectures - they don't pay attention, act bored, do other things while I am presenting. They don't get along with their peers and other students. My prediction rate for bad students is about 85-90%. 

 

Our profession is one of humanity and human contact and context. 

 

I will not support online education regardless of the population of the planet.

Producing a QUALITY practitioner outweighs quantity 1000000 to 1.

 

My opinion on this won't change.

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