Where are we going?

[Gaijyn]

First apologies if this comes off as any form of a rant, I am actually wanting to engage in some discourse if possible.

 

So I have been a PA-C for 3 years and counting.  For the most part I love the actual job of practicing medicine.  As with anything there are good days and bad.  However, what I am starting to see more and more is that glass ceiling that seems to be a lot closer than I thought it would be in my star-eyed days as a physician assistant student.  This is not so the autonomy in terms of practice with individual patients but more so as a question of where we are going as a profession. Like many I let my AAPA membership lapse due to what I felt were distinct dichotomous outlooks in terms of the growth and progression of the profession as well as what was better for the profession.  This is opposed to my local/state chapter which feels significantly more aggressive in terms of representation and pushing the profession further.

 

I watch so many nurses go through whatever pipeline they choose and almost by magic they are soon newly-minted ARNPs and able to practice with a level of autonomy in many places/states/systems that myself as a PA cannot.  Obviously I have an issue with this.  I work in the ED and have done so since my graduation, I have seen many RNs going through or completing their various NP programs and have personally felt the curriculum was woefully inadequate.  I often found myself questioning the product that was being put out.  That being said, they seem largely unconcerned and unaffected by the same limitations I find in my chosen profession.  

 

I do love being a PA in many regards.  It has been very rewarding both financially and intrinsically.  However, I continue to find myself concerned with the developing state of the profession.  I see much inaction on the national front from the organization that is reputed to represent us as a profession; enough so that a second organization started and has been much more proactive in terms of growing the profession (shout out to PAFT). I just am unsure what our pathway forward is.  Where are we going?  Separation from AMA or whatever association that seems to limit our long-term growth? Full Autonomy with creation of alternative pathway towards independent provider? The creation of accelerated bridge programs to become non-traditional MD/DOs?  I guess I am just wondering what is the way forward? Like the title says, "Where are we going?"

[LT_Oneal_PAC]

These things never end well, but I'm always a sucker for them because I always hope I'm going to hear some inside scoop from someone at PAFT or some state chapter. Can I add the caveat that we shy away from what we WISH would happen, and stick to what we think will happen or could possibly happen? The wishful thinking of a 2 year MD bridge is always nice to fantasize about, but is never, ever going to happen in this life time.

 

Forward I see a SLOW process of us moving towards the new model legislation, which is using terms like collaboration and removing physicians from responsibility of our work. Hopefully full practice autonomy will be achieved in the year or so by NM with the legislation they are trying to push.

 

We are separate from the AMA, but will never be out from the BOM. Honestly, I don't think we should be out from the BOM, but I think we should have equal representation.

 

I think the DMS with some type of integrated residency is going to be the best future option for any type of program to provide additional skills with commensurate increase in scope, but it is in a very fragile stage and could collapse at any moment if not nurtured correctly. So I won't make any predictions on what will happen with that.

 

Honestly I think more PA to DO programs will open, but they'll be exactly as LECOM is and not really a true bridge in the sense that they save you any substantial time, rather they will be programs that provide preferential entry with different prereqs to DO school.

[Gaijyn]

Thank you for your response.  I agree often times these things get ugly.  That was not and is not my intention obviously.  I put AMA but completely meant BOM (long day of too many acronyms and charting causes some confusion overload I guess).  I am personally on the fence with disassociation from the BOM.  On one hand we eliminate a significant of roadblocks in growing our profession in ways best for ourselves; however, on the other hand we also eliminate a lot of the legitimization and arguably support for our future endeavors.  Equal representation would be interesting, how would that work? Would that cause more deadlocks and pit us against them or even worse, enable our representatives to kowtow to the demands of the doctors?  I am curious to the thoughts of equal representation; would we be equal if we were still considered a lesser provider (in terms of education, ability, authority, etc)?  That may sound troll-ish but it is a serious question.  If they did not see us as equals, how would we go about making significant change without possibly going cap-in-hand for support.  Obviously I am painting a significantly extreme situation but the question is valid.

 

It seems that CAQs and residencies are likely to become increasingly more prevalent and possibly required for higher level positions and autonomy.  Further, with regards to groups and partnerships, we are relatively limited in a broad sense.  I think this is at least attributed to the nature that we have little equality in terms of practice laws and positions.  

 

Again, I am interested in the discourse that can come.  I hope it doesnt devolve into mudslinging and ineffective/unlikely goals like 2 year medical programs for bridge transitions to MD/DO.  Further, should that even be the ultimate goal, to be an MD/DO? The DMS seems interesting but it is so new that I agree it is fragile.  It remains to be seen what clinical benefit this would provide other than the doctorate for academia or possible salary improvements. 

 

Thanks for the response.  Hope to here more from the rest of our colleagues.

[LT_Oneal_PAC]

Thank you for your response. I agree often times these things get ugly. That was not and is not my intention obviously. I put AMA but completely meant BOM (long day of too many acronyms and charting causes some confusion overload I guess). I am personally on the fence with disassociation from the BOM. On one hand we eliminate a significant of roadblocks in growing our profession in ways best for ourselves; however, on the other hand we also eliminate a lot of the legitimization and arguably support for our future endeavors. Equal representation would be interesting, how would that work? Would that cause more deadlocks and pit us against them or even worse, enable our representatives to kowtow to the demands of the doctors? I am curious to the thoughts of equal representation; would we be equal if we were still considered a lesser provider (in terms of education, ability, authority, etc)? That may sound troll-ish but it is a serious question. If they did not see us as equals, how would we go about making significant change without possibly going cap-in-hand for support. Obviously I am painting a significantly extreme situation but the question is valid.

