Full Practice Responsibility Task Force

[ventana]

I read this and was impressed with your vision. I am stuck with one question for you Ventana. Your profile states "Moderator/Practice Owner." How will this proposal get the monkey off your back so you can run your practice without paying a Physician for the right to hang your own shingle. Are Physicians who operate practices paying a PA a monthly fee for a right to practice. Do they pay that fee to someone who essentially does nothing but satisfy a protectionist policy to keep others out of their practice space by raising barriers to entry? Sincerely, I ask you to address this on a street level.

 

 

I found a great doc, and we practiced together since 2012.

When he moved out of the area I could not stomach getting another one and a dream state job opened up, and i was tired of 60-80 weeks and only 80-100k in pay.  So I am in the final process of closing.  For his "name and supervision"  I paid him about 5-15k per year and he was ideal to work with - only wanted to do the bare min - never second guessed cases, referred patient questions to me,(he had to be a 1% owner) and basically collected a paycheck... for nothing....

 

So - I could do the EXACT same thing (with out the headaches) and keep 5-15k for me! and far less headaches...  As well all the local PCP offices are being bought up by the local hospital system, who is self insured, so I would have had to provide med mal as well....  

 

Now I work 1/3 as much and get far greater pay and bennies.....

[Reality Check 2]

I am reading that this is 100% supporting the unlinking of PAs from a direct physician supervisory relationship.

 

I am not sure where all the hostility is coming from with overthehorizon and JMPA.

 

After 50 years of our current situation in each state requiring a legal relationship with a physician(s) - it is completely illogical to go in barnstorming with a blazing statement of "we don't need you" - let us hang our own shingle. Don't bite the hand that feeds us - or bite it off.

 

We have no reason to alienate our environment or create animosity. Screaming about our desires and abilities is rude and really doesn't show that we are the professionals we claim to be. 

 

The physicians we work with now will still be our colleagues, referral base and whom we refer to. 

 

I have no desire to be an island of stubborn independence. I CAN manage a family practice on my own but certainly count on my colleagues in endocrine, surgery, derm, nephrology, neurology, etc etc etc etc.

 

I have always held that independence needs to be based on years of experience and perhaps some sort of test - for family practice maybe something from AAFP. We need to prove our ability and will certainly need letters of reference from our current docs during this fledgling phase of striking out for practice autonomy. 

 

Calling it garbage and flinging it aside as insulting is rude and unacceptable to me. 

 

Put this out there - look at the feedback, adjust, adapt, improvise, overcome. 

You don't run into a minefield unaware.......

 

My crusty old 2 cents of 25 yrs of doing this

[EMEDPA]

many NPs have collaborative relationships, in fact more do than don't. NPs are only independent in 22 states so in the rest they are affiliated with a doc or doc group. this proposal would not tie a pa to a specific doc, it says "if you have an issue know where to look for guidance". that could be call the local ER. your practice plan could say "john smith PA owns and operates xyz urgent care. he will make use of local medical resources for those pts with needs beyond his training and experience".

[Houstonian]

Overall, I think this is taking a necessary step.  My thoughts are several: 

 

1)  Will the law of unintended consequences apply?  If so, what might those unintended consequences result in?  Will we still be able to work in specialties as an extension of a board-certified specialist, or will our scope of practice be limited to "general medicine" positions only, since our education and training is in general medicine?   Will this cause conflicts with hospital attendings regarding who is responsible for a patient's care?  Will hospital practice become severely limited by hospital rules/regulations regarding scope of practice?

 

2)  Might there need to be a 3-5 year transition period for new graduates?  Physician in residency training are both "independent practitioners" and "supervised by their attending physicians". 

 

3)  In my experience, physicians would prefer NOT to have to supervise PAs and they don't relish having the legal liability for someone else's work.

 

4)  If a PA is between jobs, or retired...the ability to work in a volunteer situation is currently extremely limited....because of lack of a supervising physician.  Can't practice medicine without one...can't prescribe anything without a supervising MD.  Some opportunities are closed to PAs due to lack of independent licensure (some telemedicine opportunities;  overseas missions in certain organizations as examples, like Doctors Without Borders).

 

5)  Personally, I would like to be responsible for my own work; but early in my career I probably needed more guidance and direction from someone more experienced.  (Much like physicians seek guidance and direction from senior physicians...even if they are independently licensed.)

 

6)  RN's follow physician orders, yet are independently licensed.  Their scope of practice is determined by their nursing license, yet part of their accountability is in carrying out physicians orders.  Failure to do so will put their job and license at risk (unless there are extenuating circumstances which require questioning the order).   

