DAVIDHAMEL Posted July 25, 2011 Author So I finally tracked down my elusive "supervising physician" at one of my ED job sites. I was trying to update him about Maine's new supervisory requirements as dictated by the (apparently anti-PA) Board of Medicine. The Board is now requiring that twice a year the PA sit down face to face with the supervisor for a "formal review" including review of the (also soon to be mandatory) report from the PAs participation in the Prescription Monitoring Program. It seems that while NPs in the state are becoming increasingly autonomous, PAs are becoming more highly regulated. And we STILL don't have Schedule 2 prescribing privileges unless we get SPECIAL (major jumping through hoops) permission from the Board. Anyway, my supervisor's response to these changes was NOT encouraging. He is an extremely busy ED medical director, and if anything seemed kind of pissed at ME that he now has more forms to fill out and administrative tasks to perform. Sort of the straw that is going to break the camel's back. His reply to me was "You PAs had better do something politically. As an organization our hospital is becoming more inclined to hire NPs because they are now autonomous and we don't have to provide all of this additional supervisory hassle that comes with PAs." I have mentioned this before on this forum: If AAPA and the rest of us don't start pushing for true "regulatory/legal" increased autonomy, especially in primary care, we will dwindle as a profession while the NPs continue to kick ***. I've already had discussions with recruiters in Maine who tell me that since the NP rules were changed last year to allow them to practice without physician supervision, there has been a shift by primary care employers who now only want an NP. I wasn't surprised to see the preference in primary care hiring given to NPs given that they tend to be employed by satellite clinics far from the physical presence of MDs. What disturbs me is that in the ED settings where I work, the MDs are right there all the time. And yet still they would rather not have the hassle of having to review my charts, sign my Schedule 2 prescriptions, sign my recertification forms, conduct by biannual review, review my Prescription Monitoring Program reports etc, etc, etc. NP autonomy is here to stay and spreading rapidly. The MDs have no choice but to live with it whether they like it or not. For many PAs the excuse for not pushing for more freedom and autonomy has been "We can't rock the boat and anger our supervisors". Well let me tell you folks, our supervisors are already angry. Telling them they have yet more administrative and supervisory duties in managing PAs is NOT making them any happier.
DAVIDHAMEL Posted July 25, 2011 So I finally tracked down my elusive "supervising physician" at one of my ED job sites. I was trying to update him about Maine's new supervisory requirements as dictated by the (apparently anti-PA) Board of Medicine. The Board is now requiring that twice a year the PA sit down face to face with the supervisor for a "formal review" including review of the (also soon to be mandatory) report from the PAs participation in the Prescription Monitoring Program. It seems that while NPs in the state are becoming increasingly autonomous, PAs are becoming more highly regulated. And we STILL don't have Schedule 2 prescribing privileges unless we get SPECIAL (major jumping through hoops) permission from the Board. Anyway, my supervisor's response to these changes was NOT encouraging. He is an extremely busy ED medical director, and if anything seemed kind of pissed at ME that he now has more forms to fill out and administrative tasks to perform. Sort of the straw that is going to break the camel's back. His reply to me was "You PAs had better do something politically. As an organization our hospital is becoming more inclined to hire NPs because they are now autonomous and we don't have to provide all of this additional supervisory hassle that comes with PAs." I have mentioned this before on this forum: If AAPA and the rest of us don't start pushing for true "regulatory/legal" increased autonomy, especially in primary care, we will dwindle as a profession while the NPs continue to kick ***. I've already had discussions with recruiters in Maine who tell me that since the NP rules were changed last year to allow them to practice without physician supervision, there has been a shift by primary care employers who now only want an NP. I wasn't surprised to see the preference in primary care hiring given to NPs given that they tend to be employed by satellite clinics far from the physical presence of MDs. What disturbs me is that in the ED settings where I work, the MDs are right there all the time. And yet still they would rather not have the hassle of having to review my charts, sign my Schedule 2 prescriptions, sign my recertification forms, conduct by biannual review, review my Prescription Monitoring Program reports etc, etc, etc. NP autonomy is here to stay and spreading rapidly. The MDs have no choice but to live with it whether they like it or not. For many PAs the excuse for not pushing for more freedom and autonomy has been "We can't rock the boat and anger our supervisors". Well let me tell you folks, our supervisors are already angry. Telling them they have yet more administrative and supervisory duties in managing PAs is NOT making them any happier.
Acebecker Posted July 25, 2011 Have you discussed with the Maine academy of PAs? This sounds like something that needs to be addressed immediately on a local level while the AAPA gets involved nationally.
Acebecker Posted July 25, 2011 Have you discussed with the Maine academy of PAs? This sounds like something that needs to be addressed immediately on a local level while the AAPA gets involved nationally.
DAVIDHAMEL Posted July 25, 2011 Author Have you discussed with the Maine academy of PAs? This sounds like something that needs to be addressed immediately on a local level while the AAPA gets involved nationally. YES. I am a member of the Down East Association of PAs. I have emailed the organization repeatedly with my thoughts on the matter.
