Moderator EMEDPA Posted February 1, 2012 Moderator Share Posted February 1, 2012 with that said, anyone know of any residency programs that cater to rural medicine practice? there is a rural em residency at bassett healthcare in cooperstown , ny. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted February 1, 2012 Moderator Share Posted February 1, 2012 i am still struggling to appreciate the value in this residency. (bassett)there just isn't enough hard data to show that these residencies translate into improved earnings for pas and equivalent recognition (independence and terminal doctorate). you still don't understand the concept of a residency. It's about obtaining a set of skills you might never get on the job. This can and often does lead to more autonomy, better jobs, and more money.this residency trains you to run a rural er solo. Hard to get more independent than that without going to medschool. I am intimately involved with the politics of emergency medicine for pa's in this country and have been for over a quarter of a century. I know many em pa residency grads. most of them have better jobs than I do because they completed a residency. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted February 1, 2012 Moderator Share Posted February 1, 2012 i am still struggling to appreciate the value in this residency. (bassett)there just isn't enough hard data to show that these residencies translate into improved earnings for pas and equivalent recognition (independence and terminal doctorate). you still don't understand the concept of a residency. It's about obtaining a set of skills you might never get on the job. This can and often does lead to more autonomy, better jobs, and more money.this residency trains you to run a rural er solo. Hard to get more independent than that without going to medschool. I am intimately involved with the politics of emergency medicine for pa's in this country and have been for over a quarter of a century. I know many em pa residency grads. most of them have better jobs than I do because they completed a residency. Link to comment Share on other sites More sharing options...
Gonadometrics Posted February 1, 2012 Share Posted February 1, 2012 EMED writes "this residency trains you to run a rural er solo. Hard to get more independent than that without going to medschool" Why do PAs ignore the fact that residency training forces you to exchange money to gain skills that enable your supervising physician to make more money while the PA still retains a "restricted license." EMED says it's hard to get more independent that running the rural ER solo. I must ask if running the rural ER solo means the post residency PA can form his own corporation and negotiate an agreement with the hospital to manage the ER without any supervising Physician oversight. I think not. We should, as a whole, say no to PA residencies unless and until they offer something reasonable in exchange for the time and treasure they ask us to give our Physician supervisors and hospitals who profit the most. Terminal doctorate (with the Doctor title) and independent (unrestricted license). Now, I don't advocate this for a PA without a residency. I'm only saying that residency trained PAs should stop selling themselves short. Link to comment Share on other sites More sharing options...
Gonadometrics Posted February 1, 2012 Share Posted February 1, 2012 EMED writes "this residency trains you to run a rural er solo. Hard to get more independent than that without going to medschool" Why do PAs ignore the fact that residency training forces you to exchange money to gain skills that enable your supervising physician to make more money while the PA still retains a "restricted license." EMED says it's hard to get more independent that running the rural ER solo. I must ask if running the rural ER solo means the post residency PA can form his own corporation and negotiate an agreement with the hospital to manage the ER without any supervising Physician oversight. I think not. We should, as a whole, say no to PA residencies unless and until they offer something reasonable in exchange for the time and treasure they ask us to give our Physician supervisors and hospitals who profit the most. Terminal doctorate (with the Doctor title) and independent (unrestricted license). Now, I don't advocate this for a PA without a residency. I'm only saying that residency trained PAs should stop selling themselves short. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted February 1, 2012 Moderator Share Posted February 1, 2012 independence for pa's is not going to happen. physician associate? sure get rid of supervisionand call it what it really is( sponsorship/collaboration/etc) sure independence? won't happen. the entire concept of a pa is someone who works with review by a doc. for good or bad, that's what the profession is all about. want to be called "doctor"? go to medschool or become a dnp and fight it out with the docs. I'm in a postgrad doctorate program and will not call myself doctor in a clinical setting whan done. it confuses pts. dnp's are opening themselves up to all kinds of liability and litigation by introducing themselves as dr. it will come back to bite them. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted February 1, 2012 Moderator Share Posted February 1, 2012 independence for pa's is not going to happen. physician associate? sure get rid of supervisionand call it what it really is( sponsorship/collaboration/etc) sure independence? won't happen. the entire concept of a pa is someone who works with review by a doc. for good or bad, that's what the profession is all about. want to be called "doctor"? go to medschool or become a dnp and fight it out with the docs. I'm in a postgrad doctorate program and will not call myself doctor in a clinical setting whan done. it confuses pts. dnp's are opening themselves up to all kinds of liability and litigation by introducing themselves as dr. it will come back to bite them. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted February 1, 2012 Moderator Share Posted February 1, 2012 I must ask if running the rural ER solo means the post residency PA can form his own corporation and negotiate an agreement with the hospital to manage the ER yes, they can and have done this. they hire an sp(more likely 2) as an employee. several groups in rural settings are pa owned and operated 100% with sp services(chart review) provided by employee physicians. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted February 1, 2012 Moderator Share Posted February 1, 2012 I must ask if running the rural ER solo means the post residency PA can form his own corporation and negotiate an agreement with the hospital to manage the ER yes, they can and have done this. they hire an sp(more likely 2) as an employee. several groups in rural settings are pa owned and operated 100% with sp services(chart review) provided by employee physicians. Link to comment Share on other sites More sharing options...
Gonadometrics Posted February 1, 2012 Share Posted February 1, 2012 EMED writes "independence for pa's is not going to happen" Just a few points. If EMED is correct, PAs will get left behind by our DNP colleagues who will be independent and be seen by patients as Doctors and taking all opportunity from PAs. Second, if EMED is correct, then no PA should ever apply for or accept a residency. Never. Ever. It's a fool's bargain. Third, and finally, PAs could gain independent practice but we are being held back by the cohort that shaped this profession for the "last quarter century." There needs to be new thinking in the PA leadership arena. Basically, PAs are being outsmarted by the nurses and doctors. Link to comment Share on other sites More sharing options...
Gonadometrics Posted February 1, 2012 Share Posted February 1, 2012 EMED writes "independence for pa's is not going to happen" Just a few points. If EMED is correct, PAs will get left behind by our DNP colleagues who will be independent and be seen by patients as Doctors and taking all opportunity from PAs. Second, if EMED is correct, then no PA should ever apply for or accept a residency. Never. Ever. It's a fool's bargain. Third, and finally, PAs could gain independent practice but we are being held back by the cohort that shaped this profession for the "last quarter century." There needs to be new thinking in the PA leadership arena. Basically, PAs are being outsmarted by the nurses and doctors. Link to comment Share on other sites More sharing options...
Gonadometrics Posted February 1, 2012 Share Posted February 1, 2012 EMED writes "everal groups in rural settings are pa owned and operated 100% with sp services(chart review) provided by employee physicians." EMED, when you add the qualification "with sp services provided by employee physicians" the argument that this is a model of independence falls apart. If the market was ripe for opportunity, there would be no physicians signing charts so PAs could make money that the Physician feels entitled to earn instead. It is my opinion that these rare instances of PA owned practices misrepresent the facts. Nurse Practitioners enjoy true independence in many states. No chart review in many states. No physician oversight. They hang their shingle and start work. If the NP wants to work alongside a doc, the doc doesn't need to manage the NP. Independence is a major factor in the long-term success of the PA profession. Until everyone gets on board and grasps that, the NPs will swallow us whole. Link to comment Share on other sites More sharing options...