 

7)  Expect physician resistance. 

[Guest Paula]

I have been up to my eyeballs as President of my state academy in starting the process of gaining FPAR.  I am not waiting for AAPA's HOD to approve the FPAR as I do not have time to waste until the meeting in May 2017.  So it is full steam ahead and my goal is to be the first state to gain FPAR come he!! or high water, we will do it.  

[Greg Cain PA-C]

Turns out we don't have to worry about any of this.  The NPs march forward at breakneck speed and we are stuck in the 1970s.

 

https://www.va.gov/opa/pressrel/pressrelease.cfm?id=2847

 

See below posted on AAPA Huddle:

 

 

 

Posted 3 hours ago

REPLY TO DISCUSSIONOPTIONS DROPDOWN

Dear Colleagues,

I wanted to provide some additional information about the important development at the U.S. Department of Veterans Affairs. As we shared last night, the VA has finalized a rule that gives advanced practice registered nurses, with the exception of nurse anesthetists, full practice authority within the VA.

In written comments submitted in July, AAPA strongly urged the VA to include PAs in this rule. We believe that PAs should be on equal footing with our nurse colleagues and will continue to work to achieve parity with other practitioners in the VA.

The Federal Register noted, “Several commenters stated that VA should include physician assistants (PA) in the final rule and grant them full practice authority as well. Other commenters were opposed to the granting of full practice authority to PAs. We similarly received comments requesting that we include pharmacist practitioners in the rule. The granting of full practice authority to PAs and pharmacist practitioners was not addressed in the proposed rule and granting such authority in this final rule is beyond the scope of the proposed rule. VA would only be able to address the granting of full practice authority to PAs and pharmacist assistants in a future rulemaking.”

AAPA will continue to push for a rule giving PAs full practice authority in the VA.

Decisions like this dramatically demonstrate why AAPA’s Joint Task Force on the Future of PA Practice Authority has been working so hard on this issue and why it is soliciting feedback from you. We continue to hear stories from PAs about jobs going to NPs because they have full practice authority and PAs do not. If PAs are to remain competitive, the profession must pursue that authority. Please visit AAPA’s News Centerto read about the efforts of the Joint Task Force on PA Practice Authority, and send your comments to fparfeedback@aapa.org.

Thank you,

 

------------------------------
Josanne K. Pagel, MPAS, PA-C, Karuna®RMT, DFAAPA
President and Chair, Board of Directors, AAPA

Executive Director
Cleveland Clinic
North Ridgeville OH

 

Here's the link:

http://huddle.aapa.org/communities/community-home/digestviewer/viewthread?MessageKey=8cff9d0b-5143-4c55-93b7-1771ad67a764&CommunityKey=e54b07fe-0e40-4c0c-a8e4-25d744d979b5&tab=digestviewer

[Guest Paula]

It's time for PAs to rise up and assert ourselves for FPAR.  There is no reason to stay stuck in the 70's.  Please get involved in your state organizations and push the envelope with your colleagues.  It must be done.  It saddens me to think that the VA will likely start hiring more and more NPs in lieu of PAs.

 

What have we done to ourselves to continue the myth that we must be supervised?????

 

If you have to overturn your state board to get the right leaders on it.....do it.

If you need to get the right lobbyist for your state PA organization.....do it.

If you have to shake up the state medical society.....do it.

 

C'mon, people, get busy with advocacy and lift your heads out of the sand. 

 

This so irks me ...can't you tell??????

 

I know there are PAs in the VA system who are working for FPAR so this is not to criticize them.  I've read posts from some of them on the Huddle and they have been working for FPAR and we need a large coalition of PAs from the USA to step forward and support PAs in the VA system.  It is so irritating that the VA did not address PAs in this decision.

[Greg Cain PA-C]

A word to the wise.  I was evidently kicked out of the AAPA for voicing my concerns about the AAPA with regard to their failure on the VA Full Practice Authority issue.  When I tried to log in to Huddle this afternoon I was notified that "your account has been disabled."  Good riddance, they were a waste of dues money anyway if they are so sensitive as to get their collective feelings hurt that easily and ban me rather than engage in open discussion and debate.    

[overthehorizen]

Again, there needs to be more sunlight on the AAPA and their activities. Are they squashing dissent? Please copy and paste the conversations that took place in the Huddle for non members to see. The AAPA should not take issue with this if in fact they are behaving honorably.