DAVIDHAMEL Posted July 25, 2011 Author Have you discussed with the Maine academy of PAs? This sounds like something that needs to be addressed immediately on a local level while the AAPA gets involved nationally. YES. I am a member of the Down East Association of PAs. I have emailed the organization repeatedly with my thoughts on the matter.
Acebecker Posted July 25, 2011 Admittedly I am just a student, but I'm out West and, thankfully, and we have been pretty stable as far as our privileging and supervision goes. However, as one state backslides we'll see more and more states following. I will graduate in 5 weeks and begin practice so this news is fairly upsetting - I don't want my state to be next on the chopping block when it comes to PA practice guidelines. We all need to be aware of this and watchful for any trends. Let us know how things roll out. Andrew
Acebecker Posted July 25, 2011 Admittedly I am just a student, but I'm out West and, thankfully, and we have been pretty stable as far as our privileging and supervision goes. However, as one state backslides we'll see more and more states following. I will graduate in 5 weeks and begin practice so this news is fairly upsetting - I don't want my state to be next on the chopping block when it comes to PA practice guidelines. We all need to be aware of this and watchful for any trends. Let us know how things roll out. Andrew
jmj11 Posted July 25, 2011 Thirty years ago, most considered PAs better trained over all than NPs and the MD's favorite (as we worked and were trained in the medical model). While I was still a student, the nurses in Kentucky were talking about autonomy for NPs. We had a MD program director who told us, "If the NPs seek independence the AMA will crush them like cockroaches and only PAs will be used for being loyal to the MD-PA team model." However, economics speak much louder than philosophical differences. I plan on hiring another staff in a year and I really have no choice but to hire an NP because of the autonomy required for the position. For decades PAs and NPs were interchangeable. There is now daylight between us (NPs on top) and that daylight will continue to increase unless we have a shake up. The name change is one small part of that.
jmj11 Posted July 25, 2011 Thirty years ago, most considered PAs better trained over all than NPs and the MD's favorite (as we worked and were trained in the medical model). While I was still a student, the nurses in Kentucky were talking about autonomy for NPs. We had a MD program director who told us, "If the NPs seek independence the AMA will crush them like cockroaches and only PAs will be used for being loyal to the MD-PA team model." However, economics speak much louder than philosophical differences. I plan on hiring another staff in a year and I really have no choice but to hire an NP because of the autonomy required for the position. For decades PAs and NPs were interchangeable. There is now daylight between us (NPs on top) and that daylight will continue to increase unless we have a shake up. The name change is one small part of that.
Contrarian Posted July 25, 2011 We had a MD program director who told us, "If the NPs seek independence the AMA will crush them like cockroaches and only PAs will be used for being loyal to the MD-PA team model." What's slightly quaint, charming but kinda sad is that after 30 yrs.... there are still LOTS of PAs who cling to this notion... and will still parrot this nonsense to any PA who begins to hint at a need for further autonomy for PAs. EVERYTIME its brought up on this site... several PAs chime in with the "They gonna make the MDs [AMA] mad and then the NPs are gonna pay" spiel ... Thing is the NPs never pay... they get paid.
Contrarian Posted July 25, 2011 We had a MD program director who told us, "If the NPs seek independence the AMA will crush them like cockroaches and only PAs will be used for being loyal to the MD-PA team model." What's slightly quaint, charming but kinda sad is that after 30 yrs.... there are still LOTS of PAs who cling to this notion... and will still parrot this nonsense to any PA who begins to hint at a need for further autonomy for PAs. EVERYTIME its brought up on this site... several PAs chime in with the "They gonna make the MDs [AMA] mad and then the NPs are gonna pay" spiel ... Thing is the NPs never pay... they get paid.
DAVIDHAMEL Posted July 25, 2011 Author I plan on hiring another staff in a year and I really have no choice but to hire an NP because of the autonomy required for the position. This coming from a PA. Very sad.
DAVIDHAMEL Posted July 25, 2011 Author I plan on hiring another staff in a year and I really have no choice but to hire an NP because of the autonomy required for the position. This coming from a PA. Very sad.
jmj11 Posted July 25, 2011 This coming from a PA. Very sad. I have absolutely no legal option. The position is for a provider in a distant location that would never have a SP visit there. The state has already told me that I can not hire a PA for that position. I have no choice unless I hire no one.
jmj11 Posted July 25, 2011 This coming from a PA. Very sad. I have absolutely no legal option. The position is for a provider in a distant location that would never have a SP visit there. The state has already told me that I can not hire a PA for that position. I have no choice unless I hire no one.
andersenpa Posted July 25, 2011 I have absolutely no legal option. The position is for a provider in a distant location that would never have a SP visit there. The state has already told me that I can not hire a PA for that position. I have no choice unless I hire no one. That stings...............
andersenpa Posted July 25, 2011 I have absolutely no legal option. The position is for a provider in a distant location that would never have a SP visit there. The state has already told me that I can not hire a PA for that position. I have no choice unless I hire no one. That stings...............