 

It seems that CAQs and residencies are likely to become increasingly more prevalent and possibly required for higher level positions and autonomy. Further, with regards to groups and partnerships, we are relatively limited in a broad sense. I think this is at least attributed to the nature that we have little equality in terms of practice laws and positions.

 

Again, I am interested in the discourse that can come. I hope it doesnt devolve into mudslinging and ineffective/unlikely goals like 2 year medical programs for bridge transitions to MD/DO. Further, should that even be the ultimate goal, to be an MD/DO? The DMS seems interesting but it is so new that I agree it is fragile. It remains to be seen what clinical benefit this would provide other than the doctorate for academia or possible salary improvements.

 

Thanks for the response. Hope to here more from the rest of our colleagues.

Well the BOM is not about advocacy, but about public safety. This is why non-medical members are on the board despite having no training. Their vote isn't any less even though they aren't providers at all. IMO, it should be 4 physicians, 4 PAs, and 2 non-medical public advocates. Civilians are the tie breakers and should prevent PAs from over-reaching and physicians from keeping us down without evidence. Sad that it even needs to be that way.

 

I have no qualms with separating from the BOM because it might hurt future support from physicians as they never support us as it is. I have a long rant for this, but I'll digress from the topic. We already sit on many state medical boards, just need to level it out. It's simpler.

[CAAdmission]

[Reality Check 2]

Well, according to our friend Wes Johnson on the Dr. Kevin site - we aren't going anywhere and shouldn't even be thinking about it.

 

My personal take --- 

 

The primary care shortage in the US is going to force changes.

Missouri tried with the unmatched, possible FMG, barely a doctor by a day but hasn't licensed a single one yet in over 18 months.

So, that isn't working.

 

PAs particularly in Family Practice and Rural EM desperately need a plan and protocol for taking those of us with XX years of experience and testing us to some extent or certifying us somehow to become FULLY INDEPENDENT practitioners in these areas only.

I want to take the AAFP test without OB and see how I do. 

If that worked - we could be tested at that level and have ?15, ?20 years with a predominance in FP or EM and let us take this test and have a doc or docs give us references and still have a collaborating doc and let us start serving the US population with primary care providers at a larger scope with better reimbursement.

 

I don't work in a specialty anymore so I am not prepared to speak to that area. We won't ever be independent in surgery - just not logical.

 

We have been around 50 years and we really haven't advanced much - just convinced a bunch of states to follow the East Coast on Rx rights, some scope of practice and the number of PAs with each doc.

The needs of the US far outweigh what is being done and our national organization doesn't seem the least interested in even saying the words much less moving the idea forward.

 

Each state's Medical Board is soooo different. I still think it is time for a single national licensing entity to keep us centralized and to the same standards. Then we have to figure out how to convince Southern Bible Belt states to follow more progressive states in privileges, verbage, etc.

 

Yes, it is all ideological but I see it as the way things need to happen.

 

Just my old 2 cents......

[cinntsp]

It sounds like you(OP) would be a good candidate to join PAFT and rejoin AAPA to get involved in leadership roles and help take the profession in a progressive direction.

 

Sent from my Nexus 5X using Tapatalk

[Gaijyn]

I have thought about joining and pursuing leadership opportunities.  I think about it often to be honest, just not sure if I could be able to make the difference I would want without first losing my mind in frustration.  From my view point (young in my career) there seems to be several different attitudes of our colleagues.  Indifference - those that do not really care for expansion in scope or autonomy.  Aggression - those that see the writing on the wall and want to be able to be at the table and not on the outside looking-in begging for scraps.  Perhaps the most frustrating is Fear - those that are, for one reason or another, fearful or overly concerned with the effects of the fight and would rather maintain the status quo with the occasional largely symbolic victory to which they feel entitled to beat their chests about.  The last one most certainly seems to be prevalent on the national stage; or rather has been in recent years.  

 

Perhaps Cinntsp is correct, maybe I should attempt to effect change in the system.  I will definitely have to think about it.  However, should it not be the case for those people who purport themselves to be the representatives of us all to hammer away at growing our profession? In some ways we are being pushed out of the discussion regarding the primary care shortage.  While I do not necessarily agree with the nursing/NP lobby and the manner by which the present themselves, you cannot deny that they have significantly furthered their agenda and ability to secure their independence/autonomy while we have seemingly languished in the shadows of legislation.  I wish I knew what the answers were.  Or rather what the right answers were.  But while I am unable to ascertain the correct path forward, it is becoming increasingly clear that inaction is only creating further to push us further behind waiting for the next hand-me-out.  

 

Pardon the hyperbole, but the sentiment is echoed by many I would venture.  I personally feel we have long since legitimized ourselves and what we can and do provide as a profession.  Perhaps the answer is to break away at least partially and provide forward motion of our own without first asking if it is okay.  It has been nearly 50 years since the first group of PAs blazed a path through the uncharted wilderness that is this world of medicine.  While it is true we have come a long way from those days, the truth is that it seems we have much farther to go.

[Reality Check 2]

Gaijyn - you are very articulate and well spoken.

That skill will make you very valuable in discussion and, quite frankly, battle.

 

I agree that we all need to be involved. I get frustrated by the idea of committee and discussing issues ad nauseum without any actual action or change.

 

I like action and movement. Sitting on a committee that meets every 3 months or so serves no purpose to me.

 

My next thought is how to start. How do we push forward these needs for the evolution of our profession? Who do we speak with - who presents our platform - yes PAFT is a huge part of that. 

 

I understand why folks do not get involved - we all have jobs and families and debts and obligations and our time may already be at a premium just to function day to day. I myself have to get beyond that to understand that if I WANT change, I have to be willing to give something for it.

 

Let's keep this conversation moving and see what action points we have available.