[IDCtoPA]

I recommend against jumping to conclusions and assuming the worst. 

 

I think the HUDDLE site might be experiencing technical difficulties. My account indicates disabled as well. And I have not posted anything on huddle. My AAPA login still works fine. 

[overthehorizen]

 

I recommend against jumping to conclusions and assuming the worst. 

 

I think the HUDDLE site might be experiencing technical difficulties. My account indicates disabled as well. And I have not posted anything on huddle. My AAPA login still works fine. 

 

Agree. Technical difficulties are a real possibility. I will wait and see what develops. Could be nothing at all.

[AliB]

Posted about 11 PM Eastern on Huddle:

Dear AAPA Members,

If you tried to login to Huddle today (Thursday) between 4:30 and 8:00 PM, you were greeted with a rather confusing error message. A coding glitch in an update caused our login verification process to completely shut down, impacting all members. The issue has been fixed and everyone should once again have access to Huddle. 

We apologize for the inconvenience, and thank you for your patience as we worked to resolve the problem.

Best regards,

------------------------------
Catherine Gahres
Vice President, Membership Development & Services
American Academy of PAs
Alexandria VA
------------------------------

 

 

[IDCtoPA]

 

I found this post on HUDDLE this morning. I think it speaks volumes as to why PAs were not included in the VA's APRN Autonomy Rule. This post was from a member of the AAPA Board of Directors. I did not include the name as I did not ask permission to repost. I have not altered the post but I have bold faced some key points. 

 

 

"I hear the disappointment and anger. Last year the Family Practice PAs (AFPPA) brought a resolution to the 2016 AAPA HOD specifically because of the same concerns I am reading about today. The resolution was asking for Full Practice Responsibility. They wanted to continue the concept of teams in medicine but not hobble the team anymore with chart co-signatures, supervision, etc. The resolution was debated rigorously and many of your state and Constituent Organization HOD representatives argued for but mostly, against it. Eventually it was referred to committee. If the AAPA Board and staff (of which I was not a part at the time) had been less committed or "dropped the ball", there would not be an FPAR Task Force. There would not be a push to make this idea stronger within our own ranks (many of your colleagues are not interested).

If you want parity with NPs, the HOD needs to be filled with people that want this, as well. It comes down to all of us making this a discussion point when we talk to our colleagues. It can't just stay on the Huddle. If you voted in the last AAPA election, thank you. More than 90% of you did not. If you want things to change - vote. Be a member and vote for your state reps. Vote for your HOD reps and tell them what you care about. Vote for the AAPA Board of Directors. Don't let your anger and disappointment hang in the breeze. Be part of the solution. Every profession needs passionate people like those who regularly engage on this and other forums."

 

This post high lights a few issues:

 

1) Only 10% of PAs are voting for the leadership positions of the AAPA. If you are not a member paying your dues and VOTING in the election of your AAPA delegates, then shame on you and you should really stop complaining about the state of the profession or what the AAPA achieves or fails at. YOU are not doing YOUR PART. 

 

 

2) The people who were elected do not support Full Practice Authority. (Again if YOU did not vote then you have no right to complain.) They are representing the views of the 10% who elected them. If you want them to represent you and the issues you feel are important then JOIN AAPA, PAY YOUR DUES, and VOTE for a delegate that will represent your priorities. Or better yet RUN FOR OFFICE YOURSELF. BE THE CHANGE YOU WANT TO SEE!

 

 

3) I see so many posts of people complaining about the MOC testing. I get it that testing is a pain, it has been poorly managed and many feel that the tests are too high stakes and not fair. AAPA went to bat against NCCPA and made some progress on this issue. They did not get EVERYTHING that many want but they did get significant concessions. No more SA/PI-CME, No more multiple take home tests in addition to the monitored test. Despite these gains many continue to insist on complete capitulation by NCCPA or for AAPA to fund and organize a second certifying body, gain acceptance of that body by all the state legislatures, regulatory boards, and third party payers. And many of the people demanding this refuse to join AAPA and support the effort through their dues. You seem to want the rest of the PA profession to pay for your priorities while you do NOTHING except complain.