Moderator ventana Posted July 25, 2011 Moderator I have absolutely no legal option. The position is for a provider in a distant location that would never have a SP visit there. The state has already told me that I can not hire a PA for that position. I have no choice unless I hire no one. In researching opening my own clinic for the past year I became very aware that NP's are FAR better positioned for this endeavor - I have even looked into going back to get an NP degree somehow (but that did not pan out as it is a lot of school in nursing theory....) NP's have done a much better job in the political arena and are much better situated right now towards independent practice. In mass there is currently a bill pending to allow more freedom to PA's and the MASS Medical Society came out strongly against it...... really dissappointing. the time will come when our numbers are big enough that we have enough political clout to advocate our own agenda..... we might be getting close - but at some point in time we are going to have to do what is best for our own profession and I suspect this will mean distancing ourselves a little bit out from underneath the Physician - not a popular stance with the doc's but I see it coming and support it. The first simple step might be a name change to physician associate so we can at least stand on our own name instead of merely and assistant. Jmj11 - don't feel bad at hiring an NP - you have to do what you gotta do and you have blazed enough new trails for PA's!
Moderator ventana Posted July 25, 2011 Moderator I have absolutely no legal option. The position is for a provider in a distant location that would never have a SP visit there. The state has already told me that I can not hire a PA for that position. I have no choice unless I hire no one. In researching opening my own clinic for the past year I became very aware that NP's are FAR better positioned for this endeavor - I have even looked into going back to get an NP degree somehow (but that did not pan out as it is a lot of school in nursing theory....) NP's have done a much better job in the political arena and are much better situated right now towards independent practice. In mass there is currently a bill pending to allow more freedom to PA's and the MASS Medical Society came out strongly against it...... really dissappointing. the time will come when our numbers are big enough that we have enough political clout to advocate our own agenda..... we might be getting close - but at some point in time we are going to have to do what is best for our own profession and I suspect this will mean distancing ourselves a little bit out from underneath the Physician - not a popular stance with the doc's but I see it coming and support it. The first simple step might be a name change to physician associate so we can at least stand on our own name instead of merely and assistant. Jmj11 - don't feel bad at hiring an NP - you have to do what you gotta do and you have blazed enough new trails for PA's!
Swole2112 Posted July 26, 2011 While I've not yet even been accepted into PA school, I must admit that I find this talk to be a little upsetting. I've seen far too many situations where little by little, individual liberties and privileges were lost while those concerned couldn't help but stand by and watch. It happens so gradually that one doesn't even realize the time to act until that time has long since passed. What can PAs do to stop this trend and move towards autonomy? I'm serious. I don't want to look back on years spent in education and training as a PA only to see that NPs and MDs/DOs practically stand side by side while the PA profession has been reduced to the metaphorical equivalent of a 16 year old that is not to be trusted with keys to the car.
Swole2112 Posted July 26, 2011 While I've not yet even been accepted into PA school, I must admit that I find this talk to be a little upsetting. I've seen far too many situations where little by little, individual liberties and privileges were lost while those concerned couldn't help but stand by and watch. It happens so gradually that one doesn't even realize the time to act until that time has long since passed. What can PAs do to stop this trend and move towards autonomy? I'm serious. I don't want to look back on years spent in education and training as a PA only to see that NPs and MDs/DOs practically stand side by side while the PA profession has been reduced to the metaphorical equivalent of a 16 year old that is not to be trusted with keys to the car.
medman2007 Posted July 26, 2011 While I've not yet even been accepted into PA school, I must admit that I find this talk to be a little upsetting. I've seen far too many situations where little by little, individual liberties and privileges were lost while those concerned couldn't help but stand by and watch. It happens so gradually that one doesn't even realize the time to act until that time has long since passed. What can PAs do to stop this trend and move towards autonomy? I'm serious. I don't want to look back on years spent in education and training as a PA only to see that NPs and MDs/DOs practically stand side by side while the PA profession has been reduced to the metaphorical equivalent of a 16 year old that is not to be trusted with keys to the car This is not meant to be a smart aleck response, so pls don't take it that way. Without a doubt, there are issues within the PA profession that need to be addressed. These issues have been discussed/debated here very astutely by those in the know. However, don't go to any forum like this to make yourself feel better about or "solidify" the decision to pursue a particular career path. Visit nearly any online forum (Nursing, NP, CRNA, MD, DO, PT, etc.) and you would think the whole damn profession was going to crumble just by reading some posts. Just remember the context of the responses. I can't tell you how many times I've read "doom and gloom" regarding certain professions. I recall years ago when a forum group derided and ridiculed some nurses for pursuing CRNA - "nursing anesthesia is a pipe dream"; "CRNAs will be irrelevant within five yrs. . ." etc. They posted detailed "evidence" of this future decline. CRNAs still here and going strong. In 1995, a nursing professor (PhD) told me that the PA profession would be "pretty much extinct" by the year 2000?? PAs still here and going strong. Of course don't stick your head in the sand and pretend like there are no issues. But, trust me, as a student and practitioner of several different healthcare modalities there will always be vocal members of a profession who speak the loudest and think the grass is always greener somewhere else. If the "American Association of Ice Cream Taste Testers" had an online forum, then you can bet some would be complaining about that field as well
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