PA profession is rudderless

[Gonadometrics]

I read the forum regularly and have become quite discouraged by doing so. The PA profession has no direction. Every day, someone posts an anecdote about the demise of the PA profession. I believe all of them. PAs are being attacked from all sides. The PA profession is losing ground to NPs, to MDs, to patients who don't want to see someone who isn't a doctor, to practice managers, to insurance companies and to "our" own organizing bodies NCCPA and AAPA. Reading these posts reminds me of Norman Gevitz' work "D.O.s : The History of Oseopathic Medicine" His account of a nearly 100+ year war between M.D. (and Allopathic Medicine) and D.O.'s makes the trials and tribulations of PAs look minimal today. Of course, most of the PAs hard work was done in the 40 plus years before my arrival. My point though is that it appears the PA profession has no plan for its own advancement and survival. There is no unified strategy about the mission of the PA profession. There are many complaints, gripes, legitimate frustrations. However, it does appear that there is no mission statement and sadly, the PA profession has no power, seeks no power and will die without a grip on power. I would suggest that part of the reason for a lack of cohesion among PAs that prevents their advancement against these forces that will destroy the profession is that PA profession is an amalgam of strange, contradictory traits, education and behaviors. Unlike the D.O. or M.D. which were, at least in the early war years, synthetically pure in their own respective regiments, PAs do not carry an ensign that uniquely identifies us and stirs fear in our political enemies. I don't have any idea where the future of the PA profession is headed but I am tremendously discouraged by the current climate that works against us.

[Banuchi]

PA Forum is rudderless

 

I'm assuming you meant "PA Profession"??

[Gonadometrics]

Yes, the Subject now reads "PA Profession is rudderless". Thank you.

[IdahoPA]

If you see a problem, try being a part of the solution. Got an idea? Share it. It's easy to complain and be a "bench coach" but someone has to step up and rally for changes. It sounds like you're about ready to do so because you've already noticed deficiencies. You can turn a blind eye and let things continue, or do something about it. Hope you go with the latter.

 

PS. I still read "forum."

[andersenpa]

I read the forum regularly and have become quite discouraged by doing so. The PA profession has no direction. Every day, someone posts an anecdote about the demise of the PA profession. I believe all of them.

 

That may be part of the issue. Don't believe everything that you read. Each post is influenced by the personal experiences of that individual; it is not necessarily a symptom of a greater problem.

 

PAs are being attacked from all sides. The PA profession is losing ground to NPs, to MDs, to patients who don't want to see someone who isn't a doctor, to practice managers, to insurance companies and to "our" own organizing bodies NCCPA and AAPA.

 

Doesn't it seem contradictory to say that we are losing ground to NPs (nonphysicians) and then state that patients "don't want to see someone who isn't a doctor"? We are not gaining ground as quickly as our NP colleagues but the profession is not regressing. We have doubled the number of PAs in the US from 40k to 80k in ten years. To me the question is not "why are we failing", but "how can we capitalize on the culture change in medicine which will open more doors for nonphysician clinicians."

 

Reading these posts reminds me of Norman Gevitz' work "D.O.s : The History of Oseopathic Medicine" His account of a nearly 100+ year war between M.D. (and Allopathic Medicine) and D.O.'s makes the trials and tribulations of PAs look minimal today. Of course, most of the PAs hard work was done in the 40 plus years before my arrival. My point though is that it appears the PA profession has no plan for its own advancement and survival.

 

Whatever organization we have now has a clear plan- close alliance with physicians. We are under the BOMs and thus have no other real choices. Unfortunately it's a relationship where some individual physicians and certain factions $#!+ on us from time to time....and we have to take it.

 

There is no unified strategy about the mission of the PA profession. There are many complaints, gripes, legitimate frustrations.

 

What are some examples that you have dealt with, or are aware of?

 

However, it does appear that there is no mission statement and sadly, the PA profession has no power, seeks no power and will die without a grip on power.

 

We are a relativey small profession compared to physicians and nursing and thus it makes it pretty hard to get a power position. We have to advocate for ourselves, and if that ruffles feathers somewhere we will have to deal with it. We are too much a part of modern medicine to fear that the BOMs and states will pull our licenses due to political activity.

 

I would suggest that part of the reason for a lack of cohesion among PAs that prevents their advancement against these forces that will destroy the profession is that PA profession is an amalgam of strange, contradictory traits, education and behaviors. Unlike the D.O. or M.D. which were, at least in the early war years, synthetically pure in their own respective regiments, PAs do not carry an ensign that uniquely identifies us and stirs fear in our political enemies. I don't have any idea where the future of the PA profession is headed but I am tremendously discouraged by the current climate that works against us.