 

 

4) Getting rid of MOC is not going to improve your job prospects. You need to focus on the bigger picture. Full Practice Authority and Responsibility effects EVERY PA, because not having it is what is making NPs a more attractive hire. It is why they are becoming more competitive compared to PAs in the job market. Ending MOC is NOT GOING TO CHANGE THAT. Instead a very small number of PAs loosing certification and finding employment prospects diminished because they failed MOC you are going to have increasing numbers of PAs who find it difficult to find work they want because NPs are less of an administrative hassle. You are going to have increasing numbers of PAs forced to work as subordinates to NPs. The profession is being undermined NOT because of MOC testing, but because NPs, regardless of what YOU think of their training and ability, are legally allowed to do pretty much everything that a PA can and they require LESS ADMINISTRATIVE OVERSITE and in many cases LESS PHYSICIAN LIABILITY. MOC has NO EFFECT ON THAT. The people hiring you do not care how hard you have to study to pass your MOC. They do care about having to take time to review your charts, accept liability for your work, having to be present in the office with you for a set amount of time, and limits on the ratio of PA to MD/DO.

 

 

Stop focusing on the MOC TREE and look at the FOREST where NPs are less burdensome to employ. Changing THAT should be the laser like focus of AAPA and every PA who wants to see the LONG-TERM success of the PA Profession. If AAPA doesn’t make progress on this issue, PAs will still be around and they will still be taking their MOC exams because their APRN Supervisors will require it. 

 

[Joelseff]

I just read the FPAR Faq and all the documents on AAPA regarding FPAR and i think it is a tempered step in the right direction. I can't believe I never saw the posts on here till know... Oh yeah, that's right I was preparing for PANRE last month lol.

 

But I think if we don't get behind this this will be squashed just like the title change movement a few years ago.

 

I think if we truly want to move towards independence we have to do it through a methodical calculated approach vs barnstorming since we are, at least for the time being, under "medicine" and their boards. So count me in this fight...

 

Just my 2 cents.

 

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[EMEDPA]

I read through the comments they posted. seems about 80% pro and 20% con, mostly from a bunch of dinosaurs who spout " I have been a PA for 45 years and believe a doctor needs to review all my work!"

my advice to these folks: retire. the sooner the better. please. you are holding the rest of us back.

[rev ronin]

I read through the comments they posted. seems about 80% pro and 20% con, mostly from a bunch of dinosaurs who spout " I have been a PA for 45 years and believe a doctor needs to review all my work!"

my advice to these folks: retire. the sooner the better. please. you are holding the rest of us back.

In all fairness, those folks probably only have certificates or associates; the rest of us who have masters' degrees were trained to function autonomously.

[EMEDPA]

it's more a mindset than a degree I think...I got  a  BS from my PA program and I'm about as cowboy as they come.

[EMEDPA]

some of the best, most independent PAs I know have a cert or AS only...

[Reality Check 2]

I graduated 25 yrs ago and "only" got a Bachelors in Science. Was told that NCCPA was all that mattered.

 

I would NOT agree that the level of education shapes these thought processes. The region of the country, the type of practice and the individual desires make the PA what he/she is.

 

Ortho made me tired of being a puppet and drone making the doc look like a god to his patients. I got no independent thought or autonomy.  

 

Seems I am wired for FP and independent thought and autonomy. Certainly all these years have given me the experiences and strengthened the desire. 

 

 If a PA has always worked in an environment where PAs are subservient and not given space to grow - then one will not grow and if desired - will leave and go blossom somewhere else. Some are clock punchers who stay where planted. 

 

If the majority of us want to progress then the naysayers will have to choose - move on and evolve or risk unemployment or poor reimbursement. 

 

Adapt, improvise, overcome

[BruceBanner]

I'm a little late to this party but I totally agree this a HUGE step in the right direction. I read most of December's comments on their comment board---seems many if not most PAs outside of this forum feel the same way.

 

The 2 key things that really need to happen--and they recognize this---are the uncoupling of PAs from physicians and the establishment of our own state governing boards. This IS independence and autonomy, they just aren't using those words. The actual details of PA scope and authority will probably always be determined by the states. There isnt going to be an "emancipation day" when we are ceremoniously unshackled, it's probably going to be a slow state-by-state process that I'd predict will take 10 years or more. 

 

But if they lose momentum with this we are so screwed. Long-term anyways. 

[Joelseff]

In all fairness, those folks probably only have certificates or associates; the rest of us who have masters' degrees were trained to function autonomously.

I received a certificate and was trained to practice autonomously within my scope and knowledge. I got my masters after but was given that mindset in my PA schooling. So I don't think it was their degree but likely more of a mindset as Emed put it. I run into some older PAs who have this mindset. I dunno if it's just not having the will to fight or if it's really a paradigm that we should be tethered to Doctors.

 

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