Gonadometrics Posted February 1, 2012 Share Posted February 1, 2012 EMED writes "everal groups in rural settings are pa owned and operated 100% with sp services(chart review) provided by employee physicians." EMED, when you add the qualification "with sp services provided by employee physicians" the argument that this is a model of independence falls apart. If the market was ripe for opportunity, there would be no physicians signing charts so PAs could make money that the Physician feels entitled to earn instead. It is my opinion that these rare instances of PA owned practices misrepresent the facts. Nurse Practitioners enjoy true independence in many states. No chart review in many states. No physician oversight. They hang their shingle and start work. If the NP wants to work alongside a doc, the doc doesn't need to manage the NP. Independence is a major factor in the long-term success of the PA profession. Until everyone gets on board and grasps that, the NPs will swallow us whole. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted February 1, 2012 Moderator Share Posted February 1, 2012 our leadership is putting up a major fight with changing our name to a name which appropriately describes us. imagine if we tried for independence...I am not and will not become a part of our national leadership anytime soon. it is broken and beyond fixing by a lone individual or even group of individuals. when the crop of old school yes men has stopped practicing and those of my pa generation are the majority things will get done. but not until then. give it 10 years. the dnp's are already starting to feel a backlash from physician groups. it will bite them inthe butt and those np's pushing to be called dr will be amrginalized bythe physician medical community. it's already happening. pa's are getting most of the good specialty jobs out there. sure dnp's can work in primary care and open their own practices. so what? a pa can do exactly the same thing by hiring an sp employee. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted February 1, 2012 Moderator Share Posted February 1, 2012 our leadership is putting up a major fight with changing our name to a name which appropriately describes us. imagine if we tried for independence...I am not and will not become a part of our national leadership anytime soon. it is broken and beyond fixing by a lone individual or even group of individuals. when the crop of old school yes men has stopped practicing and those of my pa generation are the majority things will get done. but not until then. give it 10 years. the dnp's are already starting to feel a backlash from physician groups. it will bite them inthe butt and those np's pushing to be called dr will be amrginalized bythe physician medical community. it's already happening. pa's are getting most of the good specialty jobs out there. sure dnp's can work in primary care and open their own practices. so what? a pa can do exactly the same thing by hiring an sp employee. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted February 1, 2012 Moderator Share Posted February 1, 2012 . Nurse Practitioners enjoy true independence in many states. No chart review in many states. No physician oversight. They hang their shingle and start work. If the NP wants to work alongside a doc, the doc doesn't need to manage the NP. . time for you to apply for a distance direct entry np program. 3 years and you can be your own boss. good luck with that. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted February 1, 2012 Moderator Share Posted February 1, 2012 . Nurse Practitioners enjoy true independence in many states. No chart review in many states. No physician oversight. They hang their shingle and start work. If the NP wants to work alongside a doc, the doc doesn't need to manage the NP. . time for you to apply for a distance direct entry np program. 3 years and you can be your own boss. good luck with that. Link to comment Share on other sites More sharing options...
Gonadometrics Posted February 1, 2012 Share Posted February 1, 2012 So far, my argument against residency unless their is independence, clinical doctorate and a clinical doctor title has caused posters to encourage me to "go to medical school" or "go to NP school." Is that it? We as PAs cannot see a better future so we hunker down in self destruction. Trying to hold our position and remaining entrenched will be our own "Dien Bien Phu." Link to comment Share on other sites More sharing options...
Gonadometrics Posted February 1, 2012 Share Posted February 1, 2012 So far, my argument against residency unless their is independence, clinical doctorate and a clinical doctor title has caused posters to encourage me to "go to medical school" or "go to NP school." Is that it? We as PAs cannot see a better future so we hunker down in self destruction. Trying to hold our position and remaining entrenched will be our own "Dien Bien Phu." Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted February 1, 2012 Moderator Share Posted February 1, 2012 do you realsitically think pa's will ever be 100% independent of docs? we report to the medical boards of each state in case you forgot. the reason docs hire pa's and not np's is that they have some degree of control and oversight over our practice. take that away and we are just np's. then docs will just hire other docs and be done with us entirely. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted February 1, 2012 Moderator Share Posted February 1, 2012 do you realsitically think pa's will ever be 100% independent of docs? we report to the medical boards of each state in case you forgot. the reason docs hire pa's and not np's is that they have some degree of control and oversight over our practice. take that away and we are just np's. then docs will just hire other docs and be done with us entirely. Link to comment Share on other sites More sharing options...