 

A move toward a uniform educational standard may help in that respect. It's heresy to some, since historically we pride ourselves on diverse backgrounds. I think the current PA training model can thrive at a standard masters level, and unfortunately that will shut out some applicants who don't meet the entrance requirements. For full disclosure, I graduated from a bachelors program but that was at a time when the masters was nowhere near as common.

 

I'm not sure we need to stir fear in our enemies (NPs? not clear where you're coming from there) and how the current climate works against us, perhaps you could be more detailed.

[piteog]

I'm a physician, and I wholeheartedly disagree.

 

1. PAs have been embraced by my group and are a fast growing segment of our large practice. We predict that our future labor needs will be PA (or NP) dominated. Most practices are well behind ours and market forces will eventually cause them to change their approach.

 

2. We treat NPs = PAs, but among midlevel providers, > 90% are PAs. Our PAs (for whatever reason) tend to be slightly stronger as a group than our NPs.

 

3. PA residencies are in their infancy. In the future, PA residencies will proliferate and organize. They will continue to mimic existing physician residencies and will reduce some of the heterogeneity among PA graduates in terms of quality. Ultimately, I see the "CAQ" taking on a more prominent role (analogous to physician "boards") to certify quality. Accreditation is coming and will be important for those post-graduate programs.

 

4. PAs don't need to do much to "advance" their field. The marketplace will accomplish this without any assistance. If anything, PAs should be jockeying for position to ensure that they are preferred midlevel providers "over" NPs. NPs, meanwhile, are planning the same thing as PAs, looking to make their own education requirements more rigorous to enable them to make a quality claim. Ultimately, however, both fields will remain in high demand.

 

5. The squabbling about name changes (assistant versus associate), and political standing, etc. are, in my opinion, a meaningless waste of time. Most patients will base their opinion of the provider on the manner and quality of the information being provided. Internists, emergency physicians, family practitioners, and pediatricians all speak regularly with patients who may initially approach them with some skepticism with respect to matters they consider to be better handled by a "specialist." As a result, for many patients, generalists are on the bottom of the "trust" totem pole. However, a good provider can change minds quickly, no matter his or her background or title.

[andersenpa]

5. The squabbling about name changes (assistant versus associate), and political standing, etc. are, in my opinion, a meaningless waste of time. Most patients will base their opinion of the provider on the manner and quality of the information being provided. Internists, emergency physicians, family practitioners, and pediatricians all speak regularly with patients who may initially approach them with some skepticism with respect to matters they consider to be better handled by a "specialist." As a result, for many patients, generalists are on the bottom of the "trust" totem pole. However, a good provider can change minds quickly, no matter his or her background or title.

 

Unfortunately the anecdotal evidence speaks to the contrary in many situations. The barriers that the "assistant" title places on PAs comes from multiple avenues- patients, administrators, insurers, and nonclinical entitites. Not to mention that the name change is something that PAs want simply because, in their minds, it best represents who we are and what we do. Or the fact that we can be confused with Medical Asssistants. OR that MAs or other health care personnel who "assist physicians" (MAs/clerks/aides) have been seen to call themselves "Physician/Physician's Assistants".

 

It sounds like your practice has a forward thinking attitude towards PAs and NPs. I wish that were the norm, or even the majority.

 

We can win hearts and minds of some with our professionalism and competence- but there is no need to maintain a title which allows so much confusion and misrepresentation of how PAs function in modern medicine.

 

Would physicians be happy as "Hospital Assistants"? They assist the hospital in caring for patients? Probaby not. Titles/names/words have potent meaning. We should use them as precisely and apporpriately as possible.

 

What is you area of practice?

[HopefulPA]

Sounds like you are ready to get into the trenches of change. I hope you have joined your states PA chapter, maybe the political action committee will be a good fit.

 

As to some of your other points, I guess it depends on what State you are from. In my State, most recognize PAs as a healthcare provider. As a hospitalist PA I have been asked on more than one occassion if I could continue treating the pt as an outpt or when they are admitted to the hospital in the future could they be admitted to me. I also have heard many people state I actually prefer to see a PA over the doctor, because they tend to listen more and explain things better.

 

So there are some positives out there!

[SocialMedicine]

TWO BIG issues facings PAs .. no the biggest .... but on my radar given my work.

1) The PA bridge program will be a disaster. Most people becomes PAs because THEY WANT to be a PA. This bridge program will make more MD applicant failures appply to PA schools because they can just do a bridge. Look at all the masters of sciences programs to prepare students for med school and MCATs. Tufts, UMDNJ, and numerous other universities have large classes each year that do masters to look better for med school. What better way to handle med school than as a PA who essentially covered it already. In my opinion it makes pas look like the step before doctor and not an actual profession and DOCTORS of nursing the actual midlevel terminal profession.

 

2) We have too many and too small PA schools. You cannot have a lively academic faculty with 20 students in a class and 4 full time professors. We needs fewer and larger PA programs where we can have stand out programs with faculty who can be productive in research on the profession and in other areas relevant to healthcare. Nurse practitioners are at the front lines in many policy conversations because they have stand out people who can bring that conversation. I am in a city with a number of top nursing schools and am constantly hearing their faculty at various local policy discussions and meetings.

 

 

In my opinion

 

Side note, I love being a PA and practicing medicine. :)

[Craigk]

TWO BIG issues facings PAs .. no the biggest .... but on my radar given my work.

 

2) We have too many and too small PA schools. You cannot have a lively academic faculty with 20 students in a class and 4 full time professors. We needs fewer and larger PA programs where we can have stand out programs with faculty who can be productive in research on the profession and in other areas relevant to healthcare. Nurse practitioners are at the front lines in many policy conversations because they have stand out people who can bring that conversation. I am in a city with a number of top nursing schools and am constantly hearing their faculty at various local policy discussions and meetings.

 

 

In my opinion

 

Side note, I love being a PA and practicing medicine. :)

 

So drop the schools that have a history of putting PA's to work where they are desperately needed? I'm just a PA student from one of those 20 student classes with mostly part-time professors that work in the community and I would not trade it for any large academic center. I'd rather be Craig in my program than a number or "hey you" at a 60 or more program. I like talking to my program director on Fridays and I like doing clinical rotations with graduates from my school out in these rural clinics seeing people that need my help. Isn't that what its really all about? Isn't that why we are even here in the 1st place and given this opportunity? I don't have the answers, I'm just learning to swim but I have seen enough to know that fewer and bigger programs are not what we need.

[doubledown10]

I have to disagree. Before I go forward, i'm like you, I love practicing medicine as a PA. I don't think that it's the program that makes the PA. I'm sure we've all seen PAs that graduated from a school that carries an impressive pedigree that we wouldn't let treat a runny nose. On the other hand, we have all seen PAs that came from small schools that are stellar clinicians. In the spirit of full disclosure, I'm a military trained PA and I think that I would have benefited from a more intimate, progressive educational model instead of the mass production type of thing. Instructors in PA programs are as diverse as the PAs that are practicing and those instructors will naturally produce PAs that do things differently than those trained by other faculty.

 

I feel that being a PA is all about finding your niche. My group loves all of our PAs. In fact, our PAs contribute to our bottom line more than most of our physicians. I work ER and when I walk into the department and the attending, who is drowning in charts, looks at me and goes "Thank God you're here" I give no thought to what my title is. Our physicians treat us with dignity and respect. We have a very collegial relationship.

 

I am not overly concerned with the name change. Whenever I see a patient that says "I don't want to see a PA," I can only assume that at a point in time, they saw a PA and had an outcome that was either not what they expected or the PA was less than what they were expecting. I can understand that. But for every patient that says they don't want to see a PA, I have another that says that they love PAs. It's the same with every single profession. I do understand where there is some confusion and honestly, my own parents don't clearly understand where I fit in the whole scheme of things so it's hard to expect the general public to know what a PA is. More times than not, because of where I work, when a patient demands to see a physician and not a PA, it's because the PAs in my group won't give them hydromorphone for their chronic pain.

 

As far as representation, I have some strong feelings on that. The NP vs PA Battle is one that will continue for as long as I practice. At least that's the way that I feel about it.

[doubledown10]

Craigk, keep your attitude, bro. It's a good one. It will take you far.

[coloradopa]

TWO BIG issues facings PAs .. no the biggest .... but on my radar given my work.

1) The PA bridge program will be a disaster. Most people becomes PAs because THEY WANT to be a PA. This bridge program will make more MD applicant failures appply to PA schools because they can just do a bridge. Look at all the masters of sciences programs to prepare students for med school and MCATs. Tufts, UMDNJ, and numerous other universities have large classes each year that do masters to look better for med school. What better way to handle med school than as a PA who essentially covered it already. In my opinion it makes pas look like the step before doctor and not an actual profession and DOCTORS of nursing the actual midlevel terminal profession.