cinntsp Posted February 1, 2012 Share Posted February 1, 2012 The program at Basset seems like it's what you're looking for. Here's the link: http://www.bassett.org/bassett-medical-center/medical-education/residency-programs/rural-emergency-medicine-postgraduate-physician-assistant-program/ That program sounds pretty awesome. Link to comment Share on other sites More sharing options...
cinntsp Posted February 1, 2012 Share Posted February 1, 2012 The program at Basset seems like it's what you're looking for. Here's the link: http://www.bassett.org/bassett-medical-center/medical-education/residency-programs/rural-emergency-medicine-postgraduate-physician-assistant-program/ That program sounds pretty awesome. Link to comment Share on other sites More sharing options...
Gonadometrics Posted February 1, 2012 Share Posted February 1, 2012 EMED writes "do you realsitically think pa's will ever be 100% independent of docs? we report to the medical boards of each state in case you forgot. the reason docs hire pa's and not np's is that they have some degree of control and oversight over our practice. take that away and we are just np's. then docs will just hire other docs and be done with us entirely" First, I find the insight and political understanding of EMED intriguing even if we disagree on several themes. I found this to be a interesting dialogue. Second, to answer EMED's question; No, I don't think it is realistic that 100% of PAs will be independent. I do believe there must be a pathway toward independence (and a clinical doctorate with corresponding title) IFF ( that is, if and only if) PAs complete a residency. I am not pushing to get these concessions. I only say that we as PAs should not give up more of our time and treasure without these concessions. Our organization should form a strategy to either defeat residency expansion or enhance the bona fide rewards. EMED is correct about PAs being overseen by Medical Boards of each state. I noted earlier that nurses outsmarted us. We, as PAs, need to determine how best to circumvent that oversight as NPs have done. It won't happen overnight but it needs to happen so we can remain competitive with NPs. Lastly, EMED says PAs are hired to be overseen and controlled. I agree. However, the biggest reason PAs are hired is to make a profit. When NPs can be hired more profitably, PAs will suffer. Remember, just because NPs have independence doesn't mean they hang their own shingle. It does make it easier for Docs to hire them. EMED, no thoughts on my use of arcane references to French military history. :=D: Link to comment Share on other sites More sharing options...
Gonadometrics Posted February 1, 2012 Share Posted February 1, 2012 EMED writes "do you realsitically think pa's will ever be 100% independent of docs? we report to the medical boards of each state in case you forgot. the reason docs hire pa's and not np's is that they have some degree of control and oversight over our practice. take that away and we are just np's. then docs will just hire other docs and be done with us entirely" First, I find the insight and political understanding of EMED intriguing even if we disagree on several themes. I found this to be a interesting dialogue. Second, to answer EMED's question; No, I don't think it is realistic that 100% of PAs will be independent. I do believe there must be a pathway toward independence (and a clinical doctorate with corresponding title) IFF ( that is, if and only if) PAs complete a residency. I am not pushing to get these concessions. I only say that we as PAs should not give up more of our time and treasure without these concessions. Our organization should form a strategy to either defeat residency expansion or enhance the bona fide rewards. EMED is correct about PAs being overseen by Medical Boards of each state. I noted earlier that nurses outsmarted us. We, as PAs, need to determine how best to circumvent that oversight as NPs have done. It won't happen overnight but it needs to happen so we can remain competitive with NPs. Lastly, EMED says PAs are hired to be overseen and controlled. I agree. However, the biggest reason PAs are hired is to make a profit. When NPs can be hired more profitably, PAs will suffer. Remember, just because NPs have independence doesn't mean they hang their own shingle. It does make it easier for Docs to hire them. EMED, no thoughts on my use of arcane references to French military history. :=D: Link to comment Share on other sites More sharing options...
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