The bridge program will continue to be a niche program. It will be less popular once people figure out it won't lead to a decent residency. On the other hand it does signal that we are doing less than a stellar job in selecting PA candidates. I agree that we should be selecting PAs who want to be PAs. Not those who want to eventually be a physician. As for the DNP that still has to play out, but increased tuition for no real gain leads to fewer students not more. If you look at the data on distance learning (which more of these programs are moving to) once you move past two years the graduation rate drops dramatically. Finally it means that all your instructors have to be doctorally prepared which will be a huge problem for many smaller programs. Overall given the amount of hate its generated from the physicians this helps the PA profession not hurts it.

2) We have too many and too small PA schools. You cannot have a lively academic faculty with 20 students in a class and 4 full time professors. We needs fewer and larger PA programs where we can have stand out programs with faculty who can be productive in research on the profession and in other areas relevant to healthcare. Nurse practitioners are at the front lines in many policy conversations because they have stand out people who can bring that conversation. I am in a city with a number of top nursing schools and am constantly hearing their faculty at various local policy discussions and meetings.

In my opinion

 

Side note, I love being a PA and practicing medicine. :)

Actually we need to be moving the other way. The schools are concentrated in areas that are already oversaturated. We need to place programs in underserved areas. Small program will fill the need for providers who will stay in the community in ways that medical school never can. Look at states that don't have schools and place them there. Look at what MEDEX is doing with their Yakima and Anchorage sites. Look at what LESH has done in the valley. Its really the strongest argument against mandatory degrees.

[Corpsman2PA]

Actually we need to be moving the other way. The schools are concentrated in areas that are already oversaturated. We need to place programs in underserved areas. Small program will fill the need for providers who will stay in the community in ways that medical school never can. Look at states that don't have schools and place them there. Look at what MEDEX is doing with their Yakima and Anchorage sites. Look at what LESH has done in the valley. Its really the strongest argument against mandatory degrees.

 

Couldn't have said it better.

[jdtpac]

2. We treat NPs = PAs, but among midlevel providers, > 90% are PAs. Our PAs (for whatever reason) tend to be slightly stronger as a group than our NPs.

 

DinoR,

whenever I see a physician asking this question I always get excited because of the answer is both simple and quite profound and it's rooted in the title of each of these professions:

 

"PHYSICIAN" Assistant - "nurse" practitioner

 

PA's are trained in the same model/method as our SP's with the proponderence of the trainning given by physicians, unlike NP's. That why you are acutely aware of the differene

[SocialMedicine]

My comment was misunderstood. It is my fault. Let me quickly start over. I have been trained, mentored, and practiced with PAs from small schools and certificate problems. I am in NO WAY suggesting that a PA is better or worse strictly based on the school and size of class/faculty. My comment against 40 new PA schools (part of me died when i saw that) small in size is as follows .....

 

It is a statement of time and money, and not so much producing quality PAs (which I agree is the number one goal of any PA school). If you have a SMALL class size you likely have a SMALL number of faculty and SMALL budget and SMALL amount of time outside of directly working with students for faculty. Take a look at a program like Duke. Their are very few like this. They have a decent sized c lass, and run other educational programs to generate funds. As a result they have a large faculty. Duke faculty have the time to do research on PA history, policy, and workforce issues. When a PA program can expand itself to recruit faculty that are able to at least party work to obtain grant and other research monies that to me is ideal. This is what I am most envious about in NP schools. They have people who study and comment on policy issues ... it is these people quoted in the times, brought to policy meetings, and given more respect when advocating for a profession.

 

In my opinion. I am all for MORE PAs and providing better primary care in the US. But lets try and expand some of the programs we have first so that they can offer better education services, and recruit more faculty who can provide better commentary on PA's.

[LESH]

It is a statement of time and money, and not so much producing quality PAs (which I agree is the number one goal of any PA school). If you have a SMALL class size you likely have a SMALL number of faculty and SMALL budget and SMALL amount of time outside of directly working with students for faculty.

There are exceptions to every rule.

Duke faculty have the time to do research on PA history, policy, and workforce issues. When a PA program can expand itself to recruit faculty that are able to at least party work to obtain grant and other research monies that to me is ideal.

There are small programs that do these things and have faculty involved in policy and workforce issues.

This is what I am most envious about in NP schools. They have people who study and comment on policy issues ... it is these people quoted in the times, brought to policy meetings, and given more respect when advocating for a profession.

There are small programs that have faculty that are doing these things at the Federal and state levels.

In my opinion. I am all for MORE PAs and providing better primary care in the US. But lets try and expand some of the programs we have first so that they can offer better education services, and recruit more faculty who can provide better commentary on PA's.

I know there are small programs doing this.

[SocialMedicine]

Being an educator you have better perspective than me. I respect your comments. Based on my experience in the tristate NY area. Having studied at two major public health centers, and paying attention to whose who - it def seems like nursing schools bc of what i explained above are better positioned to be involved in policy decisions. My opinion ... take it or leave it.

[LESH]

Being an educator you have better perspective than me. I respect your comments. Based on my experience in the tristate NY area. Having studied at two major public health centers, and paying attention to whose who - it def seems like nursing schools bc of what i explained above are better positioned to be involved in policy decisions. My opinion ... take it or leave it.

 

I am a member of this forum to hear other's opinions...and vice versa. We take what we can use. Ignore the rest right? I will always try and point out that there are significant regional differences when it comes to PA practice, education and workforce needs. I have had experience as faculty at large programs (>50 students/class) and small programs (20 students/class). Program connected to large urban academic health centers and programs in the cornfields. I have seen no difference in the programs' ability to impact health policy in this state. Being from a small program (that has been effective in training and deploying primary care PAs) has been a major plus in getting a seat at the table and the ear of policy makers and governmental agencies. I think one can make the opportunity to be involved in policy decisions.

 

The faculty to student ratios for any program may be dictated by fiscal restrictions, or a plethora of other reasons. For me.

[LESH]

QUOTE=SocialMedicine;325208]Being an educator you have better perspective than me. I respect your comments. Based on my experience in the tristate NY area. Having studied at two major public health centers, and paying attention to whose who - it def seems like nursing schools bc of what i explained above are better positioned to be involved in policy decisions. My opinion ... take it or leave it.

I am a member of this forum to hear other's opinions...and vice versa. We take what we can use. I will always try and point out that there are significant regional differences when it comes to PA practice, education and workforce needs. I have had experience as faculty at large programs (>50 students/class) and small programs (20 students/class). Programs connected to large urban academic health centers and programs in the cornfields. I have seen no difference in the programs' ability to impact health policy in this state. Being from a small program (that has been effective in training and deploying primary care PAs) has been a major plus in getting a seat at the table and the ear of policy makers and governmental agencies. I think one can make the opportunity to be involved in policy decisions.

 

The faculty to student ratios for any program may be dictated by fiscal restrictions, or a plethora of other reasons. Your statement about those ratios is based on your preception of what's going on in your geographic area. As it should be. Somewhere else things may be totally different, but just as effective (if not more so) in developing a Primary Care PA workforce. I have to agree with David C. IMHO smaller programs, in areas of unmet need, would be a great help in meeting Primary Care needs.

 

We can agree to disagree, and that is good. We take what we can use.

[Iain1028]

When I see a National Ad campaign for Nursing on Major Cable TV from Johnson & Johnson and not one ad or even AM talk radio advertising for PAs, I think to myself, Yikes!!

[kayakr]

I'm a physician, and I wholeheartedly disagree.

 

1. PAs have been embraced by my group and are a fast growing segment of our large practice. We predict that our future labor needs will be PA (or NP) dominated. Most practices are well behind ours and market forces will eventually cause them to change their approach.

 

2. We treat NPs = PAs, but among midlevel providers, > 90% are PAs. Our PAs (for whatever reason) tend to be slightly stronger as a group than our NPs.

 

3. PA residencies are in their infancy. In the future, PA residencies will proliferate and organize. They will continue to mimic existing physician residencies and will reduce some of the heterogeneity among PA graduates in terms of quality. Ultimately, I see the "CAQ" taking on a more prominent role (analogous to physician "boards") to certify quality. Accreditation is coming and will be important for those post-graduate programs.

 

4. PAs don't need to do much to "advance" their field. The marketplace will accomplish this without any assistance. If anything, PAs should be jockeying for position to ensure that they are preferred midlevel providers "over" NPs. NPs, meanwhile, are planning the same thing as PAs, looking to make their own education requirements more rigorous to enable them to make a quality claim. Ultimately, however, both fields will remain in high demand.

 

5. The squabbling about name changes (assistant versus associate), and political standing, etc. are, in my opinion, a meaningless waste of time. Most patients will base their opinion of the provider on the manner and quality of the information being provided. Internists, emergency physicians, family practitioners, and pediatricians all speak regularly with patients who may initially approach them with some skepticism with respect to matters they consider to be better handled by a "specialist." As a result, for many patients, generalists are on the bottom of the "trust" totem pole. However, a good provider can change minds quickly, no matter his or her background or title.

 

Nice post - as a PA-in-progress...thank you.